Category Archives: Health Care Workers

Standards for Surgical Respirators and Masks: Relevance for Protecting Healthcare Workers and the Public During Pandemics

Source: Rachael M Jones, David Rempel, Annals of Work Exposures and Health, Volume 65, Issue 5, June 2021
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From the abstract:
National standards for surgical respirators and masks are written and enforced to protect healthcare workers from particles and microorganisms such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In addition to the ability to filter particles (e.g. filtration efficiency, FE), the standards address breathability (e.g. differential pressure), how well the mask seals to a worker’s face (e.g. fit test), the level of protection from a fluid splash, and other factors. Standards used in the USA, European Union (EU), and China were compared with respect to testing methods and certification criteria. Although there are substantial similarities in standards for respirators, such as surgical N95, FFP2, and KN95 filtering facepiece respirators (FFRs), there are differences with respect to who performs that testing and fit-testing requirements that influence certification. There is greater variation in test methods between countries for surgical (USA) or medical (EU and China) masks than for FFRs. Surgical/medical masks can be certified to different levels of protection. The impact of the similarities and differences in testing methods and certification criteria on FFR and mask performance for protecting healthcare workers from SARS-CoV-2 are discussed, as well as the value of a new standard in the EU for testing fabrics for masks used by the public. Health and safety personnel in healthcare settings must understand the differences between standards so that they can select respirators and masks that provide appropriate protection for healthcare workers.

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

Source: Matthew D McHugh, Linda H Aiken, Douglas M Sloane, Carol Windsor, Clint Douglas, Patsy Yates, The Lancet, Vol. 397, issue 10288, May 22, 2021
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From the summary:
Background
Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. We aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated.

Methods
For this prospective panel study, we compared Queensland hospitals subject to the ratio policy (27 intervention hospitals) and those that discharged similar patients but were not subject to ratios (28 comparison hospitals) at two timepoints: before implementation of ratios (baseline) and 2 years after implementation (post-implementation). We used standardised Queensland Hospital Admitted Patient Data, linked with death records, to obtain data on patient characteristics and outcomes (30-day mortality, 7-day readmissions, and length of stay [LOS]) for medical-surgical patients and survey data from 17 010 medical-surgical nurses in the study hospitals before and after policy implementation. Survey data from nurses were used to measure nurse staffing and, after linking with standardised patient data, to estimate the differential change in outcomes between patients in intervention and comparison hospitals, and determine whether nurse staffing changes were related to it.

Findings
We included 231 902 patients (142 986 in intervention hospitals and 88 916 in comparison hospitals) assessed at baseline (2016) and 257 253 patients (160 167 in intervention hospitals and 97 086 in comparison hospitals) assessed in the post-implementation period (2018). After implementation, mortality rates were not significantly higher than at baseline in comparison hospitals (adjusted odds ratio [OR] 1·07, 95% CI 0·97–1·17, p=0·18), but were significantly lower than at baseline in intervention hospitals (0·89, 0·84–0·95, p=0·0003). From baseline to post-implementation, readmissions increased in comparison hospitals (1·06, 1·01–1·12, p=0·015), but not in intervention hospitals (1·00, 0·95–1·04, p=0·92). Although LOS decreased in both groups post-implementation, the reduction was more pronounced in intervention hospitals than in comparison hospitals (adjusted incident rate ratio [IRR] 0·95, 95% CI 0·92–0·99, p=0·010). Staffing changed in hospitals from baseline to post-implementation: of the 36 hospitals with reliable staffing measures, 30 (83%) had more than 4·5 patients per nurse at baseline, with the number decreasing to 21 (58%) post-implementation. The majority of change was at intervention hospitals, and staffing improvements by one patient per nurse produced reductions in mortality (OR 0·93, 95% CI 0·86–0·99, p=0·045), readmissions (0·93, 0·89–0·97, p<0·0001), and LOS (IRR 0·97, 0·94–0·99, p=0·035). In addition to producing better outcomes, the costs avoided due to fewer readmissions and shorter LOS were more than twice the cost of the additional nurse staffing.

Interpretation
Minimum nurse-to-patient ratio policies are a feasible approach to improve nurse staffing and patient outcomes with good return on investment.

Workers’ compensation costs for healthcare caregivers: Home healthcare, long‐term care, and hospital nurses and nursing aides

Source: Kermit G. Davis, Andrew M. Freeman, Jun Ying, Jeffrey R. Huth, American Journal of Industrial Medicine, Volume 64 Issue 5, May 2021
(subscription required)

From the abstract:
Background: Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long‐term care, or home health care).

Methods: A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5‐year period were obtained from the Ohio Bureau of Workers’ Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim.

Results: Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims.

Conclusions: With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.

