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May 1999
IN THIS ISSUE
Health care workers know that they face serious hazards to their own health and well-being in the course of their jobs. As our country looks at the effects of managed care on the quality of care and the need to protect patients’ rights, the rate of injuries and illnesses suffered by health care workers on the job continues to rise. Little attention, however, is paid to this problem by employers and lawmakers. In 1997, more than 650,000 injuries were reported among the nation’s 9.5 million health care workers. With an incident rate of 16 injuries per 100 full-time workers, nursing and personal care facilities report the highest incident rate of any occupation. As alarming as these numbers may seem, the problem is even bigger, as many workers do not report injuries out of fear of losing their jobs or other retaliation. In this issue of Health Focus, we look at various health and safety hazards faced by health care workers and how AFSCME is fighting for needed protections. The last issue of Health Focus discussed the relationship between staffing and quality of patient care. But staffing also directly affects the safety of health care workers at work. Staffing shortages in health care facilities, for example, often mean that workers must work alone, thereby leaving them more vulnerable to attack by patients. In fact, health care patients were responsible for 43% of all injuries and illnesses resulting from violence in the workplace in 1997. The risk of violence is exacerbated by the change in patient mix being experienced by many facilities. More violent criminals, for example, are being sent to psychiatric facilities. Hospitals are discharging patients to nursing homes "quicker and sicker" and therefore requiring more attention and care. There are also more younger, disabled residents in nursing homes. Such changes in the patient mix require additional staff if workers’ safety, as well as quality of care, is to be protected. But few facilities have hired the needed workers. Nurses and nurses aides also have among the highest back injury rate of any occupation, with back injuries accounting for 43% of all nursing home injuries. Again, staffing shortages play a significant role in this problem, as many back injuries are caused by moving or assisting patients alone -- often because of a staffing shortage and/or lack of a lifting device. At the local level, AFSCME affiliates can fight for increased staff in their facilities. AFSCME Local 289, for example, is fighting staffing shortages at Evansville State Hospital in Indiana. According to the state Workers Compensation Board, three workers at Evansville reported missing work because of injuries from patients. According to the State’s Division of Mental Health, four staff suffered injuries from patients and 27 incidents of "behavior management" were reported. At the federal level, AFSCME is working with the Health Care Financing Administration (HCFA) and advocates to address the low staffing levels and inadequate training that are making our nation’s nursing homes unsafe for both residents and workers. AFSCME also has been involved with HCFA’s efforts to revise the "Conditions of Participation" (CoPs) which intermediate care facilities for the mentally retarded (ICF/MRs) must meet in order to get federal Medicaid funds. AFSCME has studied HCFA’s proposal and consulted with HCFA staff, met with local leaders to discuss staffing needs, and submitted comments to HCFA. We are pushing HCFA to adopt regulations which would require increased staffing as a CoP. It will likely take 2-3 years for a new set of ICF/MR regulations to be issued. AFSCME will continue to provide input during the regulatory process. It is estimated that approximately one million accidental needlestick injuries occur each year, although the number is undoubtedly much higher, since most needlesticks go unreported. Needlesticks can expose workers to deadly bloodborne illnesses. Roughly 18,000 health care workers contract hepatitis B or C annually, and 250 to 300 die each year as a result. As many as 75 health care workers contract HIV each year. Life saving needles with integrated safety features that can protect health care workers do exist. Such needles can cost 30 cents apiece, as compared with 6-7 cents for regular needles, and only a few hospitals or other health care facilities have begun using or even evaluating use of the new needles. And although the Food and Drug Administration (FDA) has approved some 250 safety needles and devices, regulatory agencies are not requiring their use. In 1986, when the HIV/AIDS epidemic was emerging and some 17,000 health care workers were becoming infected with hepatitis B each year, AFSCME petitioned OSHA for a standard to protect workers from exposure to bloodborne pathogens. OSHA issued the Blood Borne Pathogen (BBP) rule in 1991, which requires that workers be afforded various personal protective measures and that employers provide workers at risk of exposure with a hepatitis B vaccine. The vaccine is largely responsible for a 95% decline in the rate of hepatitis B infection among health care workers, saving approximately 300 lives each year.
