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Winter 2004 Volume XXIV, Number 1

3President’s Report

MaryAnn Gruden, CRNP,MSN, NP-C, COHN-S/CM

5News & Such

9Editor’s Column

Kim Stanchfield, RNCOHN-S

Colleague Connection7- Prevention of Work-Related Lifting Injuries:

Our Hospital’s Approach10 - Implementing Change

in the Pre-EmploymentProcess

Journalof the

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

19 Myths and Facts About Back Injuries inNursingBy Audrey Nelson, PhD, RN, FAAN; GuyFragala, PhD, PE, CSP; Nancy Menzel,PhD, RN, COHN-S

26 Helping Employees Cope With GriefBy Kathryn Tyler

30 Sharps Injury Risk to Physicians-in-Training and Attending Physicians: APreliminary SurveyBy MaryAnn Gruden, CRNP, MSN, NP-C,COHN-S/CM and Steve Bierman, M.D.

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

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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

Ohio River Valley: Sandra Schoenberger(513) 941-0769

Pennsylvania: Barbara Burger(215) 345-2380

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) 741-1557

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; 1-800-3 6 2 - 4 3 4 7 ; Fax: ( 7 2 4 ) 9 3 5 - 1 5 6 0 ; E - m a i l :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/SubscriptionsAddress 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.

MissionThe 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 MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

MaryAnn GrudenAOHP Executive President

This message was delivered byExecutive President, MaryAnnGruden at the Annual MembershipLuncheon and Award Presentationon Friday, October 10, 2003 at theBahia Resort Hotel, San Diego, CA

As our annual membership meet-ing draws to a close I want to take afew minutes to summarized where wehave been, to highlight the progress wehave made and to share the vision ofwhere we are going from here. Duringmy tenure as Executive President,AOHP has undergone a transition froman organization that had key strategicareas to address to an organization thathas blossomed with transition andchange. These positive changes are dueto the dedication of the Executive Boardthat you see sitting before you and toour committed management team.

Some of the highlights of the past fouryears include a change in managementservices. In 2002 we transitioned to newmanagement with Amerinet Central onlyto learn shortly after the transition thatthe parent corporation was exiting theassociation management business. Wewere fortunate to secure new manage-ment and retain our Executive Director,July Lyle and her assistant, Annie Wiestas we transitioned to Aspect Manage-ment Services. This has been a seam-less transition from my perspective andour new management has been very in-volved in assisting with the future de-velopment of the association.

At a time when national associations are

loosing members, our membership hasremained state in the past two years.We have added the category of retiredmember, conducted a membership sur-vey and changed the chapter rebate pro-cess. Portland, Oregon has formed asnew chapter.

Communication with the leadership andmembers has improved with the monthlynewsletter, “Notes from the ExecutivePresident,” distributed to the ExecutiveBoard and Chapter Presidents. Therehave been new columns in the Journal.These include “Colleague Connec-tion,” “Spotlight on a Star” and “HRClarity.” Kim Stanchfield, our JournalEditor has worked diligently to meet ourpublication schedule and she has done agreat job.

Our website was redesigned last yearand now has a “member only” sectionthat we were able to vote on for the firsttime this year. It will soon have the Jour-nal and other member only informationas a member benefit..

The “Getting Started Manual” was re-vised with a new format including thecapability of retrieving over 120 websitesin the reference chapter for quick andcurrent information related to our prac-tice.

In the area of Government Affairs,AOHP has participated actively in thearena with the formation of positionstatements for ergonomics, TB and mostrecently a joint statement with AAOHNfor the proposed changes in OSHA’srespiratory standard. This Joint state-

ment requested OSHA to consider aseparate respirator standard forhealthcare facilities. Denise Strode andI have testified at the OSHA hearingson ergonomics.

We have developed networking relation-ship with a number of related profes-sional associations. There include theAmerican Industrial Hygiene Associa-tion and with the advent of smallpoxvaccine administration we became partof the CDC’s Clinician Communicationgroup.

With the National Alliance for the Pri-mary Prevention of Sharps Injuries,NAPPSI, AOHP recently submitted aletter to John Henshaw, the AssistanceSecretary of OSHA supporting the useof securement devices instead of medi-cal adhesive tape for the securement of

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IV catheters. In the past monthNAPPSI and AOHP conducted a jointonline survey of resident/internneedlestick injuries. We will hear pre-liminary reports on that tomorrow by Dr.Steve Bierman.

We are in the final states of developingan alliance with OSHA that we are tar-geting for signature in mid-November.The focus of the alliance will be on pa-tient handling, bloodborne diseases andbioterrorism. AOHP participated in theNIOSH stakeholders meeting that wasthe preliminary step in developing theNational Exposure at Work Survey thatwas to be piloted in healthcare facilities.We have also discussed areas of com-mon interest with our colleagues atAPIC and AAOHN.

Financially, AOHP has maintained finan-cial viability with a slight dues increasethat occurred two years ago. As a re-sult of our positive financial state wewere able to re-institute our continuingeducation scholarships this year to mem-bers who were planning to attend thisyear’s national conference in San Di-ego. The year the budgeting processwas revised. It was initiated in July andit has been a more thorough and thought-ful process. As a result, during our Ex-ecutive Board meeting this week wemade the final changes and approvedthe budget with a positive operatingmargin.

Our conference planning is more stablewith the implementation of the Confer-ence Chair and Co-chair process wherethe Co-chair is mentored by the Con-ference Chair to make the transition intothis important position mare consistent.Contracts are signed for the 2004 con-ference in Tampa, Florida and San An-tonio, Texas in 2005.

There has been increased utilization of

our provider status for contact hours bymembers and vendors alike. A specialthank you goes to Kathleen VanDorenfor maintaining this function for us.

The Executive Board has been verycommitted and diligent. We had usedtechnology to our advantage while at thesame time being very cost effective.Conference call have been taking placethis year on a monthly basis to advancethe work of the association.

There have also been outside events thathave affected us during these four yearsnot only in practice by at an emotionallevel. These include the events of 9/11and OSHA’s new recordkeeping stan-dard. By the way, if you are not awarethere are new forms for 2004 OSHArecordkeeping that will be waiting foryou when you get back home to youroffice.

Looking back is useful as it gives us anunderstanding of where we were andhow far we have come. Even moreimportantly we must look ahead becauseif we rely on our past successes we willfall behind. Keenly aware of this theExecutive Board met on Tuesday to re-view our strategic plan. A vision state-ment was crafted as well as a revisedmission statement. Our vision is that“AOHP will be the defining resource andthe leading advocate for occupationalhealth and safety in healthcare.” Ourmission is that “the Association of Oc-cupation Health Professionals inHealthcare (AOHP) is dedicated to pro-moting the health and safety of workersin healthcare. This is accomplishedthrough: Advocating for employee healthand safety; Occupational health educa-tion and networking opportunities;Health and safety advancement throughbest practice and research andPartnering with employers, regulatoryagencies and related associations.

In addition, we had a progress report forour four strategic priorities that weredeveloped last fall. Our four strategicpriorities are to build membership, main-tain financial viability, gain national rec-ognition as the resource for occupationalhealth professionals in healthcare andmaximize technology. Three areas ofemphasis are membership, newsletterrevision and media communication.

Beginning today we are initiating a mem-bership campaign, “Let’s ROC forAOHP” – Recruit a Colleague. Youhave all received a letter and memberapplication. There will be incentive forcurrent members who recruit the mostnew members for 2004.

There will be changes in the monthly“Notes from the Executive President.”There will be a change in format basedon a survey of the Chapter Presidents.There will be monthly communication oftime-sensitive issues that impact prac-tice. Then, quarterly a more formalnewsletter will be emailed to membersand editors and leaders of other organi-zations. The quarterly newsletter willalternate with the Journal. The Novem-ber/December “Notes from the Execu-tive President” will be distributed as thelast issue of this newsletter.

We are developing a media list to de-velop increased visibility among editorsof publications and leaders of relatedorganizations. We will communicatingmore formally with these organizationsand also developing press releases forAOHP activities.

We need and invite your input as wemove ahead. I invite you to attend ournational committee meetings this after-noon. The committees are a great wayto become involved in the Association’swork. It is a wonderful way to meetcolleagues and have input into the fu-

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Editor’s ColumnEditor’s ColumnNews & Such

ture direction of the association. Re-member, the dictionary is the only placewhere “success” comes before “work”.If everyone does a little it is not a bur-den for any one person.

In closing, it has been a privilege to serveas your president during the past fouryears. I especially want to thank thecurrent and past Executive Board mem-

bers that have served with me duringmy terms as President. They are a greatgroup of professionals and I am proudto have had the opportunity to serve withthem. Formally, I want to thank themofr the lovely gifts I received this week.I also want to thank my husband, BobTrujillo for his continuing support andencouragement. He has been a patientand caring spouse and I do not feel that

I could have accomplished so muchwere it not for his unwavering support.Thank you all again for you support. Ilook forward to continuing my work withthe Board as President Emeritus. Havea great rest of the conference. I lookforward to seeing you next year at theGrand Hyatt in Tampa from October 6-9, 2004.

American Heart Association andOSHA Join ForcesOSHA and the American HeartAssociation signed a formal allianceNovember 20, 2003 in hopes ofimproving the health of U.S. workersand reducing the costs of cardiovascu-lar diseases—estimated at more than$350 billion in medical expenses andlost productivity this year alone.

AHA Chief Executive Officer M.Cass Wheeler said, “The good healthof our nation’s workers is essential tothe good health of our nation’seconomy. [AHA] looks forward tosharing its knowledge and resources tomake this partnership a success.”

Under the alliance, OSHA and AHAplan to work together to raise aware-ness about heart disease and stroke, aswell as develop programs to reducedeath and disability from these ill-nesses in the workplace.

Activities will include the following,among others:• developing training and educationabout automated external defibrillator(AED) program implementation• delivering AHA CPR/AED and firstaid courses when requested by em-ployers

• developing information on employeewellness that can be incorporated intoworkplace safety and health educationand training programs on topics suchas primary and secondary preventionof heart disease and stroke, exercise,fitness and weight management• disseminating information throughnewsletters and Web sites

For more information, visitwww.osha.gov orwww.americanheart.org

A Quote Worth Quoting“The most important single ingredientin the formula of success is knowinghow to get along with people.”—Theodore Roosevelt

AOHP 2003 AwardsThe following awards were presentedat the AOHP National ConferenceOctober 10 in San Diego:

The Joyce Safian Award of $500 foran association officer who bestportrays an occupational healthprofessional in healthcare role modelwas awarded to Denise Strode.

The Ann Stinson President’s Awardfor a chapter that has demonstratedoutstanding performance and en-

hanced the image of occupationalhealth professionals in healthcare wasawarded to the Southern CaliforniaChapter.

Sandra Bobbit Scholarships oftuition to the national conference wereawarded to Janet Abernathy, RosalieSheveland , and Sandy Prickitt ofNorthern California, RexenaKrivensky, Florida, LydiaCrutchfield, North Carolina, and KimCasey from Illinois.

Journal Editor Awards of $100 werepresented to Dee Tyler, ChuckLohrstorfer, Christine Poink, SandyLeaman, Beverly Smith, PhyllisBerryman, Lynne Karnitz, and LydiaCrutchfield. These members wrote“Colleague Connection” articles thatwere published in the AOHP Journal in2003.

OSHA Bulletin on Blood Tube Hold-ersOSHA recently issued a bulletin“Information Regarding the Disposalof Contaminated Needles and BloodTube Holders Used for Phlebotomy.”The purpose of the bulletin is toprovide relevant information regardingOSHA’s policy on the prohibition ofcontaminated needle removal from

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medical devices. The full text of thebulletin can be found atwww.osha.gov/dts/shib/shib101503.html.

American Academy of AudiologyAnnounces New Position StatementNIOSH researchers led a team ofhearing conservation specialists thatdrafted a new position statement forthe American Academy of Audiology(AAA) on preventing noise-inducedoccupational hearing loss. The newposition statement is available online atwww.audiology.org/professional/positions/niohlprevention.pdf. Morethan 8000 audiologists are expected touse this position statement as guidancein developing occupational hearing lossprevention programs. Most of theprinciples in the position statementreflect NIOSH’s criteria for a recom-mended standard for occupationalnoise exposure (www.cdc.gov/niosh/98-126.html).

