Environment, health & safety

Registered nurses and other healthcare workers face many occupational risks in the workplace, including the potential exposure to communicable and infectious diseases; exposures to blood or body fluids through needlesticks, other sharps injuries, and splash injuries; and exposure to chemicals, such as chemotherapeutics or cleaning agents to name a few.

Because health care is a high-risk occupation, it is important that the healthcare worker be knowledgeable and informed about the risks he or she may encounter on the job. Each healthcare worker must be proactive in mitigating those risks and must be as prepared as possible to protect his or her own health. Healthcare workers and their employers are partners in creating a healthcare safety culture.

The Occupational Safety and Health Administration (OSHA), created in 1970 with the mission to prevent work-related injuries, illnesses, and deaths, set some standards for workplace safety. In addition, the department of health in each state may offer guidelines to healthcare organizations concerning requirements for healthcare workers, such as necessary immunizations. Other organizations can also influence standards for healthcare workers; for example, The Joint Commission accredits and certifies healthcare organizations. Some standards include the review of plans of the healthcare organization impacting healthcare workers and patients such as the exposure control plan.

Federal or state legislation and regulations contribute to setting requirements for healthcare organizations. Examples of such legislation are OSHA’s Bloodborne Pathogens Standard (CFR 1910.1030) and The Needlestick Safety and Prevention Act (H.R. 5178), both of which address sharps safety and bloodborne pathogen exposures.

Respiratory protection is vitally important in many respiratory exposures, such as tuberculosis and severe acute respiratory syndrome, and in the event of a pandemic. Be prepared and confident in the use of the N-95 respirator, an important item of personal protective equipment. After the initial fit testing following medical clearance to wear an N-95 respirator, an annual fit testing is required. Know the size and manufacturer of the respirator you were fit tested to wear. For additional information on respiratory protection and fit testing, review OSHA standard 29 CFR 1910.134.

Because of the various influences and internal policies of healthcare organizations, healthcare workers may be required to undergo an annual health screening. The health screen may include a review of your employee health record, immunization status including titers, annual TB screening, fit testing for a respirator, or other fit-for-duty issues.

However, sometimes annual health assessments do not occur as scheduled or they may not be conducted at your workplace. If you have not had a health assessment by your employer in the past year, contact your occupational health office to schedule a review of your files to ensure that you are optimally prepared for any occupational risks you may encounter. Know what immunizations are required by your state for healthcare workers and what your employer is offering. Keep a personal file of your past immunizations and titers so you have documented evidence of your immunity status. Stay current on recommended immunization boosters.

An annual review is an ideal time to ask questions about any changes in policies, requirements, or procedures, such as the process for reporting occupational exposures to communicable diseases or infections or bloodborne pathogens. Be prepared to know what to do in the event you experience an exposure or injury.

Healthcare workers and their employers must partner to make the healthcare workplace safer. Knowing what occupational risks you face as a healthcare professional can equip you with the basics needed to preserve and protect your own health and to interact with your organization’s occupational or employee health department.

Selected references
Pugliese G, Perry J. The Needlestick Safety and Prevention Act (HR 5178): what does it require? University of Virginia Health System.
International Healthcare Worker Safety Center. www.healthsystem
.virginia.edu/internet/epinet/hr5178rv.cfm.
Accessed February 23, 2009.
Occupational Safety and Health Administration (OSHA). www.osha.gov. Accessed February 23, 2009.
Success story: boosting annual health screens. Hosp Employee Health. 2008;27(12):142-143.

Nancy L. Hughes is the director of ANA’s Center for Occupational and Environmental Health.

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