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Spring 2004 Volume XXIV, Number 2

3President’s Report

Denise Strode, RN, BSN,COHN-S/CM

4News & Such

5Editor’s Column

Kim Stanchfield, RNCOHN-S

6Call for Nominations

Colleague Connection7 - I Just Won a Million

Dollars!9 - Annual Infection

Control and BloodbornePathogen Training In The

Health Care Setting

1 7Community Liaison Update

By MaryAnn Gruden,CRNP, MSN, NP-C,

COHN-S/CM

Journalof the

Association of Occupational Health Professionalsi n H E A L T H C A R E

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F E A T U R E S D E P A R T M E N T S

Technology Solutions for BariatricPopulationsBy Andrea S. Baptiste, MA, CIE, EricMeittunen, MS, MBA, Georgia C.Bertschinger

Countering A Weight CrisisBy Robert J. Grossman

Ten Years’ Experience Using anIntegrated Workers’ CompEdward J. Bernacki, MD, MPHShan P. Tsai, PhD

Letter from AOHP President to OSHARegarding TB Testing

OSHA and AOHP Sign Alliance onFebruary 19, 2004

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A O H P J o u r n a l

AOHP Journal Executive EditorKimberly Stanchfield, RN, COHN-SEditor, Journal of AOHP—in Healthcare235 Cantrell Avenue, Harrisonburg, VA 22801(540) 433–4180 kstanchf@rhcc.com

AOHP HeadquartersJudy Lyle, Executive Director109 VIP Drive, Suite 220Wexford, PA 15090(800) 362-4347; Fax: (724) 935-1560E-mail: info@aohp.orgwww.aohp.org

AOHP Editorial BoardExecutive Board Officers

AOHP Executive Board OfficersPresident: Denise Strode

(309) 624-8529Vice President: Sandra Prickit

(415) 925-7213Secretary: Diane Dickerson

(703) 279-4307Treasurer: Deidre Tyler

(248) 304-4214

Regional DirectorsRegion 1: Chuck Lohrstorfer

(562) 904-5483Region 2: Jan Frustaglia

(512) 223-7764Region 3: June Duck

(757) 668-1789Region 4: Karen Bosley

(724) 284-4436Region 5: Connie Grady

(954) 985-3414

Chapter PresidentsAlabama: Felicia Ellison

(205) 750-5221California

Northern: Susan Borrego(831) 625-4646

Southern: Diana Anderson(818) 503-6803

Sierra: Betty Sumwalt(559) 624-5016

Colorado: Dana Jennings Tucker(303) 789-8491

Florida: Pat Watters(954) 430-6880

Georgia: Lynn Arndt(706) 655-5331

Illinois: Mary Bliss(309) 672-4891

Maine: Nola Weston(207) 791-3479

Maryland: Mary Walshe(301) 754-7458

Michigan: Bonita Koch(248) 652-5209

Midwest States: Tamara Vasta(216) 284-6684

New York:Nassau/Suffolk: Carol Cohan

(516) 249-2955

North Carolina: Delores Williams(336) 238-4226

Pennsylvania: Brenda Kantner(570) 621-4351

Eastern: Laurie Dagostino(215) 728-2616

Central: Bobbi Jo Hurst(717) 544-5984

Southwest: Dolores Hoffman(724) 226-7375

Northwest: Lori Sloss(814) 437-7000

Portland, Oregon: Janet Williams(503) 681-1741

South Carolina: Lynette Farnsworth(803) 898-2391

Virginia: Rosemary Burke(540) 741-1626

Washington/Seattle: Janie Garris(206) 901-7483

Wisconsin: Lynne Karnitz(920) 794-5181

Moving?Bulk mail is not forwarded! To receive yourjournal, please notify our business office ofany changes: AOHP Headquarters, 109 VIPDrive, Suite 220, Wexford, PA 15090; 1-800-362-4347; Fax: (724) 935-1560; E-mail:info@aohp.org.

Journal of AOHP—in Healthcare(© 2003 ISSN 0888-2003) is published quarterlyby the Association of Occupational Health Pro-fessionals in Healthcare and is free to members.

CorrespondentsChapter reporters

Journal AdsAddress requests for information to AOHP Head-quarters at (800) 362-4347

Subscription RatesOne year (4 issues), $125; Back issues when avail-able, $12.00 each. Reader participation welcome.

Membership/Subscript ionsAddress requests for information to AOHPHeadquarters, 109 VIP Drive, Suite 220,Wexford, PA 15090; (800) 362-4347; Fax:(724) 935-1560; E-mail: info@aohp.org.

M i s s i o nThe AOHP is dedicated to promoting the healthand safety of workers in healthcare. This isaccomplished through:• Advocating for employee and safety• Occupational health education and network-ing opportunities.• Health and safety advancement through best practice and research.• Partnering with employers, regulatory agen- cies and related associations.

The Association of Occupational Health Profes-sionals in Healthcare and its directors and editorare not responsible for the views expressed in itspublications or any inaccuracies that may be con-tained therein. Materials in the articles are thesole responsibility of the authors.

Guidelines for AuthorsAuthors may submit articles via e-mail attachment inWord (version 6) to the editor at kstanchf@rhcc.com.

Statement of Editorial PurposeThe occupational health professional in health-care is in a key position to help insure thehealth and safety of both the employees and thepatients. The focus of this journal is to providecurrent healthcare information pertinent to thehospital employee health professional; providea means of networking and sharing for AOHP’smembers; and thereby improve the quality ofhospital employee health services.

Advertisement GuidelinesAdvertisement guidelines are available from AOHPHeadquarters (800) 362-4347; Fax: (724) 935-1560; E-mail: info@aohp.org.

Manuscript GuidelinesManuscript guidelines are available through your chap-ter president or by writing to the editor. (See addressbelow.)

All AuthorsInclude your full name, credentials, and hospital/busi-ness affiliation. Include your supervisor’s name and ad-dress so that a copy of your printed article may be for-warded.

Send Copy toKimberly Stanchfield, RN, COHN-SAOHP Journal Executive Editor235 Cantrell AvenueHarrisonburg, VA 22801

Publication deadlines for the Journal of AOHP—inHealthcare:Issue Closing DateSpring February 28Summer May 31Fall August 31Winter November 30

Upcoming AOHP Conferences

2004 October 6-9: Tampa, FL2005 October 12-15: San Antonio, TX

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President’s Report

By Denise Strode, RN, BSN, COHN-S/CM

Denise StrodeAOHP Executive President

Greetings AOHP members:

This is my inaugural Presidential column.I welcome any suggestions to this col-umn for inclusion, improvement, etc. Ihope you all survived the winter withouttoo much difficulty. I always eagerlyanticipate spring weather. The boardresumed monthly conference calls inJanuary after a hiatus since October. InJanuary we had a jammed packed hourdiscussing the web master, 2004 confer-ence, and strategic initiatives. Here arethe major highlights:

June Duck needs vendor ideas/contacts@ jmduck@sentara.com. You can alsodirect your local vendor contacts to Head-quarters (info@aohp.org) and they will lo-cate a Tampa contact. We want to have10 more vendors present in Tampa.

The web vendor changed from HTMDesigns to Aspect as of February. Thischange will incorporate security featuresand make it smoother to initiate changesat the web site. Be watching for up-grades to the members’ only section.

ROC for AOHP is well underway with15 new members recruited as a directresult of our members’ recruitment ef-forts. Remember to continue ROCing forAOHP to win great prizes such as con-ference tuition or a free membership.

Governmental affairs activities continueat a fast pace. Sandy Prickitt, the newVP, has been busy sending out informa-tion almost daily as well as developing anewsletter. She attended NIWI in earlyMarch and met with representatives ofNIOSH, industrial hygienists, and legis-lators to discuss our concerns and waysto partner. She is also preparing a state-ment on safe patient handling. Mary

Ann Gruden, President Emeritus andCommunity Liaison, Diane Dickerson,Executive Secretary, and June Duck,Region 3 Director, attended the signingof the OSHA alliance on February 19 inWashington DC. We hope to have pic-tures on the Website soon. An allianceorientation will be held March 18 inWashington, DC.

