Occupational health for health Care workers
Santé au travail des personnels de santé
Literature Follow-up – Veille documentaire
JF Gehanno - Institute
of Occupational Health - Rouen University Hospital
Table of Contents
MeSH Terms for Occupational
Health for Health Care Workers
Biological hazards/Risques biologiques
Needlestick injuries to nurses, in context
AIDS update: occupational exposure & post-exposure treatment of HIV/AIDS
Preventing blood-borne infections through pharmacy syringe sales and safe
community syringe disposal.
Prevalence of safer needle devices and factors associated with their adoption:
results of a national hospital survey
Suspicions about the safety of vaccines
Vaccinations for health care workers exposed to biological risk factors:an
Physical hazards/Risques physiques
Musculoskeletal disorders/Troubles musculo-squelettiques
Work-schedule characteristics and reported musculoskeletal disorders of registered
Physical workload of student nurses and serum markers of collagen metabolism
The prevalence of musculoskeletal symptoms among British Columbia sonographers
Chemical hazards/Risques chimiques
Multiple sclerosis in nurse anaesthetists
Occupational contact dermatitis from diacetylmorphine (heroin)
Occupational allergic contact urticaria from amoxicillin
Stress – Mental disorders/Stress - psychopathologie
The effectiveness of current approaches to workplace stress management in
the nursing profession: an evidence based literature review
Managing stress: an essential of leadership
Philophonetics counselling for prevention of burnout in nurses
Why nurses leave their profession
Evidence Based Medicineve Heart Failure in the Framingham Heart Study
Documents en Français
Décret n° 2002-1475 du 16 décembre 2002 modifiant le code de santé publique
Articles& documents en Français
De plus en plus de médecins libéraux ont des arrêts de travail pour maladie
Il faudra intégrer l’idée d’une pénurie future de médecins
Epidémie de malaises au Centre hospitalier universitaire de Nice en novembre
2000 : investigation épidémiologique
OR " Disease Outbreaks"[MESH] OR "Accidents, Occupational"[MESH]
OR "Occupational Exposure"[MESH] OR "Air Pollutants, Occupational"[MESH]
OR "multiple chemical sensitivity"[MESH] OR "Universal Precautions"[MESH]
OR "Blood-Borne Pathogens* "[MESH]) AND "Health Personnel"[MESH])
OR "Disease Transmission, Patient-to-Professional"[MESH] OR "Needlestick
Injuries"[MESH] OR "Disease Transmission, Professional-to-Patient"[MESH]
OR "Nursing Staff/psychology"[MESH]
Medline search using above mentionned
Systematic follow-up of some major
Clarke SP, Sloane DM, Aiken LH.
LDI Issue Brief 2002 Sep;8(1):1-4
Center for Health Outcomes and
Policy Research, School of Nursing, University of Pennsylvania, USA.
Injuries with used needles and
other "sharps" put health care workers at risk for serious bloodborne
infections, such as HIV and hepatitis B and C. To some extent, this risk can
be lessened through safer techniques (such as not recapping needles) and safer
devices (such as needleless and self-sheathing equipment). But these injuries
occur within a context (often a hospital unit) with organizational features
that may themselves contribute to an increased or decreased risk. This Issue
Brief summarizes a series of studies that investigate whether workplace aspects
of the hospital (such as staffing levels, and organizational structure and
climate) affect the risk of needlestick injuries to nurses.
J Emerg Med Serv JEMS 2002 Dec;27(12):48-60
HCPs in the United States have
many benefits that work in their favor to help reduce the risk for disease
transmission. The United States has laws and regulations regarding the implementation
of needlesafe devices to reduce needlestick injuries. PEP is readily available
when needed, and AIDS cases continue to decline nationwide. Personal protective
equipment is readily available. Case numbers for occupational transmission
of HIV infection to HCPs remain low. The United States also has set a national
goal to cut new HIV infections in half by the year 2005. Federal law requires
every EMS department to establish a designated infection control officer.
Infection control officers must review and evaluate exposure incidents and
ensure prompt, proper medical follow-up.
Jones TS, Coffin PO.
J Am Pharm Assoc (Wash) 2002 Nov-Dec;42(6
Sinclair RC, Maxfield A, Marks
EL, Thompson DR, Gershon RR.
Public Health Rep 2002 Jul-Aug;117(4):340-9
OBJECTIVES: In this study, we collected
and analyzed the first data available on the extent of the adoption of safer
needle devices (engineered sharps injury protections [ESIPs]) by U.S. hospitals
and on the degree to which selected factors influence the use of this technology.
METHODS: We gathered data via a
telephone survey of a random sample of 494 U.S. hospitals from November 1999
through February 2000.
RESULTS: Although 83% of the sample
reported some ESIP adoption, adoption was inconsistent across types of devices.