Two New OSHA Fact SheetsOSHA has two new fact sheetsavailable at their web site: “Facts onthe OSHA Inspection Process” and“OSHA’s Role When a Worker Dieson the Job.” OSHA Inspection detailsinspection priorities and provides step-by-step details for on-site inspections.“OSHA’s Role When a Worker Dieson the Job” highlights agency assis-tance available for families of workerskilled on the job and also includesinformation on referring cases to theJustice Department for possiblecriminal prosecution.

Department of HHS Issues InterimFinal Rule on Smallpox VaccineCompensationThe Department of Health and HumanServices recently published in theFederal Register an interim final rulesetting forth eligibility criteria and theprocess for requesting benefits andreceiving payments under the federal

Smallpox Vaccine Injury Compensa-tion Program approved by congressearlier this year. The program, fundedat $42 million, provides financial andmedical benefits to eligible membersof an HHS-approved smallpox emer-gency response plan who sustainedcertain medical injuries caused by asmallpox vaccine.

UPDATED!!! IMPROVED!!!

The 8th edition of AOHP’s “ Getting Started in Occupational Health in Healthcare” is now availablein hard copy and CD-Rom. This valuable resource has been revised to include:� OSHA 300 record keeping � Introductory information regarding HIPAA� More information on ADA � New information on FMLA and Emergency Preparedness� New chapter format includes:

� “Best Practice Tips” have been incorporated at the beginning of each chapter� A collection of samples – policies and procedures and forms� Original AOHP Journal articles that have been reprinted� Page for note taking at end of each chapter� Chapter 11 -”References” - has been completely revamped with over 120 listed for direct

access to the web.Price: Binder $160; CD $105; Binder and CD $240

(prices includes shipping and handling)Contact AOHP Headquarters at 800-362-4347 to place your order!

Getting Started Manual

Vendor support is an importantfactor in the success of ourconference. If you know avendor who would be inter-

ested in exhibiting at this year'sconference in Tampa, FL,

please forward the vendor'scontact information to AOHP

Headquarters, info@aohp.org.

Interested in Being aVendor?

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Prevention of work related liftinginjuries is an important concern in thehealthcare industry. Few guidelines ortools have been developed that addressthe specific lifting demands found in theadministration of patient care.

We are pleased to share with AOHPmembers our facility’s work related lift-ing injury prevention success story. Ourhospital, Butler Memorial Hospital, is a308-bed acute care facility located 25miles north of Pittsburgh. The hospital,which employs 1,605, offers a full rangeon in-patient services including cardiacsurgery, cardiopulmonary rehab, sleepdisorders, comprehensive women’s ser-vices as well as many outpatient ser-vices.

In July of 2001, the hospital’s SafetyCommittee directed the formation of asubcommittee to investigate employee-lifting injuries and develop a strategicplan to reduce those injuries. This di-rective was the result of monthly SafetyCommittee meeting discussions on theimpact that serious injuries have on anemployee's quality of life, in addition tothe costs associated with the injury.

The Worker Safety/Injury PreventionCommittee was assembled and teammembers included a physician, the Em-ployee Health Manager, the Risk Man-ager/Safety Officer, an ergonomist, anemployee educator, a floor nurse, theDirector of Rehabilitative Services andthe Systems Improvement Manager. The task force had identified that therewere 66 lifting injuries in fiscal year end-

ing June 2001, with current and past in-juries accounting for $400,000 in relatedcosts. This data led the team to analyzethe root causes of the injuries and de-velop a corrective action plan to addressthe identified areas of concern. Theseroot causes included:

• poor transfer/lifting technique by em-ployees

• lack of policy defining safe lifting tech-nique

• lack of adequate equipment

• lack of patient assessment tool

• employee reluctance to take time toutilize

• equipment or summon additional staff

In order to effect any positive change, itwould be necessary to organize theseroot causes into manageable categories:

Policies: Policies and procedures needto be originated which address all propertechniques and practices of patient lift-ing and transfer.

Equipment: The organization wouldneed to make the proper lifting andtransferring equipment available to allstaff. It would be necessary to purchaseenough equipment to assure quick andeasy access for all staff.

Education: It would be necessary toprovide adequate education to all staffregarding, not only the proper use of lift-ing equipment, but a knowledge of thecriterion used to determine the need forits use.

Accountability: All staff need to beheld accountable for their compliancewith all lifting policies and procedures.If policies and procedures have been es-tablished, appropriate equipment hasbeen purchased and all education com-ponents have been put into place, thenstaff can be held accountable for anynoncompliance which may result in in-jury.

The group began collecting data from avariety of sources. In addition to litera-ture reviews, any available resource wastapped for information. The workerscompensation third party administratorwas contacted and their risk managerprovided input. An interview was con-ducted with safety management person-nel from a local steel factory, which wasrenowned industry-wide for its successin employee injury prevention.

Equally important, the task force devel-oped an employee survey. The purposeof the survey was to collect baseline in-formation and gage attitudes, impressionsand opinions regarding current safetypractices. Knowledge of and training onavailable lifting equipment provided bythe hospital was also addressed in thesurvey.

The group understood that an adequateamount of appropriate patient lifting/transfer equipment was going to be keyto the programs success. The purchaseof this equipment would demonstrateand validate the organization's commit-ment and support of this endeavor. Theteam approached the hospital adminis-tration and presented a proposal, whichincluded a request for $80,000. The

Colleague Connection

Prevention of Work-Related Lifting Injuries: Our Hospital’s ApproachBy Karen Bosley, RN, BSN and J. Mark Edwards

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funds would be utilized for the purchaseof needed equipment and to finance thenecessary educational hours. The groupfelt confident that this investment wouldyield a 25% reduction in lifting injuresand a $100,000 reduction in relatedcosts. Upon review of the plan, hospitaladministration provided the requestedfunds.

Additionally, the Butler Health SystemFoundation awarded the task force agrant in the amount of $10,000 to be usedfor the development of a Clinical ArtsLab and to purchase equipment. TheAccounting Department established aspecial cost center to monitor all trans-actions and expenses related to theproject.

The task force conducted several equip-ment fairs, giving employees the oppor-tunity to examine and test patient trans-fer equipment provided by various ven-dors. The ergonomist played a key rolein the procurement of equipment by de-veloping evaluation tools that the staffused while trying the various devices.

Butler Memorial Hospital's TransitionalCare Unit was chosen as the trial de-partment. This skilled nursing unit hada high number of employee lifting inju-ries and therefore, the leadership andstaff were enthusiastic about the under-taking.

Education of the staff began immedi-ately. Sufficient time was provided forthe staff to be introduced to new con-cepts and approaches to transferring andlifting patients within their unit. This in-cluded intensive training on the newequipment and daily observation of theirtechnique and practices. Employeeswere recognized and rewarded whenobserved correctly following policy andusing equipment appropriately. Theseobservations, conducted by the ergono-mist, were reported to the Task Forceon a weekly basis. This close monitor-

ing assured compliance from every em-ployee on the unit.

A user-friendly patient assessment toolwas developed and placed on every pa-tient chart. Each caregiver would beable to evaluate and determine theequipment and type of assistance neededto move or transfer a patient. The cri-terion was based on the patient's levelof independence. This tool was usedeach morning in reevaluation of the pa-tient.

Insofar as processes and proceduresrelated to safe lifting practices were in-tended to expand throughout the organi-zation, it was necessary to develop com-petencies to address all newly estab-lished requirements for lifting and trans-ferring patients.

A Worker Safety/Injury PreventionPolicy was developed for the purposeof establishing a zero tolerance standardfor employee safety violations. Thispolicy stated that employees were re-quired to adhere to established safetypolicies. This was the first time thatemployees were challenged in this man-ner and signatures were obtained fromeach employee to indicate their acknowl-edgment and understanding of the policy.

Hospital-wide purchasing practices re-quired modification to assure that rou-tine supplies were received in manage-able packaging of less than 50 lbs. Thesize of laundry bags was modified andreduced to prevent overfilling.

By the fall of 2002, the project was ex-panded to include the entire organiza-tion. Education and training had to bespecific to eachdepartment, based on the type of liftingchallenges encountered in each area.As directed by the task force, as wellas the Safety Committee, the ergono-mist spent a significant amount of timeat a variety of work stations, perform-

ing evaluations and making recommen-dations regarding ergonomically safework practices.

The task force set an initial goal of a25% decrease in employee lifting relatedinjuries associated with a $100,000 re-duction in costs. After the first year,the hospital realized a 33% injury de-crease and a cost reduction of $125,000.These results far exceeded the expec-tations of the task force.

Having been given the appropriateequipment, the proper education andclear policies and procedures, employ-ees not only performed their tasks in asafe manner, they were appreciative ofmanagement's interest and concern fortheir well being. Through the efforts andteamwork of the entire organization, thestaff, patients and Hospital were all win-ners.

Karen Bosley, RN BSN, is the Man-ager of Employee Health Services forButler Memorial Hospital in Butler PAand the current Region 4 Director ofAOHP.

Mark Edwards serves as Risk Man-ager, Safety Officer, Patient SafetyOfficer, Security Director and Chair-man of the Safety Committee for But-ler Memorial Hospital.

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As Employee Health profes-sionals, what we do makes a differ-ence in the lives of the healthcareworkers we work with daily. This is astrong and important statement. Icredit and thank my friend and fellowboard member, Diane Dickerson, forit. We were working on something,everyone was giving suggestions, andthis was part of her offering. Itimmediately struck me how true it is.

I am a firm believer that, as EmployeeHealth Professionals, we have thebest and one of the most importantjobs in the world. Our problem, fewothers know what we do and fewerstill know the real value of our role. Ido think we can change that percep-tion.

Have you taken the time to look at thedifference you make - the big and thesmall?? Think of the last time youcounseled an employee after theirexposure to a patient with HIV. You

know more about exposures, currentstatistics, laws, rules and currentprophylactic medical treatment thanany other person in your facility. And Ibet your knowledgeable, commonsense approach and caring mannerguiding and listening to this frightenedemployee made a huge difference inthat employee’s understanding of theirexposure risks. How often have youheard employees comment at the endof your counseling “thank you, I feelso much better. I was so worried”.When did you last assist an injuredemployee frightened about returning towork? Or, can you tell me howrecently you led a troubled employeeto EAP?

We affect and impact the lives ofemployees not only on an individualbasis but also facility-wide. Think ofyour wellness programs, safetyinitiatives and immunization programs.Two excellent examples of facility-wide differences that Employee

Health Professionals are makingappear in this issue of our Journal.Karen Bosley and Mark Edwardswrite about the tremendous costsavings in injury reduction due to theirwork on preventing lifting injuries andDelynn Lamott shares the benefits ofher pre-employment process improve-ments.

Sharing these successes in our Jour-nal is just one way we can changeperceptions of Employee Health. Iwould also urge you to be your ownbest cheerleader!! Let your co-workers, supervisors, and CEOs knowwhat you’ve done. Become moreactive in AOHP at your local, chapterand national level. You do make adifference and together we can makean even bigger and more powerfulone.

Editor’s Column

By Kim Stanchfield, RN COHN-S“Do You Make A Difference?”

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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While change is inevitable, it canbe a challenging process. It was notuntil I was actually in the position toimplement change that I learned howdifficult this process can be. Throughmy experience of initiating change in thepre-employment process I learned somevery valuable lessons regarding effec-tively implementing change and devel-oping strategies to overcome barriers. Iam pleased to share my experience withcolleagues.

I brought 3 years of experience as a staffnurse in Occupational Health in a largeteaching hospital to my new position asEmployee Health Manager of a smallhospital. I was confident my past expe-rience would bring about a lot of posi-tive changes to my new hospital.

My own pre-employment experience asa “new hire” was lengthy and uncoordi-nated. I initially completed a health ques-tionnaire, TB test and answered immu-nization questions in Employee Health.A drug screen and a Urinalysis werecollected. I was sent to register andthen go to the lab to have my blood drawnfor various titers, CBC, HCT, and anAlcohol screening, then on to the Emer-gency Room for a physical. I was in-formed that I was not expected; there-fore it took many calls and communica-tions before I was finally given a physi-cal. My physical consisted of having myvision and hearing checked, being asked

if I had any medical problems and hav-ing my heart and lungs listened to. Thisentire pre-employment process took al-most four hours.Experiencing the pre-employment pro-cess firsthand inspired me to take actionand change the pre-employment process.This became my first priority.

I first presented my proposed changesverbally to my superiors, which includedthe Safety Manager, Vice President ofLegal Affairs, and Vice President ofHuman Resources. The changes that Iproposed included eliminating the physi-cals, Urinalysis, CBC, HCT, and Alco-hol screening. I provided rationale as towhy these tests were not necessary orbeneficial. I also informed them of howwe would be saving a lot of money byeliminating some of these tests. In addi-tion, I proposed that we provide a simpleback evaluation by the employee healthnurse to replace the physical.