The February conference call was heldFebruary 24. A big agenda item was theconference planning. Lydia Crutchfieldneeds your success stories to fill breakout slots on Friday. If you have a suc-cessful occupational health program,send the information to her atLydia.crutchfield@carolinashealthcare.org.It is a way to earn free conference tu-ition! ABOHN will be offering theCOHN/COHN-S/CM exams at our con-ference on Saturday, October 9. Thecommittee will resume the silent auctionthis year. Please consider having yourchapter sponsor an item and support thisfun fund-raising activity.

The Journal Editor, Kim Stanchfield,needs your nomination for an AOHP star.Please contact her at kstanchf@rhcc.comif you know someone who is a great exampleof an occupational health professional.

The Executive Board is busy workingon updating and revising the GettingStarted Manual so an updated versionwill be available for the preconferenceGetting Started workshop.

The Respiratory standard is a huge con-cern for our membership. Sandy,MaryAnn Gruden, and other membershave written a letter to OSHA to dis-cuss our concerns about the enforcementof the general respiratory standard forhealthcare. This was presented to Mr.

Henshaw at the alliance signing. Sandy alsosent out a letter for members to send toOSHA. As it stands currently, OSHA willenforce the general respiratory standardas of July 1, 2004 including annual medicalsurveillance and annual fit testing.

The following offices are up for elec-tion this year: Executive Treasurer, Re-gion 1 Director, Region 3 Director, andRegion 5 Director. Contact DianeDickerson, nominations chair atdiane.dickerson@inova.com for moreinformation about the positions/require-ments. This is a GREAT opportunity touse your experience to further your pro-fessional growth and serve AOHP in aleadership role!

Thank you for your support of our won-derful organization.

Sincerely,Denise StrodeExecutive President

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News & SuchOSHA’s Top Ten in Hospitals

Here are the top ten standards OSHAcited most often at hospitals in 2003:

· Engineering and Work PracticeControls. Engineering and work prac-tice controls shall be used to eliminateor minimize employee exposure (tobloodborne pathogens). Where occupa-tional exposure remains after institutionof these controls, personal protectiveequipment shall also be used.

· Updating Exposure Control Plan.Document annual consideration andimplementation of appropriate commer-

cially available and effective safer medi-cal devices designed to eliminate or mini-mize occupational exposure.

· Recordkeeping. Using OSHA 300,300-A, and 301 forms, or equivalentforms for recordable injuries and ill-nesses.

· Housekeeping. All places of employ-ment, passageways, storerooms and ser-vice rooms shall be kept clean and or-derly and in a sanitary condition.

· Wet Floors. The floor of every work-room shall be maintained in a clean and,as far as possible, dry condition. Where

wet processes are used, drainage shallbe maintained, and false floors, plat-forms, mats or other dry standing placesshould be provided when practicable.

· Unobstructed Means of Egress.

· Clearly Visible Signs and Routes toExits.

· Maintaining Exits in BuildingsUnder Construction/Repair.

· Unobstructed Way of Travel FromExit.

· Readily Accessible Exits.

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This Editors Column, titled “I’m TooBusy!” was originally published inthe Winter 2002 Journal. I receiveda lot of great comments when it firstappeared and thought new memberscould use the sound advice and therest of us could use the reminder.

Time had come for me to write thiscolumn. It was past time, actually. Workwas more pushed than the constant stateof frenzy that is the “routine” of anyEmployee Health Managers’ work life.Orienting a clerical/clinical assistant,new programs, revisions of old pro-grams, JACHO coming in a month,and not to mention a husband with re-cent shoulder surgery had made my lifejust way “too busy.”

Considering myself “too busy” to writethis column, pushing guilty feelingsaside, I had a great thought. I wouldwrite about “being too busy.” Not onlywould I write about being busy, I wouldmake a solemn promise to all of you,my coworkers, family and friends. Iwill never use the word “busy” again.I promise. Never.

Please allow me to explain how I arrivedat the point in my life in which “busy” isdropped from my vocabulary. At work,in my office, the phone rings, and anemployee questions from the other endof the receiver “are you busy?” Now,whether you have been in the EmployeeHealth field 20 years or 20 days, all ofyou know what a ridiculous question that

is. When are we not busy?? If you an-swer the employee “no,” you are fib-bing. I am stopping the fibs. For the sakeof my sanity, I have changed my answer.Actually, I have changed my whole ap-proach; developed a new attitude.Here are my new “rules” to work andlive by. I share these with you in hopethat you will be inspired to adopt a fewfor yourself.

Rule Number One: I will never againtry to get “caught up” before leaving.No one is ever “caught up” in our pro-fession. I will accept that when I leaveat a reasonable hour, I have done mybest, and I will continue when I return.

Rule Number Two: I will close myoffice door, switch the phone to voicemail, and devote a pre-scheduled pe-riod of time each day to my assistantto facilitate her orientation. It is theonly fair thing to do. And the only peacewe have to discuss work, share con-cerns, give advice, and most important,develop open communication.

Rule Number Three: I will not go toevery meeting to which I am invited.I will evaluate what my attendancemeans to the essential functions of myjob. If I can submit reports, I will do that.And I will give outside meetings the samescrutiny.

Rule Number Four: I will arrive atwork and leave work at a reasonablehour. I will not go in on weekends, un-less it is an emergency.

Rule Number Five: I will never againfeel guilty or apologize for taking avacation, attending a necessary out-side meeting or taking an occasionalFriday off. I work hard for those andjustly deserve to enjoy them withoutpangs of guilt.

Rule Number Six: I will attempt totake a lunch break or at least walkoutside for 15 minutes every day. Nomore eating at my desk, or not eating allday and then munching all evening athome.

Rule Number Seven: When asked ifI am busy, I will reply “constantly, butI will be happy to help you if and assoon as I can.” This has always beenthe honest answer; I am now commit-ted to using it.

So, here are my seven new rules foraddressing the “busy” state of my life.Hopefully, you have picked up a fewideas to assist you. And, by the way, ifany of you have any tips for copingwith a husband off work and in a shoul-der immobilizer for 6 weeks now witha raging case of cabin fever, send themmy way!

Since this column originally appeared,I have continued to follow most of myseven rules most of the time. My as-sistant has become a valuable assetto Employee Health and the hus-band did recover from his shouldersurgery and return to work. He re-tired from 25 years of police workthe following summer…but that isanother whole column!

Editor’s Column

By Kim Stanchfield, RN COHN-S

Some Things are Worth Repeating

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Executive TreasurerRegional Directors for Regions 1, 3 and 5

Would you like a great opportunity to use your experience and commitment to AOHP in a leadership role? Now is anexcellent time to accept the challenge and take advantage of this opportunity for professional growth and networking !!!!

AOHP is seeking leaders to fill the above Executive Board of Directors’ positions for a two-year term (October 2004-October 2006).

Executive TreasurerPosition Summary: Insures the fiscal accountability of the association. This individual must have active membership inthe association for at least four years, be employed in the field of occupational health in healthcare, have fiscalmanagement skills, and be an employee health role model for the association.

Regional DirectorPosition Summary: Provides leadership through effective communication to the designated chapters and chapter presidentsby supporting the development, planning, coordination, and evaluation of regional activities; promotes the association’sphilosophy, objectives and goals; and serves on the Executive Board of Directors.

Additional information may be obtained from your chapter president or AOHP Headquarters. If you are a qualified candidate,wish to nominate a qualified member, or would like to explore being nominated please contact:

Nominations will be accepted until Friday, June 18, 2004.

2004 Call for Nominations

Diane Dickerson, RN, MS,COHN-S, SPHR

AOHP Nominations Chairperson

E-Mail: diane.dickerson@inova.comPhone: 703-279-4307

Fax: 703-279-4242

All nominees shall be verified by telephone. Nominees who agree to run for office:· Will be provided with a complete job description· Shall submit a brief (2 paragraph) philosophy and platform statement, and· Shall submit curriculum vitae to the nomination chairperson by June 18, 2004.

Elections shall be held in August 2004. Elected officers shall be installed at theannual membership meeting held during the national conference in October.

Nominees for the following awards are being sought.

Ann Stinson President’s Award for Association Excel-lence-recognizes a chapter that has demonstrated outstand-ing performance and enhanced the image of occupationalhealth professionals in healthcare.

Joyce Safian Scholarship Award- recognizes a past orpresent association officer who best portrays an occupationalhealth professional in healthcare role model.

Extraordinary Member Award-recognizes a current associa-tion member who demonstrates extraordinary leadership.

Honorary Membership Award- recognizes a person (s)who has made a significant contribution to the field of occu-pational health in healthcare.

