Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018.

OBJECTIVES: Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. METHODS: We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. RESULTS: Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups-food preparation and serving; building and grounds cleaning and maintenance; and construction trades-had significantly lower levels of health care access for all 4 measures. CONCLUSION: Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers' access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers' health and workforce stability.

Prevalence of Underlying Medical Conditions Among Selected Essential Critical Infrastructure Workers - Behavioral Risk Factor Surveillance System, 31 States, 2017-2018.

Certain underlying medical conditions are associated with higher risks for severe morbidity and mortality from coronavirus disease 2019 (COVID-19) (1). Prevalence of these underlying conditions among workers differs by industry and occupation. Many essential workers, who hold jobs critical to the continued function of infrastructure operations (2), have high potential for exposure to SARS-CoV-2, the virus that causes COVID-19, because their jobs require close contact with patients, the general public, or coworkers. To assess the baseline prevalence of underlying conditions among workers in six essential occupations and seven essential industries, CDC analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys, the most recent data available.* This report presents unadjusted prevalences and adjusted prevalence ratios (aPRs) for selected underlying conditions. Among workers in the home health aide occupation and the nursing home/rehabilitation industry, aPRs were significantly elevated for the largest number of conditions. Extra efforts to minimize exposure risk and prevent and treat underlying conditions are warranted to protect workers whose jobs increase their risk for exposure to SARS-CoV-2.

Health Risk Behavior Profile of Construction Workers, 32 States, 2013 to 2016.

BACKGROUND: Research has suggested that several health risk behaviors were more prevalent among construction workers than among the general workforce. METHODS: The prevalences of six health risk behaviors among construction workers were compared with workers in other industries using data from 32 states in the 2013 to 2016 Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: Smoking, smokeless tobacco use, binge drinking, no leisure-time physical activity, and not always using a seatbelt were significantly more prevalent (P < 0.001), and short sleep significantly less prevalent (P < 0.05), for all construction workers combined compared with workers in other industries. Prevalences varied substantially for all six health risk behaviors by construction occupation. CONCLUSIONS: Due to the high prevalence of some health risk behaviors, construction workers may benefit from interventions to reduce these behaviors, particularly since they are also potentially exposed to workplace hazards.

Health Insurance Coverage by Occupation Among Adults Aged 18-64 Years - 17 States, 2013-2014.

Lack of health insurance has been associated with poorer health status and with difficulties accessing preventive health services and obtaining medical care, especially for chronic diseases (1-3). Among workers, the prevalence of chronic conditions, risk behaviors, and having health insurance has been shown to vary by occupation (4,5). CDC used data from the 2013 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the prevalence of having no health care coverage (e.g., health insurance, prepaid plans such as health maintenance organizations, government plans such as Medicare, or Indian Health Service) by occupation. Among all workers aged 18-64 years, the prevalence of being uninsured declined significantly (21%) from 16.0% in 2013 to 12.7% in 2014. In both years there were large differences in the prevalence of being uninsured among occupational groups, ranging from 3.6% among the architecture and engineering occupations to 37.9% among the farming, fishing, and forestry occupations in 2013 and 2.7% among community and social services; and education, training, and library occupations to 37.0% among building and grounds cleaning and maintenance occupations in 2014 (p<0.001). In 2014, more than 25% of workers in four occupational groups reported having no health insurance (construction and extraction [29.1%]; farming, fishing, and forestry [34.6%]; food preparation and serving related [35.5%]; and building and grounds cleaning and maintenance [37.0%]). Identifying factors affecting differences in coverage by occupation might help to address health disparities among occupational groups.

Tdap Vaccination Among Healthcare Personnel-21 States, 2013.

INTRODUCTION: Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS: Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS: Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel.

Influenza vaccination among workers-21 U.S. states, 2013.

BACKGROUND: Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. METHODS: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry-occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. RESULTS: Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. CONCLUSIONS: This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs.

Seat Belt Use Among Adult Workers - 21 States, 2013.

Roadway incidents involving motorized vehicles accounted for 24% of fatal occupational injuries in the United States during 2013 and were the leading cause of fatal injuries among workers.* In 2013, workers' compensation costs for serious, nonfatal injuries among work-related roadway incidents involving motorized land vehicles were estimated at $2.96 billion.(†) Seat belt use is a proven method to reduce injuries to motor vehicle occupants (1). Use of lap/shoulder seat belts reduces the risk for fatal injuries to front seat occupants of cars by 45% and the risk to light truck occupants by 60%.(§) To characterize seat belt use among adult workers by occupational group, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) and found that not always using a seat belt was significantly associated with occupational group after controlling for factors known to influence seat belt use. Occupational groups with the highest prevalences of not always using a seat belt included construction and extraction; farming, fishing, and forestry; and installation, maintenance, and repair. To increase seat belt use among persons currently employed, states can enact and enforce primary seat belt laws, employers can set and enforce safety policies requiring seat belt use by all vehicle occupants, and seat belt safety advocates can target interventions to workers in occupational groups with lower reported seat belt use.

The national study to prevent blood exposure in paramedics: rates of exposure to blood.

OBJECTIVE: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. METHODS: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. RESULTS: The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. CONCLUSIONS: Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.

Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics.