I believed my superiors would be grate-ful for these needed recommendations,and quickly approve them. Not so. Muchto my surprise, they were not convincedthe changes were appropriate and ex-pressed liability concerns. Repeated at-tempts with my same proposal, sameapproach continued to fail. Ultimately Irealized that receiving approval for mychange proposal would not be so simpleand I needed to re-evaluate how to ac-complish my goal.

After careful evaluation of my previousstrategy, I realized many factors were a

barrier. First, I was new to the organi-zation; therefore, I did not have a trust-ing relationship with my superiors. Asfar as they knew, my reasons for want-ing to eliminate many of the procedurescould simply be because I was lazy anddid not want the extra work. Secondly,none of my superiors had a healthcarebackground, which made it difficult forthem to understand why certain proce-dures were not beneficial. I also real-ized that I had originally attempted tointroduce my ideas for change verbally,and had not provided any written docu-mentation. I decided a plan of actionaddressing all of these issues wasneeded.

In developing my plan of action, I firstenlisted the support of the Medical Di-rector of the Emergency Department,who had already earned great trust fromthe organization. He agreed with my pro-posed changes and was willing to en-dorse my proposal. To address the prob-lem of working with members who didnot have a healthcare background, I knewthat I would need lots of supportingdocumentation to demonstrate that myrecommendations were appropriate. Isurveyed 10 other hospitals in the arearegarding their pre-employment process.I made a graph that included all of thisinformation and compared it with ourown institution. This graph demonstratedthat our institution required much moretesting than most other hospitals. Addi-tionally, I surveyed employees who hadcompleted the pre-employment processutilizing a customer satisfaction survey.

Colleague Connection

Implementing Change in the Pre-Employment ProcessBy Delynn Lamott, RN, MS, COHN-S

Winter 2 0 0 4

11This survey included many commentsthat stated employee dissatisfaction withthe lengthy process and feelings that thephysicals were “worthless.”

After collecting all of my supporting data,I then wrote a proposal that outlined ourcurrent process, showing a cost of $227/person and taking an average time of 4hours to complete and my proposed pro-cess, which would cost $48/person andtake an average of one hour and 45 min-utes. Based on the number of employ-ees we had processed for the previousyear this would be a total savings of$92,560. I listed each procedure that Iproposed to eliminate with a brief ratio-

nale. I attached a copy of customercomments stating dissatisfaction with thecurrent process and the graph demon-strating the pre-employment process forother institutions. The proposal waswritten up in a point bulletin format thatwas brief and easy to read (See Pro-posal). I obtained the signature of theMedical Director of the Emergency De-partment on the proposal and then sub-mitted it to all three superiors. The morn-ing after I submitted my proposal I re-ceived a message from the Vice Presi-dent of Human Resources stating, “Iread your proposal and it looks great—let’s do it.”

I learned many valuable lessons from thisexperience. Most importantly; one can-not assume, as I did, that people will sim-ply trust and accept your ideas based onyour knowledge and experience. I alsolearned that ideas for change must bepresented clearly and concisely in writ-ing. Additionally, supporting documenta-tion with rationale is necessary. Enlist-ing support from those who are mostrespected and trusted in the organiza-tion is invaluable! Although this experi-ence was quite frustrating and painful attimes, I now realize that the end resultwas a better process for all.

The Occupational Health Coordinatorwith the support of Dr. X, propose revi-sions in the pre-employment evaluationprocess that will not only be more con-venient for the employee, but will in-crease the quality of our evaluation pro-cess, while decreasing the cost signifi-cantly. The proposed revisions have beenoutlined with rationale provided. This pro-posal will outline the steps taken, timespent and cost associated with the cur-rent and proposed evaluation process. Inaddition, problems experienced with thecurrent system and benefits gained withthe proposed system will be highlighted.

Proposed Revisions with Rationale

1. Elimination of M.D. Physical/hear-ing test - The physicals provided at thistime do not justify the expense or theinconvenience incurred as they do notprovide beneficial information regardingthe fitness of the employee to do the jobthey were hired for. Dr. X suggests thatwe replace this exam with a fitness/backexam given by the OHS nurse during theinitial pre-employment phase. This exam

would provide more information regard-ing the employee's ability to perform cer-tain tasks as well as give a baseline forfunctioning status. If indicated, a com-plete functions fitness/back exam can becompleted by Physical Therapy. A colorvision test could also be given in OHSusing a Isha Hara chart. In addition, theOHS could assess for potential hearingproblems and send them for a more con-clusive hearing test if needed.

2. Elimination of UA, Hgb, Hct - Thesetests are not used for employment issuesnor do they preclude employment. Inaddition, there is concern about liabilityif an abnormal result is indicated but isnotpicked up by the OHS nurse. not pickedup by the OHS nurse.

3. Alcohol Screening - Persons who arelegally intoxicated at the .1 level will be

Proposal for Revision of New Employee Processing

TimeSteps in Current Process

30 min. 1. H.R.- Paperwork

15 min.2. OHS- Health screen, T.B test

15 min.Registration3.

30 min.Labwork- UA, Hgb, Hct, Drug/Al-cohol screen, Rubella

4.

1-1.5 hours5.

1-1.5 hoursPhysical - Hearing/Vision Test,M.D Exam

6.

3.5 - 4.5 hoursTotal

Cost

0

0

0

$127

0

$100

$227/person

Wait for Lab Results Be-fore Getting Physical

Chart #1

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A O H P J o u r n a l

within normal range within five hours.Since it is unlikely that employees willroutinely come to their pre-employmentevaluation intoxicated, it is not felt thatthe cost ($52/person) warrants this test.It is reported that in the last eight yearsonly one new employee has had a posi-tive alcohol screen. The current con-sent form for Drug/Alcohol testing willstill allow OHS to order an alcohol teston a new employee if there is probablecause.

Problems Experienced With Cur-rent Process (see Chart #1)

1. Must wait at least an hour for lab re-sults to clear before you can have aphysical.

2. The wait for a scheduled physical isusually an hour or more.

3. Physicals do not provide beneficial in-formation to OHS regarding fitness forthe position employee was hired for.

4. Many of the lab tests are unneces-sary and as they do not preclude em-ployment and are not used for employ-ment issues.

5. Total cost for pre-employment pro-cess is very expensive.

New Employee Questionnaire Sur-vey Results

Comments: Had to wait 1 hour for aphysical. I felt that the physiciansscreening was not very thorough andcould as easily have been done by a reg-istered nurse. Clients should be calledbeforehand if appointments have to bechanged. I arrived at a person’s officefor a 9:30 appointment and was told thatthe person was out today and I’d haveto reschedule. Most incomplete physi-cal exam by doctor I’ve ever had. I had1&1/2 hours of downtime between mylab work and physical.

Benefits of Proposed Process (SeeChart #2)

1. Fitness/back evaluation provides bet-ter information regarding the employee'sability to perform certain tasks.

2. More convenient for the employee.

3. Takes less time to complete.

4. Significantly reduces the cost of pre-employment.

ConclusionImplementing the proposed changes forthe pre-employment evaluation will re-sult in a process that is more convenientfor the employee, provide a more com-prehensive assessment, increasing thequality, and decrease the cost approxi-mately $178/person. Based on pre-em-ployment physicals performed for fiscalyear 1996, which was 520 persons, thiswould be a cost savings of $92,560 peryear. Attached to this proposal are com-ments which reflect new employees’ dis-satisfaction with the current process. Inaddition, there is also a survey that

benchmarks what labs, procedures, etc.,other hospitals perform. Based on thisreport, you will find that the proposedrecommendations are in line with whatother hospitals perform. Dr. X and theOccupational Health Coordinator wouldlike to thank you for your time in review-ing this proposal and hope that you willapprove the recommendations. If youhave any questions or concerns regard-ing this proposal please call DelynnLamott, M.S., R.N. Occupational HealthCoordinator, at Ext. 5355.

Sincerely,

Delynn Lamott, M.S., R.N.Occupational Health Coordinator

Dr. XOccupational Health Consultant

Cost

0

0

0

$48

$48/person

Time

30 min.

15 min.

30 min.

30 min.

1.45 hours

Steps in Proposed Process

1. H.R.- Paperwork

3. Registration

2. OHS - HealthScreen, Fitness/Back Eval, Vision,T.B. Test

4. Lab Work DrugScreen, Rubella

Total

Chart #2

Winter 2 0 0 4

13

14

A O H P J o u r n a l

Dear Fellow AOHP Members:

October 6-9, 2004 may seem like a long time away, but we want you to grab your calendar or your PDA right now and pencil-in October 6th for a pre-conference workshop, then the 6pm Opening Reception with Exhibitors. Block-out October 7th forthe Opening Day packed with conference learnings, then treat yourself that night to shopping and dining at the InternationalPlaza. Reserve Friday October 8th for more interactive sessions that will help you in your everyday job, then that night threatyourself again (yes you deserve it!) to shopping and dining at the Channelside District or the historic Ybor City. SaturdayOctober 9th will provide memories to last until San Antonio 2005!

Your National Conference Committee is busy now planning the specific topics and speakers. We have reviewed all of theevaluation comments from the past year’s conferences and with careful consideration to future needs we will deliver to youTampa – Your Ticket To Tomorrow !

Topics being planned:• Complementary therapies – research and outcomes• Risk management strategies for injury reduction• medical informatics (PDA applications) – bring your PDA for hands-on session!• management of employee disability and Worker’s compensation• the new classification system - NAICS• preventing violence in healthcare workplace• chronic disease – impact to the workplace• advanced practice curriculum for both pre-conference and break-out session under the guidance (we hope!) of

Dr.Geoff Kelafant

Speakers from OSHA, NORA or NIOSH, CDC, and our accrediting board ABOHN will be asked to give updates on “hottopics” or on current regulations.

Tours!!……to the VA Patient Safety Center of Inquiry…….to Tampa General Hospital to see first hand how lift/transferdevices and ceiling-mounted equipment is reducing risk factors for the healthcare worker.

Pre-Conference on Wednesday October 6th will once again provide the Getting Started course presented by the famous SanDiego chapter of AOHP! Also scheduled for Pre-Conference will be our friends from last year ErgoLogix U – bring yourown wcomp data to this session so that you can develop your own loss analysis! We also plan to have two other half-dayworkshops - one on aggression management and the other on writing and editing.

The Grand Hyatt Tampa Bay is the location for YOUR TICKET TO TOMORROW!

AOHP Conference ’04 Planning Committee:

Jan Frustaglia – Chair concerns@austincc.edu or concerns@earthlink.netJune Duck – Co-Chair jmduck@sentara.comLydia Crutchfield Lydia.Crutchfield@carolinashealthcare.orgDana Jennings occupationalhealth@craighospital.orgSharon McLendon smclendontch@yahoo.comRexena Krivensky mikekrsky@aol.comConnie Grady cgrady@mhs-net.com

Winter 2 0 0 4

15

A special thanks to the 2003 Con-ference Chair Linda Good for a jobwell-done!

Vendors show off their productsfor conference attendees

A Look Back at A Sucessful 2003 Conference

JaneDuck,RegionalDirector,Region 3

JanFrustaglia,RegionalDirectorRegion 2

Connie Grady, Regional Director, Region 5, and ChuckLohrstorfer, Regional Director, Region 1 greet attend-ees during the conference.

16

A O H P J o u r n a l

Within content of topic be sure to include: cost of your successprogram, savings, and outcomes.

Your presentation should last 1 hour including time for questions.The attached form may be utilized for submission of information.Deadline to submit: FEBRUARY 27, 2004 ! ! ! Successfulapplicants will be notified by April 1, 2004.

Please email, fax or mail your submissions toLydia.crutchfield@carolinashealthcare.org

Lydia Crutchfield, Manager – Employee HealthAOHP Conference CommitteeP.O. Box 32861Charlotte, NC 28232-2861Phone: (704) 444-3162Fax: (704) 444-3191

2004 AOHP National ConferenceTampa, Florida

October 6 - 9, 2004O pportunity to Show case

Your Success Story

Do you have a success story of how you conquered a challenge or problem in your clinical practice? Now is youropportunity to share it with other AOHP members. Your 2004 AOHP Conference Committee has listened to thecomments on the evaluations from past conferences—Members are looking for ways to do things without reinventingthe wheel. You want to hear how others are getting their work accomplished with ease and success. Your AOHPConference Committee would like to draw on the expertise of AOHP’s members to be presenters at the conferencebreakout sessions.