A policy manifesto for paying, protecting, and empowering essential workers

Source: Molly Kinder and Laura Stateler, Brookings Institution, Metropolitan Policy Program, March 18, 2021

….Powell and his fellow frontline employees at the hospital are strenuously working to do jobs like cleaning, taking vital signs, and spending time with patients—but without the decent pay and respect that nurses and doctors earn. “These are people who work very, very, very hard, and who make very, very, very little,” he said.

With the country on track for mass vaccinations in the coming months, the worst of the pandemic may be over. But the risks facing frontline essential workers like Powell have not ended. Many of the underlining inequities they face—including low wages, structural racism, and inadequate protections—remain.

It is long past time that we treat essential workers as truly essential. Lawmakers in Washington and around the country have the opportunity to turn their policy rhetoric into real change. The recommendations in this report lay out how federal, state, and local policymakers can—finally—give essential workers what they have always deserved: the dignity of a living wage, lifesaving protections, and power in their workplaces…..

Prevention of Hand Eczema among Nurse Apprentice (PREVEDERM): An Interventional Study

Source: Horatiu Remus Moldovan, Ionela Manole, Alina Suru, Alexandra-Irina Butacu, Alin Laurentiu Tatu, Adriana Lupu, Mihai Dascalu, George-Sorin Tiplica, Carmen Maria Salavastru, Annals of Work Exposures and Health, Volume 65, Issue 2, March 2021
(subscription required)

From the abstract:
Background
Workers in the healthcare sector are at high risk of developing occupational hand eczema mainly due to frequent exposure to irritants and/or allergens. Amongst workers in healthcare, nurses are at higher risk of developing hand dermatitis.

Objectives
To evaluate the effectiveness of a short educational intervention program in preventing occupational hand eczema in nurse apprentices, using two objective tools, namely TEWL and EH, and the HECSI score.

Methods
Data regarding professions, wet work exposure, activities performed during working hours, self-reported eczema were collected from 230 nurse students, divided in two study groups: the intervention and the control group (CG). The intervention group (IG) was given education about risks and proper skin care and was provided with cosmeceuticals to be used for skin care during hospital activity. The evaluation of skin properties was performed using questionnaires, HECSI score, measurement of transepidermal water loss (TEWL) and epidermal hydration (EH).

Results
A number of 139 apprentice nurses completed the study. Of those participants who completed the study, 19.1% from CG and 19.6% from IG reported, at T1, hand eczema in the last 3 months, while at T2 (3 months later), 59.52 % of the CG and only 11.34 % from the IG stated having eczema in the last 3 months. In the IG, results showed an improvement of CM with 17% and of TEWL with 16%, with only a 0.5% improvement of CM in CG and a marked impairment of TEWL by 33%.

Conclusion
Hand eczema is a common occupational dermatosis affecting the medical staff, even during apprenticeship. Early preventive training programs are effective in reducing the burden of occupational contact dermatitis.

Occupational Heat Stress and Practical Cooling Solutions for Healthcare and Industry Workers During the COVID-19 Pandemic

Source: Josh Foster, Simon G Hodder, James Goodwin, George Havenith, Annals of Work Exposures and Health, Advance Articles, Published: September 21, 2020
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From the abstract:
Treatment and management of severe acute respiratory syndrome coronavirus-2, which causes coronavirus disease (COVID-19), requires increased adoption of personal protective equipment (PPE) to be worn by workers in healthcare and industry. In warm occupational settings, the added burden of PPE threatens worker health and productivity, a major lesson learned during the West-African Ebola outbreak which ultimately constrained disease control. In this paper, we comment on the link between COVID-19 PPE and occupational heat strain, cooling solutions available to mitigate occupational heat stress, and practical considerations surrounding their effectiveness and feasibility. While the choice of cooling solution depends on the context of the work and what is practical, mitigating occupational heat stress benefits workers in the healthcare and industrial sectors during the COVID-19 disease outbreak.

Healthcare employees concerned about profit, clients during COVID-19 outbreak

Source: Morgan Frey, S&P Global, March 27, 2020

More than half of healthcare workers are confident that consumer demand for their products and services will not decline as a result of the coronavirus pandemic, although some warned their businesses were facing serious challenges, according to a survey. The Voice of the Enterprise survey was conducted by 451 Research LLC, an offering of S&P Global Market Intelligence, between March 10 and March 19 and represents 820 responses. Of the healthcare employees surveyed, 54.8% said they did not expect a loss or reduction of customer demand, which was higher than any other industry in the survey. S&P Global Ratings expects the coronavirus’ impact on the healthcare sector will be “moderate” versus other industries.