Nominations need to be submitted AOHP Headquarters byJuly 15th. You may contact your chapter president or re-gional representative for award criteria.

Call for Award Nominees

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I did feel like I had won a million. Iwas so happy I called everyone Iknew. Six lucky AOHP members wereawarded the Sandra Bobbitt Continu-ing Education Scholarship…and I wasone of them !!!! San Diego was notjust a dream, but my goal, a goal nowmuch closer to fulfilling.

My journey to San Diego really startedwhen I became an OccupationalHealth Nurse in September 2002. Thefollowing month, my company sent meto AOHP’s Getting Started Confer-ence. Quickly, I saw the value AOHPwould hold for me in my new position.I left the pre-conference with the SanDiego flyer. I hung that flyer on thewall next to my desk and was deter-mined to get there!

I received a scholarship applicationfrom our chapter president via email.I filled it out, and as I was going tosend it, my computer erased the en-tire thing! It took me several days tofill it out again, but I finally did. I sentit and forgot about it until I received acall at home from our then ChapterPresident, now AOHP ExecutivePresident, Denise Strode. I couldn’timagine why she would be calling me–and at home when I had just left work!She told me the wonderful news.

Our organization was going throughvery difficult financial times, but I ap-pealed to them requesting time way toattend the conference. They did nothesitate to send me. This told me thatthey value me as an employee and arewilling to invest in my knowledge so

that I can take excellent care of theiremployees. They would be paying mytravel expenses, so I vowed that inreturn, I would help turn their budgetcrisis around.

My husband tried to get me to take amommy vacation. He encouraged meto go alone, but Mommy couldn’tleave her boys! So, my family and Itogether, flew out of St. Louis onWednesday, October 8. My familyconsists of my husband Nick, and twoyoung sons, Nathan, age 4, andMitchell, 18 months. Once we con-vinced my 4 year old that we weren’tgoing to fall out of the sky and that weweren’t going to run out of gas, wewere fine.

We had a wonderful time – once theconference was over. I’ve lived andlearned!! I do not recommend takingin the conference and making it a fam-ily vacation – especially with two smallchildren. This year, I plan to have thefamily come AFTER the conferenceis over!

The conference was great, but theamount of information was so intenseI was on complete overload eachevening when I came back to theroom! I was afraid I would forget allthe good things I had learned. I wantedto read over all of my notes from theday and find a way to apply every-thing to my job. And I really needed anap. My family, on the other hand,was ready to go out. One evening Ireturned to the room to find to the boyshuddled over a bag of Cheetos and

drinking soda. I snapped at my hus-band, “You mean you haven’t fedthese kids yet?! Is that their dinner?!”My poor husband was just being nice,holding them off waiting for me so theycould include me in their night out witha nice dinner! That was the night af-ter the committee meeting–a veryLONG day!

With my family with me, I feel I missedout on a lot of the networking in theevenings. Groups would get togetherand sign up to go to the area restau-rants. This was a great networkingopportunity that I plan to take full ad-vantage of this year! We did enjoyour time the two days that we had af-ter the conference. We visited SeaWorld, the Wild Animal Park, and theShadow Mountain Community Church.Dr. David Jeremiah is pastor there andhas a radio program called TurningPoint that I listen to on the way to workeach day. It gives me the inspirationthat I need to complete each day. Itwas also the perfect end to a perfectweek. We flew back into St. Louis onMonday, October 13.

There was so much information andnetworking packed into 4 short days!This was an overload like I’ve neverhad before. But, instead of draggingme down, it energized me! I am STILL(four months later) on an AOHP high!I attended all of the extras – the an-nual meeting, and the committee meet-ings. I was disappointed not to seemore members join a committee. Itwas at the end of a very long day, butit was well worth the extra time and

Colleague Connection

I Just Won A Million Dollars!By Kim Casey, RN BSN

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effort. I encourage and challenge allof you to join a committee in Tampa!

I vowed to keep my promise to my em-ployer of using this conference expe-rience to help turn our budget crisisaround. I came away from the con-ference with a seven-page list of ac-tion items. And to date, I am proud tosay, I have saved our organization

thousands of dollars by applying numer-ous action items. I strongly believeAOHP and this annual conference iscrucial to all OHN’s careers and theiremployers’ successes. After all, asDeborah DiBenedetto said at the con-ference, “Knowledge IS Power!”

Kim Casey RN, BSN is an Occupa-tional Health Nurse at Fayette

County Hospital, Member of the BJCHealth System, in Vandalia, Illinois.Kim received her BSN from St John’sCollege in Springfield, Illinois in1995 and has worked as a surgicaland emergency department nurseprior to becoming an OHN in 2002.She is a member of the Illinois Chap-ter of AOHP.

AOHP was saddened to learn of the death of GeoffKelafant, MD, MSHP, FACOEM. Geoff was theDirector of the McLeod Occupational HealthDepartment in Florence, SC. He also operatedan Internet consulting business for medical centeroccupational health departments and employeehealth departments. He was credited withnumerous local and national presentations onoccupational health issues, and was a frequentspeaker at the AOHP National Conference.

The AOHP Board of Directors extends theirsympathy to the Kelafant family.

Geoff Kelafant, MD,MSHP, FACOEM

Memorial contributions can be sent to:

The McLeod FoundationP.O. Box 100551

Florence, SC 29501-0551

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Colleague Connection

Annual Infection Control And Bloodborne PathogenTraining In The Health Care Setting

By Sandra Prickitt, RN, FNP, COHN-S

Health care workers, including physi-cians, nurses, environmental service per-sonnel and others are at risk of expo-sure to bloodborne pathogens and otherinfectious diseases on a daily basis. In1991, OSHA issued the BloodbornePathogens Standard to protect workersfrom exposure to bloodborne pathogens.In addition the Centers for Disease Con-trol and Prevention have establishedguidelines on hand hygiene and on pre-venting the transmission of Mycobacte-rium Tuberculosis in the health-care set-ting. This article summarizes the initialand annual training that is both requiredand recommended. It also, includes thefindings of a survey (Table 1) conductedby a member of the Association for Pro-fessionals in Infection Control and Epi-demiology (APIC). This survey as-sessed infection control and bloodbornepathogen training among health care pro-fessionals in health care settings nation-wide. The goal of the article is to pro-vide a framework for providing annualinfection control training to employeesin health care settings.

The primary requirement for bloodbornepathogen training comes from the Oc-cupational Safety and HealthAdministration’s (OSHA’s) BloodbornePathogen Standard. Bloodborne patho-gen annual training is required per OSHAand other infection control trainings arerecommended. Each health care facil-ity must evaluate their population for whateducational method(s) will best meettheir needs.

Bloodborne Pathogen TrainingSeveral portions of the OccupationalSafety and Health Administration’sBloodborne Pathogen Standard discussrequirements for employee information,training and maintenance of records forthese trainings.The Bloodborne Pathogen Standard’sinformation and training section[1910.1030(g)(2)(i) - 1910.1030(g)(2)(ix)(C)] describes that employers willneed to do the following:

• Ensure that all employees with occu-pational exposure participate in atraining program which must be pro-vided at no cost to the employee andduring working hours.

• Training shall be provided as follows:1. At the time of initial assignment

to tasks where occupational ex-posure may take place;

2. At least annually thereafter. An-nual training for all employeesshall be provided within one yearof their previous training.

• Employers shall provide additionaltraining when changes such as modi-fication of tasks or procedures or in-stitution of new tasks or proceduresaffect the employee’s occupationalexposure. The additional training maybe limited to addressing the new ex-posures created.

• The training program shall contain ata minimum the following elements:1. An accessible copy of the regula-

tory text of the standard and anexplanation of its contents;

2. A general explanation of the epi-demiology and symptoms ofbloodborne diseases;

3. An explanation of the modes oftransmission of bloodborne patho-gens;

4. An explanation of the employer’sexposure control plan and themeans by which the employee canobtain a copy of the written plan;

5. An explanation of the appropriatemethods for recognizing tasks andother activities that may involveexposure to blood and other po-tentially infectious materials;

6. An explanation of the use and limi-tations of methods that will pre-vent or reduce exposure includingappropriate engineering controls,work practices, and personal pro-tective equipment;

7. Information on the types, properuse, location, removal, handling,decontamination and disposal ofpersonal protective equipment;

8. An explanation of the basis for se-lection of personal protectiveequipment;

9. Information on the hepatitis B vac-cine, including information on itsefficacy, safety, method of admin-istration, the benefits of being vac-cinated, and that the vaccine andvaccination will be offered free ofcharge;

10. Information on the appropriate ac-tions to take and persons to con-tact in an emergency involvingblood or other potentially infectiousmaterials;

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11. An explanation of the procedureto follow if an exposure incidentoccurs, including the method ofreporting the incident and themedical follow-up that will bemade available;

12. Information on the post-exposureevaluation and follow-up that theemployer is required to provide forthe employee following an expo-sure incident;

13. An explanation of the signs andlabels and/or color coding

• An opportunity for interactive ques-tions and answers with the personconducting the training session.