This is the official “call-for-papers” on your success stories. Those chosen to present their topic will do so in thebreakout sessions scheduled for both Thursday and Friday afternoon. Successful applicants will be compensated withcomplimentary conference fee for one day plus complimentary one night hotel stay. Papers should include:

• 3 (behavioral) objectives (i.e., what will attendee be able to do after completing your session).• brief outline of the topic• your resume/vitae

• picture of yourself (digital picture sent via email)

Contact Conference Chair Jan Frustaglia (512) 223-7764 ifyou have conference questions .

Topics may include any of the following:

Successful Wellness programsNew Employee Orientation to EmployeeHealthWorker’s CompensationReturn to work programsNo Lift programs Safety ProgramsAccident InvestigationBack Safety ProgramsReducing injuriesReducing needlesticksSurviving an OSHA inspectionSurviving a Department of Health SurveySuccessful Post Offer Health Screening pro-gramTB ScreeningFlu Vaccine CampaignGetting along with physiciansGetting along with Infection ControlSuccessful Joint Commission SurveyBest Practices and How to Measure Them

Winter 2 0 0 4

17

Name:

Address:

Phone: Fax:

Email:

Current position and employer:

Topic/Title:

Objectives :

1.________________________________________________________________________________________

2.________________________________________________________________________________________

3.________________________________________________________________________________________

Brief Outline

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

October 6-9, 2004 Tampa, FloridaMy Success Story

Thanks for submitting to present your success story!Deadline for submission in February 27, 2004

Send by email to: Lydia.crutchfield@carolinashealthcare.orgLydia’s work ph: (704) 444-3162

Or Mail to:Lydia Crutchfield, Manager – Employee Health

AOHP Conference CommitteeP.O. Box 32861

Charlotte, NC 28232-2861Or Fax to: (704) 444-3191

2004 AOHP National Conference

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A O H P J o u r n a l

AOHP was contacted by the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) to review the useof securement devices in replacing medical adhesive tape for the securement of intravenous catheters. After review ofseveral studies that demonstrated that securement devices have significantly decrease unplanned restarts of intravenouscatheters that can lead to needlestick injuries among healthcare workers, AOHP wrote to the Assistant Secretary ofOSHA, Mr. John Henshaw supporting their use. (The letter appeared in the Fall 2003 AOHP Journal.)

The letter below is Mr. Henshaw’s response to AOHP.

AOHP Letter Receives Response

The letter shownabove was sent toAssistant Secre-tary JohnHenshaw, Occupa-tional Safety andHealth Administra-tion, Departmentof Labor fromMaryAnn Gruden,Executive Presi-dent, AOHP.

Winter 2 0 0 4

19Myths and Facts About Back Injuries in Nursing

By Dr. Audrey Nelson, RN, FAANDr. Guy Fragala, PE, CSP

Dr. Nancy Menzel, RN, COHN-S

Hospitals and nursing homes havespent considerable time and effort at-tempting to prevent back injuries amongnurses, with little improvement in theincidence or severity of musculoskeletalinjuries. In 1989 there were 4.2 lost-workday injury and illness cases per 100full-time workers in hospitals; in 2000there were 4.1 per 100. 1 Health careinstitutions could undoubtedly use soundguidance in implementing more effec-tive approaches to preventing injuries.

Manual lifting and other patient-handling tasks are high-risk activitiesfor both nurses and patients. Theprevalence of work-related backinjuries in nursing is among the highestof any profession internationally;annual prevalence rates of nursing-related back pain range from 35.9% inNew Zealand 2 to 47% in the UnitedStates 3 to 66.8% in the Netherlands. 4The 2000 incidence rate for backinjuries involving days away from workwas 181.6 per 10,000 full-time workersin nursing homes and 90.1 for hospi-tals, compared with incidence rates of98.4 for truck drivers, 70 for construc-tion workers, 56.3 for miners, 47.1 foragricultural workers, and 43.2 forworkers in manufacturing. 5 The risingrate of obesity also increases the riskof injury to nurses and other healthcare workers who handle patients.One of us (Menzel) studied patients ina Veterans Administration hospital andfound that the weight of adult patientswho required lifting ranged from 91lbs. to 387 lbs. and averaged 169 lbs.The national nursing shortage intensi-

techniques help to prevent job-relatedinjuries, research in the past 35 yearsreveals that these efforts by them-selves have consistently failed toreduce job-related injuries in healthcare as well as in other occupations. 6,

7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18 Educationand training alone are not effective forseveral reasons. While nurses havebeen taught “proper” body mechanicsfor years, only recently have theybegun to question whether the existingresearch on body mechanics can besafely applied to nursing. Early studiesfocused on men, and nursing stillconsists primarily of women. Researchon lifting techniques should considerthe effects of physical differencesamong nurses—for example, thedifferences of upper-body strength inmen and women.

People in early studies of body me-chanics were asked to lift a box withhandles—a task significantly easierthan lifting a patient, whose mass isasymmetric, bulky, and can’t be heldclose to the body. Furthermore,patients can be combative, experiencemuscle spasms, or suddenly lose theirbalance. And a patient’s ability toassist varies over the course of a day,making the same task different eachtime. The environment adds to thecomplexity; access to patients can bedifficult because of bedside clutter orconfinements of space, as in a bath-room, forcing nurses into awkwardpositions when assisting patients.

Further research is needed into theeffects of the nurse’s sex and phy-sique, the patient’s weight, and thehealth care setting before the science

fies the need to protect nurses frominjury. The time has come to abandoninjury prevention strategies that haveproved ineffective and to direct effortsto the following:

• ergonomic assessment of patientcare environments

• “engineering controls” such as newceiling-mounted mechanical liftingdevices designed to reduce manualpatient handling

• standardized protocol for assessingthe handling and moving of patients

• algorithms for deciding about thenumber of personnel and type ofequipment needed to handle and movepatients safely

• a new education model that includeshospital-unit peer leaders who wouldensure that workers use equipmentcompetently and who could helpchange nursing practice

There are many misconceptions abouthow best to prevent musculoskeletalinjuries when handling and movingpatients. Countering the myths is thefirst step toward a solution.

MYTH

EDUCATION ON LIFTINGTECHNIQUES AND TRAININGIN BODY MECHANICS AREEFFECTIVE IN REDUCINGINJURIES

FactsAlthough it’s widely accepted thatclasses in body mechanics and lifting

20

A O H P J o u r n a l

of body mechanics can be fully appliedto nursing practice.

To date, training in lifting techniqueshas been of limited value in health caresettings. Because of differencesamong nurses, physical therapists, andexercise physiologists, experts do notalways agree on the best ways fornurses to lift or assist dependentpatients. 19 Proponents of various liftingtechniques have often failed to con-sider the following issues:

• While biomechanical loading (forcesapplied to the body when performing atask) associated with lifting primarilyinvolves the lower back, other bodyparts—particularly the knees and theshoulders—are quite vulnerable andmay be injured as a result of therepeated lifting of heavy loads. 20

• Balance often is not consideredwhen nurses are taught to lift loadsfrom below flexed knees with the backstraight.

• Not all stressful patient handlingtasks are lifts, but techniques havefocused exclusively on this task. 21

Investigations show that nurses spend20% to 30% of their time bent forwardor with the trunk twisted duringactivities such as bathing, dressing, andundressing patients.

• Training programs fail to considerthat lifting, turning, and repositioningpatients are frequently performed on ahorizontal plane, such as a bed orstretcher, requiring the nurse to use theweaker muscles of the arms andshoulders as the primary liftingmuscles, rather than the strongermuscles of the legs.

Even if experts agreed on the bestlifting techniques, it’s unlikely that asingle approach would reduce injuries:teaching a proper manual liftingtechnique is an attempt to modify

behavior, which can be difficult toachieve and maintain without long-term reinforcement.

Further, the quest for effective manualtechniques may be of limited valuebecause, according to recent biome-chanical evaluations, forces exerted onthe musculoskeletal system whennurses perform patient-handling tasksare beyond reasonable limits andcapabilities, regardless of the techniqueused to perform the task manually. 21, 22

We advocate using engineeringsolutions (such as patient lifts, friction-reducing devices, or transfer belts) toreduce the risk of injury.=

MYTH

HIGH-RISK TASKS IN NURSINGARE RESTRICTED TO LIFTINGPATIENTS

FactsAs mentioned, lifting patients is not theonly stressful task in nursing. Manytasks, such as feeding, bathing, ordressing a patient, may have to beperformed while bent forward with thetorso twisted. Also, high-risk tasksperformed on a horizontal plane arecommon, including the lateral transferof a patient from bed to stretcher orrepositioning a patient in bed.

Owen and Garg identified 16 stressfulpatient-handling tasks performed innursing homes. 23 The most stressfultasks, identified in rank order, include

• transferring a patient from toilet tochair

• transferring a patient from chair totoilet

• transferring a patient from chair tobed

• transferring a patient from bed tochair

• transferring a patient from bathtubto chair

• transferring a patient from chair liftto chair

• weighing a patient

• lifting a patient in bed

• repositioning a patient from side toside in bed

• repositioning a patient in a chair

• changing an absorbent pad

• making a bed with a patient in it

• undressing a patient

• tying supports

• feeding a bedridden patient

• making a bed without a patient in it

In an unpublished study, one of us(Nelson) identified 10 stressful patienthandling tasks in rehabilitation nursing,as follows (not in rank order):

• bathing a patient in bed

• making an occupied bed

• dressing a patient in bed

• transferring a patient from bed toSurgilift (Sunrise Medical, Longmont,Colorado)

• transferring a patient from bed tostretcher

• transferring a patient from bed towheelchair

• transferring a patient from bed togeri-chair

• pulling a patient up in a chair

• pulling a patient up to the head ofthe bed

Winter 2 0 0 4

21• putting antiembolism stockings on apatient

MYTH

INJURIES TO NURSES CAN BEPREVENTED BY CAREFULSCREENING OF NURSES BE-FORE HIRING

FactsMany studies have explored hownurses affect their own risk. Themotivation for this research is thatpotential employees might be screenedor assigned to jobs according to theirlevel of risk. Further, there is disagree-ment among researchers about whichrisk factors might be used to predictinjuries. Factors to consider includelevel of fitness, 24 obesity, 25 genetics, 25

height, 10 muscular strength, 26 age, 27

and stress. 28 Restricting new hires tothose without previous back injurieswould make nursing recruitmentalmost impossible; nearly 87% ofnurses report having had a back injury.16, 17, 29 In any case, such an approachmay be discriminatory and illegal underthe Americans with Disabilities Act.

Some behaviors and habits such asdrug and alcohol consumption 30, 31 andcigarette smoking 32 might confoundassociations between occupation and ahigh risk of lower back pain. However,since many of these studies usedcorrelational research designs (whichdo not examine causation), there islimited evidence about cause andeffect between specific risk factorsand musculoskeletal discomfort orinjury.

MYTH

BACK BELTS ARE EFFECTIVEIN REDUCING RISKS TOCAREGIVERS

FactsBack belts have been used in manyindustries, including health care, toprevent musculoskeletal injuries, butthere’s no evidence that they areeffective. 33

Originally made of leather, back beltsare now usually made of a lightweight,breathable synthetic material and haveat least one strap that tightens orloosens them. Supporters claim thatsuch belts

• reduce internal forces on the spinewhen the back is forcefully exerted.

• increase intraabdominal pressure,which may counter the internal forceson the spine.

• stiffen the spine, which may decreaseinternal forces on the spine.

• restrict bending motions.

• remind the wearer to lift properly.

• reduce injuries in certain workplaces,such as those that require handlingmaterials.

According to a comprehensive studyby the National Institute of Occupa-tional Safety and Health (NIOSH),these claims remain unproved. 34 Liftingmay produce a variety of forces withinthe body that contribute to loading (thepressure on the spine). The stressescreated in the lower back when aperson is handling materials manuallyare caused by the combination of theweight lifted and the method of han-dling the load—a combination thatresults in torque at various joints. Theskeletal muscles are positioned to exertforces at these joints so that theycounteract the torque. The excessiveforce generated by the lower backmuscles is the primary source ofcompression forces on the lumbosacraldiscs. Because data indicate that thegreatest problem is in the lower lumbar

spine, many researchers considerstresses on the L5–S1 disk (lumbosac-ral joint) to be characteristic of thespinal stresses of lifting. 34

Many of the studies NIOSH reviewedsought to examine the back belt’seffect on loading, but none providedsufficient data to indicate that backbelts significantly reduce loadingduring lifting. Some believe that theincreased intraabdominal pressurethought to be provided by a back beltcounterbalances loading forces on thespine, but this theory remains contro-versial. The studies on intraabdominalpressure that NIOSH reviewed wereinconclusive, and its relationship tospinal compression is not well under-stood. Therefore, even if a back beltincreased intraabdominal pressure,there is no evidence that it wouldreduce forces on the spine or decreasethe risk of back injury.

