Occupational health for health Care workers
Literature Follow-up – September 2002
- Institute of Occupational Health - Rouen University Hospital
Table of Contents
MeSH Terms for Occupational Health for Health
Brazilian dental students' knowledge and attitudes towards
Occupational accidents among nursing personnel caused by
Sharps injury: prevention and management.
Occupational Transmission of Hepatitis C Virus
Hepatitis C: transmission, treatment and occupational risk.
Scientists join smallpox vaccine controversy.
Observational study of vaccine efficacy 14 years after trial
of hepatitis B vaccination in Gambian children.
Critical evaluation of smallpox vaccination for laboratory
Economic Analysis of Influenza Vaccination and Antiviral
Treatment for Healthy Working Adults
Supplementary statement for the 2002-2003 influenza season:
update on oculo-respiratory syndrome in association with influenza vaccination
Risk of Tuberculin Skin Test Conversion among Health Care
Workers: Occupational versus Community Exposure and Infection
Disease transmission, professionnal to patient
Occupational exposure to cytotoxic drugs in two UK oncology
Biological monitoring of hospital personnel occupationally
exposed to antineoplastic agents.
Personal exposure level and environmental ethylene oxide
gas concentration in sterilization facilities of hospitals in Japan.
Stress – Mental disorders
Working on Stress
Zero tolerance of violence against healthcare staff.
Challenging the myth of the 12-hour shift: a pilot evaluation.
Doctors' perceptions of drinking alcohol while on call: questionnaire
Education for nurses returning to practice.
Barriers to healthy eating in the nursing profession: Part
Barriers to healthy eating in the nursing profession: Part
Evidence Based Medicine
Documents en Français.
Articles& documents en Français
of Health Personnel
Medline search using above
Systematic follow-up of
Oliveira ER, Narendran
S, Falcao A.
AIDS Care 2002 Aug;14(4):569-76
The purpose of this study
was to investigate a group of Brazilian dental students' knowledge about HIV
infection, the infection control measures utilized by the dental students,
and students' attitudes towards treating HIV/AIDS patients. The study population
consisted of 250 dental students from Universidade Federal da Bahia, Brazil,
who were treating patients in clinics of the university and extra-mural rotations
at the time of the study. The survey instrument was a self-administered questionnaire
which consisted of 32 pre-coded questions and two open-ended questions. The
overall response rate to the questionnaire was 54%. More than 80% of respondents
(N = 135) considered every dental patient a potential HIV carrier. A majority
of the students were aware of the association between HIV and Kaposi's sarcoma
(92.5%), oral candidiasis (90.3%) and oral hairy leukoplakia (52.7%). A gender
difference was observed in students' knowledge of oral manifestations and
infection control measures, with females having better knowledge than males
(p < 0.05). Because of certain inadequacies in knowledge and infection
control practices among respondents, a curriculum focusing on the management
of HIV/AIDS, including infection control and legal issues is recommended.
Tomazin CC, Benatti MC.
Rev Gaucha Enferm 2001
The purpose was to conduct
a survey on work accidents which occur due to sharp cutting instruments. The
population studied consisted of nursing personnel who had suffered work accidents.
A sample of 22 female workers was selected and the individuals were interviewed.
The average age of this sample was 38 years old and there were 59.1% nursing
assistants, 22.7% nurses, 9.1% nursing technicians and 9.1% nursing attendants.
The highest number of accidents occurred during the month of June and most
of them around 3 PM. Most of the accidents reported were from the neonatal
unit. The hands were the most affected parts of the body and the majority
of the accidents were due to perforating instruments. When the accidents occurred,
50% were wearing gloves and 86.4% were vaccinated.
May D, Brewer S.
Nurs Stand 2001 Apr 25-May
quiz 53-4 Nurs Stand.
2001 Sep 12-18;15(52):26-7.
Nurses are at risk of
infection through injuries caused by infected sharps and needles. The authors
discuss the prevention and management of such injuries.
Janine Jagger; Vincenzo
Puro; Gabriella De Carli; Arthur J. Lunsk; Mark S. Sulkowsky; Stuart C. Ray;
David L. Thomas
Nurs Stand 2001 Jun 20-26;15(40):43-6
There is a risk to nurses
of contracting hepatitis C through occupational exposure, although in the
UK infection is mainly limited to intravenous drug users. In this article
Peter Washer discusses what is currently known about the virus, mainly focusing
on transmission, treatment and the risk of occupational exposure.
