Effectiveness of a workplace risk assessment team in reducing the rate, cost, and duration of occupational injury

This study evaluated the effectiveness of a consultative workplace risk assessment team in reducing the rate and severity of injury among cleaners within a 600-bed hospital. Cohorts of Cleaning Services and Orderly Services staff ever employed within both a 4-year preintervention and a 3-year postintervention period were assigned to the intervention and comparison groups, respectively. The date, compensation claims' cost, and hours lost from work were obtained for each injury during the study period. Age, gender, work experience, and hours worked were ascertained for every subject whether injured or not. Reductions of two thirds in injury rate, 73% in cost rate, and 43% in duration rate were evident in the intervention group. In comparison, the orderlies experienced a postintervention increase in all three rates. The success of the workplace risk assessment team intervention supports the adoption of a participatory approach to reducing the rate and consequence of workplace injury.     

Informal jobs and non-fatal occupational injuries

OBJECTIVES: In Brazil, workers without a formal job contract represent approximately half of the labor force but there are no official statistics on occupational injuries for them. This study estimates the annual incidence of non-fatal work-related injuries for workers with and without job contracts and examines gender differences. METHODS: This is a community-based study carried out with a random cluster area sample of the residents of Salvador, a city with 2.7 million inhabitants, the capital of the state of Bahia, northeast Brazil. Individuals from 18 to 65 years of age who reported having a paid job comprise the study population (n=2907). Data were obtained in individual household interviews with questionnaires applied by trained field workers. RESULTS: The overall estimated annual incidence rate (IR) was 5.6/100 full-time equivalent workers (FTE). The incidence of injuries differed between workers with informal (IR=6.2/100 FTE) and formal jobs (IR=5.1/100 FTE), and according to gender (IR=5.8/100 FTE for female and 5.5/100 FTE for male), but these differences were not statistically significant. Statistically significant positive associations between informal jobs and non-fatal work injuries were observed among women with medium education [incident rate ratio (IRR) 2.02, 95% CI 1.00-4.00] and women with black skin (IRR 1.71, 95% CI 0.99-2.97) who perceived a job as dangerous (IRR 2.00; 95% CI 1.09-3.64) or who had no occupational training (IRR 2.08; 95% CI 1.05-4.20). CONCLUSIONS: This study shows that non-fatal work injuries are a common health problem among adults in urban Brazil, regardless of the type of job contract or gender, which points to a need to improve workers' health and safety programs for formal and informal hired workers.     

Implementing participatory ergonomics teams among health care workers

Three participatory ergonomics teams have been established among healthcare workers in a metropolitan medical center. Three teams, consisting of orderlies, intensive care unit nurses, and laboratory workers, were selected to provide a diversity of work activities and educational backgrounds. The effectiveness of these teams was assessed by observations of team interactions, by team members' perceptions of their effectiveness, and by the teams' success in identifying problems and implementing solutions. After 1 year, one of the three groups has been highly effective by these measures. To varying degrees, the groups encountered competing time demands and obstacles in implementing solutions within current administrative structures. For some groups of health care workers, participatory ergonomics teams seem to be an effective strategy to improve health and safety. This approach may not be feasible in all areas of health care, especially in high-demand clinical areas where patient needs may take precedence over the safety of health care workers. Am. J. Ind. Med. 32:190-196. © 1997 Wiley-Liss, Inc.     