Loading on the spine increases when aperson bends farther forward. Somebelieve that if the back belt restrictsthe ability to bend, the risk of injurymight be decreased. Although a backbelt restricts range of motion duringside-to-side bending and twisting, itdoes not have the same effect when aworker bends forward, as occurswhen a nurse lifts a patient.

There is also no scientific evidence tosupport the claim that back beltsremind workers to lift properly. Butanecdotal case reports show a reduc-tion in workplace injury when backbelts have been used. Many compa-nies that have instituted the use ofbelts have also installed new equip-ment and implemented programs inergonomics, which may result in injuryreduction. Based on available evi-dence, the back belts’ capacity forreducing the occurrence of low-backinjuries remains unproved.

22

A O H P J o u r n a l

Some suggest that wearing a back beltmay increase the potential for injury,because nurses may believe they canlift more while wearing a back belt. Ifthey believe—erroneously—that theyare protected, they may unwittinglyincrease their risk by trying to lift toomuch weight. 34

MYTH

VARIOUS LIFTING DEVICESARE EQUALLY EFFECTIVE

Facts

Use of some lifting devices can causenearly as much stress to the muscu-loskeletal system as manual liftingdoes. Equipment should undergoergonomic evaluation, and the properdevice must be selected for theintended job. Whether nurses acceptthe equipment should also be deter-mined. Numerous mechanical lifts,transfer devices, and lifting aids areavailable, and new products arealways being developed. Whenconsidering mechanical lifts, there aretwo types: full-body sling lifts, whichare normally used for a totally depen-dent patient, and stand-assist lifts,which are used for patients who havesome weight-bearing capacity.

Full-body sling lifts may be mounted ona portable base or on overhead ceilingtracks. Both types have advantages.Portable-base units offer flexibility andcan be moved from room to room asneeded. Ceiling-mounted lifts are lessconvenient, but they do have one majoradvantage: nurses don’t have to golooking for them when they’re needed.Stand-assist lifts have simpler slingdevices that take less time to put on,but their application is limited topatients with weight-bearing capacity,who can follow directions, and whoare cooperative.

Methods of transfer other than slinglifts might be considered for totally

dependent patients. A bed-to-chairtransfer might be accomplished byusing a chair that can bend back into astretcher configuration, making thistransfer more easily accomplished. 35

The transfer process can be furtherfacilitated with a lateral-assist device,which can be powered electrically topull the patient from the bed to thestretcher surface, or the device can bemanual, such as the friction-reducingdevice with handles.

Vendors are eager to show theirproducts, and demonstrations caneasily be scheduled to properlyevaluate equipment. Institutions shouldlet nurses try these lift-assist devicesso they can determine which would bethe most effective.

MYTH

USE OF MECHANICAL LIFTSELIMINATES THE RISKS INVOLVED IN MANUAL LIFTING

FactsMechanical lifts can minimize the riskof injury but may not eliminate it. Aspreviously discussed, there are high-risk tasks other than lifting, such asrepositioning a patient. And oftenwhen using lifting equipment thepatient must be lifted manually first sothat the sling can be inserted. Andhuman effort is needed to move, guide,steady, and position the patient duringthe movement or transfer process.

Despite this, equipment that reducesthe total burden of patient handling ishighly beneficial since most injuries innursing are due to cumulativetrauma—that is, injuries occur slowlyover time because of repeated muscu-loskeletal stress. 36 The key to reducingthe risk of injury to nurses is toredesign high-risk lifting and handlingtasks. A hierarchy of redesign strate-gies might be considered to accom-plish this, as follows:

1. Eliminate high-risk activities,either by using equipment or deliveringa service at the bedside instead of at aremote location. For example, bedsthat convert into chairs are available,thus eliminating the risks associatedwith manual bed-to-chair transfers. Toeliminate the need to constantlyreposition a patient in bed, a mattressthat turns the patient from side to sidecan be used.

2. Redesign high-risk tasks toreduce some degree of risk. Forexample, use a mechanical liftingdevice to transfer a patient from bedto chair, minimizing the risk associatedwith manual lifting. While mechanicallifting devices may not eliminate therisk entirely, the cumulative reductionin effort may significantly reducemusculoskeletal discomfort andinjuries.

3. Choose alternative devices toreduce the magnitude of risk. Forexample, if a mechanical lift to trans-fer a patient from bed to chair is notappropriate, a gait belt can be fastenedaround the patient’s waist. (The beltcan be secured by Velcro fastenersand handles can be placed in a varietyof configurations so that the caregivercan have better access to and controlof a patient.) Another option is asliding board that can bridge the bedand the chair so that the patient canslide in a seated position rather thanbeing lifted.

MYTH

MECHANICAL LIFTS ARE NOTAFFORDABLE

FactsThe costs of proper equipment are farlower than those associated withnurses’ work-related injuries. 37 In ninecase studies that evaluated the use oflifting equipment in health care facili-ties, the incidence of injuries was

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23reduced by 60% to 95%, workers’compensation costs decreased by95%, insurance premiums dropped byas much as 50%, medical and indem-nity costs decreased by 92%, lost workdays (absence related to reportedinjury) decreased by as much as100%, and absenteeism (absencerelated to unreported injury) wasreduced by 98%. 38 As these studiesshow, lifting devices benefit the facilityand nursing staff and also improve thequality of care given.

MYTH

IF YOU BUY LIFTING EQUIP-MENT, STAFF WILL USE IT

FactsAdministrators who purchase equip-ment are often frustrated when staff

members don’t use it and it ends upstored in a back room. Staff membershave many reasons for not usingequipment, including lack of time andavailability, difficulty of use, spaceconstraints, and patient preferences.

There are several ways to purchasecostly equipment most efficiently. Byincluding nursing staff in the selectionprocess, 39 perhaps through an equip-ment fair or small clinical trial, facilitiesmay improve staff acceptance.

Another common mistake is to pur-chase manually operated equipmentrather than the slightly more expensivepowered versions. According tounpublished research conducted bytwo of us (Nelson and Menzel) withcolleagues at the James A. Haley

Veteran’s Administration MedicalCenter in Tampa, Florida, whendeciding whether to use a liftingdevice, nurses compare the effortnecessary to manually lift a patientwith the extra time required to find anduse lifting equipment. Minimizingobstacles can help increase thenumber of caregivers who use theequipment.

According to our research, othercommon mistakes include purchasingdevices in insufficient quantities,putting the lifts in inconvenient loca-tions, or inadequately maintainingequipment. When purchasing equip-ment, consider the ways in whichnurses organize their assignments.Patient lifting is not evenly distributedthroughout the day. Often, there arepeak periods in which staff mustcompete for lifting devices, and fewfacilities have adequate and conve-niently located storage space. It’scritical to develop a successful plan forplacing and maintaining equipment,including motor and frame upkeep,cleaning, laundering of slings, and slingand battery replacement.

MYTH

IF YOU SIMPLY WRITE A NO-LIFT POLICY, NURSES WILLSTOP LIFTING

FactsA few U.S. hospitals have tried toinstitute a no-lift policy based on asuccessful policy in the United King-dom. There, lifting devices have beenprovided by the National HealthService since 1993, and nurses areprohibited from lifting patients inroutine situations, which significantlydecreases the number of job-relatedinjuries. The policy states that hazard-ous manual-handling tasks are to beavoided wherever possible; whenunavoidable, they must be identified inadvance, and staff members must take

Housed in a 15,000 square foot facility, the Patient Safety Center ofInquiry at the James A. Haley Veterans Hospital, in Tampa, Florida,includes offices, examination rooms, and four research laboratories forthe study of gait and balance, biomechanics, patient safety engineering,and patient safety simulation (where new technology and variations innursing practice can be tested on mannequins equipped with measuringdevices). The center’s clinical and research initiatives seek to improvepatient and caregiver safety, enhance quality of care, and influence policy.Funding is provided by two sources within the Veterans Health Adminis-tration—Health Services Research and Development, and RehabilitationResearch and Development—as well as through the Agency forHealthcare Research and Quality.

Audrey Nelson, director of the center, explained that the facility has threemain goals: “We hope to create a culture of safety that supports nurses inproviding safe patient care, while making sure nurses work in the safestenvironments possible. We also want to build research capacity related topatient safety and to promote personal freedom, safety, and dignity forpersons with impaired mobility.” Research efforts focus on three keyareas: patient falls, hospital bed safety, and safe patient handling andmovement.

The Patient Safety Center Web site offers several clinical tools, includinga comprehensive guidebook on safe patient handling and movement thatcan be downloaded free of charge. Visit the center online atwww.patientsafetycenter.com.

The Patient Safety Center of InquiryThe Veterans Administration works to create a

‘culture of safety.’

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action to remove or reduce the risk ofinjury. The policy further requires thatfacilities provide lifting equipment tonursing staff and other caregivers.Before any moving or handling proce-dure can be performed, the nurseshould conduct a full risk assessment,completing the appropriate documenta-tion. 40

Although administrators are oftenenamored of the idea, most attempts toimplement no-lift policies in U.S.hospitals have failed because theyoverlook technologic components.Infrastructure, including an adequatenumber of lifting devices, must first bein place in order to implement asuccessful no-lift policy, which must befocused on creating a safe workplacefor caregivers, rather than on institut-ing punitive responses to mistakes. 41

EMERGING STRATEGIESSeveral emerging technologies andstrategies can improve nursing safetyfor both patients and nurses, based onengineering and administrative con-trols. 41

Engineering controls focus onbringing the activity to the patientrather than the reverse and substitutinga lower-risk task (such as a lateraltransfer) for a higher-risk one (such asa transfer from bed to chair) throughthe use of newer equipment.

Administrative controls focus onhow nursing practice is performed, aswell as how nurses are trained. Whileeducation in body mechanics andtraining in lifting techniques have beenlargely ineffective, a new educationalmodel that takes advantage of peerleaders shows promise. The VeteransHealth Administration calls these peerleaders “back injury resource nurses”or BIRNs. An ongoing NIOSH studyin a private health care facility refersto such peer leaders as “Ergo Rang-ers.” These programs use a “train the

trainer” approach to build a cadre ofleaders who change nursing practiceby teaching coworkers how to useequipment, advocating the use ofassessment protocols and algorithms,reinforcing the use of practices suchas adjusting bed height to a level that’scomfortable for the nurse, and con-ducting ergonomic assessments ofcare environments. (See the Web siteof the Patient Safety Center of Inquiryat http://patientsafetycenter.com.)

Reprinted with permission - AudreyNelson, Guy Fragala and Nancy Menzel,"The Myths & Facts of Back Injuries inNursing," American Journal of Nursing,February 2003, Vol 103, pgs 32-40.

REFERENCES1 . Bureau of Labor Statistics. Occupa-

tional industries and illnesses: Industrydata. http://data.bls.gov/cgi-bin/dsrv.

2 . Coggan C, et al. Prevalence of backpain among nurses. N Z Med J1994;107(983):306-8.

3 . Trinkoff AM, et al. Musculoskeletalproblems of the neck, shoulder, andback and functional consequences innurses. Am J Ind Med 2002;41(3):170-8 .

4 . Knibbe JJ, Friele RD. Prevalence ofback pain and characteristics of thephysical workload of communitynurses. Ergonomics 1996;39(2):186-98 .

5 . Bureau of Labor Statistics. Table R6:Incidence rates for nonfatal occupa-tional injuries and illnesses involvingdays away from work per 10,000 full-time workers by industry and selectedparts of body affected by injury orillness. 2000. http://www.bls.gov/iif/oshwc/osh/case/ostb1039.pdf.

6 . Brown J. Manual lifting and relatedfields: an annotated bibliography .Ottawa: Labor Safety Council ofOntario; 1972.

7 . Buckle P. Epidemiological aspects ofback pain within the nursing profes-sion. Int J Nurs Stud 1987;24(4):319-24 .

8 . Daltroy LH, et al. A controlled trial ofan educational program to prevent lowback injuries. N Engl J Med1997;337(5):322-8.

9 . Daws J. Lifting and moving patients. 3.A revision training programme. NursTimes 1981;77(48):2067-9.

