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3- Veille documentaire médecine du travail hospitalière Octobre 2002

(4869 lectures)   Format imprimable

Veille documentaire Avril 2002

Occupational health for health Care workers

Literature Follow-up – October - November 2002

JF Gehanno - Institute of Occupational Health - Rouen University Hospital

Table of Contents

MeSH Terms for Occupational Health for Health Care Workers
Biological hazards
Blood exposures
Effectiveness of the hands-free technique in reducing operating theatre injuries
Avoiding blood and body fluid exposures
Blood-borne viruses and health care workers
Immunogenicity of hepatitis B vaccines: implications of immune memory
The Effect of Age on Immunologic Response to Recombinant Hepatitis B Vaccine: A Meta-analysis
How medical students in their pre-clinical year perceive their own hepatitis-B-virus status: the results of a study in a Thai medical school
Airborne transmission
An Outbreak of Group A Streptococcal Infection among Health Care Workers
Contact transmission
A historical review of barrier materials
Disease transmission, professionnal to patient
Legal implications for HIV-infected clinicians
Nurses to be tested for HIV?
Physical hazards
Ionizing radiations
Radiolabeled localization of the sentinel lymph node: dosimetric evaluation in personnel involved in the procedure
Musculoskeletal disorders
Feasibility of lumbar supports for home care workers with low back pain
Chemical hazards
Current concepts: organophosphate toxicity
[Risks related to cytostatic exposure for nursing staff
[A case of pneumoconiosis in a dental technician
[Occupational dermatitis in health care personnel
[Claim, recognition and compensation of occupational dermatitis
Factors influencing total mercury levels among Lebanese dentists
Infection Control
Stress – Mental disorders
Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Aggressive behaviour and burnout among staff of homes for the elderly
Joint Programme Launches New Initiative Against Workplace Violence in the Health Sector.
Residents' hours of work
Children With Physical Disabilities Compared With Female Caregivers of Children With a Chronic Medical Condition
Inequity in occupational health services for government hospital workers in South Africa
The perceived function of health care assistants in intensive care: nurses views
Nurses. Plugged in
Clinical placements in mental health: are clinicians doing enough for undergraduate nursing students?        
Keeping nurses. How one hospital and two systems cured their staffing ills
Registered nurses' lived experience of advocacy within a critical care unit: a phenomenological study.    
Effects of shiftwork on sleep and menstrual function in nurses
Your health at work
Evidence Based Medicine
Safety and Health Good Practice on-line for the Healthcare Sector
Documents en Français
Prophylaxie des infections invasives à méningocoque
Articles& documents en Français
Sécurité des médecins
Effets secondaires associés au vaccin antigrippal : résultats de la surveillance passive, Canada 2001-2002           
Premier cas de diphtérie depuis 1989 en France
Autopsie de la RTT à l’Hôpital
Vaccin hépatite B : la polémique repart


MeSH Terms for Occupational Health for Health Care Workers

Accidents, Occupational

Air Pollutants, Occupational

Attitude of Health Personnel

Blood-Borne Pathogens*

Disease Transmission, Patient-to-Professional

Disease transmission, professionnal-to-patient

Evidence-Based Medicine

Health Personnel

Multiple chemical sensitivity

Nursing Staff/psychology*

Occupational diseases

Occupational Exposure

Universal Precautions


Medline search using above mentionned key-words

Systematic follow-up of major periodicals

Biological hazards

Blood exposures

Effectiveness of the hands-free technique in reducing operating theatre injuries.

Stringer B, Infante-Rivard C, Hanley JA.

