Healthcare and Worker Protection

According to the Centers for Disease Control, healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers.  Healthcare workers face a wide range of hazards on the job.  It may seem counter-intuitive that the healthcare industry, whose mission is the care of the sick, is itself a “high-hazard” industry for the workers it employs.  In fact, published studies have shown that workplace exposures to hazardous pharmaceuticals (including drugs used for chemotherapy, antiviral drugs, hormones, some bio-engineered drugs and other pharmaceuticals) have been associated with both acute and chronic health effects such as skin rashes, reproductive effects and cancers.  Although the potential therapeutic benefits of hazardous pharmaceuticals outweigh the risks of side effects for ill patients, exposed health care workers risk these same side effects with no therapeutic benefit.  Women represent nearly 80% of the healthcare work force.

Although it is possible to prevent or reduce healthcare worker exposure to hazards, healthcare workers continue to experience injuries and illnesses in the workplace.  According to OSHA, in 2010, the incidence rate for work related nonfatal injuries and illnesses in health care and social assistance was 139.9; the incidence rate for nonfatal injury and illnesses in all private industry was 107.7.  By contrast, two of the typically most hazardous industries, agriculture and construction, are safer today than they were a decade ago.  Unfortunately, the same emphasis on worker protection is not currently apparent in the healthcare industry.

There have been recent studies by NIOSH which have shown that healthcare workers who routinely come in contact with hazardous chemicals often lack training and awareness of necessary procedures to protect themselves from exposure.  These studies are derived from the NIOSH Health and Safety Practices Survey of Healthcare Workers, a federally funded web-based survey.  I reported in a recent blog of the most recent study published in the September issue of the Journal of Occupational and Environmental Hygiene.  This study shows that healthcare workers do not always follow recommended practices for compounding and mixing antineoplastic agents (cancer chemotherapy drugs).

Another NIOSH study published in the February 2015 issue of Infection Control & Hospital Epidemiology found that healthcare workers who disinfect medical and dental devices do not always use precautionary measures to protect themselves from exposures to disinfectants that may be respiratory and skin irritants and sensitizers.  In a 2013 study called Respiratory Evaluation Acute Care Hospitals (REACH), researchers at NISOH conducted a study to determine healthcare worker familiarity with respiratory protection practices including proper selection of devices for various scenarios where respiratory protection would be used.  The study concluded that overall, workers were unaware of when to wear respiratory protection, what type is needed in many scenarios and how to use it properly.

In a 2014 study published in the American Journal of Industrial Medicine, researchers concluded that workers administering aerosolized antibiotics were the least likely to have received training on their safe use, followed closely by those exposed to surgical smoke from laser/electrosurgical procedures.  For those exposed to surgical smoke or anesthetic gases, many did not know whether their employers had established safe handling procedures.  Chemical-specific training and awareness of employers’ safe handling procedures varied by employer work setting (ambulatory health care services versus hospitals).

NIOSH Director John Howard, has stated that “Safeguarding healthcare workers from potential occupational hazards is an essential part of providing good jobs for these dedicated men and women, and furthering high-quality patient care.  The limited information available on safe handling practices associated with use of hazardous chemicals makes our work even more important.”  These NIOSH studies have shown a need for better risk communication and the universal application of precautionary measures in the healthcare workplace.  Employers and highly trained workers in patient care have not always placed the same emphasis on training and proper practices necessary to safeguard their own health while at work.  The Cohen Group continues to work with healthcare providers in evaluating and controlling healthcare worker exposures.