All of the appropriate units in 52% of the facilities had adopted needleless
intravenous delivery systems, but the hospitals used other types of ESIPs
less often. A respondent's perception that the cost of ESIPs would not be
a problem for the hospital was the best predictor of adoption of ESIPs in
the facility, explaining 8% of the variance. Other predictors of adoption
included the size of the hospital and the presence or absence of state legislative
activity on the needlestick issue.
CONCLUSIONS: Smaller hospitals
may require special encouragement and assistance from outside sources to adopt
expensive risk-reduction innovations such as ESIPs. Although use of ESIPs
is the mandated and preferred way to protect workers from needlesticks, complete
adoption of this technology will depend on the support of the social systems
in which it is used and the people who use it.
N Engl J Med 2002 Nov 7;347(19):1474-5
Comment on: N Engl J Med. 2002
The New England Journal of Medicine
Volume 348, Issue 5: January 30, 200
Perspective: Smallpox Vaccination
-- The Call to Arms
T.L. Schraeder and E.W. Campion
Progression of the Lesion at the
Site of Inoculation after Smallpox Vaccination
K. Rubins and D.A. Relman
A Model for a Smallpox-Vaccination
S.A. Bozzette and Others
The Public and the Smallpox Threat
R.J. Blendon and Others
Current Concepts: How Contagious
A Different View of Smallpox and
Preventing the Return of Smallpox
J.G. Breman and Others
A Smallpox False Alarm
Ann Ig 2002 May-Jun;14(3 Suppl
Lipscomb JA, Trinkoff AM, Geiger-Brown
J, Brady B
Scand J Work Environ Health 2002;28(6):394-401.
back problems, long workhours,
neck problems, shift work, shoulder problems
Objectives The relationship between
a combination of demanding work-schedule characteristics and reported musculoskeletal
disorders of the neck, shoulders, and back was examined.
Methods A probability sample of
1163 nurses, randomly selected from the list of actively licensed nurses in
two states of the United States, served as the sample for this cross-sectional
study. Data were collected via an anonymous survey mailed to the participants'
homes from October 1999 through February 2000.
Results Four of the nine work-schedule
characteristics (working full-time, >8 hours/day, 2-4 weekends/month, and
other than day shift) were significantly related to musculoskeletal disorders
in one or more body sites. When a work-schedule index was created by summing
the nine characteristics, a demanding schedule was significantly associated
with musculoskeletal disorders in the neck [odds ratio (OR) 1.10, 95% confidence
interval (95% CI 1.00-1.21], shoulder (OR 1.12, 95% CI 1.01-1.23), and back
(OR 1.16, 95% CI 1.06-1.27). Adjustment for psychological and physical job
demands reduced the odds ratios slightly and therefore suggested that some
of the association between musculoskeletal disorders and schedule was due
to increased exposure to these job demands. Working "long hours"
(>12 hours/day, >40 hours/week) and "off hours" (weekends
and nondayshifts) were associated with a 50-170% increase in the age-adjusted
odds ratio for musculoskeletal disorders in the three body sites.
Conclusions The findings of this
study suggest that preventing musculoskeletal disorders requires system-level
approaches to scheduling that reduce the time of exposure to demanding work
conditions and promote healthful work-rest patterns.
Kuiper JI, Verbeek JHAM, Straub
JP, Everts V, Frings-Dresen MHW
Scand J Work Environ Health 2002;28(3):168-175.
back disorders, collagen, connective
tissues, patient handling, prospective cohort study, spine
Objectives This study explored
the association between biomarkers of type I collagen metabolism and exposure
to physical workload.
Methods In a prospective cohort
study, serum concentrations of markers of type I collagen synthesis and degradation
were assessed monthly for student nurses who worked as nurses for a period
of 6 months and compared with those of a reference group. The number of patient-handling
activities was estimated from observations at the workplace. Linear generalized
estimating equations were used to analyze differences in the serum concentrations
of the biomarkers between the exposed group and reference group, as well as
to analyze whether the number of patient-handling activities was associated
with serum concentrations of the biomarkers.
Results Serum concentrations of
the biomarkers were found to differ between the groups. The biomarkers reflected
a higher anabolism of type I collagen in the exposed group when compared with
that of the reference group. An analysis of the effect of the number of patient-handling
activities revealed that a higher exposure was associated with higher effective
type I collagen synthesis within the exposed group.