BACKGROUND: Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended. AIMS: To prospectively evaluate the effectiveness of the hands-free technique in reducing the incidence of percutaneous injuries, contaminations, and glove tears arising from handling sharp instruments. METHODS: For each of 3765 operations carried out in main and surgical day care operating theatres in a large urban hospital, over six months, circulating nurses recorded the proportion of use of the hands-free technique during each operation, as well as other features of the operation. The hands-free technique, considered to be used when 75% or more of the passes in an operation were done in this way, was used in 42% of operations. The relative rate of incidents (percutaneous injuries, contaminations, and glove tears) in operations where the hands-free technique was used and not used, with adjustment via multiple logistic regression for the different risk profiles of the two sets of operations, was calculated. RESULTS: A total of 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears) were reported. In operations with greater than 100 ml blood loss, the incident rate was 4% (18/486) when the hands-free technique was used and 10% (90/880) when it was not, approximately 60% less. When adjusted for differences in type and duration of surgery, emergency status, noisiness, time of day, and number present for 75% of the operation, the reduction in the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free technique was used and 1.5% (19/1259) when it was not used. Adjustment for differences in risk factors did not alter the difference. CONCLUSIONS: Although not effective in all operations, use of the hands-free technique was effective in operations with more substantial blood loss.

Avoiding blood and body fluid exposures.

Jagger J, Perry J.

International Health Care Worker Safety Center of the University of Virginia at Charlotesville, USA.

Nursing 2002 Aug;32(8):68

Blood-borne viruses and health care workers.

Ciuffa V, Tirrozzo SF, Vento S.

Arch Intern Med 2002 Oct 14;162(18):2141-2

Comment on: Arch Intern Med. 2002 Feb 11;162(3):345-50.


Immunogenicity of hepatitis B vaccines: implications of immune memory.

Koff RS.

Vaccine  2002 Nov 1;20(31-32):3695-701

The subunit recombinant hepatitis B virus (HBV) vaccines available in the US differ in hepatitis B surface antigen content. Clinical studies have linked higher antigen formulations with enhanced peak protective antibody levels. This is important for the elderly, smokers, the obese, and the immunocompromised. Immune memory, which is responsible for prolonged protection when HBV vaccine-induced antibody levels become undetectable, may be related to antigen persistence on immunologically active cells. Antigen persistence may be related to antigen content of the vaccine and thereby influences the duration of immunity. Proof of this concept will require additional studies of immune memory in HBV.

The Effect of Age on Immunologic Response to Recombinant Hepatitis B Vaccine: A Meta-analysis

David N. Fisman, Deepak Agrawal, and Karin Leder

Clinical Infectious Diseases    2002;35:1368-1375

Hepatitis B vaccine is a key tool for the prevention of hepatitis B infection. Age-associated changes in immune function may contribute to decreased vaccine efficacy in older individuals, although research related to this topic has yielded contradictory findings. We performed a meta-analysis of 24 published trials and studies that evaluated the association of age with response to hepatitis B vaccine, using a random-effects model. Pooling of study results suggested a significantly increased risk of nonresponse to hepatitis B vaccine among older individuals (relative risk [RR], 1.76; 95% confidence interval [CI], 1.482.10). An elevated risk of nonresponse persisted even after exclusion of poor-quality studies (RR, 1.63; 95% CI, 1.232.15) and adjustment for publication bias (RR, 1.52; 95% CI, 1.261.83), and it was present even when "older" individuals were defined as being as young as 30 years. These findings have important implications for individuals at risk for hepatitis B infection, including health care workers and travelers.

How medical students in their pre-clinical year perceive their own hepatitis-B-virus status: the results of a study in a Thai medical school.

Wiwanitkit V.

Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. viroj.w@chula.ac.th

Ann Trop Med Parasitol 2002 Sep;96(6):627-30

In 2000 all of the medical students of the Faculty of Medicine at Chulalongkorn University in Bangkok who were then in their pre-clinical year were interviewed about their hepatitis-B-virus (HBV) status. Of the 215 interviewees, 125 (58.2%) claimed to know their HBV status. Seventy (32.6%) of the subjects assumed they were immune because they had already been vaccinated against the virus, 32 (14.9%) claimed to have natural immunity following exposure to the virus, and 14 (6.5%) reported that they were HBV carriers. Another five (2.3%) of the subjects said they had been tested for HBV and found seronegative and the remaining four subjects (1.9%) who said they knew their status declined to give any more details. The 90 subjects who did not know their status were all offered HBV screening, and 62 agreed to be tested, both for the surface antigen of the virus (HBsAG) and antibody to the viral core (anti-HBc). These tests revealed that 37 subjects were seronegative (negative for both HBsAg and anti-HBc), 11 appeared to have natural immunity (negative for HBsAg but positive for anti-HBc) and the other 14 were carriers (positive for HBsAg but negative for anti-HBc). Four of the 14 carriers were also positive for the HBV 'e' antigen (HBeAg), indicating that they were highly infectious. Medical students form a high-risk group for infection with blood-borne pathogens, including HBV. That more than 40% of the pre-clinical students in the present study did not know their HBV status and fewer than 50% had been vaccinated against the virus are therefore causes for concern. Those students entering Thai medical schools for the first time clearly need to be better educated about hepatitis B and to be encouraged to be vaccinated before they begin any clinical practices.

Airborne transmission

An Outbreak of Group A Streptococcal Infection among Health Care Workers

Anthony Kakis, Laurel Gibbs, Jose Eguia, Joe Kimura, Diane Vogelei, Nancy Troup, Dennis Stevens, Edward L. Kaplan, Dwight R. Johnson, and John E. Conte, Jr.

Clinical Infectious Diseases 2002;35:1353-1359

We describe the nosocomial transmission of group A Streptococcus species (GAS) from a single source patient to 24 health care workers (HCWs). DNA typing revealed that all of the isolates were identical to that of the source patient. The isolates were M type 1, positive for production of nicotine adenine dinucleotidase, and negative for opacity factor, all of which are factors reported to have a higher correlation with invasive disease. The 24 HCWs developed symptoms of pharyngitis 4 days after exposure to the source patient. Nosocomial transmission occurred 25 h after exposure to the source patient, before the institution of outbreak-control measures. A questionnaire was distributed to HCWs to help identify the factors responsible for the high attack rate among those who were exposed. Invasive GAS disease in a nosocomial setting can be highly transmissible. Rapid identification, early treatment, and adherence to infection-control practices may prevent or control outbreaks of infection.

Contact transmission

A historical review of barrier materials.

Belkin NL.

AORN J 2002 Oct;76(4):648-53

When surgical gowns first were used, their primary purpose was to protect patients from members of the surgical team. In 1952, it was revealed that although the muslin the garments were made from may have been an effective barrier when dry, it lost barrier capability after it became wet. This disclosure triggered research to develop more satisfactory materials for this unique application. In the interim, the emergence of HIV was accompanied by the need to protect surgical team members from patients, and barrier effectiveness attained even greater importance. During the past 50 years, several attempts have been made to develop a universally acceptable and meaningful test method to demonstrate a material's barrier capability under conditions that simulate usual conditions of use. None has been successful. Today, with the trend toward minimally invasive surgery and pressure to reduce costs, perioperative nurses are confronted with selecting a product that is appropriate for the task and degree of exposure anticipated.

Publication Types: Historical Article Review Review, Tutorial

Disease transmission, professionnal to patient

Legal implications for HIV-infected clinicians.

LaFleur-Spawn S.

HIV Clin 2002 Fall;14(4):1, 4-6

Nurses to be tested for HIV?

Cooper R.

Br J Perioper Nurs 2002 Oct;12(10):341


CDC - Smallpox Response Plan and Guidelines (Version 3.0)

CDC has released an updated version of the post-event Smallpox Response Plan and Guidelines. This is the second revision to these guidelines since they were released in November 2001.

Version 3 of the guidelines contains an important additionthe "Smallpox Vaccination Clinic Guide." This guide provides the operational and logistical considerations associated with implementing a large-scale, voluntary vaccination program as part of a multifaceted response to a confirmed smallpox outbreak. Following a confirmed smallpox outbreak within the United States, rapid, voluntary vaccination of a large segment of the population might be required to (1) supplement priority surveillance and containment control strategies in areas with smallpox cases, (2) reduce the at-risk population for additional intentional releases of smallpox virus if the probability of such occurrences is considered significant, and (3) address heightened public concerns about access to voluntary vaccination.

