Veille documentaire : Médecine du travail du personnel hospitalier

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Am J Infect Control. 2008 Feb;36(1):12-21.
Needlestick and other potential blood and body fluid exposures among health care workers in British Columbia, Canada.
Alamgir H, Cvitkovich Y, Astrakianakis G, Yu S, Yassi A.
Statistics and Evaluation Department, Occupational Health and Safety Agency for Healthcare, Vancouver, British Columbia, Canada. hasanat@ohsah.bc.ca
BACKGROUND: Health care workers have high risk of exposure to human blood and body fluids (BBF) from patients in acute care and residents in nursing homes or personal homes. METHODS: This analysis examined the epidemiology for BBF exposure across health care settings (acute care, nursing homes, and community care). Detailed analysis of BBF exposure among the health care workforce in 3 British Columbian health regions was conducted by Poisson regression modeling, with generalized estimating equations to determine the relative risk associated with various occupations. RESULTS: Acute care had the majority of needlestick, sharps, and splash events with the BBF exposure rate in acute care 2 to 3 times higher compared with nursing home and community care settings. Registered nurses had the highest frequency of needlestick, sharps, and splash events. Laboratory assistants had the highest exposure rates from needlestick injuries and splashes, whereas licensed practical nurses had the highest exposure rate from sharps. Most needlestick injuries (51.3%) occurred at the patient’s bedside. Sharps incidents occurred primarily in operating rooms (26.9%) and at the patient’s bedside (20.9%). Splashes occurred most frequently at the patient’s bedside (46.1%) and predominantly affected the eyes or face/mouth. The majority of needlestick/sharps injuries occurred during use for registered nurses, during disposal for licensed practical nurses, and after disposal for care aides. CONCLUSION: The high risk of BBF exposure for some occupations indicates there is room for improvement to reduce BBF exposure by targeting high-risk groups for prevention strategies.
PubMed

J Adv Nurs. 2007 Oct;60(2):199-208.
Burnout: co-workers’ perceptions of signs preceding workmates’ burnout.
Ericson-Lidman E, Strandberg G.
Department of Nursing, Umea University, Umea, Sweden. eva.ericson-lidman@nurs.umu.se
AIM: This paper is a report of a study to describe co-workers’ perceptions of signs preceding workmates’ burnout. BACKGROUND: Burnout engenders emotional and economic suffering, both individual and societal. It is therefore important to learn to recognize early signs to prevent burnout and co-workers, who have opportunities to recognize such signs, are valuable resources in this context. METHOD: Fifteen interviews were conducted with nursing and medical staff in Sweden who had worked with a person who developed burnout. The interviews took place in 2004 and were analysed using a thematic content analysis. The narratives were obtained when co-workers already knew that their workmates were on sick leave because of burnout or had left their employment after sick leave because of burnout. FINDINGS: The findings show that co-workers retrospectively recalled a multiplicity of signs. They perceived that the people concerned were struggling to manage alone, showing self-sacrifice, struggling to achieve unattainable goals, becoming distanced and isolated, and showing signs of falling apart. CONCLUSIONS: Some of the signs preceding workmates’ burnout may be difficult to interpret as signs of burnout, because they may be regarded as qualities which are to some extent encouraged in the prevailing culture. The findings provide a complex picture of these signs that will hopefully increase our awareness of and ability to recognize such signs to facilitate the possibilities of our helping in time. The sub-themes and themes in the present study may also serve as a basis for supervisors involved in supporting clinical staff.
PubMed

