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Spring 2006 Volume XXVI, Number 2

3President’s Message

4Vice President’s Update

7Editor’s Column

8Association Community

Liaison Report

1 0Talking Points –

Heathcare Ergonomics

1 3Spotlight on an

AOHP Star

1 4Industrial Hygiene

in Healthcare

1 6Ready to Research

1 9Call for Nominations

2 0Colleague Connection

Journalof the

Association of Occupational Health Professionalsi n H E A L T H C A R E

F E A T U R E S D E P A R T M E N T S

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28

34

41

Challenges for Nursing in the21st CenturyBy Sister Rosemary Donley

Risk Factors for Group BStreptococcal GenitourinaryTract Colonization in PregnantWomenBy Renee D. Stapleton, MD, MSc, Jeremy M.Kahn, MD, MSc, Laura E. Evans, MD, MSc,Cathy W. Critchlow, PhD, and Carolyn M.Gardella, MD, MPH

Maintaining the Safety and Healthof a Diverse WorkforceBy Linda Tapp, ALCM, CSP

Reduction in Injury Rates inNursing Personnel ThroughIntroduction of Mechanical Liftsin the WorkplaceBy B. Evanoff, MD, MPH, L. Wolf, MS, CPE,E. Aton, MS, J. Canos, MPH, and JamesCollins, PhD

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A O H P J o u r n a l

AOHP Journal Executive EditorKimberly Stanchfield, RN, COHN-SEditor, Journal of AOHP—in Healthcare235 Cantrell Avenue, Harrisonburg, VA 22801(540) 433–4180 kstanchf@rhcc.com

AOHP HeadquartersJudy Lyle, Executive Director109 VIP Drive, Suite 220Wexford, PA 15090(800) 362-4347; Fax: (724) 935-1560E-mail: info@aohp.orgwww.aohp.org

AOHP Editorial BoardExecutive Board Officers

AOHP Executive Board OfficersPresident: Denise Strode

(309) 965-2217 x2586Vice President: Sandra Prickitt

(415) 492-4790Secretary: Diane Dickerson

(703) 279-4307Treasurer: Deidre Tyler

(248) 304-4214

Regional DirectorsRegion 1: Rosalic Sheveland

(408) 947-2853Region 2: Lynne Karnitz

(920) 794-5181Region 3: Kim Casey

(618) 283-1231 x275Region 4: Carol Cohan

(516) 663-2534Region 5: Barbara Burnette

(404) 531-4197 x3314

Chapter PresidentsAlabama: Felicia Ellison

(205) 750-5221California

Northern: Susan Borrego(831) 625-4646

Sierra: Betty Sumwalt(559) 624-5016

Southern: Diana Anderson(818) 503-6803

Colorado: Dana Jennings Tucker(303) 789-8491

Florida: Christine Stephenson(786) 662-8837

Georgia: Lynn Arndt(706) 655-5186

Illinois: Mary Bliss(309) 672-4894

Maryland: Cheryl LeeHlaston-Haapala(410) 368-2805

Michigan: Christine Pionk(734) 936-9242

Midwest States: Tamara Vasta(574) 647-6684

New England: Elizabeth Stowell(207) 791-3484

New York:Nassau/Suffolk: Wendy Bezko-Colligan

(516) 562-6602

North Carolina: Lydia Crutchfield(704) 444-3175

Portland, Oregon: Andrew Walker(541) 812-4182

Pennsylvania: Central: Nancy Hughes

(570) 820-6122Eastern: Stephanie Dillman

(610) 954-4704Southwest: Letitia Goodman

(412) 561-4900 x2425South Carolina: Lauren Harris

(803) 641-5677Virginia: Betsy Holzworth

(540) 829-4102Washington/Seattle: Beverly Hagar

(206) 341-0575Wisconsin: Julie Coppens

(920) 288-3011

M i s s i o nThe AOHP is dedicated to promoting the healthand safety of workers in healthcare. This isaccomplished through:• Advocating for employee and safety• Occupational health education and

networking opportunities.• Health and safety advancement through best practice and research.• Partnering with employers, regulatory

agencies and related associations.