The most important component of smallpox containment is the rapid identification, isolation, and vaccination of close contacts of infected patients and contacts of their contacts (i.e., ring vaccination). This strategy involves identification of infected persons through intensive surveillance, isolation of infected persons, vaccination of household contacts and other close contacts of infected persons (i.e., primary contacts), and vaccination of household and other potential contacts of the primary contacts (i.e., secondary contacts).

The clinic guide will assist planning for larger-scale, post-event vaccination when exposure circumstances indicate the need to supplement the ring vaccination approach with broader protective measures. The clinic guide describes the activities and staffing needs associated with large-scale smallpox vaccination clinics, including suggested protocols for vaccine safety monitoring and treatment. The clinic guide provides an example of a model smallpox clinic and provides samples of pertinent clinic consent forms and patient information sheets that would be used at a clinic.

The clinic guide and the Smallpox Response Plan and Guidelines, Version 3 are available at http://www.cdc.gov/smallpox. CDC will take additional steps to increase preparedness to respond to a smallpox exposure of any magnitude, including updates to the Smallpox Response Plan and Guidelines. Updates on infection control, in-hospital isolation recommendations, post-event vaccination protocols, and outbreak response strategies are under way and will be posted on the CDC website.


Physical hazards

Ionizing radiations

Radiolabeled localization of the sentinel lymph node: dosimetric evaluation in personnel involved in the procedure.

Pelosi E, Arena V, Bello M, Cesana P, Lamberti L, Spandonari T, Ropolo R, Sandrucci S, Bisi G.

Servizio Universitario de Medicina Nucleare, Azienda Ospedaliera San Giovanni Battista, Turin, Italy. etpelosi@virgilio.it

Tumori 2002 May-Jun;88(3):S7-8

AIMS AND BACKGROUND: Peritumoral injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided surgery does not entail any relevant radiation burden to the patients. The real issue about radiation protection concerns the personnel involved in the procedure besides the nuclear medicine personnel. The aim of our study was to evaluate the cumulative doses to personnel involved during the injection of radiolabeled compounds, under ultrasound or stereotactic guidance and the radiation burden to the personnel involved in the surgical incision of the tumor 24 hours after the administration of 99mTc-labeled colloids. METHODS AND STUDY DESIGN: We performed environmental contamination tests (SMEAR TEST) and exposure evaluation in the operating room. RESULTS: In the operating room the removed activity in the analyzed samples was less than 0.5 Bq/g and exposure to the personnel was less than 6 micro Sv/h. The evaluations made during ultrasound guidance demonstrated an equivalent and effective dose less than 20 microSv. CONCLUSIONS: Our results show that during ultrasound or stereotactic administration of radiolabeled compounds the radiation burden to the personnel involved in the procedure is virtually negligible. The surgeons too are exposed to a negligible radiation dose.


Musculoskeletal disorders

Feasibility of lumbar supports for home care workers with low back pain.

Jellema P, Bierma-Zeinstra SM, Van Poppel MN, Bernsen RM, Koes BW.

Department of General Practice, Erasmus University Rotterdam, The Netherlands. p.jellema.emgo@med.vu.nl