Am J Ind Med. 2007 Dec;50(12):921-31.
On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals.
Studnek JR, Ferketich A, Crawford JM.
National Registry of Emergency Medical Technicians, Columbus, Ohio 43230, USA. jons@nremt.org
BACKGROUND: The objective of this study was to estimate the prevalence and incidence of job-related illness or injury resulting in lost work time among a national cohort of Emergency Medical Services (EMS) professionals. Also, it was hypothesized that individual and work life characteristics were associated with the occurrence of illnesses or injury. METHODS: Data for this analysis were obtained from the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS), a prospective study of EMS professionals. The outcome variable of interest was self-reported absence from their EMS job due to an EMS work related illness or injury. The prevalence and incidence of injury with lost work time was estimated using cross-sectional and follow-up data. Multivariable logistic regression analyses were performed to determine if individual and work life characteristics were associated with occupational injury. RESULTS: The prevalence of job-related illness or injury with time away from work was estimated at 9.4%, while the 1-year incidence was estimated at 8.1 per 100 EMS providers. The results from the logistic regression model fit to follow-up data indicate that increasing call volume (OR=3.12 for very high vs. moderate, 95% CI 1.40-6.97), an urban work environment (OR=2.79, 95% CI 1.65-4.72) and a history of back problems (OR=1.72, 95% CI 1.06-2.78) were associated with reporting job-related illness or injury. CONCLUSIONS: Results from this analysis provide estimates of the prevalence and incidence of on the job illness and injury resulting in lost work time among a national cohort of EMS professionals.
PubMed

J Adv Nurs. 2007 Nov;60(3):325-33.
The Work-Related Quality of Life scale for healthcare workers.
Van Laar D, Edwards JA, Easton S.
Department of Psychology, University of Portsmouth, Portsmouth, UK.
AIM: This paper is a report of a study to develop and test the psychometric properties of the Work-Related Quality of Life scale for healthcare workers. BACKGROUND: As problems associated with stress and job satisfaction are evident for healthcare workers and nurses, a reliable tool to assess employees’ quality of working life is required. However, previous research has produced inconsistent factor structures and inadequate psychometric properties for a range of quality of working life measures. This new scale expands the concept of quality of working life by incorporating a broad six-factor structure derived from a theoretical review of the field. METHOD: We used data from a 2003 survey of 953 healthcare workers. Eighty-six per cent of the sample is female and 36% had been employed by the organization for 1-5 years. Approximately 50% of workers were employed full-time. FINDINGS: Both exploratory and confirmatory factor analysis using split-half data sets produced a good fit and a reliable 23-item, six-factor measurement model of Work-Related Quality of Life. The factors generated were labelled: Job and Career Satisfaction, General Well-Being, Home-Work Interface, Stress at Work, Control at Work and Working Conditions. CONCLUSION: The Work-Related Quality of Life measure is one of the most succinct yet psychometrically valid and reliable Quality of Working Life scales in the literature. We propose that it can appropriately be used in healthcare organizations to assess quality of working life. Further research is required to refine the instrument and assess its applicability to other areas.
PubMed

European Agency for Safety and Health at Work, 11.01.2008
E-fact 28 - Patient handling techniques to prevent MSDs in health care
MSDs are a serious problem among hospital personnel, and in particular the nursing staff. Of primary concern are back injuries and shoulder strains, which can both, be severely debilitating. The nursing profession has been shown to be one of the most at risk occupation for low back pain . The primary cause for MSDs is patient handling tasks such as lifting, transferring, and repositioning of patients. This article provides recommendations and examples for nursing staff to help reducing the number and severity of MSDs due to patient handling.
http://osha.europa.eu/publications/e-facts/efact28
http://osha.europa.eu/publications/e-facts/efact28/28_patient_handling_msds.pdf/at_download/file

J Hosp Infect. 2008 Feb 21; [Epub ahead of print]
What do healthcare workers think? A survey of facial protection equipment user preferences.
Bryce E, Forrester L, Scharf S, Eshghpour M.
Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Data on healthcare workers’(HCWs) self-reported knowledge regarding selection of facial protection equipment, usage preferences and compliance are limited. We used a questionnaire on the use of facial protection equipment at a 700-bed adult tertiary care hospital employing approximately 7000 HCWs. Clinical areas targeted were those with frequent users of N95 respirators: intensive care unit, emergency room, respiratory services, and internal medicine. Respiratory therapists were also invited. In all, 137 questionnaires (68.5%) were returned. Most (72.8%) reported that training on the use of facial protection equipment was ’sufficient’ to ‘excellent’. The PFR95 and 3M 1860 Cone were used most frequently (56%) followed by the 3M 1870 Pocket (42%). While 95% reported having been fit-tested, only 60% were tested annually. PRF95 use exceeded the number of HCWs fit-tested for the item. Overall comfort and compliance scores were 13.6/20 and 21.5/25, respectively, for respirators and 7.7/10 and 18.5/25 for protective eyewear. No relationship between comfort and years of use of either respirators or protective eyewear was found. The results highlight potential failures in effectiveness in the use of personal protective equipment that could compromise HCW safety, and support observations that compliance in the workplace is usually less than in the research setting.
PubMed

