Nonpharmacological pain management approaches among U.S. construction workers: A cross-sectional pilot study.

BACKGROUND: U.S. construction workers experience high rates of injury that can lead to chronic pain. This pilot study examined nonpharmacological (without medication prescribed by healthcare provider) and pharmacological (e.g., prescription opioids) pain management approaches used by construction workers. METHODS: A convenience sample of U.S. construction workers was surveyed, in partnership with the U.S. National Institute for Occupational Safety and Health (NIOSH) Construction Sector Program. Differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, were assessed using logistic regression models. A boosted regression tree model examined the most influential factors related to pharmacological pain management use, and potential reductions in use were counterfactually modeled. RESULTS: Of 166 (85%) of 195 participants reporting pain/discomfort in the last year, 72% reported using pharmacological pain management approaches, including 19% using opioids. There were significant differences in familiarity with nonpharmacological approaches by gender, education, work experience, and job title. Among 37 factors that predicted using pharmacological and non-pharmacological pain management approaches, training on the risks of opioids, job benefits for unpaid leave and paid disability, and familiarity with music therapy, meditation or mindful breathing, and body scans were among the most important predictors of potentially reducing use of pharmacological approaches. Providing these nonpharmacological approaches to workers could result in an estimated 23% (95% CI: 16%-30%) reduction in pharmacological pain management approaches. CONCLUSION: This pilot study suggests specific factors related to training, job benefits, and worker familiarity with nonpharmacological pain management approaches influence use of these approaches.

The need for a multi-level approach to occupational safety and health among Asian and Asian American beauty service workers.

Asian and Asian Americans (A/AA) are a group overlooked in general health outcomes but especially occupational safety and health outcomes. In the United States, the beauty service microbusiness industry (e.g., nail salons) predominantly employs immigrant Asian women who regularly encounter a plethora of occupational hazards (e.g., harmful chemical exposures -toluene, formaldehyde, bloodborne pathogens, fungi. However, due to the precariousness of beauty service jobs, cultural and linguistic barriers, and social determinants of health, A/AA beauty service workers face complex occupational safety and health challenges that require interdisciplinary collaboration and cultural competency to address. This commentary will discuss a multi-level approach including specific outreach partners that will offer the required diverse skillsets necessary for improving the occupational safety and health for this worker population in this microbusiness industry. Implications and suggestions for interventions and policy changes are also recommended utilizing the National Institute on Minority Health and Health Disparities' Research Framework.

Characterization of perceived biohazard exposures, personal protective equipment, and training resources among a sample of formal U.S. solid waste workers: A pilot study.

In the United States, the majority of waste workers work with solid waste. In solid waste operations, collection, sorting, and disposal can lead to elevated biohazard exposures (e.g., bioaerosols, bloodborne and other pathogens, human and animal excreta). This cross-sectional pilot study aimed to characterize solid waste worker perception of biohazard exposures, as well as worker preparedness and available resources (e.g., access to personal protective equipment, level of training) to address potential biohazard exposures. Three sites were surveyed: (1) a family-owned, small-scale waste disposal facility, (2) a county-level, recycling-only facility, and (3) an industrial-sized, large-scale facility that contains a hauling and landfill division. Survey items characterized occupational biohazards, resources to mitigate and manage those biohazards, and worker perceptions of biohazard exposures. Descriptive statistics were generated. The majority of workers did not report regularly coming into contact with blood, feces, and bodily fluids (79%). As such, less than one-fifth were extremely concerned about potential illness from biological exposures (19%). Yet, most workers surveyed (71%) reported an accidental laceration/cut that would potentially expose workers to biohazards. This study highlights the need for additional research on knowledge of exposure pathways and perceptions of the severity of exposure among this occupational group.