Journal of Association of Occupational HealthProfessionals (AOHP) —in Healthcare(© 2006 ISSN 0888-2002) is published quarterlyby the Association of Occupational Health Pro-fessionals in Healthcare and is free to members.

For Information aboutrepublication of any article, visit

www.CopyrightClearanceCenter.com

Statement of Editorial PurposeThe occupational health professional in health-care is in a key position to help insure thehealth and safety of both the employees and thepatients. The focus of this journal is to providecurrent healthcare information pertinent to thehospital employee health professional; providea means of networking and sharing for AOHP’smembers; and thereby improve the quality ofhospital employee health services.

The Association of Occupational Health Profes-sionals in Healthcare and its directors and editorare not responsible for the views expressed in itspublications or any inaccuracies that may be con-tained therein. Materials in the articles are thesole responsibility of the authors.

Guidelines for AuthorsAuthors may submit articles via e-mail attach-ment in Word (version 6) to the editor atkstanchf@rhcc.com.

Manuscript GuidelinesManuscript guidelines are available through yourchapter president or by writing to the editor. (Seeaddress below.)

Advertisement GuidelinesAdvertisement guidelines are available from AOHPHeadquarters (800) 362-4347; Fax: (724) 935-1560; E-mail: info@aohp.org.

All AuthorsInclude your full name, credentials, and hospital/business affiliation. Include your supervisor’s nameand address so that a copy of your printed articlemay be forwarded.

Send Copy toKimberly Stanchfield, RN, COHN-SAOHP Journal Executive Editor235 Cantrell AvenueHarrisonburg, VA 22801

Publication deadlines for the Journal ofAOHP—in Healthcare:Issue Closing DateSpring February 28Summer May 31Fall August 31Win te r November 30

Subscription RatesOne year (4 issues), $140; Back issues when avail-able, $35.00 each. Reader participation welcome.

Membership/Subscript ionsAddress requests for information to AOHPHeadquarters, 109 VIP Drive, Suite 220,Wexford, PA 15090; (800) 362-4347; Fax:(724) 935-1560; E-mail: info@aohp.org.

Journal AdsAddress requests for information to AOHP Head-quarters at (800) 362-4347

Moving?Bulk mail is not forwarded! To receive yourjournal, please notify our business office ofany changes: AOHP Headquarters, 109 VIPDrive, Suite 220, Wexford, PA 15090; 1-800-362-4347; Fax: (724) 935-1560; E-mail:info@aohp.org.

Upcoming AOHP Conferences

2006 October 4-7: Sacramento, CA2007 September 26-29: Savannah, GA

All material written directly for the Journalof the Association of Occupational HealthProfessionals in Healthcare is peer reviewed.

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President’s Message

By Denise Strode, RN, BSN, COHN-S/CM

Denise StrodeAOHP Executive

President

I hope that by the time you are read-ing this, spring has arrived. Spring al-ways conjures up thoughts of flowers,longer days, outdoor activities, and thewedding season. I don’t think of wed-dings every spring, but this year I ambusy planning my wedding. Even asmall wedding requires lots of prepa-ration. I am trying to stay organizedby utilizing a wedding checklist thatwill help me complete all tasks on time.I thought I would focus on a sampleof a checklist for AOHP activities soyou have a great membership yearwith AOHP. Consider these sugges-tions for your AOHP “To Do” list:

√ Submit a nominee for national of-fice to Dee Tyler, national nomi-nations chair, by June 16th. (dead-line). Candidates are sought for:• Regional Directors in regions

1, 3, and 5• Executive Vice President• Executive Treasurer

√ Suggest changes to the nationalbylaws by May 1 to Headquarters

√ Submit suggestions to recognize an“AOHP Star” to the Journal editor

√ Attend a chapter meeting in per-son or dial in for audioconferencing (check with yourchapter president for availability)

√ Submit an research article or Col-league Connection piece to theJournal

√ Volunteer to be your chapter’s re-porter for the e-newsletter

√ Recruit your colleagues to joinAOHP (and be eligible to win greatprizes)

√ Recruit vendors for the confer-ence. Contact Annie at Headquar-ters with contact information,ideas, etc.

