Potential chemical risks from tattoos and their relevance to military health policy in the United States.

We summarize and consolidate disparate sources of information about the practice of tattooing and its potential implications for military population health and policy. Each branch of the United States military has policies about tattoos for service members, but these have varied over time and do not cover health protection. The number of veterans receiving disability payments and the cost of those payments has been rising over time; the broad category of skin conditions accounts for 11% of disability claims. Any additional factor, such as tattoos that may increase the occurrence of adverse skin reactions, can substantially impact veteran benefit expenses and budgets. This may be a consideration for the military as it evaluates its policies related to tattoos among service members.

Risk factors for workplace encounters with weapons by hospital employees.

Objective: The specific aim of this study was to determine which risk factors were associated with frequent weapons confiscation in a healthcare facility. This study investigated the hypothesis that hospital-related factors impact the frequency of weapons confiscation. Study design: Cross-sectional. Methods: A cross-sectional survey was administered on-line to hospital security directors and assessed the associations of organizational factors with the frequency of weapons confiscation. Results: It was found that hospitals with metal detectors were more than 5 times as likely to frequently confiscate weapons, suggesting this intervention is effective. It was also found that hospitals with psychiatric units were more likely to have frequent confiscation of weapons, likely due to the standard procedure of searching patients before admission to the psychiatric unit. Conclusion: This data suggests that searching patients and using metal detectors are important tools in the prevention of weapons entering a healthcare setting.

Baseline assessment of a potassium iodide distribution for nuclear power plant emergencies in the Canadian-United States border region.

OBJECTIVE: This study sought to evaluate resident demographics and resident understanding of the proper use of potassium iodide (KI) pills as a countermeasure in the event of a nuclear power plant emergency. We also described expected behaviors of community members in the event of a nuclear accident. DESIGN: The study design utilized a cross-sectional survey with a validated written questionnaire. Subjects, Participants: The study subjects were Canadian residents living within the primary emergency planning zone of the Fermi 2 nuclear power reactor. There was a 77 percent participation rate (n = 180) in Amherst Point and 61 percent for Bois Blanc Island (commonly referred to as Bob-Lo Island) (n = 57). MAIN OUTCOME MEASURE(S): The primary study outcome measures were the number of knowledge-based questions survey respondents correctly answered about proper KI use (Ksum) and various behavior-based survey questions in the context of the extended parallel process model (EPPM). RESULTS: Overall, we found that residents in general had a very low overall comprehension of proper KI use. We found that most resident demographics (eg, age, gender) did not significantly impact their knowledge of proper KI use but did find that households with children under 13 years of age tended to have higher comprehension scores than households without young children. Most residents reported that if they thought they were exposed to radiation they would go to the hospital or call 911 and few residents knew their evacuation routes, few were aware of the emergency siren, none knew where the reception center was located, and most did not have an emergency kit in their home. The majority of the survey respondents did indicate that they would evacuate if told to do so by their government. CONCLUSIONS: Public health outreach is crucial for KI distribution programs because of the overall low pre-existing comprehension in communities. Also, hospitals and 911 must be prepared to deal with higher volume of residents seeking help should an accident occur.

New Jersey Home Health Care Aides Survey Results.

The objective of the study was to report on what violence-based training home health care aides received, their participation in health promotion classes, and home health care aides' experience with workplace violence. In 2013, a mail survey was completed by 513 home health care aides in the state of New Jersey. Ninety-four percent of the respondents were female. Respondents whose agency was part of a hospital were more likely to receive violence-based safety training than respondents whose agency was not part of a hospital (p = .0313). When the perpetrator of violence was a patient or family member, the respondents experienced verbal abuse the most (26%), then physical assault (16%) and exposure to bodily fluids (13%). Home health care aides whose agency was part of a hospital were more likely to receive violence-based safety training. Training is an important component of a workplace violence prevention program.

Hospital Security Programs and Policies Related to Guns and Other Weapons.

EXECUTIVE SUMMARY: Workplace violence in healthcare is a health and safety problem that can have a significant impact on the mission and effectiveness of organizations. To ascertain hospital approaches to address violence and experiences with guns and other weapons, we conducted a survey of International Association for Healthcare Security & Safety members. Although many hospitals have enhanced their security programs, many challenges persist. We found that armed security appears to be increasingly prevalent in hospitals, and the use of Tasers appears to be increasing the most in comparison to other weapons. Most of our survey respondents did not perceive officers losing control of their weapons during altercations in their healthcare facility as a real risk. In addition, roughly half of the respondents reported that portable metal detectors (including wands) were not used in their facilities. The disposition of weapons confiscated by security also raised concerns about how legally owned firearms can be safely returned to their owners while they are still on hospital property.

Workplace Violence and Training Required by New Legislation Among NJ Nurses.