Lancet Infect Dis 2002
Whittle H, Jaffar S, Wansbrough
M, Mendy M, Dumpis U, Collinson A, Hall A.
BMJ 2002 Sep 14;325(7364):569
Objective: To determine
the duration of protection from hepatitis B vaccine given in infancy and early
childhood. Design: Cross sectional serological study of hepatitis B virus
infection in children of various ages 14 years after the start of a trial
of vaccination regimens. Setting: Two villages in the Gambia. Participants:
Children and adolescents given hepatitis B vaccine in infancy or early childhood:
232 were aged 1-5 years, 225 aged 5-9 years, 220 aged 10-14 years, and 175
aged 15-19 years. Main outcome measures: Vaccine efficacy against infection
and against chronic infection in the different age groups. Results: Vaccine
efficacy against chronic carriage of hepatitis B virus was 94% (95% confidence
interval 89% to 97%), which did not vary significantly between the age groups.
Efficacy against infection was 80% (76% to 84%). This was significantly lower
in the oldest age group (65%, 56 to 73). Of the uninfected participants in
this age group, 36% had no detectable hepatitis B virus surface antibody.
Time since vaccination and a low peak antibody response were the most powerful
risk factors for breakthrough infection (P<0.001 in each case). Low peak
antibody response was also a risk factor for chronic carriage (odds ratio
95, 19 to 466). Conclusions: Children vaccinated in infancy are at increased
risk of hepatitis B virus infection in the late teens. The risk of chronic
carriage after sexual exposure needs further assessment to determine if booster
vaccines are necessary.
S N Isaacs
Occupational and Environmental
Patrick Y. Lee, MD; David
B. Matchar, MD; Dennis A. Clements, MD, PhD; Joel Huber, PhD; John D. Hamilton,
MD; and Eric D. Peterson, MD, MPH
Ann Intern Med. 2002;137:225-231.
have several treatment options for influenza, including vaccination and various
antiviral therapies. However, the optimal influenza prevention and treatment
strategy is unknown.
Objective: To compare
the relative health values of contemporary treatment strategies for influenza
in a healthy sample of working adults.
Design: Cost-benefit analysis
using a decision model.
Data Sources: Previously
Target Population: Healthy
employed adults 18 to 50 years of age.
Time Horizon: A complete
Interventions: Eight treatment
options (yes or no) based on the possible combinations of vaccination and
antiviral therapy (rimantadine, oseltamivir, or zanamivir or no treatment)
should infection develop.
Outcome Measures: Cost
in U.S. dollars, including the value of symptom relief and medication side
effects, which was assigned a monetary value through a conjoint analysis that
used a "willingness-to-pay" approach.
Results: In the base-case
analysis, all strategies for influenza vaccination had a higher net benefit
than the nonvaccination strategies. Vaccination and use of rimantadine, the
most cost-beneficial strategy, was $30.97 more cost-beneficial than nonvaccination
and no use of antiviral medication. The health benefits of most antiviral
treatments equaled or exceeded their costs for most scenarios. The choice
of the most cost-beneficial antiviral strategy was sensitive to the prevalence
of influenza B and to the comparative workdays gained by each antiviral therapy.
is cost-beneficial in most influenza seasons in healthy working adults. Although
the benefits of antiviral therapy for persons with influenza infection appear
to justify its cost, head-to-head trials of the various antiviral therapies
are needed to determine the optimal treatment strategy.
Advisory Committee Statement
(ACS) National Advisory Committee on Immunization (NACI)
Communicable Disease Report Volume 28 (ACS-6) September 1, 2002
Nina M. Larsen, Cara L.
Biddle, Mark J. Sotir, Nancy White, Patricia Parrott, and Henry M. Blumberg
Clinical Infectious Diseases
A prospective observational
cohort study to assess rates of and risk factors for tuberculin skin test
(TST) conversion among health care workers (HCWs) was conducted at an urban
hospital located in a high tuberculosisincidence area in 19941998. All hospital
employees undergoing required testing every 6 months were included. A total
of 69 (1.2%) of 5773 susceptible employees had a documented TST conversion
(overall rate, 0.38 per 100 person-years worked). No significant difference
existed in conversion rates among employees with frequent, limited, or no
patient contact. HCWs with a TST conversion lived in zip codes with higher
tuberculosis case rates (P .05). In multivariate analysis, TST conversion
was associated with history of bacille Calmette-Guérin vaccination (relative
risk [RR], 11.63), annual salary <$20,000 (RR, 3.67), and increasing age.