• The person conducting the trainingshall be knowledgeable in the subjectmatter covered by the elements con-tained in the training program as itrelates to the workplace that the train-ing will address.

In addition, the Training Records section[1910.1030(h)(2) - 1910.1030(h)(3)(ii)]requires the following:

• Training records shall include the fol-lowing information:1. The dates of the training sessions;2. The contents or a summary of the

training sessions;3. The names and qualifications of

persons conducting the training;and

4. The names and job titles of all per-sons attending the training ses-sions.

5. Training records shall be main-tained for 3 years from the dateon which the training occurred.

• Availability.1. The employer shall ensure that all

records required to be maintainedshall be made available upon re-quest to the OSHA Assistant Sec-retary and the Director for exami-nation and copying.

Employee training records shall be pro-vided upon request for examination and

copying to employees, to employee rep-resentatives, to the Director, and to theAssistant Secretary.

Infection Control TrainingAs regards infection control, the Cen-ters for Disease Control and Prevention(CDC) has issued guidelines on handhygiene and on preventing the transmis-sion of Mycobacterium Tuberculosis inthe health-care setting.

The CDC’s Guidelines for Hand Hygienein Health-Care Settings includes the fol-lowing recommendations for workereducational and motivational programs:

• Educate personnel regarding thetypes of patient-care activities thatcan result in hand contamination andthe advantages and disadvantages ofvarious methods used to clean theirhands.

• Monitor Health-Care Workers’(HCW’s) adherence with recom-mended hand-hygiene practices andprovide personnel with informationregarding their performance.

• Encourage patients and their familiesto remind HCWs to decontaminatetheir hands.

The CDC Guidelines for Preventing theTransmission of MycobacteriumTuberculosis in Health-Care Facilitiesrecommends that all HCWs includingphysicians have education regarding TBand is relevant to their particular occu-pational group. The training is to be be-fore initial assignments and the need foradditional training should be reevaluatedperiodically (i.e. annually). The trainingmay include the following elements:

• The basic concepts of M. Tubercu-losis transmission, pathogenesis anddiagnosis.

• The potential for occupational expo-sure to persons who have infectiousTB the health-care facility.

• The principles and practices of infec-

tion control that decrease the risk fortransmission of M. Tuberculosis.

• The purpose of PPD skin testing andthe significance of a positive PPD test.

• The principles of preventive therapyfor latent TB infection.

• The HCW’s responsibility to seekprompt medical evaluation if a PPDtest conversion occurs or if symptomsdevelop that are related to TB.

• The principles of drug therapy foractive TB.

• The importance of notifying the fa-cility if the HCW is diagnosed withactive TB so that contact investiga-tion procedures can be initiated.

• The responsibilities of the facility tomaintain the confidentiality of theHCW while ensuring that the HCWwho has TB receives the appropri-ate therapy and is noninfectious be-fore returning to duty.

• The higher risks associated with TBinfection in persons who have HIV orother causes in immunosuppression.

• Information on BCG.• The facility’s policy on voluntary

work reassignment options forimmunocompromised HCW’s.

Annual Infection Control andBloodborne Pathogen Training SurveyIn 2003, a member of APIC conducteda survey regarding Annual InfectionControl and Bloodborne Pathogen train-ing in the health care setting. The over-all findings of this survey show that allof the health care facilities that partici-pated in the survey provide annual in-fection control and bloodborne pathogentraining and that 87% combine it withother annual inservices.

The results of the survey indicate thaton average, the combined inservicetrainings last approximately 3 hours. Theinfection control and bloodborne patho-gen portion of the combined inservicetakes approximately 40 minutes. A ma-jority of the facilities provide annual train-ing via a written test and include

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11handwashing, TB and exposures, infec-tious waste, bloodborne pathogen expo-sures, and engineering controls.

The actual survey questions and surveyresults are listed below. It should be notedthat not all respondents answered allquestions. Therefore the total responsesvary from question to question.

Table 1

1. Do you do annual infection con-trol & BBP retraining?• 80 Responses Yes• 0 Responses No

2. Do you combine your training withother annual inservices?69 Responses Yes 9 Responses No

3. How long does your CombinedInservice last?• 14 responses 2 hours• 13 responses 3-4 hours• 8 responses 45-60 minutes• 7 responses 5 hours• 5 responses 1.5 hours• 3 responses 2.5 hours• 2 responses 7-8 hours

4. How long does your IC/BBP re-training last?• 15 responses 45-60 minutes• 11 responses 15-30 minutes• 11 responses 30-45 minutes

5. What type of retraining do you do?• 36 Responses Written test• 31 Responses Live• 22 Responses Computer/PPT• 19 Responses Booklets• 13 Responses Videos• 7 Responses Online

Note - Other forms included stations,storyboards, posters, self study packets.

6. If you use anything other than livepresentation, how do you require itto be done?• 17 Responses Can do anytime• 16 Responses Work time• 11 Responses Take home• 8 Responses During

scheduledinservice times

• 3 Responses Safety fair• 1 Response Throughout the

year• 1 Responses Done

throughout theyear

7. What IC/BBP areas do you coverin your annual retraining program?• 70 Responses Handwashing• 69 Responses BBP exposures• 65 Responses TB &

expousres• 64 Responses Infectious

Waste• 58 Responses Engineering

controls• 30 Responses Specific

Diseases: 30List HIV, HVC,HBV,pneumonia,communicabledisease

Note - Other topics included:bioterrorism, isolation, PPE, current is-sues, disinfectants, violence, how to con-tact ICP

8. What size is your facility?• 49 Responses 101 beds or more• 15 Responses 0-50 beds• 12 Responses 51-100 beds

9. What type of facility are you?• 30 Responses Rural• 19 Responses Large city• 16 Responses Small city• 15 Responses Other• 13 Responses Teaching• 5 Responses Research

REFERENCES:

APIClist.-kw , December 12, 2003 fromSue Tillotson RN, BS, ICP Wabash Gen-eral Hospital Mt. Carmel, IL F: 618-263-6483 T: 618-263-6350 suern@email.com

Department of Labor, OccupationalSafety and Health administrations. 29CFR Part 1910.1030. Occupational ex-posure to bloodborne pathogens; finalrule. Federal Register 1991;56:64004-182.

MMWR, CDC, October 28, 1994/43(RR13), Guidelines for Preventing theTransmission Mycobacterium Tubercu-losis in Health-Care Facilities, pp. 36-37.

MMWR, CDC, October 25, 2002/51(RR16); 1-14. Guideline for HandHygiene in Health-Care Setting.

Sandra Domeracki Prickitt,RN,FNP,COHN-S is a Nurse Practi-tioner/Employee Health Coordinatorfor Marin General Hospital’s Occu-pational Health Clinic called SutterHealth @ Work. Sandra is a memberof the Clinical Faculty at the Univer-sity of California San Francisco,Community Health Systems and thecurrent Executive Vice President ofAOHP.

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February 19, 2004

John L. HenshawAssistant Secretary of LaborOccupational Safety and Health AdministrationWashington, DC 20210

Dear Assistant Secretary Henshaw:

On behalf of the Association of Occupational Health Professionals in Healthcare (AOHP), I am writing regarding OSHA’srecent decision published on December 31, 2003. The decision to withdraw the proposed Tuberculosis (TB) standard andrequire that respirators for occupational exposure to TB be covered by the General Industry Respirator Standard, 29 CFR1910.134 presents significant concern to our members.

Our concern lies in four areas. They are outlined as follows:• There was no public comment period prior to the published change.• The General Industry Standard for Respiratory Protection was originally developed for airborne chemical hazards not

biological hazards.• Lack of proof that annual fit testing will in fact reduce transmission of TB when occupational exposure occurs.• A prior request for OSHA to consider a separate standard for biological hazards in healthcare settings was submitted

previously but not addressed.