√ Mark your calendar to attendAOHP’s national conference Oc-tober 5-7, 2006 in Sacramento, CAto celebrate our 25th year as an as-sociation. An excellent program isbeing planned. You won’t want tomiss the great learning opportuni-ties available to you! Watch yourmail for the brochure.

√ Submit nominees for associationawards. Information is available atwww.aohp.org or by contactingyour chapter president or Head-quarters office.

Awards available:• Ann Stinson (Outstanding

chapter. Due 7/15)• Extraordinary Member (Any

member is eligible EXCEPTcurrent Executive BoardMember. Due 8/15)

• Honorary Member (Recog-nizes non-member who is sup-portive of AOHP. Due 8/15)

• Joyce Safian (For current orpast executive board member.Due 8/15)

• Julie Schmid (Original re-search scholarship. Applica-tion is due 7/15)

√ Be sure you are subscribed to theAOHP listserv. This is a great net-working and educational opportunity.

√ Proudly display the AOHP posterhonoring occupational healthnurses week (mailed to all mem-bers in April).

√ Start a journal club for your chap-ter. This is a great opportunity tointroduce research relevant to oc-cupational health to your fellowchapter members

√ Are you a member that lives a dis-tance from your chapter? Considerstarting a chapter or local network-ing group. Contact your regionaldirector for help or ideas with this.

I hope all of you have “checked” manyof the above activities!!! Have ahappy and healthy spring everyone.

Denise StrodeExecutive President

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Vice President’s Update

Report on the Centers for Disease Control and Prevention’sGuidelines for Preventing the Transmission of

Mycobacterium tuberculosis in Health-Care Settings, 2005Government Affairs

By Sandra Prickitt, RN, FNP, COHN-S

Note: This article provides follow up toinformation in the AOHP Journal in 2005when these guidelines were in draft form.

On December 30, 2005, the Cen-ters for Disease Control and Preventionreleased the final updated version of theGuidelines for Preventing the Transmis-sion of Mycobacterium tuberculosis inHealth-Care Settings. The new guide-lines have been expanded to address abroader concept of health-care-associatedsettings. The term “health-care setting”now includes settings such as inpatientsettings, outpatient settings, TB clinics, set-tings in correctional facilities in which healthcare is delivered, settings in which home-based health-care and emergency medi-cal services are provided, and laboratorieshandling clinical specimens that might con-tain M. tuberculosis.

The following changes are listed at thebeginning of the document as being dif-ferent from previous guidelines:• The risk assessment process includes

the assessment of additional aspectsof infection control.

• The term “tuberculin skin tests”(TSTs) is used instead of purified pro-tein derivative (PPD).

• The whole-blood interferon gammarelease assay (IGRA),QuantiFERON®TB Gold test(QFTG) (Cellestis Limited, Carnegie,Victoria, Australia), is a Food and Drug

Sandra PrickittAOHP Vice President

Administration (FDA)-approved invitro cytokine-based assay for cell-mediated immune reactivity to M. tu-berculosis and might be used insteadof TST in TB screening programs forHCWs. This IGRA is an example of ablood assay for M. tuberculosis (BAMT).

• The frequency of TB screening forHCWs has been decreased in vari-ous settings, and the criteria for de-termination of screening frequencyhave been changed.

• The scope of settings in which theguidelines apply has been broadenedto include laboratories and additionaloutpatient and nontraditional facilitybased settings.

• Criteria for serial testing for M. tuber-culosis infection of HCWs are moreclearly defined. In certain settings, thischange will decrease the number ofHCWs who need serial TB screening.

• These recommendations usually ap-ply to an entire health-care settingrather than areas within a setting.

• New terms, airborne infection precau-tions (airborne precautions) and air-borne infection isolation room (AIIroom), are introduced.

• Recommendations for annual respira-tor training, initial respirator fit testing,and periodic respirator fit testing havebeen added.

• The evidence of the need for respira-tor fit testing is summarized.

• Information on ultraviolet germicidalirradiation (UVGI) and room-air re-circulation units has been expanded.