Agricultural injury in California migrant Hispanic farm workers

BACKGROUND: Agriculture is among the most hazardous industries in the United States. METHODS: A longitudinal study of injury among migrant Hispanic farm workers residing in six Northern California Migrant Family Housing Centers (MHCs) during the 1997 harvest season was conducted. Participants completed an initial interviewer-administered work-and-health questionnaire at the beginning of the harvest season addressing the preceding year; there were three periodic follow-up surveys. RESULTS: There were 1,201 adult farm workers (participation 85.2%) who completed the initial questionnaire. Of these, 837 (69.7%) completed the final follow-up survey. There were 86 agricultural injuries (incidence 9.3/100 full-time equivalent employees (FTEs), 95% CI 7.5-11.5/100 FTE). Increased risk for agricultural injury occurred among women paid piece-rate (RR 4.9, 95% CI 1.8-12.8). Sprains and strains were most common (31%), followed by lacerations (12%). CONCLUSIONS: Agricultural injury experience in this cohort is comparable to that of agricultural workers in other U.S. settings. Increased risk among women paid piece-rate suggests further study and potential policy changes regarding payment regimens. Heterogeneity of injury in this population presents a major prevention challenge. In view of high frequency of strain and sprain injuries, ergonomic interventions deserve further study.     

Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers

Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR = 0.814; 95% CI = 0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR program for direct care health workers, especially in small hospitals.     

Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers.

OBJECTIVE: To compare the percutaneous injury rate associated with a standard versus a safety resheathable winged steel (butterfly) needle. DESIGN: Before-after trial of winged steel needle injuries during a 33-month period (19-month baseline, 3-month training, and 11-month study intervention), followed by a 31-month poststudy period. SETTING: A 1,190-bed acute care referral hospital with inpatient and outpatient services in New York City. PARTICIPANTS: All healthcare workers performing intravascular-access procedures with winged steel needles. INTERVENTION: Safety resheathable winged steel needle. RESULTS: The injury rate associated with winged steel needles declined from 13.41 to 6.41 per 100,000 (relative risk [RR], 0.48; 95% confidence interval [CI95], 0.31 to 0.73) following implementation of the safety device. Injuries occurring during or after disposal were reduced most substantially (RR, 0.15; CI95, 0.06 to 0.43). Safety winged steel needle injuries occurred most often before activation of the safety mechanism was appropriate (39%); 32% were due to the user choosing not to activate the device, 21% occurred during activation, and 4% were due to improper activation. Preference for the safety winged steel needle over the standard device was 63%. The safety feature was activated in 83% of the samples examined during audits of disposal containers. Following completion of the study, the safety winged steel needle injury rate (7.29 per 100,000) did not differ significantly from the winged steel needle injury rate during the study period. CONCLUSION: Implementation of a safety resheathable winged steel needle substantially reduced injuries among healthcare workers performing vascular-access procedures. The residual risk of injury associated with this device can be reduced further with increased compliance with proper activation procedures.     

Fatal occupational injuries among electric power company workers

Surveillance data suggest high rates of electrocutions and fatal falls among workers in electric utility companies, who may be exposed to electric current, heights, flammable agents, and frequent motor vehicle travel. To characterize the occurrence of fatal injuries among electric utility workers, we studied workers in five electric power companies in the United States. A cohort of 127,129 men hired between 1950 and 1986 was followed through 1988. Injuries at work were identified through manual review of death certificates. The occurrence of occupational injuries was analyzed with directly adjusted rates and Poisson regression. The overall rate of fatal occupational injuries was 13.20 per 100,000 person‐years (n = 192), with 76% due to electric current, homicide, and falls from heights. Deaths were concentrated in a few groups with elevated injury rates, notably linemen (rate ratio (RR) 3.33), electricians (RR 2.79), and painters (RR 3.27). Occupations requiring daily work on elevations or frequent, direct contact with energized electrical equipment experienced markedly higher rates of fatal injury from falls and electrocutions with rate ratios of 21.8 (95% confidence interval (CI) 11.4–41.5) and 16.7 (95% CI 6.6–42.6), respectively, independent of worker age and seniority. Although fatal injury rates in this industry have declined in recent decades, significant numbers of deaths still occur. Based on the premise that all injuries are preventable, a need for continued vigilance and efforts at prevention is indicated. Am. J. Ind. Med. 35:302–309, 1999. © 1999 Wiley‐Liss, Inc.     

