Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-008229, 2012 Nov; :1-28
Introduction: Home health care is one of the fastest growing industries in the United States. Approximately 7.6 million people receive care in their homes from nurses, aides and other professionals employed by more than 17,000 provider organizations. Home health care will continue to grow as a result of the aging population, technological advances, health care cost containment strategies, infection control, and the common desire to be cared for at home. Objectives: The objectives of the completed study were to evaluate and quantify the risks of sharp medical device (sharps) injuries and other blood and body fluid exposures among home health care (HHC) nurses and aides, identify risk factors, assess the use of sharps with safety features, and evaluate underreporting in workplace-based surveillance. Methods: The study was conducted by a multi-disciplinary team at the University of Massachusetts Lowell and the Massachusetts Department of Public Health collaborating with 9 home health care agencies (26 worksites) and 2 labor unions, The partner agencies deliver most of the home health care in eastern Massachusetts. The study, called Project SHARRP (Safe Homecare and Risk Reduction for Providers), was conducted in multiple phases. Initial focus groups of direct care home health nurses and aides and in-depth interviews of managers and union representatives were conducted in 2005 - 2006 in order to learn about the culture of their work as it relates to occupational health and safety and in particular about the circumstances by which HHC nurses and aides use or encounter sharps and other blood and body fluid exposures. These qualitative findings informed the development of a large questionnaire survey which was conducted via the agency worksites or via the mail in 2006 -2007. The findings of the survey yielded quantitative risk estimates of sharps injuries and other blood and body fluid exposures for HHC nurses and aides and of the main factors contributing to the injuries and exposures. A second set of focus groups with direct care workers and in-depth interviews with managers and union representatives were conducted in 2008-2009 to present the survey findings and gain input from the workers, managers, and union regarding their interpretation and on the most effective ways to formulate the study findings in terms of an OSH prevention message and how to disseminate it to the broader home health care sector and the patient/clients who use it. Finally, a workplace-based surveillance system for sharps injuries was developed for 3 of the largest agencies. 2 years of surveillance data were collected in 2006 - 2008, corresponding to the period covered by the questionnaire survey. The SI findings of the surveillance system were compared to those of the questionnaire survey. Results: 1,125 surveys were completed yielding a response rate of nearly 70%, Approximately 35% of nurses and 6.4% of aides had experienced at least 1 sharps injury during their home health care career; corresponding figures for other blood and body fluid exposures were 15.1 % and 6.7%, respectively. Annual sharps injuries incidence rates were 5.1 per 100 full-time equivalent (FTE) nurses and 1.0 per 100 FTE aides. Medical procedures contributing to sharps injuries were injecting medications, administering fingersticks and heelsticks, and drawing blood. Other contributing factors were sharps disposal, contact with waste, and patient handling. Sharps with safety features frequently were not used. Underreporting of sharps injuries to the workplace-based surveillance system was estimated to be about 50%. Several important predictors of SI rates were identified in HHC nurses including: The SI rates were significantly higher for per-diem nurses (13.4/100 FTE) than for part-time nurses (9.11100 FTE), and lower still for full-time nurses (2.9/100 FTE). HHC nurses reporting low job satisfaction were more than twice as likely to have an SI in the last 12 months compared to those with high job satisfaction (RR = 2.6, 95% CI = 1.3 to 5.4). HHC nurses who agreed that "patient care comes before employee safety in my workplace" were more than twice as likely to have an SI compared to those who disagreed with this statement (RR = 2.2, 95% CI =1 .1 to 4.4). Conclusions: Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. The risk estimates for sharps injuries are in a similar range as in some areas of hospitals. In addition, the use of sharps without safety features is common in home healthcare, despite federal and state regulations requiring them. Home healthcare working conditions differ from the hospital setting and require specific attention for future study and the design of safe practices and interventions. The findings of this study will assist home healthcare agencies, unions, professional organizations, and govemrnent agencies by providing information that can aid in reducing blood exposure and sharps injury. Future studies of the occupational health and safety of home care are urgently needed because this industry is understudied and yet it is one of the fastest growing sectors in the U.S.
Margaret M. Quinn, Sc.D., CIH, University of Massachusetts Lowell, One University Avenue, Department of Work Environment, Lowell, MA 01854