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Injury and hazards in home health care nursing are a growing concern

October 08, 2009

Patients continue to enter home healthcare ''sicker and quicker," often with complex health problems that may require extensive nursing care. This increases the risk of needlestick injuries in home healthcare nurses. While very few studies have focused on the risks of home healthcare, it is the fastest growing healthcare sector in the U.S. In a recent study, led by researchers at Columbia University Mailman School of Public Health, the rate of needlestick-type injuries was 7.6 per 100 nurses. At this rate, the scientists estimate that there are nearly 10,000 such injuries each year in home care nurses. The findings, reported in the paper, "The Prevalence and Risk Factors for Percutaneous Injuries in Registered Nurses in the Home Health Care Sector," were published in the September 2009 issue of American Journal of Infection Control.

According to lead author Robyn Gershon, DrPH, professor of clinical Sociomedical Sciences at the Mailman School of Public Health and principal investigator, "although professionally and personally rewarding for many, home care nursing can be both physically and emotionally demanding. Our study findings suggest that home healthcare work may be dangerous for nurses who work in this setting. These types of injuries are serious as they can result in infection with bloodborne pathogens, such as hepatitis and HIV."

A critical finding of this study was the statistical correlation between needlesticks and exposure to stressful conditions in the patients' household. Nurses reporting household stressors, such as cigarette smoke, unsanitary conditions, air pollution, and vermin, were nearly twice as likely to report needlestick injuries. Most significant was the fact that home healthcare nurses exposed to violence in their patients' households were nearly three and a half times more likely to also report needlestick injuries, according to the study.

The home healthcare sector is a very important part of the nation's healthcare infrastructure with over 1.3 million workers in the field, including roughly 125,000 RNs. Many procedures previously performed only in the hospital are now routinely performed in the home.

Over 700 home healthcare RNs from across New York State were recruited for this study, which was funded by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC).

The provision of a safe work environment in the home healthcare sector is complicated by the fact that worker safety in this setting is largely unregulated. Certain OSHA regulations do not apply to workers employed in individual households. However, home healthcare agencies accredited by the Joint Commission must be in compliance with certain infection control and other standards. Protecting workers from violence in the healthcare setting is an ongoing and well recognized challenge according to Dr. Gershon, "These results indicate that household hazards in general, and home care violence in particular, needs addressing."

"Many of the unsafe conditions identified in this study can also increase risk of harm to patients," said Dr. Gershon. She further noted that as healthcare increasingly moves out from the acute care setting and into the home setting, efforts to improve the health and safety of workers in this sector is critical, with benefits to home health care workers and patients alike.

"Dr. Gershon's research on home healthcare and how it affects elderly patients and caregivers alike is key to helping us evaluate the ways to ensure that both frail older adults and their home health providers remain as safe and healthy in the home setting as possible," says Linda Fried, MD, MPH, dean of the Mailman School of Public Health. "This research is especially important since we know that 20% of the U.S. population will be over 65 years old by the year 2030." Dr. Fried is an epidemiologist and geriatrician whose career has been dedicated to the science of healthy aging.

Columbia University's Mailman School of Public Health