4- Veille documentaire médecine du travail hospitalière Janvier 2003
Veille documentaire Avril 2002

Occupational health for health Care workers

Santé au travail des personnels de santé

Literature Follow-up – Veille documentaire

January 2003

JF Gehanno - Institute of Occupational Health - Rouen University Hospital

Table of Contents

MeSH Terms for Occupational Health for Health Care Workers
Methodology/ Méthodologie
Biological hazards/Risques biologiques
Blood exposures/AES
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
Vaccination/Vaccination
Suspicions about the safety of vaccines
Smallpox vaccination
Vaccinations for health care workers exposed to biological risk factors:an overview
Physical hazards/Risques physiques
Musculoskeletal disorders/Troubles musculo-squelettiques
Work-schedule characteristics and reported musculoskeletal disorders of registered nurses
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
Allergy/Allergies
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
Other/Autre
Why nurses leave their profession
Miscellaneous/Divers
Evidence Based Medicineve Heart Failure in the Framingham Heart Study
Documents en Français
Reglementation
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 grave
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

MeSH Terms for Occupational Health for Health Care Workers

(("occupational diseases"[MESH] 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]

Methodology/ Méthodologie

Medline search using above mentionned key-words

Systematic follow-up of some major periodicals

Biological hazards/Risques biologiques

Blood exposures/AES

Needlestick injuries to nurses, in context.

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.

AIDS update: occupational exposure & post-exposure treatment of HIV/AIDS.

West K.

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.

Preventing blood-borne infections through pharmacy syringe sales and safe community syringe disposal.

Jones TS, Coffin PO.

J Am Pharm Assoc (Wash) 2002 Nov-Dec;42(6 Suppl 2):S6-9

Prevalence of safer needle devices and factors associated with their adoption: results of a national hospital survey.

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.

Vaccination/Vaccination

Suspicions about the safety of vaccines.

Campion EW.

N Engl J Med  2002 Nov 7;347(19):1474-5

Comment on:  N Engl J Med. 2002 Nov 7;347(19):1477-82.

Smallpox vaccination

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

http://content.nejm.org/cgi/content/short/348/5/381?query=TOC

Progression of the Lesion at the Site of Inoculation after Smallpox Vaccination

K. Rubins and D.A. Relman

http://content.nejm.org/cgi/content/short/348/5/414?query=TOC

A Model for a Smallpox-Vaccination Policy

S.A. Bozzette and Others

http://content.nejm.org/cgi/content/short/348/5/416?query=TOC

The Public and the Smallpox Threat

R.J. Blendon and Others

http://content.nejm.org/cgi/content/short/348/5/426?query=TOC

Current Concepts: How Contagious Is Vaccinia?

K.A. Sepkowitz

http://content.nejm.org/cgi/content/short/348/5/439?query=TOC

A Different View of Smallpox and Vaccination

T. Mack

http://content.nejm.org/cgi/content/short/348/5/460?query=TOC

Preventing the Return of Smallpox

J.G. Breman and Others

http://content.nejm.org/cgi/content/short/348/5/463?query=TOC

A Smallpox False Alarm

http://content.nejm.org/cgi/content/short/348/5/467?query=TOC

Vaccinations for health care workers exposed to biological risk factors:an overview

Gallo G.

Ann Ig 2002 May-Jun;14(3 Suppl 3):59-67

Physical hazards/Risques physiques

Musculoskeletal disorders/Troubles musculo-squelettiques

Work-schedule characteristics and reported musculoskeletal disorders of registered nurses.

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.

Physical workload of student nurses and serum markers of collagen metabolism.

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

The prevalence of musculoskeletal symptoms among British Columbia sonographers.

Russo A, Murphy C, Lessoway V, Berkowitz J.

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 symptoms.

Chemical hazards/Risques chimiques

Multiple sclerosis in nurse anaesthetists

U Flodin, A-M Landtblom, and O Axelson

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 (MS).

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.

Allergy/Allergies

Occupational contact dermatitis from diacetylmorphine (heroin).

Coenraads PJ, Hogen Esch AJ, Prevoo RL

Contact Dermatitis 2001 Aug;45(2):114

Occupational allergic contact urticaria from amoxicillin

L. Condé-Salazar D. Guimaraens M. A. González and E. Mancebo

Contact Dermatitis 2001;45 Issue 2:109

Stress – Mental disorders/Stress - psychopathologie

The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review

C Mimura and P Griffiths

Occupational and Environmental Medicine 2003;60:10-15

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.

Managing stress: an essential of leadership.

Ward KS.

SCI Nurs 2002 Summer;19(2):80-1

Philophonetics counselling for prevention of burnout in nurses.

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.

Other/Autre

Why nurses leave their profession.

Fortunato C.

N J Med 2002 Dec;99(12):51

Miscellaneous/Divers

More doctors is not the answer to the EU Working Time Directive

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 at weekends.

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."

Evidence Based Medicine

Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure as Predictors of Risk for Congestive Heart Failure in the Framingham Heart Study

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 cohort study.

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.

Documents en Français

Reglementation

Décret n° 2002-1475 du 16 décembre 2002 modifiant le code de santé publique

Livre 7 : Etablissements de santé, thermoclimatisme, laboratoires

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 publique

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.

Articles& documents en Français

De plus en plus de médecins libéraux ont des arrêts de travail pour maladie grave

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.

Il faudra intégrer l’idée d’une pénurie future de médecins

Farhi F.

Rev Infirm 2002 Nov;(85):26-9

Epidémie de malaises au Centre hospitalier universitaire de Nice en novembre 2000 : investigation épidémiologique

Pradier C et Coll.

BEH n° 45 (5 novembre 2002)

http://www.invs.sante.fr/beh/2002/45/beh_45_2002.pdf





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