10 . Dehlin O, et al. Back symptoms innursing aides in a geriatric hospital. Aninterview study with special referenceto the incidence of low-back symp-toms. Scand J Rehabil Med1976;8(2):47-53.

11 . Harber P, et al. Personal history,training, and worksite as predictors ofback pain of nurses. Am J Ind Med1994;25(4):519-26.

12 . Hayne CR. Ergonomics and back pain.Physiotherapy 1984;70(1):9-13.

13 . Lagerstrom M, Hagberg M. Evaluationof a 3 year education and trainingprogram. For nursing personnel at aSwedish hospital. AAOHN J1997;45(2):83-92.

14 . Owen BD, Garg A. Reducing risk forback pain in nursing personnel.AAOHN J 1991;39(1):24-33.

15 . Snook S, et al. A study of threepreventative approaches to low backinjury. Journal of OccupationalMedicine 1978;20(7):478-81.

16 . Stubbs DA, et al. Back pain in thenursing profession. I. Epidemiologyand pilot methodology. Ergonomics1983;26(8):755-65.

17 . Stubbs DA, et al. Back pain in thenursing profession. II. The effective-ness of training. Ergonomics1983;26(8):767-79.

18 . Venning PJ. Back injury preventionamong nursing personnel. The role ofeducation. AAOHN J 1988;36(8):327-33 .

19 . Owen BD. The lifting process and backinjury in hospital nursing personnel.West J Nurs Res 1985;7(4):445-59.

20 . Gagnon M, et al. Lumbo-sacral loadsand selected muscle activity whileturning patients in bed. Ergonomics1987;30(7):1013-32.

21 . Owen B, Garg A. Four methods foridentification of most back stressingtasks performed by nursing assistantsin nursing homes. InternationalJournal of Industrial Ergonomics1992;9?:213-20.

22 . Nelson A, et al. Redesigning patienthandling tasks to prevent nursing backinjuries. AAOHN J 2003; (In press).

23 . Owen B, Garg A. Assistive devices foruse with patient handling tasks. In: DasB, editor. Advances in industrialergonomics and safety. Philadelphia:Taylor & Frances; 1990.

24 . Legg SJ. Physiological ergonomics innursing. Int J Nurs Stud1987;24(4):299-305.

25 . Gold MF. The ergonomic workplace.Charting a course for long term care.Provider 1994;20(2):20-2, 4, 6.

26 . Kilbom A. Isometric strength andoccupational muscle disorders. Eur JAppl Physiol Occup Physiol

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251988;57(3):322-6.

27 . Lavsky-Shulan M, et al. Prevalenceand functional correlates of low backpain in the elderly: the Iowa 65+ RuralHealth Study. J Am Geriatr Soc1985;33(1):23-8.

28 . Hawkins L. An ergonomic approach tostress. Int J Nurs Stud 1987;24(4):307-18 .

29 . Fuortes LJ, et al. Epidemiology of backinjury in university hospital nursesfrom review of workers’ compensationrecords and a case-control survey. JOccup Med 1994;36(9):1022-6.

30 . Bigos SJ, et al. Back injuries inindustry: a retrospective study. II.Injury factors. Spine 1986;11(3):246-51 .

31 . Manning WG, et al. A controlled trialof the effect of a prepaid grouppractice on use of services. N Engl JMed 1984;310(23):1505-10.

32 . Kelsey JL, et al. An epidemiologicstudy of lifting and twisting on the joband risk for acute prolapsed lumbar

intervertebral disc. J Orthop Res1984;2(1):61-6.

33. 29 CFR pt. 1910; (2000).34 . NIOSH Back Belt Working Group.

Workplace use of back belts: reviewand recommendationms. Rockville,MD: National Institute for Occupa-tional Safety and Health; 1997.

35 . Williamson K, et al. Occupationalhazards for nurses - part II. Image: thejournal of nursing scholarship1988;20(3):162-8.

36 . Ronald LA, et al. Effectiveness ofinstalling overhead ceiling lifts.Reducing musculoskeletal injuries in anextended care hospital unit. AAOHN J2002;50(3):120-7.

37 . Spiegel J, et al. Implementing aresident lifting system in an extendedcare hospital. Demonstrating cost-benefit. AAOHN J 2002;50(3):128-34.

38 . Fragala G. Injuries cut with lift use inergonomics demonstration project.Provider 1993;19(10):39-40.

39 . Ergonomics Technical Advisory Group.

Patient care ergonomics resourceguide: safe patient handling andmovement. Patient Safety Center ofInquiry. 2001. htp://www.patientsafetycenter.com/Pt%20Care%20Ergonomics%20Resource%Guide%20%Part%One.pdf.

40 . Manual handling operations regula-tions. (1992). SI 1992/2793.

41 . Plog B, et al. Fundamentals ofindustrial hygiene. Itasca, IL: NationalSafety Council.

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Helping Employees Cope with GriefBy Kathryn Tyler

HR’s Quick, Compassionate Response To The Sudden Death of an Employee’s LovedOne Can Boost Worker Morale, Loyalty -and ultimately--Productivity.

On the afternoon of Aug. 10,1998, Christopher Novak, then an HRdirector for a ceramic dinnerwaremanufacturer in Syracuse, N.Y., wasin a meeting with HMO representa-tives when he got a phone call thatwould change his life.

“I remember picking up the receiverand barely comprehending the words,”Novak says. The police officer told himthat Cynthia, his wife of 14 years, hadbeen in a car accident. Cynthia wasseven months pregnant with their sec-ond son. Their first son, Ryan, was 9.

“After the call, I ran to tell my boss,the general manager of the facility,”Novak says. “He told me he woulddrive me to the hospital. He sat withme for hours.” The general managerwas with Novak when the surgeon toldhim that both his wife and their unbornson, who would be named Hunter, haddied.

Novak was devastated, but the outpour-ing of caring and support from his em-ployer and colleagues helped. The vicepresident of HR flew in from Toledofor the funeral, Novak says. “He stillsends me a card every August 10. Hisactions mean a tremendous amount tome.”

Hundreds of people attended a funeralreception that Novak’s employer coor-dinated. “My colleagues volunteeredtheir personal time to care for my sonwhile I ran errands,” he says. “Dinnershowed up on our doorstep every nightfor sixmonths, literally. My colleagues

completely and willingly shouldered mywork obligations to give me time to con-centrate on my family. Their expres-sions of support meant a lot at a timewhen my emotional energy was gone.I will appreciate that forever.”

A death in the family—especially if it’ssudden, because of an accident, per-haps, or a heart attack, a criminal actor suicide—can plunge survivors intosorrow and even depression, alteringtheir work habits and affecting thosearound them. How an employer reactsduring this vulnerable time can make adifference in a grieving employee’s re-covery. The HR professional’s respon-sibilities include:

• Ensuring that bereavement policiesare established.

• Helping the grieving worker commu-nicate with colleagues.

• Helping co-workers express theirsympathy.

• Helping the bereaved employee andhis or her supervisor deal with any lin-gering productivity issues.

Stages of Grief

Although people deal with grief in vari-ous ways—one person might feel an-gry, another anxious—experts say it’sa reaction that typically progressesthrough stages. Initially, there can beshock and denial, followed by anger,suffering and possibly depression. Nextcomes adjustment to loss, followed byacceptance and then reinvestment ofone’s emotional energy in other rela-

tionships. Some people may not movethrough all of those stages, and somemay move forward and then return toa previous stage.

Further, the sudden death of a lovedone brings additional complications,particularly if the death had a violentcause or is outside the normal order ofevents, such as when a child dies be-fore a parent. The most critical factorfor the bereaved, however, is that therewas no chance to prepare or saygoodbye.

“When someone dies suddenly, youhave to deal with everything at once.There’s no anticipatory grief,” saysHelen Fitzgerald, training director forthe American Hospice Foundation(AHF) in Fairfax, Va., and author ofGrief at Work, an AHF resourcemanual. “You don’t have the chanceto have the final conversation to talkabout your life and what you meant toeach other.”

Also, the shock phase of grief may lastlonger for those whose loved ones diesuddenly. People often misinterpret theshock, thinking the employee is OK,when, in fact, the reality hasn’t hit yet,says Fitzgerald, who is certified in tha-natology, the study of death and psy-chological mechanisms for coping withdeath.

“When [someone dies], people mightbe apt to support you, bring you food,”says Therese Schoeneck, executivedirector of Hope for Bereaved Inc., anonprofit organization in Syracuse thatprovides support services for grieving

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27people. “But when the reality hits, yourco-workers have gone on about theirown lives. Then it really sinks in.”

Policies and ProceduresHR’s most important task in helpingemployees overcome a sudden loss isto make certain there are policies andprocedures for handling matters suchas life insurance benefits, bereavementleave, emergency loans, leave-sharingand condolence gifts.

“HR departments must ensure thatthey are not lacking in their benefitsadministration procedures. This is nota trivial matter,” says Novak, whogivesspeeches on moving forwardthrough adversity.

At least one week of paid bereavementleave should be available, says NaomiNaierman, AHF president and CEO.Also, it is considerate to have a leave-sharing program through which co-workers can donate their unused per-sonal time to a colleague in need. (See“Giving Time to Grieve,” November1999, p. 66.)

Carol Hoffman, a licensed clinical so-cial worker who manages the work/lifeprogram for the University of Califor-nia at Berkeley (UC Berkeley), alsorecommends having an emergencyloan program to help employees pay forfuneral and related expenses. Althoughyou should coordinate other thought-ful, personalized gestures for the be-reaved, it is wise to send an official con-dolence gift from the company imme-diately.

At Aegon Direct Marketing Services,an insurance company in Plano, Texas,Laura Robinson, divisional HR devel-opment/communications manager,gives bereaved employees a copy of abook, presented in a cedar case, withmonthly readings and information oncoping with loss.

Hoffman emphasizes that managersshould treat all bereaved employeesequitably. “You don’t want to sendflowers to one person and not to an-other,” she says. “Have some guidingprinciples.”

HR should also streamline its proceduresso they can be completed quickly. UCBerkeley instituted an e-mail system thatnotifies the necessary administrative de-partments—HR, benefits, employee as-sistance program (EAP)—when anemployee’s loved one dies.

Thoughtful GesturesAnother key role of the HR professionalis to serve as liaison between the be-reaved employee and his or her col-leagues. The HR professional should askthe employee what to tell colleaguesabout the loss, Fitzgerald suggests.

“With sudden death, some things areconfidential [such as suicide] and not ev-erybody needs to know,” she says. “Iwould call that person and ask, ‘Whatdo you want me to tell your colleagues?’This is important, because you don’t getinto the game of who knows what.”

Also, HR can coordinate thoughtfulgestures. “Channel colleagues’ desireto help into constructive avenues thatoffer both compassionate support andpractical assistance to the employeeand [his or her] family,” Novak says.For instance, his colleagues workedwith the local bank branch to start ascholarship fund for his son. “It gavepeople a personal, constructive way tocontribute.”

Other ways to help include makingmeals, providing child care or mowingthe lawn. Schoeneck says thoughtfulgestures are appreciated—a fruit bas-ket, cookies, flowers or even a bag ofpaper plates, cups, napkins and tissuefor the endless stream of funeral visi-

tors. She also recommends spreadingout thoughtful acts over time. For ex-ample, writing a note or a card periodi-cally shows ongoing support.

And by all means, attend the funeral.

“Be there,” says Kenneth J. Doka ofPoughkeepsie, N.Y., a senior consult-ant to the AHF and editor of Living withGrief After Sudden Loss: Suicide, Ho-micide, Accident, Heart Attack, Stroke(Taylor and Francis, 1996). “There’snothing like tangible support. Peopleremember what others did.”

Also bear in mind that the ways youreact to the employee’s unexpected losshave far-reaching implications amongyour workforce. If co-workers see thatthe bereaved is treated well, they willfeel more confident about their em-ployer, Hoffman says.

Grief Education

Grief costs U.S. companies more than$75 billion annually in lost productivity,according to the Grief Recovery Insti-tute, a nonprofit foundation in ShermanOaks, Calif. Helping employees to dealwith their grief and that of others is com-passionate and proactive, and it bodeswell for productivity. “When you edu-cate people about grief, you normalizeit,” says Fitzgerald.

Hoffman advises employers to offer pro-grams that help employees and theirfamilies keep their wills, medical direc-tives and other end-of-life legal paper-work up-to-date so they won’t have todeal with it while they are grieving. Forinstance, employers can host presenta-tions on topics such as power-of-attor-ney and funeral options.

