Micro-environmental factors impact breathing zone exposures: A simulated petrochemical manufacturing facility task.

This study investigates the impact of micro-environmental factors on worker breathing zone exposure levels in petrochemical facilities. A laboratory simulation study evaluated near-field exposure to methane for a typical maintenance task. Individual and combinations of micro-environmental factors significantly affected methane exposure. Airflow direction and speed were significant determinants of exposure concentration reduction. A side airflow direction at medium to high speed produced the lowest gas concentration in the breathing zone. Worker body orientation relative to the methane emission point was also a critical factor affecting gas concentration in the worker's breathing zone. The study provides insights into how variations in airflow and small changes in position impact near-field exposures for petrochemical tasks, guiding industrial hygiene professionals' training on qualitative exposure estimation and providing input for near-field exposure modeling to guide quantitative exposure and risk assessment.

"[It] Does Harden a Person Working in Such a Stressful Environment": U.S. Correctional Nurses Share Spillover Effects of Their Work.

BACKGROUND: The United States makes up 4.4% of the world's population but nearly a quarter of the world's incarcerated population. Despite caring for nearly 2 million incarcerated persons and managing their unique needs, little is known about how this work spills over and affects the nurses who work in correctional settings. STUDY OBJECTIVE: This descriptive study aimed to (a) examine write-in answers regarding correctional nurse perceptions of how their work impacts their health and their home lives and (b) explore correctional nurse responses for how to improve the work environment to better support their well-being. METHOD: The researchers compiled and analyzed qualitative data from a cross-sectional study where U.S. correctional nurses (N = 270) completed an online survey. Manifest content analysis was used to analyze optional write-in data. RESULTS: Approximately 41% (n = 111) of participants answered qualitative questions. Participants were primarily White (77.3%) and non-Hispanic or Latino (88.7%), working in prisons (65.8%), and employed by the state (63.8%) as registered nurses (70%). Three major themes emerged: (a) "personal impact": increased stress and burnout, overwhelming work hours, and emotional and physical effects; (b) "social relationships and family impacts": withdrawn, strained homelife, and uncertainty; and (c) "need for change": improved staffing, reduced mandatory overtime, and better support from management. CONCLUSIONS: Correctional organizations may consider ways to support the well-being of their nurses through adequate staffing, flexible scheduling, decreased mandatory overtime, and hiring effective nurse managers as key members of the correctional team.

Unlocking Prevalence Data: Describing the Job Stress and Well-being of U.S. Correctional Nurses.

BACKGROUND: Little is known about the health and well-being of U.S. correctional nurses. To protect correctional nurses, a better understanding of organizational characteristics, job stress, and well-being must be undertaken. METHOD: A cross-sectional design was used in the form of an online survey. Correctional nurses were conveniently recruited using national listservs and snowball sampling. Variables were measured with the Health & Safety Executive Management Standards Indicator Tool, Nurse Wellbeing Index, and the Perceived Stress Scale. Data were analyzed using descriptive statistics and analyses of variance. FINDINGS: Two hundred seventy participants (142 registered nurses, 83 licensed practical nurses/licensed vocational nurses, and 42 advanced practice nurses) completed the survey. Job stress scored moderate (M = 16.26, SD = 7.14), and well-being levels were just below the risk for adverse events (M = 1.8, SD = 3.06). Lower scores were noted for managerial support (M = 3.13, SD = 0.35) and job demands (M = 3.56, SD = 0.92), but slightly better for job control (M = 3.57, SD = 0.77), peer support (M = 3.85, SD = 0.64), and workplace relationships (M = 3.73, SD = 0.95). CONCLUSIONS: Significant differences between organizational characteristics, job stress, and well-being were found across nursing licensure, workplace environments, biological sex, and employment through state or private agencies. Registered nurses working in U.S. prisons experienced the highest job stress and worse well-being. APPLICATION TO PRACTICE: This work is an essential next step in promoting healthy workspaces, urging the need for further research establishing the impact of organizational characteristics and job stress on nurse well-being.

Neck Muscle Coactivation Response to Varied Levels of Mental Workload During Simulated Flight Tasks.

