RESUMO
Objective-This report describes deaths from drug overdoses in 2020 in U.S. residents in 46 states and New York City by usual occupation and industry. Methods-Frequencies, death rates, and proportionate mortality ratios (PMRs) are presented using the 2020 National Vital Statistics System mortality data file. Data were restricted to decedents aged 16-64 for rates and 15-64 for PMRs with usual occupations and industries in the paid civilian workforce. Age-standardized drug overdose death rates were estimated for usual occupation and industry groups overall, and age-adjusted drug overdose PMRs were estimated for each usual occupation and industry group overall and by sex, race and Hispanic-origin group, type of drug, and drug overdose intent. Age-adjusted drug overdose PMRs were also estimated for individual occupations and industries. Results-Drug overdose mortality varied by usual occupation and industry. Workers in the construction and extraction occupation group (162.6 deaths per 100,000 workers, 95% confidence interval: 155.8-169.4) and construction industry group (130.9, 126.0-135.8) had the highest drug overdose death rates. The highest group-level drug overdose PMRs were observed in decedents in the construction and extraction occupation group and the construction industry group (145.4, 143.6-147.1 and 144.9, 143.2-146.5, respectively). Differences in drug overdose PMRs by usual occupation and industry group were observed within each sex, within each race and Hispanicorigin group, by drug type, and by drug overdose intent. Among individual occupations and industries, the highest drug overdose PMRs were observed in decedents who worked as fishers and related fishing occupations and in fishing, hunting, and trapping industries (193.1, 166.8-222.4 and 186.5, 161.7-214.1, respectively). Conclusions-Variation in drug overdose death rates and PMRs by usual occupation and industry in 2020 demonstrates the disproportionate burden of the ongoing drug overdose crisis on certain sectors of the U.S. workforce.
Assuntos
Indústria da Construção , Overdose de Drogas , Humanos , Overdose de Drogas/mortalidade , Cidade de Nova Iorque/epidemiologia , Ocupações , Estados Unidos/epidemiologiaRESUMO
Objectives-This report describes COVID-19 mortality in 2020 among U.S. residents in 46 states and New York City by usual occupation and industry.
Assuntos
COVID-19 , Estados Unidos/epidemiologia , Humanos , Cidade de Nova Iorque , Indústrias , OcupaçõesRESUMO
OBJECTIVES: To measure associations between employment precarity and mental health among United States (US) workers. METHODS: This study used data from the US Medical Expenditure Panel Survey for 2008-2021. Multivariable generalized estimating equations were used to measure associations between employment precarity (operationalized as a multi-dimensional exposure) and self-rated mental health after adjusting for relevant confounders. Marginal effects analysis was used to assess potential dose-response relationships between precarity and mental health. RESULTS: Our sample (n = 57,529) was representative of >106 million US workers employed throughout 2008-2021. Compared to those with low levels of employment precarity, those with medium and high levels of precarity had an increased odds of reporting poor/fair mental health (aOR = 1.21; 95% CI = 1.11, 1.32 and 1.51; 95% CI = 1.36, 1.68, respectively). Marginal effects analysis indicated that increasing levels of precarity were associated with an increased probability of reporting poor/fair mental health. CONCLUSIONS: Increasing levels of employment precarity were associated with poor/fair self-rated mental health, findings potentially indicative of a dose-response relationship between the two. These nationally representative findings suggest employment precarity is an important social determinant of mental health. Future research could investigate how best to mitigate the negative effects of precarity on workers' lives and well-being, particularly regarding mental health.
Assuntos
Segurança do Emprego , Saúde Mental , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Gastos em Saúde/estatística & dados numéricos , Segurança do Emprego/psicologia , Segurança do Emprego/estatística & dados numéricos , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS: The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS: While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION: Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.
