Blood exposure and primary prevention in the home care workplace.
Lipscomb J; Geiger-Brown J; Johnson J; McPhaul K; Trinkoff A; Storr C
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-008237, 2010 Feb; :1-17
Background: Non-licensed Direct Care Workers (DCW), also known as Personal Care Assistants ( PCAs), as well as RNs and other health care professionals providing care to clients in the home need protection from work related exposures that may lead to injuries or illnesses, just as their counterparts who work in institutional settings do. Because the home care environment does not include features of an institutional work setting such as security, housekeeping, standard room configurations and bed types, as well as standard healthcare environmental hazard controls including needle disposal systems and safety-engineered needles and sharps, they may be at greater risk when exposed to blood or body fluids. In addition, ready access to post-exposure treatment or prophylaxis may be lacking. Methods: To understand more about the risk of blood exposure and injury in home care work, we conducted a five year mixed methods research study that included a series of focus groups and cross sectional surveys (at two points in time) as well as an intervention effectiveness evaluation. Three home care populations were the subject of the descriptive survey work: urban Illinois (IL) Personal Care Assistants (PCAs), Maryland (MD) Registered Nurses (RNs) and MD home care agency directors. The community based PCA intervention consisted of small group trainings, with a shorter training refresher one year later. The employer intervention consisted of a training workshop and materials. Results: Findings are summarized from 1) the baseline PCA and RN surveys, 2) the employer survey and 3) the intervention effectiveness evaluation. 1) Findings from the baseline surveys of 980 PCAs ( 74% response) and 794 RNs (65% response) found a rate of 8.1 blood and body fluid contacts per 100 FTE reported among PCAs compared with an RN reported rate of 26.7 contacts per 100 FTE. As expected, the majority of PCAs did not report using needles or lancets on the job. However, for those PCAs who performed work activities such as handling needles or lancets, they were five times as likely to be exposed as the RNs. We did not find any significant associations between the organization of work, available hazard controls and blood exposure in either populations, although further analyses are underway. 2) Phone interviews with administrators of 30 MD home care agency (47.6% response), found that twelve agencies reported 18 sharps related incidents within the past 12 months, with three of these incidents resulting in practice/procedure changes. Only 23.3% of the agencies reported extensive staff involvement in evaluation of their risk exposure plan and they reported that 73.3% of patient generated sharps are discarded in impermeable containers in household garbage. 3) A process evaluation of the PCA intervention program found home care aides were able to effectively articulate facts that they learned from a training session with less than 2% providing inaccurate information. Participation in the intervention lead to a statistically significant increase in the reported usage of proper sharps containers among the home care aides (P=.033) one year later. Conclusions and Implication: PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that are unacceptable and indicate the need for additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts such as the small group interactive training evaluated in this study and found to be effective in changing PCA behavior related to sharps disposal are needed to protect all home care workers from blood exposure, namely by assuring coverage and enforcement of the revised OSHA Bloodborne Pathogen Standard. Occupational health and long term care experts and policy makers must collaborate on strategies to provide further protection from blood and other hazards facing professional and non-professional direct care workers and the public they serve.
Workers; Work-environment; Personal-services-industry; Exposure-levels; Injuries; Immune-system-disorders; Household-workers; Needlestick-injuries; Hazards; Bloodborne-pathogens; Body-fluids; Prophylaxis; Training; Statistical-analysis; Behavior; Questionnaires; Health-care-personnel; Nurses; Nursing
Jane Lipscomb RN, PhD, FAAN, University of Maryland Baltimore, 655 W. Lombard St., Room 655c, Baltimore, MD 21201
Final Grant Report
NTIS Accession No.
National Institute for Occupational Safety and Health
University of Maryland, Baltimore