Occup Med (Lond) 2002 Sep;52(6):317-23

The aims of this study were to assess the compliance of home care workers with low back pain (LBP) in using a lumbar support, to establish the benefit experienced from the support, and to determine the predictive factors for that compliance and benefit. Only home care workers who had LBP at the start of the study or who had experienced at least two episodes of LBP in the 12 months prior to the study could apply for participation. The study consisted of two phases. In phase I (the first week of the study), workers used the lumbar support each working day. In phase II (the following 6 months), subjects were instructed to use the lumbar support only on those working days when they experienced LBP. Weekly questionnaires were used to measure compliance; monthly questionnaires were used to measure the benefit experienced. Fifty-nine workers participated in the study. Overall, they scored their perceived benefit from the lumbar support as 7 on a scale of 0-10, and 61-81% of the workers were compliant. Multiple linear regression analysis showed that the best predictor for experienced benefit is the degree of confidence in expected pain reduction due to the lumbar support, measured after phase I (R(2) = 0.70). Multiple logistic analysis showed that the best predictor for compliance is the extent to which subjects consider they can influence their own health status (R(2) = 0.49). Because both the benefit experienced and the compliance rate were substantial, the use of lumbar supports by home care workers with LBP seems feasible. However, we cannot recommend extensive use of lumbar supports in home care workers with LBP based solely on the results of the present study. First, there is a clear need for a randomized clinical trial on this topic.


Chemical hazards

Current concepts: organophosphate toxicity.

Walker B Jr, Nidiry J.

Inhal Toxicol 2002 Sep;14(9):975-90

Recent cases of nosocomial poisoning associated with the treatment of patients contaminated with organophosphate (OP) insecticides and the increasing potential for exposure to these chemicals elevate into sharper focus the continuing clinical and public health problem of pesticide poisoning. Despite a number of reports on the multiple aspects of OPs insecticides and their health effects, the general public and health services professionals, broadly defined, remain confused and misinformed about this class of chemicals. In this article we examine sources of exposure and current knowledge of health effects of OPs. The protection of health care workers is also discussed.

 [Risks related to cytostatic exposure for nursing staff]

[Article in French]

Leboucher G.

Presse Med 2002 Oct 5;31(32):1530; discussion 1530

[A case of pneumoconiosis in a dental technician]

[Article in Japanese]

Horiike A, Fujita J, Okitsu H, Bandoh S, Ishii T, Tojo Y, Okada H, Ishida T, Sato K, Yamadori I.

First Department of Internal Medicine, Kagawa Medical University, Kagawa, Japan.

Nihon Kokyuki Gakkai Zasshi 2002 Jul;40(7):579-82

We report a case of pneumoconiosis in a dental technician. He was a 33-year-old man who had worked in a dental clinic as a dental technician for 12 years. In October 1999, he visited to the National Zentsuji Hospital complaining of progressive cough and sputum over a three-year period. Although he received medication, his condition did not improve. He visited the same hospital again on May 8, 2000. His chest radiographs and CT films showed massive shadows in both upper lung lobes. Pneumoconiosis was diagnosed from the pathological findings in a lung specimen obtained by video-assisted thoracic surgery (VATS). There are few reports of pneumoconiosis of dental technicians diagnosed by VATS.

[Occupational dermatitis in health care personnel]

[Article in French]

Barbaud A.

Service de dermatologie Hopital Fournier 54035 Nancy. a.barbaud@chu-nancy.fr

Rev Prat 2002 Sep 1;52(13):1425-32

Occupational dermatosis are frequent among healthcare workers. Irritant hand dermatitis is more common than allergic contact dermatitis. It is enhanced by the exposure to irritants: water, detergents, disinfectants and a history of atopic dermatitis. Natural rubber latex contained in rubber gloves can induce contact urticaria or generalized immediate allergic reactions. Contact eczema can be induced by rubber accelerators such as thiurams, disinfectants (glutaraldehyde, dodecyldimethylammonium). Nurses can become sensitized to handled drugs (antibiotics, propacetamol...). These occupational allergies have to be diagnosed, because sensitized nurses can develop severe generalized cutaneous adverse drug reactions if they are systemically exposed to the same drug than those that has previously induced an occupational contact allergy.

Publication Types: Review Review, Tutorial

PMID: 12385152 [PubMed - indexed for MEDLINE]

[Claim, recognition and compensation of occupational dermatitis]

[Article in French]

Fantoni-Quinton S, Frimat P.