An Updated Review of Literature for Air Medical Evacuation High-Level Containment Transport During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: In 2019, our team conducted a literature review of air medical evacuation high-level containment transport (AE-HLCT) of patients infected with high-consequence pathogens. Since that publication, the coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous air medical evacuations. We re-examined the new literature associated with AE-HLCTs to determine new innovations developed as a result of the pandemic. METHODS: A literature search was performed in PubMed/MEDLINE from February 2019 to October 2021. The authors screened abstracts for the inclusion criteria and reviewed full articles if the abstract was relevant to the aim. RESULTS: Our search criteria yielded 19 publications. Many of the early transports of patients with COVID-19 used established protocols for AE-HLCT, which were built from the most recent transports of patients with Ebola virus disease. Innovations from the identified articles are subdivided into preflight considerations, in-flight operations, and postflight operations. CONCLUSION: Lessons gleaned from AE-HLCTs of patients with COVID-19 in the early weeks of the pandemic, when little was known about transmission or the severity of the novel disease, have advanced the field of AE-HLCT. Teams that had never conducted such transports now have experience and processes. However, more research into AE-HLCT is needed, including research related to single-patient portable isolation units as well as containerized/multipatient transportation systems.

Best practices of highly infectious decedent management: Consensus recommendations from an international expert workshop.

With the increasing number of highly infectious disease incidents, outbreaks, and pandemics in our society (e.g., Ebola virus disease, Lassa fever, coronavirus diseases), the need for consensus and best practices on highly infectious decedent management is critical. In January 2020, a workshop of subject matter experts from across the world convened to discuss highly infectious live patient transport and highly infectious decedent management best practices. This commentary focuses on the highly infectious decedent management component of the workshop. The absence of guidance or disparate guidance on highly infectious decedent management can increase occupational safety and health risks for death care sector workers. To address this issue, the authorship presents these consensus recommendations on best practices in highly infectious decedent management, including discussion of what is considered a highly infectious decedent; scalability and storage for casualty events; integration of key stakeholders; infection control and facility considerations; transport; care and autopsy; psychological, ethical, and cultural considerations as well as multi-national care perspectives. These consensus recommendations are not intended to be exhaustive but rather to underscore this overlooked area and serve as a starting point for much-needed conversations.

Perceived work exposures and expressed intervention needs among Michigan nail salon workers.

BACKGROUND: Nail salon workers are an underserved population exposed to various occupational hazards. Comprised primarily of women and immigrants, these workers face challenges that further increase their workplace exposures and adverse health outcomes. Though previous studies have noted nail salon workers' exposures, these studies have yet to explore the workers' insights on intervention needs. This study among Michigan nail salon workers addresses this gap. METHODS: This qualitative study was informed by the phenomenology methodological framework anchored within critical social theory. Participants were recruited from nail salons in Southeast Michigan to partake in focus groups. Interviews were recorded, transcribed, and analyzed using content analysis. RESULTS: Three focus groups were conducted with 13 participants. Three major categories emerged. The first category, workers' perceived work-related stressors, included six themes: lack of standardized policies, regulations, education/training; disconnect between education/training and real-world practice; inadequate knowledge on exposures and safety protocols; unsafe nail products; customer pressure; and immigrant-related pressures. The second category, health issues perceived to be directly related to workplace exposures, included two themes: symptoms experienced due to contact with nail products and symptoms due to poor ergonomics. The third category, participants' perceived intervention needs, included four themes: continuing education; updates with new products; communication with key stakeholders; and partnership building and resource access. CONCLUSIONS: To our knowledge, this is the first qualitative study among U.S. nail salon workers focused in Midwest. In addition to the noted individual and organizational-level interventions, policy level implications are discussed given discrepancies in training and practices across states.

A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit.

Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.

Update on Ebola Treatment Center Costs and Sustainability, United States, 2019.

We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines.

Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.

U.S. Medical Examiner/Coroner capability to handle highly infectious decedents.

In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs' capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.

Review of Literature for Air Medical Evacuation High-Level Containment Transport.