Assuntos
Vigilância em Saúde Pública , Determinantes Sociais da Saúde , Estados Unidos , Humanos , Saúde Pública , Centers for Disease Control and Prevention, U.S. , Desigualdades de SaúdeRESUMO
Objectives. To characterize COVID-19 vaccine uptake and hesitancy among US nurses. Methods. We surveyed nurses in 3 national cohorts during spring 2021. Participants who indicated that they did not plan to receive or were unsure whether they planned to receive the vaccine were considered vaccine hesitant. Results. Among 32 426 female current and former nurses, 93% had been or planned to be vaccinated. After adjustment for age, race/ethnicity, and occupational variables, vaccine hesitancy was associated with lower education, living in the South, and working in a group care or home health setting. Those who experienced COVID-19 deaths and those reporting personal or household vulnerability to COVID-19 were less likely to be hesitant. Having contracted COVID-19 doubled the risk of vaccine hesitancy (95% confidence interval [CI] = 1.85, 2.53). Reasons for hesitancy that were common among nurses who did not plan to receive the vaccine were religion/ethics, belief that the vaccine was ineffective, and lack of concern about COVID-19; those who were unsure often cited concerns regarding side effects or medical reasons or reported that they had had COVID-19. Conclusions. Vaccine hesitancy was unusual and stemmed from specific concerns. Public Health Implications. Targeted messaging and outreach might reduce vaccine hesitancy. (Am J Public Health. 2022;112(11):1620-1629. https://doi.org/10.2105/AJPH.2022.307050).
Assuntos
COVID-19 , Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , VacinaçãoRESUMO
Objectives. To explore previous COVID-19 diagnosis and COVID-19 vaccination status among US essential worker groups. Methods. We analyzed the US Census Household Pulse Survey (May 26-July 5, 2021), a nationally representative sample of adults aged 18 years and older. We compared currently employed essential workers working outside the home with those working at home using adjusted prevalence ratios. We calculated proportion vaccinated and intention to be vaccinated, stratifying by essential worker and demographic groups for those who worked or volunteered outside the home since January 1, 2021. Results. The proportion of workers with previous COVID-19 diagnosis was highest among first responders (24.9%) working outside the home compared with workers who did not (13.3%). Workers in agriculture, forestry, fishing, and hunting had the lowest vaccination rates (67.5%) compared with all workers (77.8%). Those without health insurance were much less likely to be vaccinated across all worker groups. Conclusions. This study underscores the importance of improving surveillance to monitor COVID-19 and other infectious diseases among workers and identify and implement tailored risk mitigation strategies, including vaccination campaigns, for workplaces. (Am J Public Health. 2022;112(11):1599-1610. https://doi.org/10.2105/AJPH.2022.307010).
Assuntos
Vacinas contra a AIDS , COVID-19 , Vacinas contra Influenza , Vacinas contra Papillomavirus , Vacinas contra Vírus Sincicial Respiratório , Vacinas contra a SAIDS , Adulto , Vacina BCG , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19 , Vacina contra Difteria, Tétano e Coqueluche , Humanos , Intenção , Vacina contra Sarampo-Caxumba-Rubéola , VacinaçãoRESUMO
BACKGROUND: The Cybersecurity and Infrastructure Security Agency (CISA) produced an advisory list identifying essential critical infrastructure workers (ECIW) during the coronavirus disease 2019 (COVID-19) response. The CISA advisory list is the most common national definition of ECIW but has not been mapped to United States (U.S.) Census industry codes (CICs) to readily identify these worker populations in public health data sources. METHODS: We identified essential critical infrastructure industry designations corresponding to v4.0 of the CISA advisory list for all six-digit North American Industry Classification System (NAICS) codes and cross-walked NAICS codes to CICs. CICs were grouped as essential, non-essential, or mixed essential/non-essential according to component NAICS industries. We also obtained national estimated population sizes for NAICS and Census industries and cross-tabulated Census industry and occupation codes to identify industry-occupation pairs. RESULTS: We produced and made publicly available spreadsheets containing essential industry designations corresponding to v4.0 of the CISA advisory list for NAICS and Census industry titles and codes and population estimates by six-digit NAICS industry, Census industry, and Census industry-occupation pair. The CISA advisory list is highly inclusive and contains most industries and U.S. workers; 71.0% of Census industries comprising 80.6% of workers and 80.7% of NAICS industries comprising 87.1% of workers were designated as essential. CONCLUSIONS: We identified workers in essential critical infrastructure industries as defined by CISA using standardized industry codes. These classifications may support public health interventions and analyses related to the COVID-19 pandemic and future public health crises.
Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Censos , Humanos , Indústrias , Ocupações , Estados Unidos/epidemiologiaRESUMO
Like their counterparts in healthcare, workers in medical examiner and coroners' offices are considered essential workers. The frequency and urgency of their work during the coronavirus disease 2019 (COVID-19) pandemic have only become of greater importance. Because of the increased mortality in the general population due to SARS-CoV-2, the virus that causes COVID-19, it is reasonable to assume that the workload and risk of occupational exposure to SARS-CoV-2 have increased for these workers who are required by state law to investigate deaths known or suspected to be due to a contagious disease that constitutes a public hazard. Studies investigating the impact of the COVID-19 pandemic on these workers and their operations have been limited. The objective of this study was to conduct an assessment of routine medical examiner and coroners' office duties (e.g., infectious disease testing and decedent transport) by surveying the 67 county medical examiner and coroners' offices in Pennsylvania to characterize how the rise in infectious disease cases from COVID-19 influenced workload and resource needs. Quantitative results demonstrated an increase in workload and use of personal protective equipment (PPE) while engineering control usage remained the same. Qualitative results revealed various challenges experienced by the offices during the pandemic including limitations in access to PPE, insufficient storage space for increased numbers of decedents, personnel shortage/burnout, and limited or no engagement at the state level for emergency response planning and implementation. These data are valuable to inform the need for additional guidance or supplies and may be used to optimize resource planning and implementation (e.g., personnel, facilities, and supplies) for both routine and surge demand scenarios.
Assuntos
COVID-19 , Exposição Ocupacional , COVID-19/epidemiologia , Médicos Legistas , Pessoal de Saúde , Humanos , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pennsylvania/epidemiologia , Equipamento de Proteção Individual , SARS-CoV-2RESUMO
BACKGROUND: Public health research uses decedents' usual industry and occupation (I&O) from US death certificates to assess mortality incidence and risk factors. Of necessity, such research may exclude decedents with insufficient I&O information, and assume death certificates reflect current (at time of death) I&O. This study explored the demographic implications of such research conditions by describing usual occupation and current employment status among decedents by demographic characteristics in a large multistate data set. METHODS: Death certificate occupations classified by Standard Occupational Classification (SOC) (ie, compensated occupation) and other categories (eg, student) for 36 507 decedents (suicide, homicide, other, undetermined intent) age 22+ years from the 2016 National Violent Death Reporting System's (NVDRS) 32 US states were analyzed. Decedents not employed at the time of death (eg, laid off) were identified through nondeath certificate NVDRS data sources (eg, law enforcement reports). RESULTS: Female decedents, younger (age < 30 years) male decedents, some non-White racial group decedents, less educated decedents, and undetermined intent death decedents were statistically less likely to be classified by SOC based on death certificates-primarily due to insufficient information. Decedents classified by SOC from death certificates but whose non-death certificate data indicated no employment at the time of death were more often 30+ years old, White, less educated, died by suicide, or had nonmanagement occupations. CONCLUSIONS: Whether decedents have classifiable occupations from death certificates may vary by demographic characteristics. Research studies that assess decedents by usual I&O can identify and describe how any such demographic trends may affect research results on particular public health topics.
Assuntos
Atestado de Óbito , Emprego/estatística & dados numéricos , Indústrias/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Vigilância da População/métodos , Adulto , Idoso , Causas de Morte , Feminino , Homicídio/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
The opioid epidemic affects multiple segments of the U.S. population (1). Occupational patterns might be critical to understanding the epidemic. Opioids are often prescribed for specific types of work-related injuries, which vary by occupation* (2). CDC used mortality data from the National Occupational Mortality Surveillance (NOMS) system to examine unintentional or undetermined drug overdose mortality within 26 occupation groups. This study included data from the 21 U.S. states participating in NOMS during 2007-2012. Drug overdose mortality was compared with total mortality using proportional mortality ratios (PMRs) indirectly standardized for age, sex, race, year, and state. Mortality patterns specific to opioid-related overdose deaths were also assessed. Construction occupations had the highest PMRs for drug overdose deaths and for both heroin-related and prescription opioid-related overdose deaths. The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and health care practitioners. The workplace is an integral part of life for the majority of the adult U.S. population; incorporating workplace research and interventions likely will benefit the opioid epidemic response.