The effect of training for a participatory ergonomic intervention on physical exertion and musculoskeletal pain among childcare workers (the TOY project) – a wait-list cluster-randomized controlled trial

ObjectiveMany employees have high physical exertion at work and suffer from musculoskeletal pain (MSP) leading to sickness absence with large costs. Participatory ergonomics is a potentially effective intervention for reducing physical exertion, MSP and sickness absence. The main aim of this study was to investigate the effectiveness of a 20-week workplace participatory ergonomic intervention among childcare workers on physical exertion and MSP.MethodsIn a two-arm cluster-randomized trial, 190 workers were recruited from 16 childcare institutions and randomly assigned to either a 20-week participatory ergonomics intervention consisting of three training workshops or a control group receiving usual care. Primary outcomes were physical exertion during work, maximal pain intensity, number of pain regions, and pain-related work interference. Secondary outcomes were MSP-related sickness absence, need for recovery (NFR), employee involvement, and self-efficacy. We followed the intention-to-treat principle and adhered to the registered study protocol (ISRCTN10928313).ResultsAfter 20 weeks, half the workers noticed some positive changes in their work. However, there were no statistically discernible effects in physical exertion, maximum pain intensity, pain-related work interference, or number of pain regions. We found a significant reduction of MSP-related sickness absence in the intervention compared to the control group [-0.48 days per month (95% confidence interval (CI), -0.8– -0.1]. We found no significant effects in NRF or involvement of employees, but self-efficacy was reduced in the intervention compared to the control group [-0.2 (95% CI, -0.3– -0.0)].ConclusionThis 20-week training for a participatory ergonomic intervention in childcare workers did not show effects on physical exertion and MSP, but was both feasible and effective in reducing MSP-related sickness absence.     

Occupational fatalities of Hispanic construction workers from 1992 to 2000

BACKGROUND: Hispanic construction employment has dramatically increased, yet published data on occupational risk is lacking. METHODS: Data from the Census of Fatal Occupational Injuries (CFOI) and current population survey (CPS) were examined from 1992 to 2000. Fatality rate, relative risk (RR), and risk index were calculated using CFOI fatality data and CPS data on hours worked, adjusted to full-time-equivalents (FTE). Data between 1996 and 2000 were combined to allow reliable comparisons of age and occupational groups. RR and 95% confidence intervals were calculated. RESULTS: In 2000, Hispanics constituted less than 16% of the construction workforce yet suffered 23.5% of fatal injuries. RRs were: helpers, construction trades, 2.31 (95% CI: 1.41-3.80); roofers 1.77 (95% CI: 1.38-2.28); carpenters 1.39 (95% CI: 1.08-1.79); and construction laborers 1.31 (95% CI: 1.17-1.46). CONCLUSIONS: Hispanic construction workers consistently faced higher RRs, for every year from 1992 to 2000 and for every age group. In 2000, Hispanic construction workers were nearly twice (1.84, 95% CI: 1.60-2.10) as likely to be killed by occupational injuries as their non-Hispanic counterparts.     

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.     

Use of safety devices and the prevention of percutaneous injuries among healthcare workers.

OBJECTIVE: To study the effectiveness of safety devices intended to prevent percutaneous injuries.Design. Quasi-experimental trial with before-and-after intervention evaluation. SETTING: A 350-bed general hospital that has had an ongoing educational program for the prevention of percutaneous injuries since January 2002. METHODS: In October 2005, we implemented a program for the use of engineered devices to prevent percutaneous injury in the emergency department and half of the hospital wards during the following procedures: intravascular catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood sampling, and intramuscular and subcutaneous injections. The nurses in the wards that participated in the intervention received a 3-hour course on occupationally acquired bloodborne infections, and they had a 2-hour "hands-on" training session with the devices. We studied the percutaneous injury rate and the direct cost during the preintervention period (October 2004 through March 2005) and the intervention period (October 2005 through March 2006). RESULTS: We observed a 93% reduction in the relative risk of percutaneous injuries in areas where safety devices were used (14 vs 1 percutaneous injury). Specifically, rates decreased from 18.3 injuries (95% confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients in the emergency department (P=.002) and from 44.0 injuries (95% CI, 20.1-83.6 injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days in hospital wards (P=.007). In the control wards of the hospital (ie, those where the intervention was not implemented), rates remained stable. The direct cost increase was 0.558 euros (US$0.753) per patient in the emergency department and 0.636 euros (US$0.858) per patient-day in the hospital wards. CONCLUSION: Proper use of engineered devices to prevent percutaneous injury is a highly effective measure to prevent these injuries among healthcare workers. However, education and training are the keys to achieving the greatest preventative effect.     