In the setting of an effective tuberculosis infectioncontrol program, TST
conversion rates were low, and risk of conversion among HCWs was associated
most strongly with nonoccupational factors.
Ziegler E, Mason H J,
Baxter P J
Occup Environ Med 2002
Aims: To investigate the
potential exposure to cytotoxic drugs of staff on two oncology wards in a
large district, UK hospital under normal working conditions. Methods: Cytotoxic
drug exposure was monitored in urine samples, surface wipes, and on disposable
gloves by using a number of commonly used marker drugs, namely cyclophosphamide,
ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire
data on their work practices, potential exposure, use of protective personal
equipment, and relevant training were collected from nursing, domestic, and
clerical staff on two oncology wards. Results: The majority of staff were
female with a mean age of 31 years. Roughly half of the staff studied were
specifically trained nurses with an average of 3.5 years experience of administering
cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried
out on the wards. Disposable gloves, plastic armlets and aprons, but not eye
protection, were invariably worn where there was potential exposure to cytotoxics.
No cytotoxic drug was detected in any of the staff's urine samples. Isolated
disposable latex gloves from nurses administering drugs showed some contamination,
as did some surfaces within the wards' sluice rooms, but not in the ward areas
where the drugs were stored and checked prior to administration. Conclusions:
The risk management strategies in place, including use of personal protective
equipment, staff training, and other organisational measures, have ensured
that internal exposure is lower than the detection limits for the current
biological monitoring methods. Levels of contamination appear significantly
lower than earlier, non-UK published studies where different risk management
strategies were in place and, in particular, ward staff may have been involved
in some degree of cytotoxic drug reconstitution.
Roberta Turci, Cristina
Sottani, Anna Ronchi and Claudio Minoia.
Toxicology Letters, Volume
134, Issues 1-3, 5 August 2002, Pages 57-64.
To detect trace amounts
of urinary cyclophosphamide (CP), ifosfamide (IF) and methotrexate (MTX),
sensitive and specific high-performance liquid chromatography/ tandem mass
spectrometry (HPLC-MS/MS) procedures, incorporating either liquid-liquid (for
CP and IF), or solid-phase, extraction (for MTX) have been developed. Urinary
platinum (Pt) was also detected using inductively coupled plasma-mass spectrometry
(ICP-MS). These methods showed acceptable imprecision and inaccuracy. The
limit of detection (LOD) was 50 ng/l for CP and IF, 200 ng/l for MTX and 1
ng/l for Pt. Biomonitoring was performed on two consecutive days on nine subjects
preparing, and seven administering, antineoplastic drugs. Urine was collected
at the beginning, at the end and during the work shift. Eighteen urine samples
were positive for CP (range: 50¯10031 ng/l), whereas IF was detected in one
subject only (153 ng/l). LOD was never exceeded for MTX. In urine samples
from nurses and pharmacy technicians, Pt was detected in three subjects (range
920¯1300 ng/l). These findings were compared with the results from a previous
survey carried out in the same hospital when different work practices were
in use. The proposed methods are simple, fast and reliable and can be used
to identify exposure of hospital personnel handling antineoplastic drugs.
Hori H, Yahata K, Fujishiro
K, Yoshizumi K, Li D, Goto Y, Higashi T.
Appl Occup Environ Hyg
Personal and environmental
(stationary) ethylene oxide (EO) gas concentrations in gas sterilization facilities
were measured at six workplaces in five hospitals. An ethylene oxide gas monitor
(3M #3551) was used for both personal and stationary samplings. A gas detector
tube was also used for instantaneous sampling. In most workplaces, the personal
exposure levels of EO were below the detection limit of the gas monitor. Most
of the time-weighted average (TWA) concentrations by the stationary sampling
were below the threshold limit value of EO (TLV-TWA = 1 ppm), but in one workplace,
more than 4 ppm of EO were detected in front of the sterilizer in a clean
room during a 24-hour measurement, although all the personal exposure levels
were below the detection limit. Method of aeration after the sterilization
was very important for reducing the EO exposure. The EO gas concentrations
in two workplaces where sufficient aeration was carried out were below the
detection limit in all the stationary samples. In one workplace where insufficient
aeration was performed, EO was detected from 16 of 17 stationary samples,
and more than 90-200 ppm of EO was determined by the gas detector tube near
the worker's face at the moment when the door of the sterilizer was opened
and the sterilized materials were removed.