Service de medecine du travail, pathologie professionnelle Hopital Claude-Huriez 59037 Lille.

Rev Prat 2002 Sep 1;52(13):1451-5

Occupational dermatitis are very frequent with important social and economic implications. Detection of an occupational factor must be systematic because it may require prevention and a compensation may be due to the patient. The general practitioner will be assisted either by the occupational physician or by specialised services to help the patient to take the necessary administrative steps.

Factors influencing total mercury levels among Lebanese dentists.

Harakeh S, Sabra N, Kassak K, Doughan B.

Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, New York, NY 10022, USA. sh09@aub.edu.lb

Sci Total Environ 2002 Oct 7;297(1-3):153-60

The aim of the current study is to examine the various factors, which contribute to high levels of mercury (Hg) in the hair of Lebanese dentists. The survey, which was carried out on ninety-nine dentists in the greater Beirut area, included a structured questionnaire designed to provide information about the parameters that influenced their occupational exposure to Hg. These included: precautionary measures, dental fillings, work habits and lifestyle of the tested dentists. The study showed that two of the four investigated precautionary measures had a significant effect on Hg level. The results revealed that, at the 95% confidence levels, Hg concentration in hair was significantly lower among the dentists who always used gloves and masks. Multiple regression analysis showed that the use of masks (P = 0.055) had significant effects on mercury accumulation in hair. In addition, dentists who saw more than eight patients per day had marginally higher mercury levels in their hair than those who did not. Since it was shown that precautionary measures could limit exposure to Hg concentration, then the use of protective measures needs to be emphasized.


Infection Control

Stress – Mental disorders

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction 

Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD, RN; Jeffrey H. Silber, MD, PhD

JAMA. 2002;288:1987-1993

Context  The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.

Objective  To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.

Design, Setting, and Participants  Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.

Main Outcome Measures  Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.

Results  After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.

Conclusions  In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

Aggressive behaviour and burnout among staff of homes for the elderly.

Evers W, Tomic W, Brouwers A.

Int J Ment Health Nurs 2002 Mar;11(1):2-9

This study examines relationships between experienced aggressive behaviour and burnout of staff caring for residents living in homes for the elderly (n = 551). Burnout was conceptualized as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization and reduced personal accomplishment. From the results of the hierarchical regression analyses it appeared that physical and psychological aggression and the number of weekly working hours had a significant relationship with emotional exhaustion of staff. Psychological aggression was found to have a significant relationship with depersonalization. Neither sex nor age had a relationship with any of the burnout dimensions. Implications for research and suggestions for work and training of staff caring for the elderly are discussed.



Joint Programme Launches New Initiative Against Workplace Violence in the Health Sector

GENEVA (ILO News) - Faced with a mounting toll of violence afflicting on average one of every two health workers worldwide, a joint programme of labour, health and public service organizations today launched a new initiative aimed at helping health professionals fight fear, assault, humiliation and even homicide where they work.

The joint task force - comprising the International Labour Office (ILO), the World Health Organization (WHO), Public Services International (PSI) and the International Council of Nurses (ICN) - has launched a set of "Framework guidelines for addressing workplace violence in the health sector" during a meeting at ILO headquarters in Geneva.

The initiative comes in the face of a mounting problem in hospitals and other health workplaces worldwide, both in developed and developing countries. Research* shows that nearly 25 per cent of all violent incidents at work occur in the health sector and that more than 50 per cent of health care workers have experienced such incidents.

"The current knowledge is only the tip of the iceberg", adds international safety and health specialist Vittorio di Martino, who has studied violence in the workplace for the task force. "The enormous cost of violence at work for the individual, the workplace and the community at large is becoming increasingly apparent."

The study notes that violence in the health sectors goes well beyond assaults or affronts to the individuals, threatening the quality of health care as well as productivity and development. Says di Martino: "The consequences of violence at work in the health sector have a significant impact on the effectiveness of health systems, especially in developing countries."