HR can also provide grief educationtraining. After the terrorist attacks ofSept. 11, 2001, Aegon invited AHF togive a one-day workshop on grief to itsHR staff. “We wanted to be prepared

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to help our folks in case something elsehappened,” Robinson says. “We talkedabout the stages of grief and how peoplemanifest those stages. [The trainer]gave us information about different reli-gious practices, so there was some di-versity training, too.”

Grief education is available throughEAPs, AHF, organizations such asHope for Bereaved, hospitals and otherlocal health organizations. Some ser-vices charge regular seminar rates;others offer programs at no cost.

What if an employee loses a loved onebefore you have provided grief educa-tion? Bring trainers in within 72 hoursof the death, advises Schoeneck. “Ifyou go in much later, the walls start togo up, and employees aren’t so [recep-tive].”

Grief education “was a godsend” forthe employees at Beacon Federal, abank in Kirkville, N.Y., after the sud-den death of clerk Toni Wood’s son fiveyears ago, says the firm’s president,Ross Prossner. “I was at work when ithappened,” Wood says. Prossner anda co-worker, Donna Maxwell, tookWood outside, where undercover po-lice officers and her sister-in-law werewaiting. They told her that her 14-year-old son, Billy, had been struck by aspeeding car while riding his bicycleand had died instantly.

Wood was shattered. “You live andbreathe your kids; to think you couldgo on without them is unbelievable,”she says. “What I remember was,when they told me, Mr. Prossner andDonna said, ‘We are here for you; weare going to help you through this.’They didn’t just say it, they did it.”

The company shared Wood’s loss. “Wewere so grief-stricken, it paralyzed thewhole organization,” says Prossner. Atthe time, the bank had about 70 em-ployees. “When grief overtakes the

heart of an organization, you need somecoaching.” Prossner asked Hope forBereaved to do some in-house griefeducation training.

“They spoke to our employees aboutthe grieving process and helped us un-derstand how we could support her,”he says. “They coached us on how tobe with her. Everybody wanted to runup and cry with her, but you could dothat all day long. Getting back to workis part of what you have to do, eventhough you don’t want to.”

When each co-worker expresses con-dolences, it can be overwhelming,Novak says. “Every time the phonerings and a person asks how you’redoing, you want to be gracious, butyou’re operating on emotional empty.”

Instead, Novak recommends having arepresentative—a close co-worker, su-pervisor or HR professional—who cancheck in with the grieving employee ev-ery few days during bereavementleave. Schoeneck suggests that on theemployee’s first day back at work, aspokesperson could say: “I’m repre-senting the rest of us. We didn’t wantto inundate you, but we’re so sorry foryour loss and we’re here for you.”

The Return to WorkWhen the employee returns to work,the HR professional should refer theperson to grief counseling resourcesand be a liaison between the bereavedand supervisors. But HR’s role in factbegins earlier. While the employee isaway, HR should become well versedon the company’s EAP and mentalhealth benefits. Also, HR profession-als should have an up-to-date resourcelist of community grief counselors andsupport groups, Fitzgerald suggests.

For instance, when Wood returned towork two and a half weeks after los-ing her son, Prossner took her to Hopefor Bereaved. “They gave me a lot of

tools,” she says. “I don’t know if Iwould have checked that out [on myown].”

When the grieving employee is backat work, HR should facilitate a meet-ing between the employee and super-visor, Fitzgerald says. “Set up a con-text where the [bereaved] person cansay, ‘I’m having a rough time on thisproject; can I get some help?’”

Doka adds, “When people experiencea significant loss, it affects themcognitively; they don’t work as effi-ciently. The key is good communica-tion.”

Fitzgerald agrees. “It’s important for be-reaved employees to have open com-munication with their supervisors.Schedule regular meetings to talk openlyabout performance.” Have follow-upmeetings with the bereaved and the su-pervisor at predetermined intervals, suchas at 30 and 90 days.

Begin the meeting by asking the em-ployee if he or she would like to talkabout the experience, and then listen.Bereaved people often feel compelledto tell their stories. Next, discuss any ac-commodations the employee needs—such as a flexible schedule, reducedworkload or temporary reassignment—as well as the supervisor’s expectations.

“If the work is redistributed, it’s very im-portant to include all co-workers in thedecision, rather than just do it, whichcauses resentment,” Schoeneck warns.

Keep in mind that the employee needsample time to grieve. “The weight of thatexperience doesn’t just dissipate whenyou go back to work,” Novak says.“There were days when I just had to gohome.”

Prossner allowed Wood to go for a walkor go home when she was having a hardday, he says.

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29“It’s helpful to take time off when youneed to go to the lawyer, sell the de-ceased person’s house or just be sad onthe person’s birthday,” says Hoffman.

Discuss potential reassignments if thebereaved cannot or does not want to per-form his or her usual tasks. For example,when Wood returned to work, she re-quested—and received—a different po-sition. “I used to be a customer servicerepresentative, and I knew I wouldn’tbe able to do that,” she says.

Prossner allowed her to switch positions.“She was a great employee; we just used

her talents in other areas of the bankwhere she didn’t have to meet peopleface-to-face,” he says.

Thanks to support from his company andothers, Novak was able to move on af-ter his loss. He founded The SummitTeam, a training and consulting firm, andhe has remarried. In early May, his wife,Jeannette, gave birth to a son whom theynamed Connor James. His older son,Ryan, is an honor roll student, a musi-cian and an athlete.

“Recognize that the employee needs achampion in [his or her] corner at that

moment,” he says. “Be that championand do what you can to minimize everyother work-related worry for them.”

Kathryn Tyler, M.A., is a freelancewriter and former HR generalist andtrainer in Wixom, Mich.

Reprinted with the permission ofHRMagazine, published by the Society forHuman Resources Management, Alexandria,VA.

*AOHP does not endorse any particular program or topic listed.

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Introduction

Every year, healthcare workers inthe U.S. suffer at least 590,000 sharps in-juries from needlesticks and other causes1. Safety authorities report that many ad-ditional sharps injuries go unreported,especially among physicians and physi-cians-in-training. For example, one sur-vey of 14,215 healthcare workers foundthat surgeons neglected to report 73 per-cent of sharps injuries they incurred; otherhealthcare workers failed to report 52 per-cent of their sharps injuries 2. Overall per-cutaneous injury rates among doctors,nurses and other healthcare workers maynow be declining due to the increased useof safety devices and other factors. None-theless, occupational risk from needlesticksremains a significant issue, and devices thatrequire user activation are a continuingsource of injuries 3.

Sharps injuries are well-documentedsources of fatal infections. Of injuredworkers who become infected, an esti-mated 100 to 200 die every year fromHepatitis B 3, with hundreds more annu-ally being diagnosed with the potentiallyfatal Hepatitis C 4. In addition, as of June2001, nearly 200 cases of HIV inhealthcare workers were considered ei-ther confirmed or possible occupational-related transmissions 5.

Over the past few years, attention to theneedlestick safety issue has resulted in stateand federal mandates requiring safer meth-ods and work practices in healthcare fa-cilities. Most of the focus has been on the

risk to nurses. But a substantial proportionof sharps injuries occurs in medical teach-ing situations to medical students, interns,residents, and fellows. Especially whenunderreporting is taking into account, thepercentage of injuries to healthcare work-ers that is suffered by medical students andyoung physicians is substantial, judgingfrom the few studies on the topic. Oneeight-year survey found that physicians-in-training (residents and fellows) suffered21 percent of all sharps injuries, the sec-ond-highest amount after nurses (33 per-cent) 6. Yet, the sharps injury risk faced byphysicians-in-training has received littleattention and has not been extensively ana-lyzed.

To augment current knowledge about therisk faced by attending physicians and phy-sicians-in-training, the Association of Oc-cupational Health Professionals inHealthcare (AOHP) joined the NationalAlliance for the Primary Prevention ofSharps Injuries (NAPPSI) in surveyingAOHP members.

In particular we wanted to learn moreabout needlesticks from suturing, which arethe most common sharps injury amongphysicians-in-training 7. One publishedanalysis of 2,111 percutaneous injuries in ateaching hospital found that about 35 per-cent of the injuries to interns and residentswere caused by suture needles 8.

We hoped that in addition to adding to whatis known about needlesticks suffered byresidents and other young doctors, our datacould be useful in identifying options thatreduce sharps injury risk. Many such inju-ries are entirely avoidable today when

sutureless technologies are used, makingthe continuing toll of suture needlesticksall the more unfortunate.

Among common procedures associatedwith suture needlesticks are wound clo-sure and securement of various catheterssuch as peripheral IVs, central venouscatheters and arterial lines. For closure ofsome kinds of wounds, surgical glues andfibrin sealants provide alternatives to theuse of suture and suture needles, but manysuch wounds must still be closed by sutur-ing. Regarding the suturing of cathetersinto place, two recent studies found aneedlestick rate of between 1 percent and2 percent when central venous catheters(CVCs) were suture-secured 9, 10. Basedon industry estimates that approximatelysix million CVCs are placed in the U.S.each year, this rate translates into between60,000 and 120,000 needlesticks caused bysuture securement of CVCs alone. Onesolution lies in the use of specially designed,sutureless catheter securement devicesthat are now available. These relativelynew devices are recognized by the U.S.Occupational Safety and Health Adminis-tration and the Centers for Disease Con-trol and Prevention, as being safer alter-natives to suture needles for both patientsand healthcare workers 11, 12.

MethodIn September 2003, a request was e-mailed to the approximately 75 percent ofAOHP members for whom the associa-tion had e-mail addresses (about 750members). The e-mail asked that mem-bers complete a survey regarding sharpsinjuries to medical students, interns, resi-dents, fellows, and attending physicians.

Sharps Injury Risk to Physicians-in-Training and AttendingPhysicians: A Preliminary Survey

By MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM and Steve Bierman, M.D.

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31The requested data covered the preced-ing three-month period (June-August2003). Respondents were guaranteedthat their identity and the identity of theirinstitutions would be kept confidential.Thus, each response represented a sepa-rate sharps injury incident, with the totalnumber of responses representing a to-tal number of incidents, not respondentsor source institutions.

Data was requested in the following gen-eral categories: whether or not the in-jury occurred in a teaching hospital; cat-egory of injury (needlestick or other);procedure type (passing sharps or su-turing); body part injured; departmentwhere exposure occurred; category ofmedical staff person injured; specialty ofinjured person; root cause of the injury;whether or not the patient was knownto be infected; if the patient had a trans-missible infection, the nature of the in-fection; and whether or not the injuredperson received post-exposure prophy-laxis. Respondents were also asked todescribe the exposure incident (seeSidebar, page 35).

If the injury-causing procedure involvedsuturing, the survey directed respondentsto categorize the type of procedure andnote whether the procedure involvedstraight or curved needles. Respondentswho reported catheter-related sutureneedlesticks were asked to name thetype of catheter; note whether a sched-uled or unscheduled restart was in-volved; and categorize the reason forany unscheduled restart.

Members were asked to respond within10 days by either completing the surveyonline at the NAPPSI website(www.nappsi.org) or printing out thesurvey and faxing it to the NAPPSI of-fice. NAPPSI staff compiled the data.

ResultsA total of 36 responses was received,plus a report on an injury to an RN that

was outside the purview of the study.Of the 36 relevant responses, 22 con-cerned injuries occurring in teaching hos-pital settings.

Attending physicians received 53 per-cent of injuries reported overall, with phy-sicians-in-training accounting for the re-maining 47 percent (Table A). Amongphysicians-in-training, residents receivedby far the highest proportion of injuries(28 percent).

Of all root causes, manual manipulationof suture needles was the most frequent,accounting for 33 percent of injuries(Table B, pg. 33). Other prominentcauses included hurrying (19 percent)and actions of a co-worker (17 percent).Among suture-related injuries, most (81percent) occurred during wound closure,with suture securement of catheters be-ing the second most common cause (15percent). Nearly all of the sutureneedlesticks (91 percent) occurred withcurved suture needles, rather thanstraight needles.

Among source patients known to havetransmissible infections (6 patients, 17

percent of all patients involved in re-ported incidents), five (83 percent) wereinfected with Hepatitis C and one (17percent) was known to have HIV. Post-exposure lab work was performed for75 percent of injured those injured, and11 percent received post-exposure pro-phylaxis. It is not known whether any ofthe injured clinicians seroconverted toHepatitis C or HIV.

The most common body parts injuredwere the fingers (75 percent) and hands(22 percent) – a total of 97 percent ofreported injuries. Nearly half (47 percent)of the injuries occurred in the operatingroom, with 14 percent taking place inpatient rooms (Table C, pg. 34).