� First, there was no public comment period prior to the published change.This change was published in the Federal Register on New Year’s Eve without the opportunity to comment on annual fittesting for occupational exposure to TB. AOHP welcomes the opportunity to support the efforts of OSHA. Our position onthese matters is that the health and safety requirements be based on current scientific outcomes. Annual fit testing has notbeen proven to be effective in decreasing the spread of TB when occupational exposure occurs.

Editors Note: The following letter is AOHP’s response to OSHA decisionto withdraw the proposed TB standard.

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13� Second, the General Industry Standard for Respiratory Protection was originally developed for airborne chemical

hazards not biological hazards.The original General Industry Standard for Respiratory Protection when published in 1971 and later revised in 1998 wasdeveloped for airborne chemical hazards. Protecting healthcare workers from occupational exposure to airborne diseases isdifferent from protecting workers against particulate and/or chemical hazards. Adequate protection for healthcare workersinvolves a variety of infection control measures that have been recommended by the Centers for Disease Control andPrevention (CDC). These measures have been effective in reducing the transmission of TB to healthcare workers and havenot required annual fit testing.

We concur with our colleagues from the Association for Professionals in Infection Control and Epidemiology (APIC) in their1/21/04 comments to OSHA that “health care facilities cannot measure or accurately determine the potential for exposureand/or the relevance when dealing with patients who may or may not have an infection; who may or may not have aninfectious load capable of being transmitted; who may or may not have a way to disseminate their organisms; and who mayor may not have an organism that is capable of being transmitted via airborne spread, etc.”

To clarify APIC’s comments when caring for patients there are many variables that must be considered, unlike chemicalhazards. A patient who is coughing up blood does not necessarily have TB. There are other possible reasons for the cough,for example, lung cancer or a blood clot to the lungs. These are the everyday clinical decisions that healthcare practitionersmake and that is why the general industry standard should not apply to healthcare.

� Third, lack of proof that annual fit testing will in fact reduce transmission of TB when occupational exposureoccurs.

Current CDC guidelines recommend the use of respiratory protection for health care workers performing high-hazardprocedures or working in TB isolation rooms. There are studies that suggest that different methods of fit testing producedifferent results.

Respiratory fit testing was addressed in the Institute of Medicine (IOM) report commissioned by Congress in 2000,“Tuberculosis in the Workplace.” The report states “in facilities that admit only the occasional individual with tuberculosis orthat have a policy of transferring such individuals, workers are likely to see no or very marginal additional protection from anextensive respiratory protection program.” The report also discusses the costs of such a program. It reports that the directcosts estimated in the Federal Register are significantly lower than the actual cost of implementing a program.

We are especially concerned about small healthcare facilities in areas where there is a very low incidence of TB. Implementinga full respiratory protection program would be a significant burden in time and resources when the facility may never have aTB patient. Facilities should be able to determine the need for a TB respirator program based on the annual TB assessmentrecommended by the CDC.

In addition to the direct costs, the indirect cost of implementing such a program and its impact on the ability of healthcareworkers to adequately provide patient care must also be considered. Such a program could 1) impact patient care services,2) be labor intensive and 3) be a logistical challenge for the most seasoned manager. Given the current scientific evidencethe cost/benefit of an annual fit testing program for TB cannot be supported.

� Fourth, a prior request for OSHA to consider a separate standard for biological hazards in healthcare settingswas submitted previously but not addressed.

On September 4, 2003, AOHP and the American Association of Occupational Health Nurses (AAOHN) submitted writtencomments to OSHA during the comment period for revisions of the Respiratory Protection Standard (29 CFR 1910). Wesupported OSHA’s efforts to simplify the standard with the new CNP REDON fit testing protocol. In those comments weasked OSHA to consider “the fact that the need for respirators varies by industry, and” recommended “that protocols reflectthe unique challenges and characteristics for employees in each work environment.”

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Given that the primary need for respirators within a healthcare setting is to protect workers against airborne biologicalhazards we asked OSHA to consider a separate standard for airborne biological agents. A separate standard could moreappropriately address the respiratory protection issues that face healthcare workers including fit testing on hire and thenannual surveys to determine any possible need for re-fit testing. To my knowledge we did not receive any feedback on ourcomments.

Our goal is the same – to ensure a safe working environment for healthcare workers. We ask that with the current CDCrecommendations and lack of scientific evidence to support annual fit testing, that OSHA reconsider the annual fit testingrequirement for TB and consider a separate standard for airborne biological hazards.

We thank you for this opportunity to communicate our concern and look forward to an opportunity to collaborate in thedevelopment of a standard that would be appropriate for healthcare. Please contact MaryAnn Gruden at 412/578-6792 ormagaohp@yahoo.com for additional information.

AOHP, a national association of approximately 1000 members, is dedicated to promoting the health and safety of workers inhealthcare. This is accomplished through: Advocating for employee health and safety Occupational health education and networking opportunities Health and safety advancement through best practice and research Partnering with employers, regulatory agencies and related associations.

Sincerely,

Denise Strode, BSN, COHN-S/CMExecutive President

AOHP is on the World Wide WebVisit the AOHP Web site to learn more about AOHP’s mission, goals, and

professional standards. The site contains the most current information on chapteractivities, membership, as well as helpful phone numbers.

AOHP welcomes your coments or inquiries. E-mail us at info@aohp.org.

www.aohp.org

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OSHA and AOHP Sign Alliance on February 19, 2004

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Seated: John Henshaw, OSHA Administrator; MaryAnn Gruden, President EmeritusStanding: June Duck, Region 3 Director; Diane Dickerson, Executive Secretary

This is the first Journal report from the AssociationCommunity Liaison. You may be asking, “What is an As-sociation Community Liaison?” The AOHP AssociationCommunity Liaison (ACL) was a position approved by theExecutive Board of Directors at the 2003 Fall Board Meet-ing in San Diego. The role of the ACL is to serve as afacilitator to accomplish the strategic imperatives/priori-ties of AOHP with regard to the increased national namerecognition; collaborative efforts with governmental agen-cies; other professional associations with common inter-ests and with the healthcare community at large. Thisposition is a part-time, paid, non-voting member of the Ex-ecutive Board of Directors. In addition, the ACL will:

• identify and collaborate with key governmentalagencies and associations,

• report directly to the Executive President,• participate in Executive Board meetings,• be a member of the Government Affairs Committee,• serve as the Association’s representative at

designated governmental functions• provide updates in the Association’s publications.

Since January 1, 2004 the two major efforts that the ACL hasbeen involved in have been:1) the signing of the OSHA Alliance on February 19, 2004with Mr. John Henshaw, Assistant Secretary of Labor2) drafting a letter in response to OSHA’s withdrawal of theproposed TB Respiratory Protection Standard and the require-ment for annual respirator fit testing. The final letter wasdelivered to Mr. Henshaw at the time the Alliance was signed.

Association Community Liaison UpdateBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

The signing of the OSHA Alliance was an exciting mo-ment for AOHP. In addition to myself, Diane Dickerson,Executive Secretary and June Duck, Region 3 Directorwere present for the signing. Our Alliance representativeat OSHA is Sandra Kahn. Along with Sandra, we will beworking with Elise Handelman, OSHA’s Director of Oc-cupational Health Nursing as the Alliance is implemented.March 18 marked our orientation meeting and our firstimplementation meeting took place March 19th.

We had the opportunity to briefly meet with Mr. Henshawand discuss the Alliance and our needs in healthcare. Inaddition, Mr. Henshaw was presented with a letter from AOHPExecutive President Denise Strode outlining our concern aboutthe withdrawal of the proposed TB standard and the require-ment for annual respirator fit testing. We emphasized that thehealth and safety of our workers is our primary concern andthat we want our care to be based on science.

AOHP released its first press release when the Alliancewas signed. We developed a media list and also circulatedthe press release to approximately 30 other occupationalhealth-related organizations and publications. OSHA alsoprepared a press release that was posted on their website– www.osha.gov. A copy of the Alliance is in this issue ofthe Journal as well as a copy of the letter regarding thewithdrawal of the proposed TB standard.

I am honored to serve as the Association’s first ACL. Up-dates will be included in the Journal and newsletter. Ifyou are interested in helping with the implementation ofthe Alliance or have issues that you feel are appropriatefor the ACL to address, please contact me at 412/578-6792 or by email at magaoph@yahoo.com.