• Additional information regardingMDR TB and HIV infection has beenincluded.

The following information is excerpted fromthe guidelines and highlights some of theareas most pertinent areas for occupationalhealth professionals in healthcare.

TB Screening Risk Classificationsfor Use in Determining Need forFrequency of Screening HCW’sLow-Risk. To be applied to settings inwhich persons with TB disease are notexpected to be encountered, and expo-sure to M. tuberculosis is unlikely. Thisclassification should also be applied toHCWs who will never be exposed to per-sons with TB disease or to clinical speci-mens that might contain M. tuberculosis.

Medium risk. Should be applied to settings inwhich the risk assessment has determinedthat HCWs will or will possibly be exposedto persons with TB disease or to clinical speci-mens that might contain M. tuberculosis.

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5Potential ongoing transmission. Should betemporarily applied to any setting (or groupof HCWs) if evidence suggestive of per-son-to-person (e.g., patient-to-patient, pa-tient-to-HCW, HCW-to-patient, or HCW-to-HCW) transmission of M. tuberculosishas occurred in the setting during the pre-ceding year. Evidence of person-to-per-son transmission of M. tuberculosis in-cludes 1) clusters of TST or BAMT conver-sions, 2) HCW with confirmed TB disease,3) increased rates of TST or BAMT con-versions, 4) unrecognized TB disease in pa-tients or HCWs, or 5) recognition of an iden-tical strain of M. tuberculosis in patients orHCWs with TB disease identified by deox-yribonucleic acid (DNA) fingerprinting.

If uncertainty exists regarding whetherto classify a setting as low risk or me-dium risk, the setting typically should beclassified as medium risk.

TB Screening Procedures for Settings(or HCWs) Classified as Low Risk• All HCWs should receive baseline

TB screening upon hire, using two-step TST or a single BAMT to testfor infection with M. tuberculosis.

• After baseline testing for infectionwith M. tuberculosis, additional TBscreening is not necessary unless anexposure to M. tuberculosis occurs.

TB Screening Procedures for Settings(or HCWs) Classified as Medium Risk• All HCWs should receive baseline

TB screening upon hire, using two-step TST or a single BAMT to testfor infection with M. tuberculosis.

• After baseline testing for infectionwith M. tuberculosis, HCWs shouldreceive TB screening annually (i.e.,symptom screen for all HCWs andtesting for infection with M. tubercu-losis for HCWs with baseline nega-tive test results).

TB Screening Procedures for Set-tings (or HCWs) Classified as Po-tential Ongoing Transmission• Testing for infection with M. tuber-

culosis might need to be performedevery 8-10 weeks until lapses in in-fection control have been corrected,and no additional evidence of ongo-ing transmission is apparent.

• The classification of potential ongo-ing transmission should be used asa temporary classification only. Itwarrants immediate investigationand corrective steps. After a de-termination that ongoing transmissionhas ceased, the setting should be re-classified as medium risk. Maintain-ing the classification of medium riskfor at least 1 year is recommended.

Settings Adopting blood assay formycobacterium tuberculosis(BAMT) for Use in TB ScreeningSettings that use TST as part of TB screen-ing and want to adopt BAMT can do sodirectly (without any overlapping TST) orin conjunction with a period of evaluation(e.g., 1 or 2 years) during which time bothTST and BAMT are used. Baseline test-ing for BAMT would be established as asingle step test. As with the TST, BAMTresults should be recorded in detail. Thedetails should include date of blood draw,result in specific units, and the laboratoryinterpretation (positive, negative, or inde-terminate – and the concentration ofcytokine measured, for example, inter-feron-gamma [IFN-g]).

Exposure Follow-up to a Known SourcePatient with Mycobacterium Tuberculosis

For TB exposures in the healthcare set-ting, the document recommends follow-up in 8-10 weeks with either a TST orsymptom screen depending on theemployee’s previous testing.

Respiratory Protection

The guidelines refer to OSHA’s decisionin December, 2003, for Respirator use forTB as regulated under the general indus-try standard for respiratory protection (29CFR 1910.134, http://www.osha.gov/SLTC/respiratoryprotection/index.html).