There were many similarities betweenthe nature of injuries reported in teach-ing vs. nonteaching hospitals. However,several notable differences emerged. Allof the catheter-securement-related su-ture needlesticks occurred at teaching hos-pitals, and all were suffered by physicians-in-training. A larger proportion of overallinjuries was suffered by physicians-in-training (69 percent) at teaching hospitals.A higher percentage of radiology-related

Table A Types of Physicians-in-Training and Attending Physicians

Who Sustained Sharps Injuries (All responses n=36)

0

2

4

6

8

10

12

14

16

18

20

Attending Physician Resident Fellow Intern Medical Student

types of physicians-in-training/attending physicians

nu

mb

er

32

A O H P J o u r n a l

injuries (14 percent) was reported at teach-ing institutions, and improper sharps dis-posal also accounted for a higher injuryrate in these hospitals. Among incidentsreported by respondents at teaching hos-pitals, all source patients with known in-fections were infected with hepatitis C.

DiscussionThese findings underline the fact that medi-cal sharps injuries remain a risk forhealthcare personnel, despite state andfederal regulations that address the prob-lem and despite development of many

Table B Root Cause of Sharps Injuries

(All responses n=36)

0

2

4

6

8

10

12

14

Manualmanipulation

Hurrying Co-workerprecipitated

Other Improperdisposal

No "safe zone"practice

Two-handedrecap

Used sharps ontray

root cause

nu

mb

er

valuable needlestick safety technologies.Hospitals’ compliance with governmentsharps safety mandates falls far short ofideal. It is also obvious that some institu-tions have been slow to adopt the safestdevices and methods.

Our personal experience bears out theobservation that physicians often do notreport accidental needlesticks they havesustained. Reports collected in our sur-vey were injuries reported by doctors to ahospital's occupational health professional,typically a nurse. This reporting processlikely contributed to underreporting. Manyif not most physicians have little incentiveto report sharps injuries because hospitals

are typically not responsible for physicians’insurance coverage. Physicians in train-ing are in some cases hospital employeescovered by workers compensation.

Nonetheless, some patterns can be dis-cerned from the reported data. Notably,all catheter securement-related injuriesoccurred in teaching hospitals. This sug-gests that physicians-in-training are atparticular risk for these injuries. Becausethey are in a learning situation and morelikely to be assigned the task of securingcatheters, residents and other young phy-

sicians are more vulnerable to these kindsof injuries. Use of sutureless, OSHA-rec-ognized securement devices would elimi-nate this problem, as demonstrated in twopublished studies 9, 10.

Attending physicians and physicians-in-training reported roughly the same num-ber of sharps injuries. This suggests thatwhen sharps are used, accidents can hap-pen to anyone who comes in contact withthem, regardless of experience level.

Curved suture needles are regarded bysome clinicians as being effective safetydevices. However, our survey suggestsotherwise. All but one of the wound clo-

sure injuries were sustained with a curvedsuture needle. This underscores the wis-dom of the “primary prevention” approachto sharps safety – that is, eliminating thesharp implement where possible, rather thanjust using a “safer” sharp. Further, it callsinto question the myth that straight needlesare the predominant cause of suture inju-ries.

Three practices (manual manipulation ofsuture needles, actions of a co-worker, andhurrying) accounted for 69 percent of re-ported injuries. Given that most suture-re-lated injuries involved wound-closure pro-cedures, a two-pronged approach that com-bines work practice controls and engineer-ing controls could make a substantial dif-ference in reducing risk. The followingwork practice controls could substantiallyreduce the incidence of injuries to physi-cians-in-training and attending physicians:

1. Training that stresses the hazards of hur-rying. Whether closing wounds or secur-ing catheters, the job is not complete untilthe suturing is complete. As in tightropewalking, extreme alertness is required ev-ery step of the way. Hurrying becauseyou’re “almost there” can lead to a dan-gerous mistake.

2. Training that stresses the importance ofavoiding actions that might injure a col-league, especially when suture needles mustbe used. The development of videos andother materials could be useful in makingphysicians more safety-conscious. Clini-cians in teaching institutions should also beacquainted with and demonstrate knowl-edge of the literature on suture needlestickdangers.

3. Avoiding manual manipulation of sutureneedles. Physicians should be trained tomanipulate suture needles with instrumentsonly, thereby reducing some of the injuryhazards documented in the survey.

Regarding engineering controls (devices),we have already discussed the value of

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33

Table C Department Where Exposure Occurred

(All responses n=36)

0

2

4

6

8

10

12

14

16

18

Operating room Patient room Radiology Delivery room Other Emergencydepartment

Clinic Cardiac cath lab

department

num

ber

-- especially those such as safety cathetersthat require clinician activation -- can stillinjure healthcare workers if the preven-tive features fail or are improperly used,or if the clinician does not activate them.Further, any instrument that can be provento reduce the risk of suture needle expo-sure should be adopted, provided it can beshown to be appropriate and feasible.

In addition to the general problem of phy-sician underreporting of sharps injuries, our

ConclusionIn the long term, better training can help toreduce risk the needlestick risks docu-mented in the survey. But the need todevelop training materials and programsshould not be used as an excuse to delaytaking other steps. Specifically, adoption ofthe engineering controls recommendedabove would immediately reduce the riskof sharps injuries and possibly save lives.Our survey also underlines the value ofhaving medical educators – and physicians-

primary prevention technologies such assurgical glues and sutureless catheter se-curement devices, which can eliminate therisk of a suture-related injury. Healthcarefacilities should also adopt the use of “sec-ondary prevention” devices such as safetyscalpels and retractable needles whensharps must be used. Facilities should beheld accountable when they do not adoptavailable primary and secondary preven-tion measures. Also, an ongoing campaignshould be aimed at young doctors to alertthem to needlestick hazards and in foreignthem of their rights to demand safer de-vices. Primary prevention is generally pref-erable where it can be implemented, be-cause secondary-prevention safety devices

survey has the limitation of being an initialstudy with a low response rate. It coveredonly a three-month period and relied onthe initiative of concerned occupationalhealth professionals to take the time to fillout survey forms. Our decision to encour-age more responses by promising respon-dents anonymity meant we could not as-certain how many institutions were repre-sented in the data, nor could we follow upwith respondents for additional informa-tion. Clearly, a definitive assessment willcome from a prospective, long-term studyanalyzing suture needlestick injuries inacute-care settings such as teaching hos-pitals.

in-training themselves -- insist that theirinstitutions acquire the safest technologyavailable.

That said, economic and cultural barriersmust still be surmounted at many hospitalsbefore the safest devices are adopted.Many hospitals purchase supplies througha “primary business partner” that may notstock the requested devices. This businessarrangement can preclude purchasingsafer devices that are not on contract.Hospitals must allow more flexible pur-chasing arrangements if healthcare work-ers are to enjoy the safest possible workenvironment. Hospital safety committeesshould also be empowered to fully investi-gate safety issues and take appropriatemeasures as needed. Such steps will notonly ensure a safer workplace but alsoassist institutions in complying with stateand federal sharps safety regulations.

We recommend preparation of a moreextensive survey that:

1. covers longer periods of time;

2. proactively contacts prospective respon-dents rather than relying on them to fill outthe survey, and

3. further illuminates areas of interest iden-tified in the current study. Additional dataon unsafe practices will also inform thedevelopment of effective sharps safetytraining protocols and technologies.

MaryAnn Gruden, CRNP, MSN, NP-C,COHN-S/CM, is Coordinator, EmployeeHealth Services at The Western Penn-sylvania Hospital, West Penn Alleghenyhealth System (Pittsburgh, Pa.) andPresident Emeritus, Association of Oc-cupational Health Professionals inHealthcare. Steve Bierman, M.D. isPresident of the nonprofit National Al-liance for the Primary Prevention ofSharps Injuries, which is based inCarlsbad, Calif.

34

A O H P J o u r n a l

Footnotes1. International Health Care Worker Safety Cen-

ter; “Annual number of occupational percutaneous

injuries and mucocutaneous exposures to blood or

potentially infective biological substances”; 1998.

2. “Percutaneous injury reporting in U.S. hospi-

tals, 1998”; F. Alvarado, A. Panlilio, D. Cardo, and

the NaSH Surveillance Group; Hospital Infections

Program, Centers for Disease Control and Preven-

tion.

3. "2001 Percutaneous Injury Rates," Perry, J.,

Parker, G, Jagger, J., Advances in Exposure Pre-

vention, Vol. 6, No. 3,2003.

4. Draft guideline for infection control in health

care personnel; Centers for Disease Control and

Prevention; Washington, D.C.; Government Print-

ing Office, 1997. Cited in: Safer needle devices:

protecting health care workers; Occupational Safety

and Health Administration; October 1997.

6. Centers for Disease Control and Prevention;

Updated US Public Health Service Guidelines for

the Management of Occupational Exposures to

HBV, HCV and HIV and Recommendations; Mor-

bidity and Mortality Weekly Report 2001; 50:RR-

11.

7. E-mail communication, International Healthcare

Worker Safety Center, University of Virginia.

8. “Sharps injuries in a pediatric teaching hospital:

a shared responsibility”;

Sumathi Nambiar, Marie-Michèle Léger, and Nalini

Singh; Archives of Pediatric & Adolescent Medi-

cine 2001;155:1277-1278.

9. “Sutureless securement device reduces complica-

tions of peripherally inserted central venous cath-

eters”: Alvin J. Yamamoto, MD et al: Journal of

Vascular and Interventional Radiology; January

2002: Vol. 13, No. 1: 77-81.

10. “StatLock® catheter securement device sig-

nificantly reduces central venous catheter compli-

cations”; Gregory J. Schears, MD et al; Patient

Safety Initiative 2000; Spotlight on Solutions:

Compendium of Successful Practices, Vol. 1; Joint

Commission on Accreditation of Healthcare Orga-

nizations and National Patient Safety Foundation.

11. Evaluation of sutureless catheter securement

devices to prevent needlestick injuries, Jan. 23,

2003; www.osha.gov/pls

/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=24428&p_text_version=FALSE12. Guidelines for the Prevention of Intravascular

Catheter-Related Infections, MMWR Recommen-

dations and Reports, Volume 51, Number RR-10;

www.cdc.gov/ncidod/hip/iv/iv.htm.

Sharps Injuries in the Operating Room or Other Clinical Settings

· Suturing and accidentally stuck self with suture needle (n=11)· Assisting with wound closure and was stuck in finger with suture needle· Attempting to move dirty instruments away from area when physician threw the suture needle onto tray causing the resident sustain needlestick· Trying to reinsert the stylette into the biopsy needle, lost concentration and sustained a needlestick with contaminated biopsy needle· During suturing (EENT) sustained needlestick· While assistant reached for instrument the surgeon, at the same time, pulled suture needle up and through during closure and sustained abrasion by the needle· Retracting and was stuck while chief surgical resident while trying to tie off a bleeding vessel· Suturing after a delivery and coworker sustained a needlestick· While suturing a foot laceration, the patient moved unexpectedly bumping the hand of the physician causing a needlestick· Hurrying to close during a case where the patient was bleeding and an assisting physician sustained a needlestick

Radiology· Occurred during procedure in interventional radiology while trying to gain ac- cess· During angiography procedure tried to readjust wires that were over the patient’s face while contaminated angion needle was in hand and sustained needlestick

Line Insertion· Using a safety scalpel to cut sutures after line was inserted and did not realize the safety scalpel was going the direction it was and sustained laceration· While inserting line, broke a lidocaine ampule and the glass pierced the con taminated glove and skin causing a laceration· Resident was suturing line and accidentally bumped a resident coworker who was assisting and the coworker sustained a needle stick· Placing femoral line during code situation· Suturing line and sustained puncture wound

Other· Cut by another person using bandage scissors· Pathologist reached for brush and sustained laceration from a used blade that had been improperly disposed by a co-worker· Two hand recap of needle used to administer local anesthetic prior to block· Sustained a needlestick while a student nurse was performing a return demonstration of the removal of a PAC needle from a patient· Sustained needlestick of clean needle through a contaminated glove

Description of Exposure Incidents for All Respondents(n=32)

Winter 2 0 0 4

35

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The “Let’s ROC for AOHP” Program extends until September 30, 2004.AOHP Members who recruit the most new members 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

The new members you recruit will have to reference you as their reason forjoining. AHOP staff also will respond to new member applications asking if theywere referred by an existing AOHP member.

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

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Attention AOHP Members:

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