Work organization and musculoskeletal injuries among a cohort of health care workers

OBJECTIVES: This study investigated the relationship between work-organization factors (job control, job demands, and workload measures) and the risk of lower-body musculoskeletal injury among health care workers. METHODS: A four-year, retrospective cohort study of 3769 health care workers was carried out in one acute care hospital in the Canadian province of British Columbia. A job-exposure matrix was constructed for the work-organization factors from survey and administrative data and assigned to workers on the basis of their occupation and department of employment. Musculoskeletal injuries resulting in workers' compensation claims were ascertained from the injury database of the hospital's Occupational Health and Safety Department. RESULTS: In the final Poisson models adjusted for demographic and biomechanical factors, an increased risk for compensated musculoskeletal injuries of the lower back and lower limb was related to low job control [relative risk (RR) 1.64, 95% confidence interval (95% CI) 1.08-2.49] and workload defined by working during periods of high absenteeism within a department (RR 2.10, 95% CI 1.61-2.98). The risk also increased with more biomechanical demands in an occupation and with a recent previous injury. CONCLUSIONS: The results indicate that work-organization characteristics (job control and workload) were associated with an increased risk of musculoskeletal injuries resulting in a compensation claim. These associations remained after the effect of demographic and biomechanical factors was taken into consideration. The association with workload measured by departmental levels of absenteeism should be explored further in future studies as reverse causality (musculoskeletal symptoms resulting in absenteeism) could not be fully ruled out in the current study.     

Severe injury among Hispanic and non-Hispanic white children in Washington state

OBJECTIVES: The authors' anecdotal experience at a regional Level I trauma center was that Hispanic children were overrepresented among burn patients, particularly among children with burns due to scalding from hot food. This study describes injury incidence and severity among Hispanic and non-Hispanic white infants, children, and adolescents with serious traumatic injuries in Washington State. METHODS: Data from the Washington State Trauma Registry for 1995-1997 were used to identify injured individuals aged < or = 19 years. Ratios of overall and mechanism-specific injury incidence rates for Hispanic children relative to non-Hispanic white children were calculated using denominator estimates derived from U.S. Census Bureau population data. Hispanic children and non-Hispanic white children were also compared on several measures of severity of injury. RESULTS: In 1995-1997, serious traumatic injuries were reported to the Registry for 231 Hispanic children aged < or = 19 years (rate: 54 per 100,000 person-years) and for 2,123 non-Hispanic white children (56 per 100,000 person-years), yielding an overall rate ratio (RR) of 1.0 (95% confidence interval [CI] 0.8, 1.1). Motor vehicle crashes and falls accounted for one-third to one-half of the injuries for each group. Infants, children, and adolescents identified as Hispanic had higher rates of injuries related to hot objects (i.e., burns) (RR=2.3; 95% CI 1.3, 4.1), guns (RR=2.2; 95% CI 1.5 to 3.3), and being cut or pierced (RR=3.5; 95% CI 2.2 to 5.5). The Hispanic group had a lower injury rate for motor vehicle accidents (RR=0.7; 95% CI 0.5, 0.9). Mortality rates were similar (RR=1.1; 95% CI 0.7, 1.7). The mean length of hospital stay was 5.5 days for the Hispanic group and 8.8 days for the non-Hispanic white group (difference=3.3 days; 95% CI -0.7, 7.4). CONCLUSIONS: The study found little difference between Hispanic and non-Hispanic white infants, children, and adolescents in the burden of traumatic pediatric injury. However, burns, guns, drowning, and being pierced/cut appeared to be particularly important mechanisms of injury for Hispanic children. More specific investigations targeted toward these injury types are needed to identify the underlying preventable risk factors involved.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study