European Agency for Safety
and Health at Work
Nurs Stand 2001 Jan 3-9;15(16):39-41
A government campaign
aimed at stopping violence against healthcare staff is a start in dealing
with the problem of aggression in the workplace. Staff attitudes will also
need to be addressed, particularly in those areas where violence has become
an accepted part of the job, if zero tolerance is to be achieved.
Bloodworth C, Lea A, Lane
S, Ginn R.
Nurs Stand 2001 Apr 4-10;15(29):33-6
AIM: The aim of this pilot
evaluation was to assess whether changing a nursing shift pattern to incorporate
12-hour shifts would have positive effects for patients and staff in a ward
environment. METHOD: All nurses, night sisters and therapists in contact with
the ward during the trial were asked to complete a questionnaire. Data on
sickness, agency use, 'untoward incidents' and spread of unsocial hours were
also analysed to see what effects a change in shift pattern had. RESULTS:
The new shift pattern offered benefits for patients through improved communication,
increased continuity of care and more content staff. In addition, staff complied
to the Working Time Regulations (DTI 1998) with no change to their unsocial
hour pay. There was also a reduced need for agency nurses. CONCLUSION: This
study illustrated the potential a new nursing shift pattern involving 12-hour
shifts has for patient care, as well as for staff job satisfaction and efficient
management of the ward. Twelve-hour shifts are infamous in nursing and many
studies cite exhausted and dissatisfied staff as a reason for the negative
press (Fitzpatrick et al 1999, Todd et al 1993). In particular, Todd et al
(1989) claimed that the quality of patient care was negatively affected on
wards that used a 12-hour shift pattern. The study reported here challenges
Todd et al's work (1989, 1993) by demonstrating the benefits a change in shift
pattern to 12-hour shifts can have for patients and staff in a ward environment.
Ahmad T, Wallace J, Peterman
J, Desbiens NA.
BMJ 2002 Sep 14;325(7364):579-80
Nurs Stand 2001 Jan 10-16;15(17):39-41
Faugier J, Lancaster J,
Pickles D, Dobson K.
Nurs Stand 2001 May 23-29;15(36):33-6
AIM: The aim of this study
commissioned by the NHS Executive North West was to identify the main areas
of the nurse's working environment that prevent healthy eating, to ascertain
if nurses have enough nutritional knowledge to make informed choices, and
to review sources, availability and quality of food provided for nursing staff.
METHOD: A purposive sample size of 126 nurses from across eight healthcare
sites in the North West region completed questionnaires. RESULTS: Shift patterns
and failure to take breaks were identified as the two main barriers to healthy
eating by respondents. However, satisfaction with food on offer and a supportive
environment were also identified as important influences. CONCLUSION: Several
recommendations were made as a result of the study. Ideally, nurses should
take regular breaks. Food should carry nutritional labelling and nutritional
information should be displayed at healthcare sites in a more imaginative
and innovative way. More refrigerated vending machines with a selection of
healthier options should be supplied. Packed lunches or plated salads obtainable
from restaurants by evening and night-shift nurses should be offered, in addition
to a better selection of sandwiches and other food choices outside the hours
of 9 am to 5 pm, Monday to Friday. Nurses should be encouraged to drink the
recommended amount of eight glasses of water per day (Health and Fitness Tips
2000) by providing adequate water dispensers. The possibility of having separate
catering facilities for staff who wish to avoid patients and visitors during
breaks should be explored.
Faugier J, Lancaster J,
Pickles D, Dobson K.
Nurs Stand 2001 May 30-Jun
AIM: This is the second
of two articles that report on work commissioned by the NHS Executive North
West, to explore the perceived barriers to healthy eating within the nursing
profession. METHOD: Observations were made of catering facilities within eight
healthcare sites (six acute hospitals, an NHS walk-in centre and an NHS Direct
site) across the North West region. Twenty four unstructured interviews were
conducted with nurses and three were sampled from each healthcare site. RESULTS:
Four main themes emerged as barriers to healthy eating: availability; variety;
distance from catering facilities; and breaks/staffing levels/workload issues
CONCLUSION: Respondents in this study do not consider their working environments
to be conducive to healthy eating practices.