Conclusions These results indicate
that serum concentrations of these biomarkers of type I collagen metabolism
can reflect differences in exposure between contrasting groups, and also varying
levels of exposure between persons within an occupation
Russo A, Murphy C, Lessoway V,
Appl Ergon 2002 Sep;33(5):385-93
A survey (n = 211, 92% response
rate) was carried out to determine baseline prevalence of musculoskeletal
symptoms and identify related biomechanical, psychosocial, work organization
and demographic factors among the population of sonographers in British Columbia,
Canada. Ninety-one percent of respondents reported musculoskeletal pain or
discomfort that they associated with the work tasks of scanning. Almost half
reported frequent and severe symptoms. The neck, shoulder, and upper back
were the main symptomatic body sites. A very small minority were absent from
work due to the symptoms, with more than two thirds of respondents reporting
working in pain. Bivariate analyses found significant associations between
scanning time, static postures, psychosocial factors, and degree of musculoskeletal
U Flodin, A-M Landtblom, and O
Occup Environ Med 2003; 60: 66-68
Background: Volatile anaesthetics
are chemically related to organic solvents used in industry. Exposure
to industrial solvents may increase the incidence of multiple sclerosis
Aim: To examine the risk
among nurse anaesthetists of contracting MS.
Methods: Nurses with MS
were identified by an appeal in the monthly magazine of the Swedish
Nurse Union and a magazine of the Neurological Patients Association
in Sweden. Ninety nurses with MS responded and contacted our clinic.
They were given a questionnaire, which was filled in by 85 subjects;
13 of these were nurse anaesthetists. The questionnaire requested
information about work tasks, exposure, diagnosis, symptoms, and
year. The number of active nurse anaesthetists was estimated based
on information from the National Board of Health and Welfare and
The Nurse Union. Incidence data for women in the region of Gothenburg
and Denmark were used as the reference to estimate the risk by
calculation of the standardised incidence ratio (SIR).
Results: Eleven of the 13
nurse anaesthetists were exposed to anaesthetic gases before onset
of MS. Mean duration of exposure before diagnosis was 14.4 years
(range 4–27 years). Ten cases were diagnosed in the study period
1980–99, resulting in significantly increased SIRs of 2.9 and 2.8
with the Gothenburg and the Danish reference data, respectively.
Conclusion: Although based
on crude data and a somewhat approximate analysis, this study provides
preliminary evidence for an excess risk of MS in nurse anaesthetists.
The risk may be even greater than observed, as the case ascertainment
might have been incomplete because of the crude method applied.
Further studies in this respect are clearly required to more definitely
assess the risk.
Coenraads PJ, Hogen Esch AJ, Prevoo
Contact Dermatitis 2001 Aug;45(2):114
L. Condé-Salazar D. Guimaraens
M. A. González and E. Mancebo
Contact Dermatitis 2001;45 Issue
C Mimura and P Griffiths
Occupational and Environmental
The effectiveness of current approaches
to workplace stress management for nurses was assessed through a systematic
review. Seven randomised controlled trials and three prospective cohort studies
assessing the effectiveness of a stress management programmes were identified
and reviewed. The quality of research identified was weak. There is more evidence
for the effectiveness of programmes based on providing personal support than
environmental management to reduce stressors. However, since the number and
quality of studies is low, the question as to which, if any, approach is more
effective cannot be answered definitively. Further research is required before
clear recommendations for the use of particular interventions for nursing
work related stress can be made.
SCI Nurs 2002 Summer;19(2):80-1
Sherwood P, Tagar Y.
Aust J Holist Nurs 2002 Oct;9(2):32-40
Nurses who have self-reported burnout
rate their experiences prior to and after the intervention to reveal significant
reductions in their burnout experience on all items. Philophonetics counselling
interventions address feelings of victimization, disorientation, loss of decision
making power, lack of interpersonal boundaries and disconnection from one's
inner being and one's internal resources.
N J Med 2002 Dec;99(12):51
Rhona MacDonald, BMJ
BMJ 2003;326:68 ( 11 January )
Recruiting extra doctors in order
to comply with the European Working Time Directive is not the most effective
use of financial and human resources, warns the Department of Health in guidance
issued last week.
Instead, it suggests that "creative
redesign" of working patterns is needed, including changing the working
patterns of consultants and specialist registrars, to avoid the big increases
in staffing that would otherwise be needed.
From August 2004 doctors in training,
who had previously been excluded from the directive, will come within its
remit. This means they should work for a maximum 58 hours a week, with a further
reduction to 48 hours a week by 2009. At the moment many such doctors would
be working as many as 72 hours in the NHS.
Other recommended solutions include
reducing the number of rotas and stopping the practice of doctors snatching
a few hours' sleep between shifts while in a hospital, as this counts as being
on duty under the directive. Doctors will be expected to work more intensive
resident rotas, supported by on-call cover from home.
This will be achieved by the sharing
of cover between specialties and developing the roles of other staff. For
example, one pilot project, covering acute medical and orthopaedic departments
in Birmingham Heartlands and Solihull NHS Trust, will introduce senior nurses
to replace doctors in training between 1700 and 0900 on weekdays and all day
Jo Hilborne, who chairs the BMA's
junior doctors' negotiating committee, said: "In the absence of any robust
and practical guidance from the Department of Health, it is likely that many
trusts will introduce a shift system for their junior doctors, as this is
much simpler to operate."