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IntroductionThe prevalence of overweight and obese adults in the UnitedStates continues to rise. A Body Mass Index (BMI) of over30 defines obesity internationally. BMI is calculated by pa-tient weight (kg) divided by height squared (m2).

Table 1: International Standards for BMI.

In 1988-1994, the age-adjusted prevalence of overweightadults older than 20 years (BMI e” 25) was 56% and rose to64% in 1999-2000.

In 1988-1994, the age-adjusted prevalence of obese adultsolder than 20 years (BMI e”30) was 23% and increased to30% in 1999-2000 1.

Results from the Behavioral Risk Factor surveillance system(1991-2001) self reported data show that from 1991-2000,there was a 61% prevalence increase in obesity among U.S.adults. There are many obesity related diseases that remain asignificant threat to the health of the bariatric population.Obesity statistics report that 80% of type II diabetes, 70%cardiovascular disease, 42% breast and colon cancer and 30%gall bladder surgery are all related to obesity 2. Given thesestatistics, a proactive approach should be taken to control theincrease in obesity as well as protect caregivers from poten-tial injury when caring for bariatric patients.

Patient handling is a common task in healthcare, but with thesteady rise in worker compensation costs in the nursing occu-pation, safe patient handling has become a major topic of dis-

Technology Solutions for Bariatric PopulationsBy Andrea S. Baptiste, MA, CIE, Eric Meittunen, MS, MBA, Georgia C. Bertschinger

cussion. The healthcare industry is gradually accepting thereality that manually lifting and transferring physically depen-dent patients is a high-risk activity, for the caregiver and thepatient. Managing obese patients provide special challengesto nursing care staff. Some of these difficulties including theinability to turn, transfer or ambulate patients can contributeto pressure ulcers. Respiratory insufficiency can develop dueto overweight hypoventilation syndrome. Colostomy care be-comes complicated due to a large abdominal apron of fat.From the caregivers’ perspective, treatment of bariatric pa-tients subjects caregivers to an increased risk of injury. Tominimize this risk, the appropriate use of technology is onesolution in managing this special population.

The intent of this article is to raise awareness that there aretechnological solutions available for the management and careof bariatric patients.

The categories of equipment listed below can be found on thefollowing website: www.patientsafetycenter.com, under tech-nology resource guide. Please note that the manufacturingcompanies or products mentioned are not necessarily endorsedby the Veterans Hospital.

As workers compensation cost rises and our population grows,there is more of a need for caregivers to take responsibilityfor their safety at work and there is also a need for improvedequipment to assist in patient care. The following categories arewritten to expand knowledge base as to what technological solu-tions are currently available for the bariatric population.

Various Categories of Technology:

Ambulatory and Mobility AidsAmbulatory and Mobility Aids consist of assistive devices forpatients who are unsteady in standing or walking. In this cat-egory, equipment includes but is not limited to walkers, canes,gait training devices and crutches. A gait trainer is a frame onwheels used to provide support to a patient when walking orambulating. The patient is placed in a specialized harness,which is affixed to the gait trainer. This enables the patients’weight to be fully supported if needed. Gait trainers are typi-

(Footnotes)1 National Center for Health Statistics, Health E- Stats, www.cdc.gov/nchs/products/pubs/pubd/hestats/obese/obse99.htm2 Obesity statistics. http://www.annecollins.com/obesity/statistics-obesity.htm

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19cally utilized in rehabilitation until the patient has developedenough strength and can walk independently. An example ofsuch a trainer is the Liko Ultra Twin Free Span, which pro-vides patient support up to 880 lbs.

When choosing a mobility aid, it is important to ensure thatthe device is adjustable in width or wide enough to accommo-date the user. The structural integrity and weight limitation ofeach assistive device also needs to be taken into account toguarantee safe use of the mobility aid. If storage is a concern,there are bariatric walkers that can be folded and easily car-ried. Some manufacturers that offer walkers for bariatricpatients include Access Care, Medline Industries Inc., TFI,Hill-Rom, or Sten-Barr Medical Inc.

Bathing EquipmentMany slips and falls occur in the shower or bathroom due topoor flooring and lack of proper equipment. By implementingthe proper use of appropriate equipment in the bathroom, theprobability of a fall is reduced. The bariatric patient is espe-cially susceptible to falls given the lack of balance and weak-ness in the knees and ankles. Options to improve safety in thebathroom include use of grab bars, elevated toilet seats, tubtransfer benches, bath benches and shower trolleys. It is im-portant that grab bars are strong enough to support the weightof the user and that they are strategically placed.

Tub transfer benches are devices that assist in the transfer ofunsteady patients into the tub. These benches are seatedsurfaces that extend over tubs, and are designed to fit stan-dard bath tubs. Weight capacity of these transfer aids rangefrom 650-850 lbs. Another option for those residents who aresteadier on their feet is security rails, which are attached tothe rim of the tub.

The weight capacity of toilets should be considered for safety,as regular toilet capacities may have different weight accom-modations due to the type of porcelain used. It is necessary tocheck with the manufacturer for the maximum weight allow-ance. How the toilet is mounted (floor, wall hung), also has asignificant impact on the weight capacity. Some Kohler mod-els will handle weight capacities up to 1,000 pounds if thecommode is floor mounted compared to 500 pounds for awall hung model. Even at these capacities, extreme care shouldbe taken not to underestimate the structural support neededto accommodate this weight.

Beds/MattressesDue to excessive skin folds, additional body weight, lack ofmobility, failure to clean and treat certain areas, some bariatric

patients are susceptible to pressure ulcers and thus requirespecialized surfaces. There are numerous beds and mattressesdesigned to accommodate the needs of bariatric patients.Some beds offer various features designed to serve differentpurposes, such as low air loss or specialty surfaces. Sometreatment systems and beds are specifically made for easiertransport of bariatric patients. Examples of beds with mat-tresses that try to prevent and control the development ofpressure ulcers are: Access Care Air Bed, Access Care Ul-tra Select, Air Care BariSelect Bed, Gaymer Industries UltraAire Select Mattress. This list is not a comprehensive listand does not include all the manufacturers.

Special beds also offer chair positioning, vibration and lateralrotational therapy functions. These features greatly assist inrepositioning, treatment of pulmonary dysfunction and the re-duction of pressure sores.

TransportationTransport of bariatric patients can be made easier by use of apowered system built into a bed (Intellidrive by Hill-Rom) orvia a detachable battery operated device (StatMover), shownin Figure 1.

The Total Care Intellidrive system operates by unplugging thebed and releasing the brakes. There are two handles at thehead of the bed, which are used to steer and the bed is movedby depressing buttons and applying a minimal force to initiatemovement. An alternative device used for patient transport isthe Stat-mover, which is a detachable, battery-operated sys-tem, capable of moving a 600 lb patient in bed. It is attachedto the head of the bed and powered by two batteries, whichprovide power. The Stat-mover has an adjustable steeringangle and docking height, and is operated by a toggle switch,similar to that of an electric scooter.

Figure 1: Patient transport

Inherent in the process of care and management of patients

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is transfers from bed to wheelchair or bed to toilet. There areseveral challenges involved in transferring bariatric patients,such as inadequate size of doorways, inappropriate sized bedsor commodes and unavailable floor based lifts with ability toaccommodate larger weights. One way of reducing the num-ber of transfers is the use of ceiling-mounted lifts.

Ceiling LiftsCeiling-mounted lifts are becoming a favorable investment inmany hospitals in the United States. These lifts differ fromfloor-based lifts in that they suspend from the ceiling and there-fore do not impose on limited floor space and storage. Thereare two available ceiling lift configurations: single track andtransverse track. A single-track system follows a dedicatedpath; therefore patient care activities involving vertical trans-fers are limited to this specific path. A transverse coveragesystem provides broader coverage within the room.

Advantages of the ceiling- mounted patient lift include: (a)ease in training nurses about use, (b) ease in maneuveringover floors and around furniture, (c) no need for storage, (d)conveniently located at bedside (e) increased patient securityand comfort, and (f) less strenuous on nurses than traditionalfloor based lifting devices. However, these new devices dohave a few drawbacks, including (a) cost and (b) coveragerestrictions limited to where tracks are installed. Examples ofsome ceiling lifts available for bariatric patient handling are:MediMan Saturn, BHM Voyager, Barrier Free Stretcher Lift,or Access Care Overhead lift.

