You’re invited to join the roundtable
March 1, 1998 6 minutes read
You’re invited to join the roundtable
Air your concerns; share your wisdom
Rules, regulations, guidelines. Does it seem that they just keep coming, increasing your responsibilities and duties? Do you have thoughts and opinions on the important issues that affect your job, as well as the health and safety of the employees at your institution? Do you feel that no one is listening to your concerns? If so, a new feature that will appear periodically in Hospital Employee Health has been designed especially for you.
HEH Roundtable will focus on an issue of particular concern to hospital employee health practitioners. The issue will be announced in the newsletter several months ahead of time, to enable readers who are interested in participating to write or fax us with a brief statement of opinion. We will then call you for a short interview at your convenience. Each participant will be asked the same questions, and the results will be published in a roundtable format in an upcoming issue.
This is your opportunity to express yourself on the important issues of the day, as well as to learn what your colleagues are thinking and planning. We hope you will participate. Your thoughts and experience are important, whether your employee health department serves a population of 100 or 10,000!
To start off this new feature, the topic will be the new tuberculosis standard proposed by the U.S. Occupational Safety and Health Administration. Some questions to consider are: Do you think a standard is necessary? Will the standard as proposed be effective? How will the proposed standard affect your job? What portions of the standard might need to be changed?
Share your thoughts in the first HEH Roundtable. To participate, jot down a synopsis of your response to the proposed TB standard and fax it right away to: Barrie Rissman, Editor, Hospital Employee Health, at (770) 664-7103. The deadline is March 20. Please include your phone number, the name of your hospital, and the best time to call.
Also, if you have ideas for future roundtable topics, please let us know. We look forward to hearing from you.
Jeffe DB, Mutha S, L’Ecuyer PB, et al. Health care workers’ attitudes and compliance with universal precautions: Gender, occupation, and specialty differences. Infect Control Hosp Epidemiol 1997; 18:710-712.
With the goal of designing interventions to improve compliance with universal precautions (UP), researchers distributed an anonymous survey to 84 nurses and 26 physicians (71 women, 37 men, mean age 39 years) from five St. Louis-area hospitals. The survey included information about gender, age, occupation, and specialty (surgical or nonsurgical), in addition to items about attitudes toward and readiness to comply with UP.
The survey assessed attitudes toward: (1) using double gloves, (2) using protective eyewear, (3) safe sharps disposal, (4) reporting only high-risk injuries, and (5) hepatitis B vaccine.
Respondents also were asked to indicate their readiness to comply with five specific precautions: (1) using "double gloves where I might be exposed to body fluids," (2) wearing "protective goggles or glasses where I might be splashed with blood and body fluids," (3) depositing "all used sharp instruments and contaminated supplies into an appropriate safety container," (4) reporting "all needlesticks and sharps injuries to the employee health department," and (5) being "fully vaccinated against hepatitis B."
Because surgical personnel are believed to be at higher risk, the researchers analyzed occupation and gender differences within the surgical specialty group alone, comparing surgeons with operating room (OR) nurses.
Men and women were distributed similarly across surgical and nonsurgical specialties. Similar numbers of doctors and nurses were present in both groups; however, only five of 26 doctors were women, one of 12 surgeons was a woman, and 23 of 30 surgical nurses were women.
Regarding attitudes toward double-gloving, 36% of all respondents disagreed with the need to wear two sets of gloves every time they perform an invasive procedure with sharp instruments, 47% agreed, and 17% neither agreed nor disagreed.
Responses to all other attitude items were skewed toward agreement or disagreement. Most respondents (84%) disagreed that prescription eyeglasses without side shields are a sufficient barrier to prevent exposure to a patient’s blood and body fluid. The majority (79%) also disagreed that they report needlesticks and other accidental injuries involving blood exposures only if they know that the patient is HIV-positive or has AIDS, hepatitis B, or hepatitis C.
On the other hand, most (89%) agreed it’s appropriate to drop sharps in a safety container without covering them. The majority (84%) agreed that every hospital employee should get hepatitis B vaccine.