OBJECTIVE: To evaluate neck muscle coactivation across different levels of mental workload during simulated flight tasks. BACKGROUND: Neck pain (NP) is highly prevalent among military aviators. Given the complex nature within the flight environment, mental workload may be a risk factor for NP. This may induce higher levels of neck muscle coactivity, which over time may accelerate fatigue, increase neck discomfort, and affect flight task performance. METHOD: Three counterbalanced mental workload conditions represented by simulated flight tasks modulated by interstimulus frequency and complexity were investigated using the Modifiable Multitasking Environment (ModME). The primary measure was a neck coactivation index to describe the neuromuscular effort of the neck muscles as a system. Additional measures included perceived workload (NASA TLX), subjective discomfort, and task performance. Participants (n = 60; 30M, 30F) performed three test conditions over 1 hr each while seated in a simulated seating environment. RESULTS: Neck coactivation indices (CoA) and subjective neck discomfort corresponded with increasing level of mental workload. Average CoAs for low, medium, and high workloads were: .0278(SD = .0232), .0286(SD = .0231), and .0295(SD = .0228), respectively. NASA TLX mental, temporal, effort, and overall scores also increased with the level of mental workload assigned. For ModME task performance, the overall performance score, monitoring accuracy, and resource management accuracy decreased while reaction times increased with the increasing level of mental workload. Communication accuracy was lowest with the low mental workload but had higher reaction times relative to increasing workload. CONCLUSION: Mental workload affects neck muscle coactivation during combinations of simulated flight tasks within a simulated helicopter seating environment. APPLICATION: The results of this study provide insights into the physical response to mental workload. With increasing multisensory modalities within the work environment, these insights may assist the consideration of physical effects from cognitive factors.

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies.

OBJECTIVE: This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices. INTRODUCTION: The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices. METHOD: The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices. RESULTS: The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes. CONCLUSION: There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated. PRACTICAL APPLICATION: Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

The Factors Associated with the Development of COVID-19 Symptoms among Employees in a U.S. Healthcare Institution.

Healthcare workers have experienced increased occupational health risks caused by COVID-19 disease. The purpose of this project was to examine the relationships between reporting COVID-19 symptoms by employees in a healthcare institution in the United States and employees' demographics, vaccination status, co-morbid conditions, and body mass index (BMI). This project employed a cross-sectional design. It involved the analysis of data on COVID-19 exposure and infection incidents among employees in the healthcare institution. The dataset contained more than 20,000 entries. The results indicate that being female, African American, between 20 and 30 years old, diagnosed with diabetes, diagnosed with chronic obstructive pulmonary disease (COPD), or on immunosuppressive medicines is associated with greater reporting of COVID-19 symptoms by the employees. Furthermore, BMI is associated with reporting COVID-19 symptoms; the higher the BMI, the greater the likelihood of reporting a symptomatic infection. Moreover, having COPD, being 20-30 years old, being 40-50 years old, BMI, and vaccination status were significantly associated with employees reporting symptoms while controlling for other variables associated with reporting the symptoms among the employees. These findings may be applicable to other infectious disease outbreaks or pandemics.

An Investigation into Occupational Related Stress of At-Risk Workers During COVID-19.

OBJECTIVES: Nearly all workers and industry sectors have been affected by the ongoing coronavirus disease 2019 (COVID-19) pandemic in some form since March 2020. However, the pandemic-related stressors experienced in the workplace may vary from industry to industry and may have disproportionally affected some workers. This study investigates increased stress levels, stressor events, and other perceptions of stress from at-risk workers during COVID-19. METHODS: An in-depth work-related stress survey that incorporated many aspects of work, life, work-life balance, and the health of employer-employee relationships was developed with a focus on COVID-19-related stressors. The cross-sectional survey was distributed online through professional networks from October to November 2021. The survey results were statically analyzed using Kruskal-Wallis one-way analysis of variance (ANOVA) after grouping the industry sectors into the four groups to determine trends within these groupings. RESULTS: The survey was completed by 670 workers in sectors such as manual labor, business/office service, healthcare, and education. A variety of trends were determined between the occurrence of COVID-19 and work stress which had, in some cases, affected some industry sectors to a larger degree than others. More than 50% of the participants reported experiencing an increased workload since the onset of the pandemic with some sectors, like healthcare, reporting an increased workload more frequently at 80%. Around 55% of respondents believed they could be exposed to COVID-19 in their workplace, ranging from 52% of business/office service workers to 77% of healthcare workers. CONCLUSIONS: As workplaces navigate past the pandemic, occupational stress should be addressed head-on through workplaces providing expanded resources so as to assure work stress associated with future pandemics are mitigated appropriately. Whether the stressor is associated with irregular shift work or psychosocial aspects (i.e. relying on coworkers), many of these stressors have the possibility to become exacerbated by external factors such as pandemics.

Impact of Ergonomic Posture on the Chemical Exposure of Workers in the Petroleum and Chemical Industry.