More than 20% of U.S. paramedics are exposed to blood each year. Little is known about the circumstances that lead to these exposures. The objective of this study was to describe blood exposure events among U.S. paramedics. A mail survey was conducted in 2002-2003 among a nationally representative sample of licensed paramedics. Eighty percent of needle/lancet sticks involved non-safety devices. A third of mucous membrane exposures occurred even though the paramedic was wearing eye or face protection; in half of the events, the exposures were caused by the patient vomiting, spitting, or coughing up blood; in a third of the events, the patient was being uncooperative or combative. In 83% of the non-intact skin exposures, the paramedic was wearing disposable gloves; the non-intact skin was covered before the call in a third of the events, but the cover did not prevent exposure; 40% of the events occurred when the patient was being uncooperative or combative. These results suggest that blood exposure among paramedics could be reduced through increased use of safety devices and personal protective equipment, improved engineering and design, and increased compliance with Universal Precautions, and that paramedics need techniques for avoiding blood exposure while treating uncooperative or combative patients.

The national study to prevent blood exposure in paramedics: exposure reporting.

BACKGROUND: This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The present analysis assesses reporting of exposures to employers. METHODS: A questionnaire was mailed in 2002-2003 to a national sample of paramedics selected using a two-stage design. Information on exposure reporting was obtained on the two most recent exposures for each of five routes of exposure. RESULTS: Forty-nine percent of all exposures to blood and 72% of needlesticks were reported to employers. The main reason for under-reporting was not considering the exposure a "significant risk." Females reported significantly more total exposures than males. Reporting of needlesticks was significantly less common among respondents who believed most needlesticks were due to circumstances under the worker's control. Reporting was non-significantly more common among workers who believed reporting exposures helps management prevent future exposures. Reporting may have been positively associated with workplace safety culture. CONCLUSIONS: This survey indicates there is need to improve the reporting of blood exposures by paramedics to their employers, and more work is needed to understand the reasons for under-reporting. Gender, safety culture, perception of risk, and other personal attitudes may all affect reporting behavior.

Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics.

PURPOSE: The aim of the study is to estimate incidence rates of occupational blood exposure by route of exposure (needlesticks; cuts from sharp objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and blood contact with nonintact skin) in US and California paramedics. METHODS: A mail survey was conducted in a national probability sample of certified paramedics. RESULTS: Proportions of paramedics who reported an exposure in the previous year were 21.6% (95% confidence interval [CI], 17.8-25.3) for the national sample and 14.8% (95% CI, 12.2-17.4) for California. The overall incidence rate was 6.0/10,000 calls (95% CI, 3.9-8.1). These rates represent more than 49,000 total exposures and more than 10,000 needlesticks per year among paramedics in the United States. Rates for mucocutaneous exposures and needlesticks were similar (approximately 1.2/10,000 calls). Rates for California were one third to one half the national rates. Sensitivity analysis showed that potential response bias would have little impact on the policy and intervention implications of the findings. CONCLUSION: Paramedics continue to be at substantial risk for blood exposure. More attention should be given to reducing mucocutaneous exposures. The impact of legislation on reducing exposures and the importance of nonintact skin exposures need to be better understood.

Blood-borne pathogens among firefighters and emergency medical technicians.

OBJECTIVE: Firefighters and emergency medical services (EMS) personnel have the potential for occupational exposures to blood, which increases their risk for occupational blood-borne infection. To address this concern, the authors conducted a literature review of occupational blood exposures, the seroprevalence of blood-borne pathogens among these workers, and the seroprevalence of blood-borne pathogens among the patients they serve. METHODS: A MEDLINE search was conducted, and all identified articles that described surveys of exposures to blood or surveillance of blood-borne infections among firefighters and/or emergency medical technicians (EMTs) in the United States were reviewed. For hepatitis B, only seroprevalence surveys conducted after the 1992 requirement by the Bloodborne Pathogens Standard to offer vaccination to potentially exposed employees were included. RESULTS: From these data, the expected number of annual occupational hapatitis C virus seroconversions was estimated to be between 5.8 and 118.9 per 100,000 employee-years for EMT-paramedics, between 3.4 and 33.7 per 100,000 for firefighter-EMTs, and up to 3.6 per 100,000 for firefighters (non-EMT). CONCLUSIONS: This review suggests there are a limited number of studies addressing this issue, and these studies have numerous limitations. Despite the expected occupational seroconversions and recognizing the limitations in drawing conclusions from these studies, it appears that firefighters and EMS personnel do not have an elevated seroprevalence of hepatitis C virus compared with the general population. Improved exposure surveillance programs would clarify exposure risks and identify potential interventions for firefighters and EMS personnel.

Injuries and illnesses treated at the World Trade Center, 14 September-20 November 2001.

INTRODUCTION: In response to the 11 September 2001 terrorist attacks on the World Trade Center (WTC), the United States Public Health Service (USPHS) deployed Disaster Medical Assistance Teams (DMATs) and the Commissioned Corps to provide on-site, primary medical care to anyone who presented. Patients included rescue and recovery workers, other responders, and some members of the general public. OBJECTIVE: A descriptive analysis of WTC-USPHS patient records was conducted in order to better understand the short-term impact of the WTC site on the safety and health of individuals who were at or near the site from 14 September-20 November 2001. METHODS: The Patient Treatment Record forms that were completed for each patient visit to these USPHS stations over the 10-week deployment period were reviewed. RESULTS: Patient visits numbered 9,349, with visits peaking during Week 2 (21-27 September). More than one-quarter of the visits were due to traumatic injuries not including eye injuries (n = 2,716; 29%). Respiratory problems comprised more than one-fifth of the complaints (n = 2,011; 22%). Eye problems were the third most frequent complaint (n = 1,120; 12%). With respect to the triage class, the majority of visits fell into the lowest category of severity (n = 6,237; 67%). CONCLUSION: USPHS visits probably were skewed to milder complaints when compared to analyses of employer medical department reports or hospital cases; however, given the close proximity of the USPHS stations to the damage, analysis of the USPHS forms provides a more complete picture of the safety and health impact on those who were at or near the WTC site.