ABSTRACT: BACKGROUND: Injuries to working age adults are common and place a considerable burden on health services accounting for more than 10% of GP sick notes and 14% of those claiming benefits because they are unable to work in the UK. General practitioners (GPs) currently assess fitness to work and provide care and referral to other services to facilitate return to work (RTW). Recent UK recommendations suggest replacing GP sickness certification with independent assessments of fitness to work after four weeks sick leave. The impact of a wide range of injuries on RTW and subsequent need for independent fitness to work assessments has not been well studied in the UK. The aim of this study was to quantify RTW and factors predicting RTW following a wide range of injuries. METHODS: We used a multicentre longitudinal study, set in four acute NHS Trusts in the UK which recruited emergency department (ED) attenders and hospital admissions for injury and included those aged 16-65years that were employed or self-employed before the injury. Participants were followed up by postal questionnaire at 1, 4 and 12 months post injury to measure health status (EQ-5D), recovery, use of health and social services, time off work in the preceding month and work problems amongst those who had RTW. Multivariable Poisson regression with a robust variance estimator was used to estimate relative risks for factors associated with RTW. RESULTS: One month after injury 35% of ED attenders had fully RTW. The self employed were more likely (RR 1.70, 95% CI 1.17 to 2.47 compared with employed) and the moderate/severely injured less likely to RTW (RR 0.48, 95% CI 0.32 to 0.72 compared with minor injuries). At four months, 83% of ED attenders had RTW and self employment and injury severity remained significant predictors of RTW (self employment RR 1.15, 95% CI 1.03 to 1.30; moderate/severe injury RR 0.79, 95% CI 0.68 to 0.92). At four months 57% of hospital admissions had RTW. Men were more likely than women to RTW (RR 1.94, 95% CI 1.34 to 2.82), whilst those injured at work (RR 0.49, 95% CI 0.27 to 0.87 compared with at home) and those living in deprived areas (most deprived tertile RR 0.59, 95% CI 0.40 to 0.85 and middle tertile RR 0.61, 95% CI 0.40 to 0.93) were less likely to RTW. Health status was significantly poorer at one and four months after injury than before the injury and was significantly poorer amongst those that had not RTW compared to those that had. Problems with pain control, undertaking usual activities, mobility and anxiety and depression were common and persisted in a considerable proportion of participants up to four months post injury. CONCLUSIONS: Injuries have a large impact on time off work, including amongst those whose injuries did not warrant hospital admission. The majority of injured people would require an in-depth fitness for work assessment if recent UK recommendations are implemented. Many people will have on-going pain, mobility problems, anxiety and depression at the point of assessment and it is important that patients are encouraged to use primary care services to address these problems. A range of factors may be useful for identifying those at risk of a slower recovery and a delayed RTW so that appropriate interventions can be provided to this group.     

Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace

BACKGROUND: Health care workers incur frequent injuries resulting from patient transfer and handling tasks. Few studies have evaluated the effectiveness of mechanical lifts in preventing injuries and time loss due to these injuries. METHODS: We examined injury and lost workday rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities, and surveyed workers regarding lift use. RESULTS: The post-intervention period showed decreased rates of musculoskeletal injuries (RR = 0.82, 95% CI: 0.68-1.00), lost workday injuries (RR = 0.56, 95% CI: 0.41-0.78), and total lost days due to injury (RR = 0.42). Larger reductions were seen in LTC facilities than in hospitals. Self-reported frequency of lift use by registered nurses and by nursing aides were higher in the LTC facilities than in acute care hospitals. Observed reductions in injury and lost day injury rates were greater on nursing units that reported greater use of the lifts. CONCLUSIONS: Implementation of patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings. Strategies to facilitate greater use of mechanical lifting devices should be explored, as further reductions in injuries may be possible with increased use.     

