Overexertion injuries in home health care workers and the need for ergonomics

Home health care workers have high rates of back injuries and other musculoskeletal problems. This article addresses issues surrounding work-related overexertion injuries in home health care workers, including summaries of relevant research on workers in home settings as well as in traditional health care settings such as hospitals and nursing homes. The main work factors associated with these injuries are forceful exertions and awkward postures during patient- care tasks, especially while lifting and moving patients. Ergonomics-the design of work tasks to best accommodate natural human capabilities-is the most promising approach for preventing injuries, and for enhancing the comfort and safety of workers and patients.     

Access to medical care for occupational disorders: difficulties and disparities

Despite state laws guaranteeing full insurance coverage for work-related disorders, many injured workers have difficulty obtaining access to appropriate medical care. Barriers to access arise because: patients are unable to prove that their conditions are caused occupationally; they are discouraged by employers from reporting occupational injuries; workers' compensation insurance carriers aggressively contest claims; and other reasons. Evidence suggests that minority subpopulations of workers are most affected. Overcoming these barriers will require a multifaceted approach involving regulatory oversight, participation of workers in the design of health plans and the selection of providers, and specific measures to detect and prohibit discriminatory care.     

Why most workers with occupational repetitive trauma do not file for workers' compensation

Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. All individuals were interviewed over the telephone using a standardized questionnaire. The questionnaire included questions about the precipitating event; demographics; health limitations; mood; pain level; and attitudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, standardized questions from previous surveys were used. The interviewed individuals with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease reporting law. Workers reported during 12 weeks in the spring of 1996 by a Michigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 reports received, 490 individuals could not be reached, 22 did not speak English, 12 had died or were too incapacitated by other medical conditions, and 581 refused. We interviewed 59% of all eligible workers and 73% of all workers who were reachable and capable of responding in English. Only 25% of workers diagnosed with musculoskeletal disease filed a workers' compensation claim. The factors significantly associated with filing a claim were (1) increased length of employment (> 21 years: odds ratio [OR], 3.01, 95% confidence interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34, 95% CI, 1.01 to 5.47; 6 to 10 years: OR, 1.76, 95% CI, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; < 1 year: OR, 1.00; (2) lower annual income (< $40,000: OR, 1.75, 95% CI, 1.06 to 2.88 vs > or = $80,000: OR, 1.00); (3) workers' dissatisfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician restrictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physician providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15, 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01; company physician: OR = 1.00); (6) off work > or = 7 days (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 0.82, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR, 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with a work-related problem is likely to file a workers' compensation claim. The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.     

Investigating the longer-term health consequences of work-related injuries among youth

PURPOSE: To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records. METHODS: A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors. RESULTS: Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location. CONCLUSION: Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.     

A survey of percutaneous/mucocutaneous injury reporting in a public teaching hospital

Our objective was to determine if healthcare workers were reporting all percutaneous and/or mucocutaneous injuries and to use such data to formulate appropriate interventions. The Infection Control Department distributed anonymous surveys of healthcare personnel between 1992 and 1995. The elicited information included the number of percutaneous and mucocutaneous injuries experienced and reported in the last five years and the reasons for not reporting every exposure when applicable. Five hundred and forty nine surveys were received, from physicians, dentists, registered nurses, licensed vocational nurses, nurses aides, and operating room technicians. Overall, of the 549 respondents, 45% (245) had no injuries, 30% (163) had been injured and had reported all injuries, and 26% (141) had not reported all injuries. Reasons for not reporting included sterile/clean needlestick (39%), little or no perception of risk to employee (26%), too busy (9%), and dissatisfaction with follow-up procedures (8%). Reasons stated for not reporting injuries indicate a need for continued education in the risk of acquiring blood-borne pathogens from such injuries. The results also illustrate the importance of targeting prevention efforts to specific groups, such as physicians, that would not be identified by routine reporting mechanisms.     