OBJECTIVES: Despite a rise in automation, workers in the petroleum refining and petrochemical manufacturing industry are potentially exposed to various chemicals through inhalation while performing routine job duties. Many factors contribute to the degree of exposure experienced in this setting. The study objective was to characterize the impact of workplace conditions, anthropometric variability, and task orientation on exposure for a simulated routine operations task. METHODS: A chemical exposure laboratory simulation study was designed to evaluate the dependent variable of chemical exposure level in the breathing zone for methane and sulfur hexafluoride. The independent variables were (i) posture of the worker, (ii) worker anthropometry, (iii) process configuration, and (iv) gas density. RESULTS: Pipe height was a significant predictor of gas concentration measured in the breathing zone when located in a position that encouraged the gas to enter the breathing zone of the worker. Worker anthropometry had a major impact; tall worker's (male) chemical concentrations exceeded those of the short worker (female) for methane simulations but the opposite resulted for sulfur hexafluoride. Also, worker posture had a significant impact on gas exposure where nonneutral postures were found to have higher levels of chemical concentration. CONCLUSIONS: The study findings indicate that the breathing zone location is altered by posture and worker height, which changes the exposures relative to the emission source depending on the gas density of the chemicals that are present. As a result, qualitative risk assessment cannot be performed accurately without accounting for these factors. Practically, controls may need to account for worker size differences and posture adaptations.

Workplace Violence Prevention Training, Safety Resources, and Commitment to HHCWs' Safety.

BACKGROUND: The threat of workplace violence (WPV) is a primary safety concern for home health care workers (HHCWs). WPV prevention training is a critical tool for HHCWs' safety. Yet, most existing WPV prevention training is limited or not specific to HHCWs' environment, the patient's home, and neighborhood. The purpose of this study was to describe WPV prevention training, resources used, and commitment to HHCWs' safety. METHODS: Using a cross-sectional design, HHCWs from two sites located in Southwestern Ohio completed the Violence Against Home Healthcare and Hospice Workers survey, a 37-item survey used to describe frequency and characteristics of WPV prevention training and resources. Descriptive statistics were used to analyze the data. FINDINGS: Half (n = 25) of the HHCWs received WPV prevention training. Training content focused on characteristics of aggressive/violent patients and family members (n = 19, 82.6%), but limited content about characteristics of hazardous neighborhoods (n = 15, 65.2%). Cellular phones (n = 43, 97.7%) were primarily used as a resource to promote safety, few cellular phones (n = 1, 2.3%) were provided by the agency. CONCLUSIONS/APPLICATION TO PRACTICE: HHCWs described WPV prevention training content and resources used to promote safety. WPV prevention training is deficient in procedures for seeking psychological care, screening patients for violent behavior, skills for self-protection, characteristics of hazardous neighborhoods, and physical maneuvers and verbal methods to diffuse or avoid aggressive behavior. Access to WPV prevention training and resources for HHCWs needs to be strengthened. Occupational Health Nurses can assist their employers with developing WPV prevention training for HHCWs.

Examining the Impact of Stressors during COVID-19 on Emergency Department Healthcare Workers: An International Perspective.

Emergency department healthcare workers are known to face a unique combination of pressures from their careers and work environments regularly. Caring for dying patients and making difficult lifesaving decisions not only continued but also became more prevalent for emergency department healthcare workers during the COVID-19 pandemic. A growing body of literature revealed that the mental and emotional toll of COVID-19 has been tremendous. However, the burden of COVID-19 on the overall physical health and work-life balance on this group needs to be understood. This study aimed to describe the impact of stress on wellbeing and health across the globe among emergency department healthcare workers. A cross-sectional survey comprising work-family and family-work conflict scale, work-life balance, physical symptoms inventory, Oldenburg Burnout Inventory, satisfaction with job and life, and life change index scale was distributed to a convenience sample through listservs and social media. In total, 287 participants responded, 109 completing all questions. Fatigue was the most common symptom reported to occur daily (28.4%, n = 31), followed by muscle pain (13.8%, n = 15) and backache (11.9%, n = 13). Nurse practitioners reported the highest number of physical symptoms and the highest average scores and counts of stressful life events, while registered nurses indicated the highest work-family conflict levels. Linear regressions showed that stressful life events are significantly associated with both physical symptoms and work-family conflict. Results underscore the need to better support emergency department workers to mitigate the risks associated with occupational stress. Protective organizational policies and increased support strategies may be employed to improve wellbeing and cultivate a more sustainable workforce.