INTRODUCTION: Aeromedical evacuation (AE) is a challenging process, further complicated when a patient has a highly hazardous communicable disease (HHCD). We conducted a review of the literature to evaluate the processes and procedures utilized for safe AE high-level containment transport (AE-HLCT) of patients with HHCDs. METHODS: A literature search was performed in PubMed/MEDLINE (from 1966 through January 2019). Authors screened abstracts for inclusion criteria and full articles were reviewed if the abstract was deemed to contain information related to the aim. RESULTS: Our search criteria yielded 14 publications and were separated based upon publication dates, with the natural break point being the beginning of the 2013-2016 Ebola virus disease epidemic. Best practices and recommendations from identified articles are subdivided into pre-flight preparations, inflight operations, and post-flight procedures. CONCLUSIONS: Limited peer-reviewed literature exists on AE-HLCT, including important aspects related to healthcare worker fatigue, alertness, shift scheduling, and clinical care performance. This hinders the sharing of best practices to inform evacuations and equip teams for future outbreaks. Despite the successful use of different aircraft and technologies, the unique nature of the mission opens the opportunity for greater coordination and development of consensus standards for AE-HLCT operations.

U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update.

In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to care for patients with highly hazardous communicable diseases (HHCDs), such as Ebola virus disease. This survey describes the clinical laboratory support capabilities of U.S. HLIUs, including the specific test menus that HLIUs have identified to safely manage HHCD patients and the locations where such testing would be performed. In spring 2016, a survey was electronically distributed, as a fillable pdf file, to the 56 U.S. HLIUs. Site representatives completed the surveys, and data were coded and analyzed in an electronic spreadsheet, using descriptive statistics. Thirty-six HLIUs (64%) responded, and 33 completed the laboratory capabilities section. Thirty-one HLIUs (94%) had performed risk analyses for all laboratory procedures and equipment. Twenty-nine (88%) had decontamination procedures specified for all laboratory equipment used for patients with suspected or confirmed HHCDs. On-site laboratories in 27 HLIUs (81%) had the capacity to inventory and to securely store HHCD patient specimens. Ten HLIUs (31%) had at least one test they would conduct within the patient isolation room. The high-risk nature of HHCDs and the occupational exposures that may occur in clinical laboratories demand advanced preparation and risk assessment of work practices, laboratory equipment, and instrumentation by HLIU laboratories. Although risk analyses of clinical laboratory testing and equipment that HLIUs have conducted have likely focused on those for Ebola virus, HLIUs must be prepared to revise their current procedures for other HHCDs.

Personnel Management and Biosecurity of U.S. High-Level Isolation Units.

OBJECTIVE: To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured. BACKGROUND: Fifty-six US hospitals have been designated HLIUs, capable of providing safe care to patients with highly infectious disease. METHODS: An electronic survey was administered to the 56 HLIUs in spring of 2016. Responses were collected via a fillable PDF and analyzed using descriptive statistics. RESULTS: Thirty-six HLIUs (64%) responded; 33 completed surveys, and 3 reported no longer being a designated HLIU. HLIUs reported large numbers of multidisciplinary staff, primarily consisting of RNs and critical care clinicians. Nearly all HLIUs (94%) required orientation training, although hours varied. CONCLUSIONS: Over a short period, HLIUs recruited and trained significant numbers of staff with little guidance. Costs of ongoing trainings are considerable, and it remains unclear how HLIUs will continue funding these activities.

US State Public Health Departments Special Pathogen Planning.

CONTEXT: US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction with the Centers for Disease Control and Prevention. OBJECTIVE: To identify existing guidelines and perspectives of state health departments pertaining to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs). DESIGN: An electronic 8-question survey with subquestions was administered as a fillable PDF. SETTING: The survey was distributed to publicly accessible e-mails of state health department employees. PARTICIPANTS: State epidemiologists, emergency preparedness directors, or chief medical officers from each of the 50 states and the District of Columbia were contacted; a representative from 36 states and the District of Columbia responded (73%). MAIN OUTCOME MEASURES: Descriptive statistics were used to identify the proportion of state health departments with various existing protocols. RESULTS: A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (eg, EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89%) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16%) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59%) had operationally exercised transport of a patient to an HLIU. CONCLUSIONS: Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Recent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.

Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers.

To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness.

A gap analysis of the United States death care sector to determine training and education needs pertaining to highly infectious disease mitigation and management.