OBJECTIVE: The aim of this study was to examine nurses' knowledge of the state of New Jersey (NJ) Violence Prevention in Health Care Facilities Act, workplace violence training, and experience with workplace violence. METHODS: In 2013, 309 (22.5% response rate) nurses returned a mailed survey. Univariate and multivariate analyses were conducted. RESULTS: Ninety percent of respondents were female. When the perpetrator was a patient or a family member, the respondents experienced verbal abuse the most (57.8%), followed by threats (52.3%), and physical assault (38.3%). Respondents who had heard of the regulation (89.6%) received a higher proportion of training than those who had not heard of the regulation (57.9%) (P < 0.0001). CONCLUSIONS: Nurses who received at least 80% of the required training components were more likely to feel more secure at work, suggesting that training is an important tool to address workplace violence.

Workplace violence and hospital security programs: regulatory compliance, program benchmarks, innovative strategies.

The authors describe the issue of workplace violence in hospitals, a New Jersey state law and regula- tions regarding workplace vio- lence in healthcare, and some innovative strategies that are being utilized to help reduce the occurrence and risk of violence. The authors also discuss compli- ance with the New Jersey regula- tions.

Hot yoga establishments in local communities serving pregnant women: a pilot study on the health implications of its practice and environmental conditions.

Hot yoga establishments have been increasing in popularity in local communities. Studios may support participation among pregnant women though no clinical studies currently exist that examine prenatal hot yoga effects. The pilot study described in this article aimed to assess the spread of prenatal hot yoga and to provide information on the environmental conditions and practices of those who engage in hot yoga within a local community. A thermal environment meter was used to measure ambient air conditions during three 90-minute hot yoga classes. Mothers who practiced prenatal hot yoga were more likely than non-hot yoga practitioners to have someone aside from an obstetrician/gynecologist discuss prenatal exercise safety with them. Prenatal public health education campaigns need to be refined. Public health officials and obstetricians/gynecologists need to be aware that those who engage in a hot yoga practice are more likely to trust someone other than their health care provider or public health professional regarding safety of this practice.

Lead-based paint awareness, work practices, and compliance during residential construction and renovation.

The U.S. Environmental Protection Agency recently implemented the Renovation, Repair and Painting (RRP) rule that applies to pre-1978 residences because of the potential presence of lead-based paint. Enforcement of this rule may be difficult and therefore it is crucial to understand the awareness and beliefs of contractors and the general public because these will likely be major determinants of exposures resulting from residential renovation work. The study described in this article utilized two mailed surveys: one directed to the general public and the other directed to contractors. The surveys were conducted in New Jersey and Virginia. Field observations were also recorded for work sites in New Jersey. Results indicated a high awareness among the general public about the hazards of lead, a low level of screening by children's doctors for lead exposure, frequent use of work practices that generate lots of dust, poor hygiene among contractors, and the potential for low compliance of contractors with the RRP rule. In particular, contractors who do not believe lead is a serious health hazard are expected to have the lowest compliance with the RRP rule. These findings serve as targets for effective public health interventions through education and outreach.

Impact of hospital security programmes and workplace aggression on nurse perceptions of safety.

AIM: To assess how nurses' perception of their safety and risk of violence was affected by their work environment and whether this perception correlated with their actual risk. BACKGROUND: The work environment has an impact on nurses' perception of their risk of violence and this perception affects worker productivity, quality, employee retention, worker satisfaction and their actual safety. METHODS: A cross-sectional survey was conducted in person of 314 emergency department nurses and 143 psychiatric nurses, and assault data was collected from injury logs. RESULTS: This study found that nurses in the emergency and psychiatric units differed in their perception of violence and safety. The workplace elements that led to a perception of lower risk of violence were not correlated with a lower rate of injury from violent acts. The nurses' beliefs about the adequacy of security equipment, security guards and the frequency of verbal abuse were strongly correlated with perceived safety. CONCLUSION: Several factors that influence nurses' perception of their risk of violence are not well correlated with their actual risk. IMPLICATIONS FOR NURSING MANAGEMENT: Managers must address workplace elements that affect nurse perceptions because this has an impact on quality and employee retention. They must also address factors that have an impact on the actual risk of violence because this study showed, for the first time, that these may differ from perceptions.

Emergency department security programs, community crime, and employee assaults.

BACKGROUND: Violence against health care workers is a serious occupational health hazard, especially for emergency department (ED) employees. A significant degree of variability in security programs among hospital EDs is present in part due to the absence of federal legislation requiring baseline security features. Nationally, only voluntary guidelines from the Occupational Safety and Health Administration (OSHA) for the protection of health care workers exist. OBJECTIVES: The purpose of this study was to examine ED security programs and employee assault rates among EDs with different financial resources, size, and background community crime rates. METHODS: This cross-sectional survey was conducted among large and small hospitals located in communities with low or high rates of community crime. Hospital financial data were collected through the state health department, and employee assault data were abstracted from hospital OSHA logs. Comparisons were made using a chi-squared or Wilcoxon test. RESULTS: Small hospitals located in towns with low community crime rates implemented the fewest security program features despite having the second highest rate of assault-related OSHA-recordable injuries among ED employees (0.66 per 100,000 staff hours). CONCLUSION: Due to the highly stressful workplace characteristics of EDs, the risk of employee assault is universal among all hospital sizes in all types of communities.

