Illustration by Malcolm Garris/PhotoDisc

by Megan Flaherty
October 15, 1998

Some health professionals consider workplace health hazards just another part of their job that they don’t like but have to accept. At two recent conferences, health safety experts had a message for these people: Wake up! Health workers can do a lot to keep themselves and their co-workers safe, both by protecting themselves and by advocating for a safer workplace environment.

To successfully advocate for workplace safety, some nurses may need to undergo a fundamental shift in thinking, experts say. "It’s sort of an attitudinal thing within nursing itself where you just think that your major job is to provide for the patient. We have not really stood back and looked at protecting ourselves on behalf of that patient," said Bernice Owens, PhD, RN, an expert on back injuries from the University of Wisconsin-Madison School of Nursing.

There have been a few steps forward and a few steps back in making healthcare workplaces safer, say experts.

Need for safe needles

Work places have seen "some important gains in preventing needlesticks" in recent years, according to Janine Jagger, PhD, MPH, director of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville. Around 787,000 sharps injuries and blood contacts occur annually now, Jagger said. For the past decade or so, it was estimated that at least 800,000 exposures occurred annually.

Between 20 and 39 healthcare professionals are infected with HIV from sharp instrument injuries or blood exposures each year, according to the center. Nurses are the health workers most likely to be exposed to and infected with HIV through a needlestick injury or blood contact, Jagger said.

The best way nurses can protect themselves from needlesticks is to use their clout as the largest healthcare profession to "push for safer technology starting today," Jagger said. Safety needle devices have been proven to protect health workers, she said. So far, devices have penetrated the market to varying degrees. For example, 60 percent of devices used for IV infusion are now safety devices and 26 percent of IV catheters are safety devices, but less than 10 percent of all other types are safety devices, she said.

Another step to be taken to protect nurses is better training for students and new employees, Jagger believes. Drawing blood and starting IVs are among the most hazardous procedures health workers carry out, but among the first procedures performed by nurses in training as well as medical residents, Jagger said. "They should be taught under very strict conditions so they can’t perform in the clinic setting until they’ve met training and performance standards," she said.

"Nurses are much more likely to be activists for patients than they are for themselves," Jagger said. They are probably also more likely to advocate for other health workers when it comes to safe needle devices, she said. "I would like nurses to view their activism as benefiting their colleagues rather than themselves. We’ll make progress faster."

Latex allergies

Latex emerged as a health threat to health professionals when universal precautions were instituted in 1986. At that point, health workers started wearing predominantly latex gloves and went from using millions of pairs of gloves a year to billions, according to the National Institute of Occupational Safety and Health (NIOSH).

Some of the 400 new manufacturers that met the demand may have produced gloves with allergen levels up to 3,000 times higher than those found in the gloves made by earlier manufacturers, experts speculate. Also, 90 percent of the gloves were used with powder, which transports latex particles through the air.

Now, it has been estimated that more than a million healthcare workers have developed latex allergies in the United States, said Kristi K. Miller, MS, RN, a latex allergy clinical nurse specialist for Allina Health System in Minnetonka, Minn. NIOSH prevalence reports indicate that from 8 to 12 percent of regularly exposed healthcare workers have latex allergies, although they don’t always exhibit symptoms. And symptoms—which include hives and itching, runny nose, scratchy throat, and asthma—can progress so that they occur when a person is inhaling latex particles rather than through direct contact. Although it’s rare, anaphylactic shock can occur also. Many people have milder dermatitis reactions to latex that don’t qualify as latex allergies, but may be a step toward the full-fledged allergy. The reactions cause poison ivy-like rashes on the part of the body that has come in contact with latex (usually hands).

Among health workers, 5 to 16 percent with latex allergies may have to leave healthcare work entirely. However, employers that are able to change to low-allergen, non-powdered or non-latex gloves may be able to save the careers of latex-sensitive nurses, Miller said. Latex allergies can cost the healthcare system anywhere from $20,000 to $250,000 per case in workers compensation costs and lost productivity, she said. "We’re losing the value of good people from the bedside that don’t want to leave," she said.

In the ’90s, physicians are more likely to recognize and diagnose latex allergies. And health workers, who have become more aware of the problem, are seeking help instead of ignoring symptoms, Miller said. "You want to diagnose it because it will affect your health for the rest of your life," Miller said.

Health workers can protect themselves from latex exposure and allergy in the workplace by using non-latex gloves for activities that don’t involve contact with infectious materials, using powder-free gloves with reduced protein content when handling infectious materials, and making sure good housekeeping practices are used to remove latex-containing dust from the workplace.

Back injuries

Long before the emergence of HIV or widespread latex allergies, nurses were suffering back and other musculoskeletal injuries. Even with the introduction of sturdier, easier-to-use and more comfortable assistive devices in the last 10 years, back injuries still rank as the leading cause of disability and career loss, said Bernice Owens, PhD, RN, an expert from the University of Wisconsin-Madison School of Nursing.

"The problem with a back injury is that it’s a cumulative trauma. Very seldom is it the result of doing just one thing. Nurses will say, ‘I’ve done it this way for years and I’m OK.’ What they don’t realize is there is damage over time," Owens said.

The health workers most at risk for back injuries are nursing assistants who work in home care and nursing homes, Owens said. Home care aides usually work alone in a place that was not set up for the provision of health care. "You’ve got low beds and confined workspace and carpeting to deal with when trying to use a mechanical lift," she said. At nursing homes, staffing is low and aides have to perform a lot of ADLs for people who can’t care for themselves, she said.

In hospitals, critical care and med/surg nurses suffer the most back injuries. When staff is cut, or the educational level of staff is lowered through restructuring, injuries to all health workers increase substantially, Owens said. Between 1990 and 1994, injuries to RNs, LVNs, unlicensed assistive personnel, and other personnel increased more than 50 percent at 12 hospitals in Minnesota that had downsized, according to the Minnesota Nurses Association.

Owens said besides using assistive devices to reduce the risk of injuries, nurses should give patients time to help themselves instead of lifting them automatically. "Many nurses think that backaches are just part of the job. We have to get beyond that attitude. We do have a right to go home without back pain."

Take care of yourself

Certain situations—especially emergencies—may preclude proper safety precautions, said certified occupational health nurse Maria Gabriel, RN, a member of the National Safety Council’s occupational health nurses advisory committee. "Your goal is to take care of the person right away. You don’t stop to think, ‘Let’s make sure I lift the patient correctly,’ " Gabriel said. "You try very hard to do the right thing, but everybody’s human."

In any sector of today’s bottom-line oriented healthcare industry, protecting yourself from injury is challenging, said certified occupational health nurse Teresa Emig, RN, chair of the National Safety Council’s advisory committee. And employers and employees must share the blame, she said. Some employers are pushing the limits when it comes to the number of employees needed to do a job safely, Emig believes. Meanwhile, some employees are too willing to put up with it. "We’re so willing and ready to help that I think we neglect ourselves sometimes," she said.

In the long run, that attitude won’t help anyone, said Eleanor Vogt, PhD, RPh, senior fellow at the National Patient Safety Foundation. "We have to work at creating a safe environment for everyone. Otherwise, the workers will find themselves becoming patients really quickly."

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Related Web sites

International Healthcare Worker Safety Center

National Institute of Occupational Safety and Health

American Association of Occupational Health Nurses

Allina Health System