Assuntos
Acidentes/estatística & dados numéricos , Analgésicos Opioides/intoxicação , Overdose de Drogas/mortalidade , Ocupações/estatística & dados numéricos , Vigilância da População , Adulto , Indústria da Construção/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Exposição Ocupacional/prevenção & controle , Dispositivos de Proteção Respiratória/estatística & dados numéricos , Aerossóis , Antineoplásicos , Desinfetantes , Feminino , Humanos , Exposição por Inalação/prevenção & controle , Masculino , Máscaras/estatística & dados numéricos , National Institute for Occupational Safety and Health, U.S. , Infecções Respiratórias/prevenção & controle , Fumaça , Estados UnidosRESUMO
Amyotrophic lateral sclerosis (ALS) and Parkinson's disease, both progressive neurodegenerative diseases, affect >1 million Americans (1,2). Consistently reported risk factors for ALS include increasing age, male sex, and cigarette smoking (1); risk factors for Parkinson's disease include increasing age, male sex, and pesticide exposure, whereas cigarette smoking and caffeine consumption are inversely associated (2). Relative to cancer or respiratory diseases, the role of occupation in neurologic diseases is much less studied and less well understood (3). CDC evaluated associations between usual occupation and ALS and Parkinson's disease mortality using data from CDC's National Institute for Occupational Safety and Health (NIOSH) National Occupational Mortality Surveillance (NOMS), a population-based surveillance system that includes approximately 12.1 million deaths from 30 U.S. states.* Associations were estimated using proportionate mortality ratios (PMRs), standardizing indirectly by age, sex, race, and calendar year to the standard population of all NOMS deaths with occupation information. Occupations associated with higher socioeconomic status (SES) had elevated ALS and Parkinson's disease mortality. The shifts in the U.S. workforce toward older ages and higher SES occupations highlight the importance of understanding this finding, which will require studies with designs that provide evidence for causality, detailed exposure assessment, and adjustment for additional potential confounders.
Assuntos
Esclerose Lateral Amiotrófica/mortalidade , Disparidades nos Níveis de Saúde , Ocupações/estatística & dados numéricos , Doença de Parkinson/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Classe Social , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls (i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth) was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular inspection of nitrous oxide delivery and scavenging equipment for leaks, availability of standard procedures to minimize exposure, periodic training, ambient air and exposure monitoring, and medical surveillance.
Assuntos
Anestésicos Inalatórios , Óxido Nitroso , Exposição Ocupacional/prevenção & controle , Poluentes Ocupacionais do Ar/toxicidade , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/prevenção & controle , Anestésicos Inalatórios/toxicidade , Assistentes de Odontologia , Higienistas Dentários , Odontólogos , Humanos , Exposição por Inalação/efeitos adversos , Exposição por Inalação/prevenção & controle , National Institute for Occupational Safety and Health, U.S. , Óxido Nitroso/toxicidade , Exposição Ocupacional/efeitos adversos , Inquéritos e Questionários , Estados Unidos , VentilaçãoRESUMO
Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handling guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs. Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which included a sample of approximately 1,800 nurses who had administered liquid antineoplastic drugs during the past seven days. Regression modeling was used to examine predictors of personal protective equipment use, engineering controls, and adverse events involving antineoplastic drugs. Approximately 14% of nurses reported experiencing an adverse event while administering antineoplastic drugs during the previous week. Usage of recommended engineering controls and personal protective equipment was quite variable. Usage of both was better in non-profit and government settings, when workers were more familiar with safe handling guidelines, and when perceived management commitment to safety was higher. Usage was poorer in the absence of specific safety handling procedures. The odds of adverse events increased with number of antineoplastic drugs treatments and when antineoplastic drugs were administered more days of the week. The odds of such events were significantly lower when the use of engineering controls and personal protective equipment was greater and when more precautionary measures were in place. Greater levels of management commitment to safety and perceived risk were also related to lower odds of adverse events. These results point to the value of implementing a comprehensive health and safety program that utilizes available hazard controls and effectively communicates and demonstrates the importance of safe handling practices. Such actions also contribute to creating a positive safety climate.