Preliminary study of propyl bromide exposure among New Jersey dry cleaners as a result of a pending ban on perchloroethylene.

Many states are considering, and some states have actively pursued, banning the use of perchloroethylene (PERC) in dry cleaning establishments. Proposed legislation has led many dry cleaners to consider the use of products that contain greater than 90% n-propyl bromide (n-PB; also called 1-bromopropane or 1-BP). Very little information is known about toxicity and exposure to n-PB. Some n-PB-containing products are marketed as nonhazardous and "green" or "organic." This has resulted in some users perceiving the solvent as nontoxic and has resulted in at least one significant poisoning incident in New Jersey. In addition, many dry cleaning operators may not realize that the machine components and settings must be changed when converting from PERC to n-PB containing products. Not performing these modifications may result in overheating and significant leaks in the dry cleaning equipment. A preliminary investigation was conducted of the potential exposures to n-PB and isopropyl bromide (iso-PB; also called 2-bromopropane or 2-BP) among dry cleaners in New Jersey who have converted their machines from PERC to these new solvent products. Personal breathing zone and area samples were collected using the National Institute for Occupational Safety and Health Sampling and Analytical Method 1025, with a slight modification to gas chromatography conditions to facilitate better separation of n-PB from iso-PB. During the preliminary investigation, exposures to n-PB among some workers in two of three shops were measured that were greater than the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) for n-PB. The highest exposure measured among a dry cleaning machine operator was 54 parts per million (ppm) as an 8-hr time-weighted average, which is more than 5 times the ACGIH TLV of 10 ppm. The preliminary investigation also found that the work tasks most likely to result in the highest short-term exposures included the introduction of solvent to the machine, maintenance of the machine, unloading and handling of recently cleaned clothes, and interrupting the wash cycle of the machine. In addition, this assessment suggested that leaks may have contributed to exposure and may have resulted from normal machine wear over time, ineffective maintenance, and from the incompatibility of n-PB with gasket materials.

Communicating information in an emergency preparedness pill distribution campaign.

OBJECTIVES: Public health agencies are often tasked with the development and execution of interventions, but the communication strategy and its impact on the effectiveness of an intervention is often not evaluated or incorporated by local and state health agencies. The primary objective of this study was to determine the impact of information from various sources on knowledge about an emergency preparedness public health intervention involving the mass distribution of medicine. METHODS: The study used validated written mail surveys containing 12 simple knowledge-based questions. One-way ANOVA, the Studentized Newman-Keuls (SNK) test, logistic regression, and multiple regression were used to evaluate the data. RESULTS: Reading an educational fact sheet or receiving job training were the highest predictive variables for correct responses on the survey among all groups. Commercial media were found to potentially diminish comprehension among survey respondents. There was significant variability in knowledge among different groups surveyed, ranging from an average of 15% to 74% correct responses on the survey. CONCLUSIONS: This study found that job training and fact sheets that are delivered directly to the intended recipients are very effective at enhancing knowledge among the general public and emergency responders. Conversely, we found that commercial media, such as television, may be detrimental to educating the public about important public health interventions. The internet was not widely used by the survey respondents to obtain information; this raises questions regarding the usefulness of websites for emergency preparedness education.

Survey of current lead use, handling, hygiene, and contaminant controls among New Jersey industries.

In 2003, a chemical handling and use survey was mailed to New Jersey employers identified as currently using lead in their industrial processes. This survey was used to ascertain characteristics about lead use, handling, and protection of employees during manufacturing operations. The survey included a diverse group of current lead users with a total lead use range from less than 1 pound to more than 63 million pounds of lead per year. The survey allowed for a comprehensive characterization of hazards and protective measures associated with this metal, still commonly used in many products and industrial processes. Forty-five surveys were returned by companies that are listed in the New Jersey Adult Blood Lead Registry, which is part of the New Jersey Adult Blood Lead Epidemiology and Surveillance (ABLES) program. This program records and investigates cases of adults with greater than 25 mu g/dL of lead in their blood; most cases are related to occupational exposures. This survey found that greater than 25% of these surveyed companies with significant potential for lead exposure did not employ commonly used and basic industrial hygiene practices. In addition, the survey found that 24% of these companies had not conducted air sampling within the last 3 years. Air sampling is the primary trigger for compliance with the Occupational Safety and Health Administration (OSHA) general industry lead standard. Only 17% of the companies have ever been cited for a violation of the OSHA lead standard, and only 46% of these companies have ever had an OSHA inspection. State-based surveillance can be a useful tool for OSHA enforcement activities. Elevated blood lead values in adults should be considered as a trigger for required compliance with an OSHA general industry lead standard.