Subgroup differences were found in attitudes toward double-gloving and reporting only high-risk injuries. More surgical than nonsurgical staff reported both disagreement (43% vs. 33%, respectively) and agreement (48% vs 36%) with the need to double-glove for invasive procedures, but more nonsurgical (31%) than surgical (10%) staff reported being uncertain about the need to double-glove. In the surgical specialty group, more surgeons (58%) than OR nurses (37%) disagreed with the need to double-glove for invasive procedures, but the difference was not statistically significant.
Regarding reporting only high-risk injuries, more nonsurgical compared to surgical staff (88% vs. 63%) disagreed, as did more nurses compared to physicians (80% vs. 73%), and women compared to men (84% vs. 69%). Within the surgical specialty group, more women than men disagreed (79% vs. 44%), and more men than women agreed (50% vs. 21%).
A high level of compliance was noted with the five precautions. Respondents reported 100% compliance with appropriate sharps disposal. More than 90% indicated compliance with wearing protective eyewear and reporting all sharps injuries to the employee health department.
More doctors than nurses (64% vs. 34%) reported compliance with double-gloving, whereas 54% of nurses and 32% of doctors have no plans to double-glove. Within the surgical subgroup, more men than women (77% vs. 23%) and more surgeons than OR nurses (75% vs. 36%) reported compliance with double-gloving.
Regarding compliance with receiving hepatitis B vaccine, 100% of the doctors and men in the sample reported compliance, compared to 85% of the nurses and 82% of the women. The researchers speculate doctors’ compliance may be due to having received vaccine while in medical school or as house staff.
In discussing their findings, the researchers describe as "worrisome" the fact that respondents in surgical specialties were more likely to disagree with the need to double-glove for invasive procedures, and that a greater percentage of surgeons than OR nurses disagreed. This could be related to several health care worker beliefs: that not all surgical procedures require extra protection, that there is a low prevalence of bloodborne diseases where they work, that double gloves do not provide extra protection, that it is unnecessary due to poor enforcement of infection control policies, or that double-gloving reduces manual sensibility.
Another concern was that more surgical staff and men indicated they would report sharps injuries only when the patient is known to have a bloodborne infection. This could be attributed to schedule and time difficulties, lack of perceived risk, not knowing the protocol for injury reporting, fear of breaches in confidentiality or negative reprisals, or not wanting to take the time.
Noting the biases of self-reported data, the researchers also point out that their respondents may have perceived themselves to be at lower risk with little or no urgency to comply with UP due to the lower prevalence of HIV/AIDS in their area than in many other cities. Nevertheless, "subgroup differences . . . point to interesting trends in the data and underscore the importance of considering subgroup differences when designing interventions for improving compliance" with UP, they state.
• American Occupational Health Conference April 24-May 1 in Boston. The 57th annual conference includes scientific courses, technical exhibits, pre- and post-conference sessions, employment services, and guest activities. Co-sponsored by the American College of Occupa tional and Environmental Medicine (ACOEM) and the American Association of Occupational Health Nurses (AAOHN). Contact: AAOHN, (404) 262-1162, ext. 110, or ACOEM, (847) 228-6850, ext. 152.
• Public Hearing, U.S. Occupational Safety and Health Administration’s Proposed Rule on Occupational Exposure to Tuberculosis begins April 7, 1998 at 10 a.m., in Washington, DC, Frances Perkins Building Auditorium, U.S. Department of Labor, 200 Constitution Ave. NW. Hearings also are planned in Los Angeles, Chicago, and New York City. Contact: Bonnie Friedman, OSHA Office of Information and Consumer Affairs, (202) 219-8148, for dates and locations.
• Fourth International Conference on Occupa tional Health for Health Care Workers Fall 1999. Sponsored by the International Commission on Occupational Health. Contact: Pierre Robillard, MD, Montreal Public Health Department, Occupa tional and Environmental Health Unit, 75 Port-Royal East Room 240, Montreal, Quebec, Canada H3L 3T1. Telephone: (514) 858-7510, ext. 245. Fax: (514) 858-5993. E-mail: [email protected].
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