PURPOSE: A United States industry-specific gap analysis survey of the death care sector-which comprises organizations and businesses affiliated with the funeral industry and the handling of human remains- was developed, the results analyzed, and training and education needs in relation to highly infectious disease mitigation and management were explored in an effort to identify where occupational health and safety can be enhanced in this worker population. METHODS: Collaborating national death care organizations distributed the 47-question electronic survey. N = 424 surveys were initiated and results recorded. The survey collected death care sector-specific information pertaining to the comfortability and willingness to handle highly infectious remains; perceptions of readiness, current policies and procedures in place to address highly infectious diseases; current highly infectious disease training levels, available resources, and personal protective equipment. RESULTS: One-third of respondents have been trained on how to manage highly infectious remains. There was a discrepancy between Supervisor/Management and Employee/Worker perceptions on employees' willingness and comfortability to manage potentially highly infectious remains. More than 40% of respondents did not know the correct routes of transmission for viral hemorrhagic fevers. CONCLUSIONS: Results suggest death care workers could benefit from increasing up-to-date industry-specific training and education on highly infectious disease risk mitigation and management. Professional death care sector organizations are positioned to disseminate information, training, and best practices.

A pilot study on psychosocial factors and perceptions of organizational health among a sample of U.S. waste workers.

Solid waste workers encounter a number of occupational hazards that are likely to induce stress. Thus, there are likely to be psychosocial factors that also contribute to their overall perceptions of organizational health. However, attitudes regarding the aforementioned among solid waste workers' have not been assessed. This descriptive, cross-sectional pilot study operationalized the INPUTS Survey to determine workers' perceptions of organizational health and other psychosocial factors of work. Percentage and mean responses to each INPUTS domain are presented in accordance with their survey manual. Pearson's chi-squared tests were run on count data; Fisher's exact tests were run for count data with fewer than five samples. ANOVAs were run on the continuous items. Due to a relatively low sample size (N = 68), two-sided p values < 0.1 were considered statistically significant. Most solid waste worker participants reported high decision authority, that they perceived their management to prioritize workplace health and safety, and had high job satisfaction. However, perceptions of support for health outside of the realm of occupational safety and health was lower. Addressing traditional occupational health hazards continues to take precedence in this industry, with less of a focus on how the social determinants of health may impact workplace health.

The Relationship Between Workplace Drug Policies, Opioid Misuse, and Psychological Distress: Evidence From the 2020 National Survey on Drug Use and Health.

Background: This study, using a nationally representative dataset of the U.S. workforce, examines how punitive workplace drug policies relate to opioid use/misuse and psychological distress. Methods: The sample included adults aged ≥18 years who participated in the National Survey on Drug Use and Health and were employed in 2020. Hierarchical multivariate logistical models were constructed to address the research questions. Results: The weighted, design-based estimates indicate that of 147 831 081 workers, 3.38% reported misusing opioids in the last 12 months. Having a punitive workplace policy was associated with higher rates of opioid use/misuse among workers aged ≤ 34 compared to their same-aged counterparts in nonpunitive workplaces, and among workers identifying as Black, Indigenous, or Person of Color who also experienced severe psychological distress the past year. Conclusion: Some employers may think drug testing policies are net-beneficial to worker well-being; these findings indicate such policies may interact in harmful ways with psychological distress.

An Online Training Module to Increase Knowledge and Awareness of Chemical Exposures and Safety Measures Among Nail Salon Workers.

OBJECTIVE: We developed an online training module targeting nail salon workers' knowledge of chemical exposure and safety, responding directly to the workers' expressed needs in a Midwest State. METHODS: Following a needs assessment, we designed and developed the module content. Implementation and evaluation approaches were rolled out into three phases. RESULTS: Seven workers completed the English version of the module and 24 workers completed the Vietnamese version. The average pre-test scores for those who completed the English and Vietnamese versions of the training were 81.43% and 58.33% respectively. The average post-test score was 98.57% for English and 91.67% for Vietnamese. CONCLUSION: Culturally appropriate educational resources are effective facets of enhancing nail salon workers' awareness, and their occupational health subsequently.