Portable bases can be used to suspend full body sling liftswhere overhead tracks are not available or practical. How-ever, it is important to know the weight limit on these portablebase lifts as they may not be able to handle the weight of abariatric patient. The Chiltern Invadex is an example of afree-standing gantry bariatric system used for patient trans-port with maximum weight capacity of 980 lbs. The type ofceiling track installed depends on the patient’s need, frequencyof use, patient population and the cost involved. The benefitof using a ceiling mounted lift needs to be weighed against thecost of alternative options, such as powered floor lifts.

Powered Floor Based LiftsPowered Lifts offer many benefits when caring for a bariatricpatient. One key advantage is that caregivers do not have tomanually move or reposition patients due to the mechanicaladvantage these lifts can provide. The transfer becomes pow-ered versus manual so there is less risk of injury to thecaregiver. However, placement of a sling underneath the pa-tient still proves to be a challenging task for most caregivers.Many functional features of powered lifts include transfer-

ring patients from bed to chair or repositioning them by simplypressing a button. It is imperative that the drive motor of thepowered lift is compatible with the patient’s weight. Whenusing powered lifts, patients need to first be fitted with slingsof the right size to ensure no skin shearing or pressure pointsexist during the transfer.

Figure 2: Powered floor based lift

Lateral Transfer AidsOne of the highest risk tasks in nursing is the transfer of apatient from a bed to a stretcher. This type of transfer re-quires the caregiver to reach over the stretcher to the bedwhere the patient is lying, then pull the patient over to thestretcher. This task forces the caregiver into a poor, awk-ward posture. The use of lateral transfer aids can eliminatethe need for poor postures, thus reducing the risk of injury tothe caregivers. Lateral Transfer Aids are devices used forthe lateral transfer of patients, and vary in types from: a) Airassisted, b) Mechanical Lateral aids, and c) Manual Lateralsliding aids.

Air Assisted DevicesAn air-assisted lateral transfer device is a flexible mattress,which is placed under a patient and inflated by a portable airsupply. The bottom side of the mattress has thousands of holesallowing the air to pass through.This air flow allows the pa-tient to be transferred to the other surface on a cushionedfilm of air. This reduction in friction between the bed andbottom of mattress reduces the amount of force required bythe caregiver to make a successful transfer. Key strengthsof air assisted sliding aids are that they provide a good sur-face for patients with compromised skin integrity (pressuresores or burns) and there is no weight limit. This type of de-vice is especially useful for the transfer of bariatric patients.

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Figure 3: Air Assisted Lateral Transfer Aid

Mechanical DevicesMechanical lateral transfer aids are those devices, which elimi-nate the need to manually slide patients, thus substantiallyreducing the risk of injury to caregivers. A mechanical lateraltransfer aid may be mechanically assisted or motorized inorder to provide a safe and successful transfer. The key ben-efit of these products is the reduction in the risk of injury tothe caregiver. Mechanical lateral aids are highly recommendedwhen treating the bariatric population, given the higher rangeof weight capacities. The mechanical features of these prod-ucts cause them to be more costly than air assisted and ManualLateral sliding aids. However the benefits of purchasing thesedevices far outweighs the cost.

Manual DevicesManual lateral sliding aids are fabric devices, positioned underthe patient, providing a smoother surface on which to slide thepatient laterally. These devices are used like transfer boards withthe added advantage of reduced friction due to the type of fabricused. Properly designed handles and the use of pull straps canimprove the caregivers’ grasp and reduce forward reach duringtransfers. However, these fabric devices are not appropriate forthe lateral transfer of bariatric patients because some of themare too narrow and cannot sustain weights over 400 lbs. Werecommend the use of either air assisted or mechanical lateraltransfer aids when performing these types of transfers.

Equipment and UseSignificant progress has been made in the area of patient trans-fer equipment design in the past fifteen years. Devices thatwere non-existent are now prevalently available to meet theneeds of nearly all-patient populations; specifically for that ofthe bariatric patient. Noted improvements include incremen-tal increases in the comfort, lift capabilities, and style of pa-tient transfer devices.

The collaborative effort among healthcare organizations, staff,and manufacturers has produced improvements to these de-vices resulting in a favorable impact on the quality of patient

care. However continuous improvement is needed in areasof standardization of increased capacities in order to meet theneeds of our changing patient demographics.

Essential, is a transfer device that will help the caregiver as-sist patients in getting out of private vehicles. The device shouldbe automated and designed to eliminate staff having to lift inawkward positions and manually lifting patients. This deviceshould be able to adjust to cars and trucks of any height, andaccommodate patients of any weight. This would be a tre-mendous help to those working in Emergency Departmentswithin hospitals.

In addition, consideration should be made for the appropriateimplementation of devices within the patient care setting tofacilitate utilization by staff. Healthcare settings that havepurchased equipment or have a plan in place for leasing needa mechanism to keep staff informed of the options available.The equipment inventory or possible lease options will changefrequently as equipment becomes available on the market.The communication mechanism needs to be easily updated tokeep current with the changing environment. An internal equip-ment web site with pictures, descriptions, usage tips and or-der information may be a viable option if the healthcare set-ting utilizes computer technology as an information source forstaff. The web site could include a link if there is a corre-sponding Nursing Procedural Guideline to be used with theequipment. For example, an expanded capacity equipmentflow chart was described in a procedural guideline and placedon the intranet at Mayo Clinic to provide information for pa-tient care staff. 1 Internal pre-identified resource specialists canprove to be a valuable equipment resource to staff. Clinicalnurse specialists, bariatric unit staff, nursing education special-ists, nursing supervisors, safety/ ergonomic coordinators, supportservice coordinators and material managers can provide staffwith equipment options and consult on specific issues as needed.Nursing Education Specialists can help with immediate trainingregarding new equipment. Poster presentations given at internalposter fairs, and “hands on” demonstrations keep staff knowl-edgeable about new and existing equipment options.

Here is an example of the patient admission process from theEmergency Room or General Admissions Desk:

Flow Diagram for PatientsEntering the Healthcare SettingPatients come to the healthcare setting in two ways: a plannedadmission or an emergency admission. A flow diagram canbe utilized to understand how technology and resourcesused together will provide the patient and staff with a safeenvironment of care, as shown below in Figure 4

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Conclusion:The main objective of this article is toincrease awareness that there are tech-nological solutions for caring for specialneeds populations, such as bariatric pa-tients. It is very important that all healthcare

(Footnotes)3 De Ruiter H., Meittunen E., Sauder K. Improving safety for caregivers through collaborative practice. Journal of Healthcare Safety,Compliance & Infection Control, Vol 5, No.2, February/March 2001, Figure 1. Mayo Collaborative Proactice Model, pp. 63

workers have a planned process, protocoland procure the appropriate equipmentprior to the entry of a bariatric patient. Clearcommunication is essential for frontlinestaff, patients, safety coordinators and fam-ily members to improve the comfort level

when using equipment for transfers. Useof equipment in patient handling will re-duce the physical demands placed onnurses and others when caring for bariatricpatients. Adopting a pro-active approachshould reduce the risk of injury to patientsand staff, maintain a healthier environmentand foster job satisfaction amonghealthcare workers.

Andrea S. Baptiste, MA, CIE is aBiomechanist/Ergonomist at the PatientSafety Center, James A. Haley Veterans’Hospital, Tampa, Florida. She managesthe Biomechanics Lab and is a gradu-ate of NYU Masters Program in Ergo-nomics and Orthopaedic Biomechanics.A Certified Ergonomist and member ofHuman Factors Ergonomics Society.

Eric Meittunen, MS, MBASafety Coordinator at the MayoClinic, Rochester, MN. Graduate ofthe Carlson School of Business-Uni-versity of Minnesota: Master of Busi-ness Administration Executive Pro-gram and the University of Wiscon-sin-Stout: Master of Science Risk Con-trol Management/Safety Program.

Georgia C. Bertschinger is a Sup-port Services Coordinator at MayoRochester Hospitals. She plans anddirects non-clinical resource activi-ties, primarily focusing on medicalequipment/supply provision and ex-pense management, environment ofcare, hospital facilities and relatedstandardization.

Illustrations were kindlyprovided by Apex DynamicsInc., Hovertech Internationaland Richmark Technologies.