Traumatic Injury Rates in Meatpacking Plant Workers

ABSTRACT

This was a 3-year retrospective cohort study of traumatic injuries in a midwestern pork meatpacking plant. Based on n = 5410 workers, this was a diverse workforce: Caucasian (56.6%), Hispanic (38.9%), African American (2.7%), Asian (1.1%) and Native American (0.8%). There were n = 1655 employees with traumatic injuries during this period. At 6 months of employment, the probability of injury was 33% in the harvest workers who were responsible for slaughter operations. The overall incidence injury rate was 22.76 per 100 full-time employees per year. Women experienced a higher incidence for injury than men. The risk ratio (RR) for traumatic injury was significantly lower in Hispanic workers compared to Caucasians (RR = 0.54, 95% CI = 0.49–0.60) and nonsignificantly higher in African American and Native American workers after adjusting for age, gender, work section assignment, and experience (RR = 1.33, 95% CI = 1.21–1.47). These findings suggest that either Hispanics are very safe employees or they underreport injuries. We make the case for the latter in the discussion.     

Assessment of occupational eye injury risk and severity: an analysis of Rhode Island workers' compensation data 1998-2002

BACKGROUND: Occupational eye injuries have been recognized as a serious health risk to workers and are in need of further investigation to develop effective interventions. METHODS: Rhode Island workers' compensation claims of ocular injury between 1998 through 2002 (n=8,877) were examined. The Current Population Survey was used to estimate occupational employment levels as a baseline for rate calculations. RESULTS: The estimated ocular injury claim rate was 32.9 per 10,000 workers (95% CI=32.3-33.6), with the cost of claims totaling $1,514,666 and averaging $171 per claim. The highest estimated claim rate of all occupations was found for construction laborers of 373.7 per 10,000 workers (95% CI=267.1-480.3). Relative to the durable manufacturing industry, the highest risk of injury resulting in disability indemnification was the wholesale trade industry (OR=2.18, 95% CI=1.19-4.01, P<0.05). CONCLUSIONS: Many of the eye injuries reported were likely preventable. Greater diligence, training, and safety precautions are needed to reduce the risk of eye injury to employees.     

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.     

Adverse work and environmental conditions predict occupational injuries. The Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study.

This study was designed to test whether the total objective adverse work and environmental conditions, expressed as the ergonomic stress level (ESL), would predict occupational injuries over a 2-year period. The study population consisted of 4,096 men from 21 factories in six industrial sectors who were studied as part of the Israeli Cardiovascular Occupational Risk Factors Determination in Israel (CORDIS) Study, 1985-1987. The ESL (assigned four levels, 1-4) was based on an ergonomic assessment which covered 17 risk factors pertaining to safety hazards, overcrowding, cognitive and physical demands, and environmental stressors. The ESL was found to be a highly reliable measure and stable over a period of 2-4 years. The incidence of injuries among workers in low ESL conditions (level 1) was 10.3%. It increased with higher ESL's: 11.7% in level 2 (relative risk (RR) = 1.13, 95% confidence interval (CI) 0.86-1.50); 21.6% in level 3 (RR = 2.09, 95% CI 1.68-2.62); and 23.8% in level 4 (RR = 2.31, 95% CI 1.85-2.88). After adjustment for age, job experience, educational level, managerial status, and occupational status (white/blue collar), injury occurrence was significantly elevated for those at level 3 (adjusted odds ratio (OR) = 1.46, 95% CI 1.12-1.91) and level 4 (adjusted OR = 1.81, 95% CI 1.39-2.37) but not for level 2 (adjusted OR = 0.87, 95% CI 0.65-1.18). The authors conclude that adverse work and environmental conditions, objectively assessed, can predict occurrence of occupational injuries.