J Contemp Dent Pract. 2008 Jan 1;9(1):1-13.
Tuberculosis: infection control/exposure control issues for oral healthcare workers.
Porteous NB, Terezhalmy GT.
Department of Dental Diagnostic Science, the University of Texas Health Science Center at San Antonio, TX, USA. porteous@uthscsa.edu
AIM: The aim is to present the essential elements of an infection control/exposure control plan for the oral healthcare setting with emphasis on tuberculosis (TB). METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on TB infection-control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to TB infection-control issues is supported by data derived from well-conducted trials or extensive controlled observations. In the absence of supportive data the information is supported with the best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective TB infection-control plan include a three-level hierarchy of administrative, environmental, and respiratory-protection controls. CLINICAL SIGNIFICANCE: Standard precautions provide the fabric for strategies to prevent or reduce the risk of exposure to bloodborne pathogens and other potentially infectious material. However, standard precautions are inadequate to prevent the spread of organisms through droplet nuclei 1-5 micron in diameter and additional measures are necessary to prevent the spread of Mycobacterium tuberculosis. Oral healthcare settings have been identified as outpatient settings in which patients with suspected or confirmed infectious TB disease are expected to be encountered. Therefore, oral healthcare settings must have a written TB infection-control program.
PubMed

J Emerg Med. 2008 Feb 16; [Epub ahead of print]
Attitudes and practices regarding influenza vaccination among emergency department personnel.
Fernandez WG, Oyama L, Mitchell P, Edwards EM, St George J, Donovan J, Feldman JA.
Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Social & Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts.
In the United States, infections related to influenza result in a huge burden to the health care system and emergency departments (EDs). Influenza vaccinations are a safe, cost-effective means to prevent morbidity and mortality. We sought to understand the factors that contribute to the professional and personal influenza vaccination practices of health care workers in the ED setting by assessing their knowledge, attitudes, and practices with regards to the influenza vaccine. A cross-sectional study of all full-time ED staff (nurses, emergency medicine residents, and emergency medicine faculty) at an urban academic medical center in Boston treating > 90,000 ED patients annually, was performed. We examined knowledge, attitudes, and practices regarding personal influenza vaccination and support of an ED-based influenza vaccination program using an anonymous, self-administered questionnaire. Of 130 ED staff, 126 individuals completed the survey (97% response rate). Overall, 69% of respondents reported that they were very or extremely likely to be vaccinated before the coming influenza season. Residents (94%) and attending physicians (82%) were significantly more likely than nurses (42%) to be vaccinated (p PubMed

Infez Med. 2007 Sep;15(3):187-90.
Clinical case of seroconversion for syphilis following a needlestick injury: why not take a prophylaxis?
Franco A, Aprea L, Dell’Isola C, Faella FS, Felaco FM, Manzillo E, Martucci F, Pizzella T, Sansone M, Simioli F, Simioli S, Izzo CM.
Infectious Diseases Hospital D. Cotugno, Naples, Italy.
A 47-year-old woman was pricked accidentally with a needle previously used for a neurosyphilitic man. At day 0 she had no positive laboratory results for the infection, while the source, at day 1, had TPHA positive, but no post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject missed the day 30 follow-up, and underwent our visit at day 90, when she showed no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive 1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160, FTA-Abs IgM = negative.
PubMed