She continued: "Hospital mergers
may be inevitable in order to produce the critical mass of doctors required
to ensure patient safety."
Agha W. Haider, MD, PhD; Martin
G. Larson, ScD; Stanley S. Franklin, MD; and Daniel Levy, MD
Ann Intern Med. 2003;138:10-16.
Background: Although hypertension
is a principal precursor of congestive heart failure (CHF), the separate relations
of systolic, diastolic, and pulse pressure with risk for heart failure have
not been fully elucidated.
Objective: To examine the value
of blood pressure predictors of heart failure.
Design: Community-based inception
Setting: Framingham, Massachusetts.
Patients: 2040 free-living Framingham
Heart Study participants (mean age, 61 years [range, 50 to 79 years]).
Measurements: The association
of baseline systolic, diastolic, and pulse pressure with risk for incident
CHF was examined in 894 men and 1146 women. Framingham Heart Study participants
free of CHF at the baseline examination (performed from 1968 to 1973) were
monitored for up to 24 years (mean, 17.4 years) for new-onset heart failure.
Cox proportional hazards models were used to adjust for age, sex, smoking,
left ventricular hypertrophy, body mass index, diabetes mellitus, high-density
lipoprotein cholesterol level, and heart rate; hazard ratios and 95% CIs for
blood pressure variables were estimated.
Results: CHF developed in 234
participants (11.8%) during the follow-up period. All three blood pressure
components were related to the risk for CHF, but the relation was strongest
for systolic and pulse pressure. A 1-SD (20 mm Hg) increment in systolic pressure
conferred a 56% increased risk for CHF (hazard ratio, 1.56 [95% CI, 1.37 to
1.77]); similarly, a 1-SD (16 mm Hg) increment in pulse pressure conferred
a 55% increased risk for CHF (hazard ratio, 1.55 [CI, 1.37 to 1.75]). These
associations were unrelated to age, duration of follow-up, and initiation
of treatment for hypertension during follow-up; they were also observed in
patients with systolic hypertension (systolic blood pressure 140 mm Hg) at
the baseline examination (hazard ratio, 1.41 [CI, 1.18 to 1.69] for pulse
pressure and 1.42 [CI, 1.14 to 1.76] for systolic pressure).
Conclusions: Although each component
of blood pressure was associated with risk for CHF, pulse and systolic pressure
conferred greater risk than diastolic pressure. Increased pulse pressure may
help identify hypertensive patients at high risk for overt CHF who are candidates
for aggressive blood pressure control.
Livre 7 : Etablissements de santé,
Titre 1 : Etablissements de santé
Chapitre 4 : Les établissements
publics de santé
Section 2 : Organes représentatifs
Sous-section 1 : Commissions médicales
d'établissement (Articles R714-16-1 à R714-16-34)
Article R714-16-22 du code de santé
Siègent avec voix consultative
à la commission médicale d'établissement :
a) Le directeur général, le directeur
de l'établissement ou, pour les syndicats interhospitaliers, le secrétaire
général. Ils peuvent se faire représenter par un membre du corps des personnels
de direction de leur choix et être assistés par un ou des collaborateurs de
leur choix dont le directeur du service des soins infirmiers ;
b) Le représentant du comité technique
d'établissement prévu à l'article L. 714-19 ;
c) Le médecin inspecteur régional
et le médecin inspecteur de la santé ;
d) Un représentant de la commission
du service de soins infirmiers élu par cette commission au scrutin majoritaire
à un tour ; en cas d'égalité de suffrages, le plus âgé des candidats est élu;
e) Le médecin-conseil de la caisse
assurant l'analyse d'activité de l'établissement en application de l'article
R. 166-5 du code de la sécurité sociale.
f) Le médecin responsable de l'information
médicale, s'il n'est pas membre de la commission ;
g) Le médecin responsable de
la médecine du travail, s'il n'est pas membre de la commission.
Toutefois, les personnes mentionnées
aux b à g ci-dessus ne siègent pas lorsque la commission médicale d'établissement
se réunit en formation restreinte dans les cas prévus à l'article R. 714-16-24.
Le Quotidien du Médecin 22/01/03
Chez les médecins de ville, le
nombre des arrêts de travail de plus de trois mois, ainsi que le nombre de
bénéficiaires de pension d'invalidité permanente, ont beaucoup progressé ces
dernières années. Les cancers et les affections psychiatriques motivent une
grande partie de ces arrêts de travail temporaires ou définitifs. Or les praticiens
se retrouvent souvent dépourvus face aux conséquences psychologiques et financières
de leur maladie grave.
Rev Infirm 2002 Nov;(85):26-9
Pradier C et Coll.
BEH n° 45 (5 novembre 2002)