However, the BBP standard does not go far enough to prevent needlesticks and other injuries which can expose workers to HIV/AIDS, hepatitis C and other illnesses. Therefore, AFSCME is working in coalition with other unions and interested parties to secure legislation at the state and federal levels which would require the use of needles and other medical devices with built-in safety features. AFSCME helped to get such a law passed in California and we are working on similar legislation in other states. Hepatitis C: The Next Epidemic Hepatitis C threatens to be the next health care epidemic. Indeed, it is expected that the disease will soon become a more significant cause of death in California than AIDS. Hepatitis C is an infection of the liver which is caused by the hepatitis C virus (HCV). Symptoms range from loss of appetite, nausea and vomiting to fatigue, abdominal and joint pain, fever and jaundice. Infected people may not experience any symptoms, however, and many do not know they have the disease. Chronic hepatitis C can cause cirrhosis (hardening and shrinking of liver tissue), end-stage liver disease and cancer. The disease can be fatal. HCV is primarily transmitted through direct blood-to-blood contact. For health care workers, contaminated needles and syringes cause the bulk of infections. The virus can be detected through a simple blood test, although often it is necessary to confirm test results with a more thorough assay or liver biopsy. Unlike hepatitis A or B, however, no vaccine exists to prevent hepatitis C. And unlike hepatitis B, there is no drug to prevent infection after exposure.
Although no one knows why, about 15% of those infected with HCV spontaneously eradicate the virus without treatment. The rest eventually develop chronic hepatitis C. While there is no comprehensive treatment, the drug "interferon alfa" may be effective in about 25% of patients. Adding a second drug (ribavirin or Virazole) in clinical trials increased the success rate to 31-38%. Interferon can have debilitating side effects--flu-like symptoms, fatigue, bone marrow suppression, cognitive changes and depression. Ribavirin can cause anemia and birth defects. In the 1980’s the United States experienced a resurgence of tuberculosis (TB) as well as the emergence of a strain of TB which is resistant to multiple drugs. Many factors were responsible for this catastrophy, including the dismantling of the public health infrastructure and a rising number of people with weakened immune systems due to HIV infection. In 1993, a labor coalition led by AFSCME petitioned OSHA to issue a standard to protect workers from occupational exposure to TB. Hearings were finally held in 1997, at which AFSCME presented 20 witnesses and submitted a survey on TB infection control practices in workplaces covering 100,000 workers. AFSCME is urging the agency to require and enforce compliance with the Centers for Disease Control and Prevention (CDC) guidelines to prevent TB exposure, which would require health care facilities to conduct an exposure assessment, to identify and isolate confirmed and suspected cases of TB in a timely manner, to isolate rooms under negative pressure, and to provide respirators, training, and skin testing. Despite having raised this issue with OSHA six years ago, however, we are still waiting for the agency to issue a final rule. Back Injuries, Carpal Tunnel and Other Work-Related Musculoskeletal Disorders Back injuries, carpal tunnel syndrome and other work-related musculoskeletal disorders (WMSDs) account for over a third of all reported serious injuries, affecting more than 650,000 American workers each year. Nurses and nurses aides also have among the highest back injury rates of any occupation due to lifting and moving patients. WMSDs cost employers an estimated $15-20 billion in direct, workers compensation costs alone. But the scope of the problem is actually much worse, since many workers do not report injuries for fear of retaliation. Following 8 years of intense resistance by employer groups and their allies in Congress, OSHA finally issued a draft proposal of its ergonomics standard this past February. As required under law, the agency is now conferring with small businesses before it can publish a proposed rule and begin the formal rulemaking process. The draft outlines six basic elements of an ergonomics program, which certain employers will have to develop: Management Leadership and Employee Participation; Hazard Identification & Information; Job Hazard Analysis and Control; Training; Medical Management; and Program Evaluation. OSHA plans to issue a final rule in the year 2000. The proposed rule is a positive development, but it needs to be strengthened. The rule would cover workplaces in which employees perform lifting operations -- which would include health care facilities, where many patients must be lifted and moved -- as well as manufacturing plants. However, in other workplaces, employers would not be required to take any proactive measures to prevent injuries, unless a worker reported experiencing problems, for example a data entry clerk complaining of hand and/or wrist pain. Help in the Fight for a Strong OSHA Ergonomics Standard AFSCME will be actively participating in the rulemaking process to secure a standard that will protect all of our members. We will need to submit examples of AFSCME members who have been injured at work because of ergonomic hazards. As important, we will need to submit examples of successful ergonomics programs that have reduced the number of injuries. If you have information that we can use or have further questions on ergonomics, call James August at 202-429-1228 or send an e-mail to jaugust@afscme.org. Meanwhile, we will need to fight for a strong ergonomics standard on another front. Rep. Blunt (R-MO) has introduced a bill, called the "Workplace Preservation Act," which would do nothing of the sort. What the bill would do is prevent OSHA from issuing a final ergonomics rule until that National Academy of Sciences (NAS) completes a new study and submits it to Congress. But we don’t need a new study. The NAS has already issued a report, which concluded that workplace ergonomic hazards cause musculoskeletal disorders, and that effective preventive measures have been demonstrated. Just 10 years ago, latex allergies were almost unheard of. Yet today, 10 - 21% of the nation’s 8.8 million health care workers, and 1-3% of the population at large, have this allergy. The sharp rise in reported allergies stems from a sevenfold increase in the use of latex gloves since 1987, when the Centers for Disease Control and Prevention began recommending the use of latex gloves to protect against infection from HIV