The research reported here was supported by the PatientSafety Center, Department of Veterans Affairs, and theMayo Clinic. The views expressed in this article are thoseof the authors and do not necessarily represent the viewsof the Department of Veterans Affairs.

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23

Countering A Weight CrisisBy Robert J. Grossman

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

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Ten Years’ Experience Using an Integrated Workers’ CompEdward J. Bernacki, MD, MPH

Shan P. Tsai, PhD

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

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May 2004

Dear Fellow AOHP Members:

By the end of June’04, you will have the Conference Brochure in your mailbox inviting you to attend the annual AOHP Conferencein Tampa, Florida! There you will receive “Your Ticket To Tomorrow.” The Grand Hyatt Hotel Tampa Bay, Tampa is thelocation. October 6-9, 2004 is the date.

Wednesday, October 6 will provide three full-day and four half-day workshops:• “Getting Started” 8-hour workshop ideal for those new to the field of occupational health in healthcare, taught by

members of Northern California AOHP Chapter.

• Center for Biological Defense at the University of South Florida will partner with AOHP to provide an 8-hour BioReadinesstraining.

• Isernhagen Work Systems, Duluth, MN, will send their faculty member Linda Ellis Darphin, PT to provide one of theiresteemed programs “Case Manager’s Role in Facilitating Worker Rehabilitation” for an 8-hour workshop.

• Advanced Practice, 4 hour seminar with Michael Hodgson, MD and Mark Russi, MD.

• ErgoLogix is returning to present its popular The Economics of Workplace Safety. Register for this 4-hour workshop to“refine the business of safety” for your hospital. Start now to gather your work comp data – bring those ‘numbers’with you to this workshop.

• “Demystifying the Selection of Lift & Transfer Equipment” presented by Steve Gould, WY’EAST Medical, will offerthe attendee this 4-hour workshop to selection of appropriate equipment.

• A 4-hour workshop will be a field trip to the VA Patient Safety Center in Tampa! A bus will transport you to/from thecenter where you will visit the five research labs.

Wednesday evening 6pm we will welcome our many exhibitors at our Opening Reception. Get your tropical cruise attire inyour luggage right now so you are dressed and ready for this event!

Thursday, Friday and Saturday General Sessions and Breakout Sessions you can look forward to:

• KEYNOTE speaker Paula White, OSHA Washington DC, addressing the AOHP/OSHA partnership Alliance signed in February2004 – its impact to worker health and safety and the implementation strategies of the Alliance.

• Teresa J. Brady, PhD, Senior Behavioral Scientist at the CDC, presenting “Using Health Communications to PromotePhysical Activity Among People With Arthritis.”

• Steve Bierman, MD, founder of NAPPSI, will provide an update to sharps injury prevention.

• Florida public health department presenter on the topics of TB and infectious disease control.

• Michael Hodgson, MD, MPH, Director, Occupational Health Program, Veterans Health Administration, Washington, DC,will present “Personal Protective Equipment in Healthcare Facilities After Terrorist Events.”

• Joan M. Spencer, CIH, OSHA compliance in Tampa, will present “Bloodborne Pathogen Standard Requirements: A CloserLook at the OSHA Inspection Directive” and topic “Most Frequently Cited OSHA in Healthcare.”

• Mary Amann, RN, MS, COHN-S/CM, FAAOHN, Executive Director-ABOHN, presenting “Results of a National PracticeAnalysis and the Implications for Hospital Occupational Health Nurses.”

• Bette J. Tweten, PhD, Assistant VP Employee Development Carolinas HealthCare System, presenting “Managing andValuing Difference: Yours, Mine and Ours.”

• Cheryl Brennan, RN, BSN, Senior Loss Control, Berkley Risk Administrators, presenting “How to Herd Cats: A Lesson onEffective Workers’ Compensation Injury Management.”

Spring 2 0 0 4

39• Ken Aebi, ErgoLogix & Bob Williamson, RN, MS, Manager Workers’ Comp, Ascension Health, co-presenting “Creating and

Marketing A Safe Patient Handling Program.”

• Katherine Duesman, RN, Clinical Director, Retractable Technologies, presenting “Safety By Design: Preventing NeedlestickInjuries with Engineering Controls.”

• Polly G. Zimmermann, RN, MS, MBA, CEN, Assistant Professor in Nursing, presenting “Making Your Office Time MoreEffective.”

• Robert D. Booth, MPH, CIH, LHRM, VP Risk Manager/Industrial Hygienist, ONCORE, Inc., presenting “Investigating andSolving Indoor Air Quality problems.”

• Linda Haney, RN, MPH, COHN-S, CSP, Clinical Director for Diligent, presenting “Are You Competent Using The BrennerModel.”

We plan to continue to offer Advanced Practice Focus geared for the physician, nurse practitioner and experienced occupationalhealth professional for Breakout Sessions throughout the conference.

2004 Conference Committee has invited posters chosen from the 2004 Safe Patient Handling & Movement Conference. Thisdisplay will hopefully begin the tradition of poster abstract review for 2005!

The 2004 Conference will have not only one, but two field trips! On Friday morning 20 registrants only will enjoy a bus trip toTampa General Hospital (TGH) narrated by member Joann Shea, ARNP, MS, COHN-S. Joann, Director of Employee Health andWellness at TGH, and her staff will conduct a walking tour of the hospital, showing the Lift Team in action with the patient liftingequipment.

Conference Breakout Sessions including “Success Stories” will be on topics:• Medical Informatics-PDAs – a hands-on session

• Complementary Therapies utilized in healthcare today – outcomes and research

• Successful patient-lifting programs

• American Nurses Association’s Handle With Care campaign

• Nuts and Bolts of Return-to-Work Programs

ABOHN will again offer a certification exam session on Saturday October 9 at the Grand Hyatt Hotel. Contact ABOHN tollfree 888-842-2646 or email info@ABOHN.org or visit the website www.abohn.org for additional information for COHNcertification. A reception will be held Thursday evening at 6 pm sponsored by ABOHN.

The Silent Auction has been resurrected, so plan now to assemble those baskets, buckets, or bags with goodies from yourregion - include small items such as gift cards from stores or coffee shops, so you won’t be laden with items going throughairport security. The annual 6 am Health Walk will be extra special as you will have the pathways within the tropical areasurrounding the hotel to walk. If your fitness requires indoor workout, the Hyatt’s workout room is superb with equipment,Jacuzzi, AND sauna!

AND we have put together a Post Conference 5 Day cruise with Carnival Cruise Lines leaving port in Tampa October 11-16to visit Grand Cayman Island and Cozumel, Mexico.

The Grand Hyatt sits within a 35-acre wildlife preserve directly on the shore of Tampa Bay and literally a five minute complementaryshuttle ride to/from the airport. Tampa attractions include Busch Gardens, Ybor City, beaches, sports events, Florida Aquarium,and don’t forget Disney World is only a 75 minute drive to Orlando, Florida.

We look forward to seeing you in Tampa!

Jan Frustaglia, RN, BS, CCM, COHN-S2004 AOHP National Conference Chairjfrustag@austincc.edu or concerns@earthlink.net(512) 223-7764

PRSRT STDU.S. Postage

POSTAGE PAIDWarrendale, PAPermit No. 20

Association of Occupational Health Professionals in Healthcare109 VIP Drive, Suite 220Wexford, PA 15090

Address Service Requested

“Let’s ROC (Recruit Our Colleagues) for AOHP”How does FREE tuition to the 2004 Conference in Tampa Sound?

What if we add FREE AOHP membership for a year??Recognition at the 2004 Conference and AOHP Journal and website???

The “Let’s ROC for AOHP” Program extends until September 30, 2004. AOHP Members who recruit the most newmembers will receive:1. Free Conference Tuition at AOHP’s 2003 Event2 . Free AOHP Membership For One Year3 . Recognition at 2004 National Conference4 . Journal/Website Recognition

New members you recruit need to reference you as their recruiter when joining.

Benefits of AOHP membership include:• Networking at chapter and national level.• Continuing education opportunities through chapters and the annual national conference. AOHP is a continuing

education provider.• Getting Started Manual and Workshop for newcomers to occupational health in health care• Quarterly peer-reviewed AOHP Journal and electronic newsletter• Access to position statements and standards of practice• Legislative representation at the national level as pertinent issues emerge• Personal opportunities to develop leadership skills and professional growth• Scholarship opportunities