Health and safety among Massachusetts home care nurses: bloodborne pathogen exposures
From the Massachusetts Nurse Newsletter
September 2008 Edition
By Pia Markkanen, ScD
Over the past four years, UMass Lowell researchers—in collaboration with the Occupational Health Surveillance Program at Massachusetts Department of Public Health, the MNA, eight home healthcare agencies and one additional healthcare union—have been working on Project SHARRP (Safe Homecare and Risk Reduction for Providers) to examine the problem of exposure to bloodborne pathogens in home health care settings. The study characterized sharps injuries and other blood/body fluid exposures in the home health care setting; evaluated the availability and use of devices with safety features; and identified barriers to reporting sharps injuries.
In 2006-2007, the Project SHARRP survey was sent to 1,772 clinicians working in home health care setting throughout central and eastern Massachusetts; 1,225 completed surveys were returned. The respondents, including 787 nurses, described their experiences with sharps injuries and other blood/body fluid exposures. The average nurse was 48 years old and worked in home health care for 11 years. Over their entire careers, 35 percent of these nurses experienced at least one sharps injury. During the 12 months prior to the survey, 4.3 per- cent of the nurses sustained at least one sharps injury while in a home health care setting.
The survey results revealed several notable points:
- The sharps injury rate for home health care nurses is actually in the same range as the overall sharps injury rate in hospitals1. The survey compared the two settings by looking at the number of sharps injuries per 100 full-time equivalent employees—which corrects for the number of hours worked.
- Work schedule and tenure matter when it comes to sharps injuries. Per-diem and part-time nurses had higher rates than full-time nurses. Also, nurses with shorter home health care tenure—less than five years—had about three times the sharps injury rate as those with more than five years of experience.
- Most sharps injuries involved two groups of medical devices: the majority of injuries occurred with hollow-bore needles, in particularly with syringes and blood drawing devices, followed by cutting blades (such as lancets). Nurses were more likely to be injured when performing the following procedures: administering injections, putting sharps into disposal containers, venipuncture, and fingersticks/heelsticks.
- Most sharps injuries occurred while using sharps devices without safety features (details to be presented in a future edition of the Massachusetts Nurse).
- Nurses reported a number of factors that contributed to their most recent sharps injuries. These included lack of work space; clutter; distractions from other persons in the home; and poor lighting. Aggressive or uncooperative patients were also reported by some participants to have contributed to their injuries, and almost 25 percent of nurses said time pressures were a contributing factor.
- Home health care nurses indicated that the most common reasons for not reporting a sharps injury to their employer were lack of time, fear of being blamed (or “getting in trouble”) and the perception of low risk of infection.
The SHARRP survey findings confirm that bloodborne pathogen exposure is a significant hazard in home health care settings. The survey also illustrates the need to provide guidance for injury/exposure prevention.
In the coming months, Project SHARRP and the MNA will continue to explore and propose specific strategies for reducing sharps injuries and other blood/body fluid exposures in health care settings.
Pia Markkanen is a research professor at the Department of Work Environment and Lowell Center for Sustainable Production at University of Massachusetts Lowell.