Latex allergy is a reaction to certain proteins in latex rubber, which is found in most latex gloves as well as many medical, household, and other common products. An allergic reaction can be caused either by direct contact or by inhaling a powder which manufacturers sprinkle inside latex gloves to help them slip on to the hand easily. Allergic reactions range from skin rashes, hives and itching to mild and serious respiratory problems and even shock. Latex allergies can be fatal. No workers can consider themselves completely safe from this allergy, since the allergy can build up slowly, often beginning with a simple hand rash, which, complicating matters further, may or may not be caused by a latex allergy. Some people have no symptoms at all, until they find themselves suffering from serious respiratory problems or potentially-fatal shock. Many common items have latex in them, so once a person develops the allergy, routine activities can become difficult or even dangerous. Exacerbating this problem, there is no known cure, and the blood test most commonly used to diagnose the allergy is not very reliable. A skin prick test is currently being tested and is awaiting FDA approval Several state legislatures (IN, MN, NE, NY, OR, PA and WI) have introduced legislation to limit the use of latex gloves in hospitals and other health care settings. Glove makers have strongly resisted such legislation, however, and no important measures have become law. The FDA held a conference on latex allergies in 1992, but so far it has not issued any regulations other than a requirement that medical devices containing latex be labeled as a possible allergen. And while nonlatex gloves can be used as a substitute for many activities, hospitals claim that alternatives cost as much as 30% more than latex and only a few have either banned or restricted the use of latex gloves. (According to a professor at Johns Hopkins, which is becoming latex free, however, that hospital purchased stretch vinyl as a substitute in sufficient quantity that no increase in cost was incurred.) If latex gloves are used, they should be powder-free and have reduced protein content to minimize exposure. AFSCME Takes Violence Prevention to the Streets There are two million cases of workplace violence each year. Homicides are the second leading cause of death in the workplace and the leading cause of death for women. Health care patients caused 43% of all workplace violence injuries and illnesses in 1997, and those employed in medical and mental health occupations ranked fourth and fifth, respectively, for the number of violent victimizations in the workplace during the period 1992-96. There is a very dangerous myth that workplace violence is random and unpredictable, and therefore there isn’t anything we can do about it. The reality, however, is that most incidents are both predictable and preventable. And like any other workplace hazard, it is the employer’s responsibility to institute reasonable safety precautions and protocols. While some progress has been made on how to prevent violence in traditional workplace settings -- in 1996, for example, OSHA issued its Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers -- the myth that workplace violence is random, unpredictable and uncontrollable persists virtually unchallenged for one group of workers: community health care and social services workers who must travel to the neighborhoods and homes where their patients and clients live. AFSCME affiliates United Nurses Association of California (UNAC) and United Domestic Workers (UDW) have decided to lead the country in taking on this problem. Working with a state legislator in California, they have introduced a bill which would require employers of community health care and domestic workers to adopt various violence prevention measures which are recommended in the State’s Guidelines for Security and Safety of Health Care and Community Service Workers. For example, under the bill employers would be required to:
A Strong Local Union is the Key to a Safe Workplace In any industry, it is never too early to institute safety precautions. Dangerous conditions that can cause injuries, illnesses and fatalities must be corrected before tragedies happen. But worker safety laws are not strong enough and enforcement is inadequate, and management often fails to institute adequate measures on its own. Workers and their unions must take matters into their own hands and pressure their employers to ensure a safe workplace. Workers can bargain over protective measures and their enforcement during contract negotiations and through working on labor-management committees. These committees can examine the link between injuries and staffing, whether injuries occur more in some units or shifts more than others, and other safety factors, and can pressure the employer to employ safer procedures and equipment. Also, we all can call our state and federal representatives, particularly when legislation which either protects or threatens our safety is being considered. AFSCME members in New Jersey, for example, are fighting hard for a needlestick bill during this legislative session. For assistance on a wide variety of hazards faced by health care workers, contact AFSCME’s health and safety staff in the Research Department. | |||
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