Assuntos
Antineoplásicos/administração & dosagem , Enfermeiras e Enfermeiros , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Cultura Organizacional , Roupa de Proteção/estatística & dados numéricos , Gestão da Segurança , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Consensus organizations, government bodies, and healthcare organization guidelines recommend that surgical smoke be evacuated at the source by local exhaust ventilation (LEV) (i.e., smoke evacuators or wall suctions with inline filters). METHODS: Data are from NIOSH's Health and Safety Practices Survey of Healthcare Workers module on precautionary practices for surgical smoke. RESULTS: Four thousand five hundred thirty-three survey respondents reported exposure to surgical smoke: 4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported LEV was always used during these procedures, while 47% reported use during laser surgery. Those reporting LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection. CONCLUSIONS: Study findings can be used to raise awareness of the marginal use of exposure controls and impediments for their use. Am. J. Ind. Med. 59:1020-1031, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Exposição Ocupacional/análise , Saúde Ocupacional/normas , Salas Cirúrgicas/normas , Fumaça/análise , Adulto , Eletrocirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , National Institute for Occupational Safety and Health, U.S./normas , Exposição Ocupacional/normas , Inquéritos e Questionários , Estados Unidos , Ventilação/normasRESUMO
Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among nurse anesthetists compared to the other anesthesia care providers. Successful management of waste anesthetic gases should include scavenging systems, hazard awareness training, availability of standard procedures to minimize exposure, regular inspection of anesthesia delivery equipment for leaks, prompt attention to spills and leaks, and medical surveillance.
Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Anestésicos Inalatórios , Anestesistas , Exposição Ocupacional/prevenção & controle , Poluentes Ocupacionais do Ar , Anestesiologistas , Humanos , Exposição por Inalação/prevenção & controle , National Institute for Occupational Safety and Health, U.S. , Estados UnidosRESUMO
Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas.
Assuntos
Antineoplásicos/administração & dosagem , Fidelidade a Diretrizes/estatística & dados numéricos , Enfermeiras e Enfermeiros , Adulto , Fatores Etários , Escolaridade , Feminino , Luvas Protetoras/estatística & dados numéricos , Humanos , Masculino , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Equipamento de Proteção Individual/estatística & dados numéricos , Equipamento de Proteção Individual/provisão & distribuição , Guias de Prática Clínica como Assunto , Análise de Regressão , Gestão da SegurançaRESUMO
Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine self-reported use of engineering, administrative, and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procedures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring, and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions, and report any safety concerns.
Assuntos
Antineoplásicos , Composição de Medicamentos , Fidelidade a Diretrizes/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Exposição Ocupacional/prevenção & controle , Farmacêuticos/estatística & dados numéricos , Roupa de Proteção/estatística & dados numéricos , Equipamentos de Proteção/estatística & dados numéricos , Adulto , Idoso , Feminino , Luvas Protetoras/normas , Luvas Protetoras/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , National Institute for Occupational Safety and Health, U.S. , Roupa de Proteção/normas , Equipamentos de Proteção/normas , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: Evaluate precautionary practices and extent of use of ethylene oxide (EtO) and hydrogen peroxide gas plasma (HPGP) sterilization systems, including use of single chamber EtO units. DESIGN: Modular, web-based survey. PARTICIPANTS: Members of professional practice organizations who reported using EtO or HPGP in the past week to sterilize medical instruments and supplies. Participating organizations invited members via email which included a hyperlink to the survey. METHODS: Descriptive analyses were conducted including simple frequencies and prevalences. RESULTS: A total of 428 respondents completed the module on chemical sterilants. Because most respondents worked in hospitals (87%, n=373) analysis focused on these workers. Most used HPGP sterilizers (84%, n=373), 38% used EtO sterilizers, with 22% using both. Nearly all respondents using EtO operated single chamber units (94%, n=120); most of them reported that the units employed single use cartridges (83%, n=115). Examples of where engineering and administrative controls were lacking for EtO include: operational local exhaust ventilation (7%; n=114); continuous air monitoring (6%; n=113); safe handling training (6%; n=142); and standard operating procedures (4%; n=142). Examples of practices which may increase HPGP exposure risk included lack of standard operating procedures (9%; n=311) and safe handling training (8%; n=312). CONCLUSIONS: Use of precautionary practices was good but not universal. EtO use appears to have diminished in favor of HPGP which affords higher throughput and minimal regulatory constraints. Separate EtO sterilization and aeration units were still being used nearly one year after U.S. EPA prohibited their use.