Occupational injury and disease among patients presenting to general practitioners in a community health centre

Abstract: A prospective survey was conducted of all patients presenting over a six-month period to the primary medical care unit of a community health centre in an urban industrial area to determine the number and types of work-related injuries and disease, the causes, and details of the injured workers and their workplaces. Two-hundred and eighty-three patients, 7.2 per cent of the total number of patients attending, were diagnosed as having a work-related injury or disease; 250 patients had occupational injuries and 33 had occupational diseases. The most common injuries were open wounds, sprains and strains, contusions and eye injuries; the most frequent diseases were musculoskeletal strain syndromes, dermatitis and respiratory conditions. Most of those injured were skilled tradesmen or labourers from small (less than 30 employees) or medium-sized (30 to 99 employees) manufacturing workplaces. In five of the local medium-sized workplaces, more than 10 per cent of the workforce presented with occupational injury or disease in the six months. The mechanisms of injury for common injuries such as back strain and eye injuries are described. Most patients were managed totally within the primary care setting. Thirty per cent of all patients surveyed received a worker's compensation certificate. It is possible that occupational diseases were underdiagnosed and that worker's compensation was underutilised. The information obtained from the survey is being used in planning prevention.     

Occupational injuries in Korea: a comparison of blue-collar and white-collar workers' rates and underreporting

This study was performed to determine the differences in occupational injuries and illnesses between white-collar and blue-collar workers and to estimate the magnitude of the underreporting of these injuries and illnesses in Korea. Two datasets were used. One was a cohort established in the Gyeongin area with workers who underwent mandated health examinations, and the other was the National Health Insurance (NHI) data of claims submitted by workers employed between 1999 and 2001. Workers were classified into two groups--white-collar and blue-collar workers--according to their job types and the type of health examination they received. Injury rates were calculated for white-collar and blue-collar workers. The differences in the incidences of musculoskeletal diseases or injury and poisoning between the two groups were regarded as unreported occupational injuries or illnesses. Thereafter, work-related injury rates were estimated. With regard to medical treatment for musculoskeletal diseases or injuries and poisonings covered by the NHI, blue-collar workers had 3.47 more cases per 100 person-years than white-collar workers. This translates into a rate of between 12.57 and 18.1 injured workers per million working hours. The injury rate was 2.74 to 3.29 injured workers and the incidence rate was 3.62 to 5.44 injuries and illnesses per hundred workers. The estimated occupational injury and illness rates in this study were likely to be two to three times higher than those officially reported. However, the limitations of the study should also be considered.     

Work-related pain and injury and barriers to workers' compensation among Las Vegas hotel room cleaners

OBJECTIVES: We examined the prevalence of work-related pain and injury and explored barriers to and experiences of reporting among workers. METHODS: We surveyed 941 unionized hotel room cleaners about work-related pain, injury, disability, and reporting. RESULTS: During the past 12 months, 75% of workers in our study experienced work-related pain, and 31% reported it to management; 20% filed claims for workers' compensation as a result of work-related injury, and 35% of their claims were denied. Barriers to reporting injury included "It would be too much trouble" (43%), "I was afraid" (26%), and "I didn't know how" (18%). An estimated 69% of medical costs were shifted from employers to workers. CONCLUSIONS: The reasons for underreporting and the extent of claim denial warrant further investigation. Implications for worker health and the precise quantification of shifting costs to workers also should be addressed.     

Chronic symptoms in construction workers treated for musculoskeletal injuries.