Related:
S&P: For-profit hospitals may weather procedure cancellations amid COVID-19
Source: Ricky Zipp, S&P Global, March 26, 2020

Most for-profit hospitals should have enough liquidity to overcome the next three to six months of volume declines as the coronavirus pandemic continues to stress health systems and take a toll on the U.S. economy, according to S&P Global Ratings analysts.

Not-For-Profit Acute Care Sector Outlook Revised To Negative Reflecting Possible Prolonged COVID-19 Impact
Source: S&P Global Ratings, March 25, 2020
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Key Takeaways:

  • We have revised our not-for-profit acute health care sector outlook to negative due to the quickly evolving COVID-19 pandemic and the subsequent investment market deterioration which could pressure credit quality.
  • We believe certain credits, especially those with healthy unrestricted reserves and liquidity, may be better able to manage through this crisis.
  • Duration, location, and severity will be important considerations in determining the broader impact of this pandemic on the sector.

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

Source: Orianne Dumas, Krislyn M. Boggs, Catherine Quinot, Raphaëlle Varraso, Jan‐Paul Zock, Paul K. Henneberger, Frank E. Speizer, Nicole Le Moual, Carlos A. Camargo Jr., American Journal of Industrial Medicine, Early View, November 6, 2019
(subscription required)

From the abstract:
Background:
Exposure to disinfectants among healthcare workers has been associated with respiratory health effects, in particular, asthma. However, most studies are cross‐sectional and the role of disinfectant exposures in asthma development requires longitudinal studies. We investigated the association between occupational exposure to disinfectants and incident asthma in a large cohort of U.S. female nurses.

Methods:
The Nurses’ Health Study II is a prospective cohort of 116 429 female nurses enrolled in 1989. Analyses included 61 539 participants who were still in a nursing job and with no history of asthma in 2009 (baseline; mean age: 55 years). During 277 744 person‐years of follow‐up (2009‐2015), 370 nurses reported incident physician‐diagnosed asthma. Occupational exposure was evaluated by questionnaire and a Job‐Task‐Exposure Matrix (JTEM). We examined the association between disinfectant exposure and subsequent asthma development, adjusted for age, race, ethnicity, smoking status, and body mass index.

Results:
Weekly use of disinfectants to clean surfaces only (23% exposed) or to clean medical instruments (19% exposed) was not associated with incident asthma (adjusted hazard ratio [95% confidence interval] for surfaces, 1.12 [0.87‐1.43]; for instruments, 1.13 [0.87‐1.48]). No association was observed between high‐level exposure to specific disinfectants/cleaning products evaluated by the JTEM (formaldehyde, glutaraldehyde, bleach, hydrogen peroxide, alcohol quats, or enzymatic cleaners) and asthma incidence.

Conclusions:
In a population of late career nurses, we observed no significant association between exposure to disinfectants and asthma incidence. A potential role of disinfectant exposures in asthma development warrants further study among healthcare workers at earlier career stage to limit the healthy worker effect.

The Constant Caregiver: Work–family Spillover among Men and Women in Nursing

Source: Marci D Cottingham, Jamie J Chapman, Rebecca J Erickson, Work, Employment and Society, OnlineFirst Published November 8, 2019
(subscription required)

From the abstract:
Work–family spillover is a central concept in the work and occupations literature, with prior research detailing its negative outcomes and gendered dimensions. With increased demands for careworkers and more men entering occupations such as nursing, we examine experiences and perceptions of spillover using qualitative data from a diverse sample of 48 US nurses. We find similarities across men and women in terms of exhaustion and stress as well as in anticipating spillover in their careers. Yet, we also find some differences, with men (but not women) highlighting the transfer of emotional capital between work and family. We extend work–family research by broadening the concept of spillover to include its anticipation and the transfer of emotional capital – both aspects that have been previously under-examined. These findings have implications for the retention and support of careworkers and refine the concept of spillover in ways that could apply to various employment sectors.

U.S. Nursing Assistants Employed in Nursing Homes: Key Facts (2019)

Source: PHI, September 3, 2019

From the abstract:
This research brief provides the latest annual snapshot of U.S. nursing assistants employed in nursing homes, including key demographics and a variety of wage and employment trends. This year’s research found that 581,000 nursing assistants support older people and people with disabilities in nursing homes. Nursing assistants are injured more than three times more frequently than the typical American worker, and earn a median hourly wage of $13.38 and a median annual income of $22,200.

Key Takeaways:
– The number of nursing assistants employed in nursing homes in the U.S. declined from just over 599,000 in 2008 to 581,000 in 2018.
– Nursing assistants earn a median hourly wage of $13.38 and a median annual income of $22,200.
– Nursing homes will need to fill nearly 680,000 nursing assistant job openings between 2016 and 2026.