Almost a year in: Virtual offices remained an ergonomic trouble spot.

BACKGROUND: Many individuals continued to work from home even after nearly 9 months since the COVID-19 pandemic started in spring of 2020. OBJECTIVE: To conduct a follow-up survey of the faculty and staff of a large Midwest university to determine whether there had been any changes to their home work environment and health outcomes since a prior survey conducted at the start of the pandemic in spring of 2020. METHODS: An electronic survey was sent out to all employees, staff, and administration (approximately 10,350 individuals) and was completed by 1,135 individuals. RESULTS: It was found that not much had changed after nearly 9 months of working at home. Faculty and staff continued to primarily use laptops without an external keyboard, monitor or mouse. Few participants reported using chairs with adjustable armrests. These conditions continued to result in high levels of body discomfort (49% neck and head, 45% low back, and 62% upper back and shoulders having moderate to severe pain). CONCLUSION: If workers are going to continue to work from home, companies will need to accommodate them with more than a laptop, and should include an external keyboard, monitor, and mouse.

The virtual office: A perspective from college students.

BACKGROUND: As the COVID-19 pandemic took root in the United States, most universities quickly transitioned to online and remained there through spring 2021. OBJECTIVE: The study objective was to identify the impact of the switch to online on student home offices and corresponding health outcomes. METHODS: An online survey was sent out to all student at a large Midwest university to assess the work practices and health outcomes. RESULTS: In total, 1074 responses were completed. The shift to online not only resulted in most students utilizing laptop computers without external monitors, keyboards, or mouse input devices, but also a major increase in the amount of time spent using technology (on average 31 to 40 hours per week). The amount of severe to extreme discomfort in the neck, shoulder, upper back, and lower back was alarming (above 41%). CONCLUSION: The home offices of students were often sub-optimal, indicating the need to educate university students.

Teachers feeling the burden of COVID-19: Impact on well-being, stress, and burnout.

BACKGROUND: Teachers have had to deal with many of the negative aspects of COVID-19 over the past year. The demands associated with the sudden requirement to teach remotely, and later having to manage hybrid (both in person and online) learning may be having adverse effects on the mental and physical health of teachers. OBJECTIVE: To determine whether COVID-19 continued to impact teacher stress, burnout, and well-being a year into the pandemic. METHODS: An online survey was sent out to 5300 teachers in public and private schools, and 703 completed the survey. RESULTS: Stress and burnout continue to be high for teachers, with 72% of teachers feeling very or extremely stressed, and 57% feel very or extremely burned out. Many teachers struggled to have a satisfactory work-family balance (37% never or almost never; 20% only has sometimes). CONCLUSION: School systems must start to deal with the mental and physical health of teachers before a large number of them leave the profession.

Workers' compensation prescription medication patterns and associated outcomes.

BACKGROUND: Opioid use in the treatment of musculoskeletal injuries is a complex decision where benefits must be balanced with risk. Previous research has shown an association between higher opioid doses and adverse health effects. The study's objective was to investigate whether opioid prescriptions are associated with increased costs and deaths through an injury mechanism or as a direct result of the opioid prescription. METHODS: Data for 144,553 deidentified Ohio Bureau of Workers' Compensation claims from 2010 to 2014 with shoulder, knee, and low back injuries were obtained and followed until 2016. Each claim had associated prescription information. Injury claims were further classified using the allowed diagnoses by single or multiple body areas affected and injury severity ("simple" or "complex"). The outcome variables were medical and indemnity costs, lost days, MaxMED (maximum claim-prescribed daily morphine equivalent dose), and death status. Association between maximum opioid dose with deaths was determined by logistic regression analysis. RESULTS: Several outcome variables, including claim medical and indemnity costs, and the likelihood of claimant death, showed significant associations with the MaxMED. In the analysis of claim deaths, these associations held for all claim types (except complex), even after adjusting for age, gender, surgery, and lost time. CONCLUSION: The association between increasing opioid doses and deaths for low-severity diagnoses was disturbing given the lack of demonstrated efficacy of opioids for treatment of minor injuries. A focus on provider education, increased utilization of non-opioids, and early intervention for minor soft-tissue injuries could reduce claims costs, disability, and future deaths.

The impact of emergency responder musculoskeletal injuries in the State of Ohio.