Women are especially vulnerable. While ambulance staff are reported to be at greatest risk, nurses are three times more likely on average to experience violence in the workplace than other occupational groups. Since most health workers are women, the gender dimension of the problem is evident.

In accordance with the European Commission, the guidelines define workplace violence as "incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health". Although workplace violence has become a serious problem in all service sectors, reports* show that health workers are among those particularly at risk:

In the United States, health care workers face a 16-times greater risk of violence than other service workers. More than half of the claims of aggression in the workplace in the US

come from the health sector.

In the United Kingdom, nearly 40 per cent of the National Health Service (NHS) staff reported being bullied in 1998.

In Australia, 67.2 per cent of health workers have experienced physical or psychological violence in 2001.

Widespread violence at work against health personnel is not limited to the industrialized world. More than half of the health personnel in Bulgaria (75.8 per cent), South Africa (61 per cent) and Thailand (54 per cent) and 46.7 per cent of health workers in Brazil have experienced at least one incident of physical or psychological violence in 2001.

Research also shows that psychological violence in the health sector - including verbal abuse, bullying and mobbing - is more frequent than physical violence and between 40 and 70 per cent of the victims report significant stress symptoms.

Workplace violence affects all professional groups, genders and work settings in the health sector. The highest rates of offences, however, were reported by ambulance staff, nurses and doctors. Large hospitals in suburban, densely populated or high crime areas, as well as those located in isolated areas, are particularly at risk.

In many countries, reporting procedures are lacking and perpetrators are not persecuted. Strategies to combat workplace violence in the health sector still have a long way to go, starting with raising awareness and building understanding among health personnel and other parties concerned at all levels.

The guidelines are intended to support all those responsible for safety in the workplace, be they governments, employers, workers, trade unions, professional bodies or the general public. In particular, the guidelines show how health workers can approach the problem of violence in the health sector while considering all types of intervention and involving all parties concerned in a coherent, non-discriminatory, culturally and gender sensitive manner; identify, assess and reduce the risks through preventive action; and minimize the impact of violence and prevent its recurrence.

The guidelines prioritize the development of a human-centred workplace culture based on dignity, non-discrimination, equal opportunity and cooperation, including a clear policy statement on violence at work from the top management and awareness raising initiatives at all levels. The ILO is expected to adopt a Code of Practice on Violence and Stress at Work in Services - A Threat to Productivity and Decent Work in October 2003.




Residents' hours of work


BMJ 2002;325:1184-1185 ( 23 November )

Children With Physical Disabilities Compared With Female Caregivers of Children With a Chronic Medical Condition 

Henry C. Tong, MD; Geeta Kandala, MD; Andrew J. Haig, MD; Virginia S. Nelson, MD, MPH; Karen S. J. Yamakawa, MS; Ki Y. Shin, MD

Arch Pediatr Adolesc Med. 2002;156:1138-1142

Objectives  To evaluate if physical functioning is different in female caregivers of children with physical disabilities compared with female caregivers of children with nondisabling medical illnesses, and to investigate the factors associated with functioning level.

Design  Cross-sectional survey.

Setting  University-based clinics.

Patients  Ninety consecutive female caregivers of children presenting to a pediatric physical medicine and rehabilitation (PM&R) clinic, and 23 presenting to a pediatric endocrine clinic.

Intervention  Fifteen-minute self-administered survey.

Main Outcome Measures  The dependent variable measured was physical functioning (physical functioning subscale of the Short Form-36). Independent variables measured were the average back pain severity over the last week (100-mm visual analog scale), mood (using the Center for Epidemiologic Studies–Depression Scale), work status, amount of lifting at work, caregiver demographics, child demographics, and the physical functioning ability of the child (measured using the WeeFIM scale).