BACKGROUND: Soft tissue musculoskeletal injuries make up a high proportion of all work-related injuries in construction. Data from Workers' Compensation claims indicate that strains and sprains are the leading compensable injury for construction workers. This study describes the consequences of soft tissue musculoskeletal injuries for construction workers, and assesses the persistence of symptoms after an injury and the impact of that injury on return to work. METHODS: Through an Emergency Department surveillance system [Hunting et al., 1994a], we recorded 176 construction worker visits, from 5/01/93 through 2/28/95, for strains, sprains, joint injury or pain, tendinitis, dislocations, hernias, or other musculoskeletal injuries excluding fractures. Telephone interviews were conducted several months after workers had visited the emergency room for a musculoskeletal injury. RESULTS: Seventy individuals were interviewed about the long-term impacts of 72 incidents that had resulted in work-related musculoskeletal injuries. For 46 (62%) of the 74 diagnoses, problems continued beyond two months. The likelihood of problems continuing more than two months varied considerably by body location of injury. Hispanic workers and older workers were more likely to have continuing symptoms. Eleven of the 45 construction workers with symptoms persisting longer than two months were not employed at the time of the interview. Only 11 of the 45 workers with ongoing symptoms told us that modifications had been made to their jobs to accommodate their symptoms. About one-quarter of these 45 subjects reported substantial effects on home or work life. CONCLUSIONS: Acute musculoskeletal injuries in construction workers frequently result in chronic symptoms, and those with chronic symptoms report substantial effects of the injury on their quality of life. Job accommodations were made in a minority of these injuries. These findings point to the need for heightened efforts for injury prevention in this industry.     

Reason for Visit: Is Migrant Health Care That Different?

PURPOSE: The purpose of this pilot study was to determine the reasons for which migrant agricultural workers in Pennsylvania seek health care. METHODS: Participants were individuals 14 years of age and over, actively involved in agricultural labor and presenting for medical care at 6 migrant health care centers. Bilingual health care providers randomly selected and interviewed the participants. FINDINGS: The most commonly reported reason for visiting the health care provider was for physical examination. The most frequent acute problems were related to the musculoskeletal and integumentary systems. Frequently cited problems in the medical history were hypertension, musculoskeletal/back pain, and gastrointestinal conditions. Most medications being taken were for cardiovascular or pain-related problems. CONCLUSIONS: These results suggest that migrant workers present with medical problems that are similar to those of the general primary care population. Many problems were recurrent and represented common chronic medical conditions.     

Implication of the prevalence of needlestick injuries in a general hospital in Malaysia and its risk in clinical practice

Objectives  To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed. Methods  A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia. Results  The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries. Conclusions  The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.     

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.     

Musculoskeletal injuries among operating room nurses: results from a multicenter survey in Rome,Italy

Aim  

Chronic disorders of the musculoskeletal system, particularly low back pain (LBP), are increasing and represent a social and economic problem of growing importance, especially if correlated with working conditions. Health care workers are at higher risk of developing LBP during work shifts in the hospital. The aim of this study was to assess the prevalence of LBP among operating room nurses and to investigate the risk factors for musculoskeletal injuries in the operating room.     

User-friendly system (a smartphone app) for reporting violent incidents towards emergency nurses in the Emergency Department: an Italian multicenter study

Background:Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting.Objectives:To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting.Methods:Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting.Results:Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T₀, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T₁. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high.Conclusions:The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.     

Gender differences in self-reported physical and psychosocial exposures in jobs with both female and male workers

OBJECTIVE: The aim was to determine whether men and women with the same job are equally exposed to work-related physical and psychosocial risk factors for musculoskeletal complaints. METHODS: Men (n = 491) and women (n = 342) in 8 jobs with both female and male workers completed a questionnaire on exposure to work-related risk factors. Gender, job title, and potential confounders were included in the final statistical models. Separate analyses were performed for desk workers and assembly workers. RESULTS: For most risk factors gender differences in exposure were found. Among desk workers exposures were most often higher for women, which was the opposite for assembly workers. CONCLUSIONS: Although exposure assessment relied on self-report, it seems unlikely that gender differences in reporting behavior completely explained gender differences in exposure. Thus, gender differences in exposure are present within the same job.     

Health care use associated with work-related musculoskeletal disorders among hospital workers

Introduction: The purpose of this study was to investigate if work-related musculoskeletal disorders (WMSDs) are associated with increased health care use, over and above workers’ compensation health care benefits, in the period prior to and following a workers’ compensation claim indicating gradual progression and declining function associated with musculoskeletal morbidity. Methods: This study employed secondary analysis of employment data, workers’ compensation claim data and provincial (universal) medical services data for a cohort of health care workers; and investigated rates of medical care contacts among injured workers with a WMSD claim (n=549) compared to a matched group of non-claim workers. Predictors of health care contacts were estimated using general linear regression. Results: WMSD injured workers had significantly higher rates of health care contacts associated with a claim compared to non-injured workers, over and above workers compensation health care benefits. In the final multi-variable model, a WMSD claim among injured workers was associated with an estimated 69% (95% CI, 1.50, 1.91) increase in health care use for the 12-month period immediately after the injury date compared to non injured workers. Conclusion: The pattern of visits for WMSDs suggests that workers visit general practitioners as part of an ongoing pattern of symptoms, resulting in frequent utilization of health services prior to work disability that is also reflected in health care contacts after return-to-work.     

Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses

BACKGROUND: Musculoskeletal complaints represent a common occupational problem for health care workers throughout the world. Despite their sizeable numbers, however, few epidemiological studies have investigated musculoskeletal complaints among Chinese hospital nurses. Objective To assess the prevalence of, and risk factors for, musculoskeletal complaints among hospital nurses in mainland China. METHODS: A total of 282 female, registered nurses were surveyed (92% response rate) using a modified Chinese-language version of the Standardized Nordic Questionnaire. Body sites were divided into the neck, shoulder, upper back and lower back regions. RESULTS: The 12 month period-prevalence of musculoskeletal complaints at any of the four regions was 70%. The lower back was the most commonly reported body site (56%), followed by the neck (45%), shoulder (40%) and upper back (37%). High mental pressure, boring or tedious tasks and limited work support were identified as significant risk factors (adjusted odds ratios: 1.79-2.52). No correlations were found between manual handling or perceived physical exertion and increased reporting of musculoskeletal complaints. CONCLUSION: This study has shown that musculoskeletal complaints are prevalent among Chinese hospital nurses. The correlation with various psychosocial factors is also consistent with evidence from other countries.     

Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices

AIMS: To review the literature on sharps injuries and occupational bloodborne virus transmission in health care in the UK and the worldwide evidence for injury prevention of sharps safety devices. METHODS: Literature review by online database and Internet resource search. RESULTS: Twenty-four relevant publications were identified regarding UK reported sharps injury rates. UK studies showed as much as a 10-fold difference between injuries reported through standard reporting systems (0.78-5.15 per 100 person-years) and rates estimated from retrospective questionnaires of clinical populations (30-284 per 100 person-years). National surveillance data from England, Wales and Northern Ireland gives a rate of 1.43 known hepatitis C virus or human immunodeficiency virus (HIV) transmissions to health care workers per annum. When extrapolated, this suggests an approximate rate of 0.009 such viral transmissions per 1000 hospital beds per annum. Risk of infection from sources with no risk factors is extremely small (less than one in one million for HIV transmission based on Scottish data). Thirty-one studies on the efficacy of sharps safety devices showed evidence of a reduction in injuries, with the greatest reductions achieved by blunt suture needles and safety cannulae. CONCLUSIONS: Although injuries remain common, confirmed viral transmission in the UK has been relatively rare. The degree of under-reporting of sharps injuries may be as much as 10-fold. Safety-engineered devices are likely to be effective at injury reduction.     

Occupational health and safety in Australia

The focus of OHS in Australia is on workplace-based prevention rather than individual health care. Over the past decade, workers' compensation data have shown continuous improvement in work-related deaths, serious injuries and diseases. Injuries from work-related vehicle incidents are the leading cause of fatalities. There is a high incidence of on-road incidents in light vehicles; this problem is under-recognised, and better incidence data are required to support more effective interventions. Rates of many long-latency diseases such as cancers are underestimated, and again more reliable information is needed, particularly on work-related exposures to carcinogens. Disease-related deaths are largely confined to older workers. Musculoskeletal injuries and disorders are the most frequent and costly OHS problem, constituting a large majority of non-fatal injuries and diseases. There is growing recognition that their risk management should be more evidence based, integrating assessment and control of psychosocial and 'manual handling' hazards. A high rate of population ageing is increasing risk of chronic diseases, including musculoskeletal disorders, which is helping to raise awareness of the importance of protecting and promoting workforce health. Strategies to achieve this have been developed but implementation is at an early stage.