BACKGROUND: Emergency personnel operate in environments that put them at higher risk of injury to the musculoskeletal system. These injuries result in lost workdays, medical costs, and decreased productivity, all which impact emergency response systems. OBJECTIVE: This study serves to assess the causes, costs, and disability of common work-related musculoskeletal injuries within the police, emergency medical service (EMS) workers, and firefighters of Ohio based on data from the OBWC (Ohio Bureau of Workers' Compensation). METHODS: Our dataset included all OBWC injury claims involving a shoulder, low back, or knee from 2010 through 2014. Police and Firefighter leaders were analyzed separately from those not in a leadership role, and workers with combined Firefighter/EMS roles were analyzed separately from "pure" Firefighters and EMS personnel. Data were organized through univariate analysis of variance with post-hoc Tukey tests and analyzed based on the job of the individual and whether the individual was in a leadership role. RESULTS: Police Officers had the highest number of total injuries in the dataset, followed by Firefighters and Firefighters/EMS workers. Police Officers and Firefighters injured their back and knees more often than their shoulders, while EMS workers injured their backs and shoulders more often than their knees. CONCLUSIONS: The mechanisms through which injuries occur are also dependent on the job. Police officers experienced a higher percentage of motor vehicle related back problems, while firefighters had a higher percentage of injuries from overexertion. Musculoskeletal injury claims in these emergency personnel resulted in opioid prescriptions approximately 10%of the time.

An assessment of ergonomic issues in the home offices of university employees sent home due to the COVID-19 pandemic.

BACKGROUND: As millions of workers have shifted to telework, special accommodations for workers with respect to ergonomics may be required to ensure the workforce remains healthy. METHODS: A survey about home office ergonomics and discomfort was sent to faculty, staff, and administrators by email and was completed by 843 individuals. RESULTS: Over 40%of the participants reported moderate to severe discomfort (severe low/middle back pain, moderate discomfort in eyes/neck/head, and discomfort in the upper back/shoulders). Laptops (always and often) were widely used (85%) with most using the laptop monitor (55%) of all respondents. Further, less than 45%of the seating conditions were reported as having adjustable arm rests. CONCLUSION: As teleworking in makeshift offices becomes more common, the risk of significant discomfort and potentially more serious musculoskeletal disorders may result from poor static postures. Companies may need to accommodate workers by allowing them to take home office chairs, external monitors, keyboards, and mice as laptops are insufficient, ergonomically.

Workers' compensation costs for healthcare caregivers: Home healthcare, long-term care, and hospital nurses and nursing aides.

BACKGROUND: Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long-term care, or home health care). METHODS: A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5-year period were obtained from the Ohio Bureau of Workers' Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim. RESULTS: Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims. CONCLUSIONS: With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.

Electronic Cigarettes: Exposure to Secondhand Vapors at a Long-Term Healthcare Company.

Introduction: Healthcare workers in long term care settings have limited control over their occupational secondhand exposure to electronic cigarettes and other tobacco products. Methods: The study aimed to identify the perceived frequency of exposure to exhaled electronic cigarette vapor on healthcare workers within two sites of a long-term healthcare company. An online survey was completed by 149 (out of approximately 500) employees that asked about electronic cigarette personal usage, concerns for exposure, exposure times, and demographic data. Results: Twelve percent of all survey respondents expressed concerns related to second-hand exposure. Of those exposed, employee estimated exposure time was 2.1 minutes per shift for electronic cigarettes compared to 12.1 minutes per shift for cigarettes/cigars/pipes. Conclusions: Overall self-reported secondhand exposure to electronic cigarettes and cigarettes/cigars/pipes was low. To determine a definitive exposure level, quantitative sampling can be done related to chemical exposure via passive inhalation of the smoke and vapor cloud for cigarettes and electronic cigarettes, respectively. Education can be provided to healthcare workers and residents in long-term care facilities regarding risk of exposure to secondhand smoke to alleviate employees concerns with exposure.

Design and development of the home healthcare worker observation tool.

Background: The rapidly growing number of home healthcare workers (HHCW) are exposed to unique occupational hazards within each patient home. This article describes the development of an observation tool to document occupational hazards HHCWs encounter. Methods: Tool development followed three steps: determining content domain, content validity, and inter-rater agreement. Results: Expert feedback guided the revision of content domain to 636 items. Scale level content validity index (S-CVI) was 0.90. Inter-rater agreement tests resulted in percent agreement and accuracy mean of 89.5% and frequency variables resulted in standard deviations from 0 to 8.62. Conclusions: The observation tool encompasses the diverse range of occupational hazards HHCWs encounter; inter-rater percent agreement and overall accuracy scores were acceptable. Future pilot testing of this tool among broader raters and populations is recommended to characterize its usability, internal consistency, and reliability to assess HHCW occupational hazards.