Results  The mean (SD) physical functioning score of caregivers of children in the pediatric PM&R clinic was 80.6 (21.9), which was less than the score of 90.2 (17.6) for caregivers in the pediatric endocrine clinic (mean difference, 9.6; 95% confidence interval, -0.9 to -18.4). The physical functioning score of 77.7 (22.9) in caregivers of PM&R clinic children with a WeeFIM scale score of 1 to 4 was significantly worse than the 90.5 (14.8) in female caregivers of children with a WeeFIM score of 5 to 7 (mean difference, 12.8; 95% confidence interval, -2.0 to -23.6). This decrease is associated with the average pain severity, mood, and total length of time of back pain in the previous 12 months. Regression analysis shows that pain severity and caregiver mood are significantly related to the physical functioning status of the caregiver.

Conclusions  Physical functioning is decreased in female caregivers of children with a physical disability. This decrease is associated with caregiver pain severity and mood.

Inequity in occupational health services for government hospital workers in South Africa

P. P. Moodley and M. O. Bachmann

Occupational Medicine 2002; 52:393-399

South Africa's inequitable public health system is mainly delivered by provincial health departments, and exemplifies the potential and problems of occupational health services in middle-income countries. The occupational health services for 153 265 employees in all of South Africa's 370 provincial hospitals were described and compared. Information was obtained from 303 (82%) hospitals, using a self-completed questionnaire and telephone interviews. Thirty-two per cent of hospitals had an occupational health clinic, but 61% of employees worked in hospitals with a clinic. Occupational health clinics were more likely to be present in larger hospitals, and were strongly associated with provision of primary care and chronic disease services to workers. Thirty-nine per cent of hospitals had a safety officer, 41% had access to an industrial hygienist or environmental health officer, and 80% had health and safety committees, as required by law. While occupational health services were more likely in larger hospitals, workforce size did not explain the marked differences between provinces. The study shows that substantial occupational health services exist, but that important gaps persist, even in wealthier provinces and especially in provinces without coherent occupational health policies.

The perceived function of health care assistants in intensive care: nurses views.

Wainwright TA.

Intensive Crit Care Nurs 2002 Jun;18(3):171-80

Homerton University Hospital, London, UK. teresa.wainwright@homerton.nhs.uk

The purpose of this study was to discover nurses' views on the function of Health Care Assistants (HCA) in Intensive Care (ICU). A questionnaire that utilised open-ended questions was distributed to all registered nurses working on the researchers ICU. Questions were based on issues including; general views on the utilisation of HCA, the transfer of aspects of nursing workload, education and training. A response rate of 96% was achieved. The results indicated strong support for the introduction of HCA on the researchers ICU but conflicting opinion in regards to the function they should serve. In light of the results, this study seeks to open the debate concerning HCA' suitability for employment in the researchers ICU. Recommendations are also made for practice and further research.

Nurses. Plugged in.

Greene J.

Hosp Health Netw 2002 Oct;76(10):18, 4

Infrared technology allows hospitals to keep track of where their nurses are. Hundreds of hospitals use such systems--but some nurses say that they violate their privacy.

Publication Types: News

Clinical placements in mental health: are clinicians doing enough for undergraduate nursing students?

Mullen A, Murray L.

Int J Ment Health Nurs 2002 Mar;11(1):61-8

There are growing concerns identified in the literature about the lack of quality clinical placements in mental health for undergraduate nursing students. This study outlines an innovative student programme, designed and implemented by clinicians, committed to providing a quality clinical placement for students. The programme was evaluated by the use of an open-ended questionnaire administered to a sample of 10 undergraduate nursing students. Results of this evaluation suggested that the programme was able to provide a positive clinical experience in mental health for nursing students and is worthy of a more controlled investigation.

Keeping nurses. How one hospital and two systems cured their staffing ills.

Scalise D.

Hosp Health Netw 2002 Oct;76(10):44-6, 48, 2

The nurse shortage is threatening to reach crisis proportions for hospitals around the nation. But one hospital and two health care systems have virtually eliminated their nurse vacancy rates through strategies that respect and energize their nursing staffs.

Registered nurses' lived experience of advocacy within a critical care unit: a phenomenological study.

Breeding J, Turner de S.

Westmead Hospital,


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