Fit TestingThe guideline refers to the OSHA docu-ment listed above regarding fit testing. Thefrequency of periodic fit testing should besupplemented by the occurrence of 1) riskfor transmission of M. tuberculosis, 2) fa-cial features of the wearer, 3) medical con-dition that would affect respiratory func-tion, 4) physical characteristics of respira-tor (despite the same model number), or5) model or size of the assigned respirator.

QC Program for Techniques for TSTAdministration and Reading TSTResultsBecause of random variation in TST ad-ministration and reading TST the guidelinerecommends a quality program for thoseHCWs who are responsible for TST pro-cedures. The document recommends thatall TST procedures (i.e., administering,reading, and recording the results) shouldbe supervised and controlled to detect andcorrect variation. Corrective actions mightinclude coaching and demonstration by theTST trainer. Annual re-training is recom-mended for HCWs responsible for admin-istering and reading TST results.

QC for Administering TST by theMantoux MethodFor TST trainers, the guideline recom-mends that ideally, the TST trainer shouldparticipate in QC TST administrations withother TST trainers to maintain TST trainercertification. State regulations specify whois qualified to administer the test by injection.

The TST trainer should observe and coachthe HCW trainee in administering multipleintradermal injections by the Mantouxmethod. The TST trainer should recordprocedural variation on the observationchecklist (refer to Appendix F of the guide-line). TST training and coaching shouldcontinue until more than 10 correct skin testplacements (i.e., >6 mm wheal) are achieved.

Model TST Training ProgramThe guideline refers to a model TST train-ing program for placing TST and readingTST results that has been produced by the

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National Health and Nutrition ExaminationSurvey NHANES. The number of hours,sessions, and blinded independent duplicatereading (BIDR) readings should be deter-mined by the setting’s TB risk assessment.The following information can be usefulfor a model TST training program.

Initial training for a TST placer ideallyconsists of three components.• Introductory lecture and demonstra-

tion by an expert TST placer ortrainer. An expert TST trainer is aqualified HCW who has receivedtraining on administering multipleTST and reading multiple TST re-sults (consider 3 hours of lecture).

• Supervised practical work using pro-cedural checklists observed andcoached by the expert TST trainer(consider 9 hours of practical work).

• Administration of more than 10 totalskin tests on volunteers by using in-jectable saline and producing more than10 wheals that measure 6-10 mm.

TST training should include supervisedTST administration, which is a procedurein which an expert TST trainer supervisesa TST trainee during all steps on the pro-cedural observation checklist for TST ad-ministration. Wheal size should be checkedfor all supervised TST administrations, andskin tests should be repeated if wheal sizeis inadequate (i.e., <6 mm). TST trainingand coaching should continue until morethan10 correct skin test placements (i.e.,>6 mm wheal) are achieved.

QC for Reading TST Results by thePalpation MethodThe TST trainer should participate in QCreadings with other TST trainers to main-tain TST trainer certification. When train-ing HCWs to read TST results, providingmeasurable TST responses is helpful (i.e.,attempt to recruit volunteers who haveknown positive TST results so that the train-ees can practice reading positive TST results).

TST readers should correctly read bothmeasurable (>0 mm) and nonmeasurable

responses (0 mm) (e.g., consider readingmore than 20 TST results [at least 10 mea-surable and at least 10 nonmeasurable], ifpossible). The TST trainer should observeand coach the HCW in reading multipleTST results by the Palpation method andshould record procedure variation on theobservation checklist.

Initial training for a TST reader ideallyshould consist of multiple components.• Receiving an introductory lecture and

demonstration by an expert TSTreader. Training materials are avail-able from CDC and CDC-sponsoredRegional Model and Training Centersand should also be available at the lo-cal or state health department (con-sider 6 hours for lecture and demon-stration).

• Receiving four sessions of supervisedpractical work using proceduralchecklists (observed and coached byan expert TST reader) (consider16hours of practical work).

• Performing BIDR readings (considermore than 80, if possible). TST train-ers should attempt to organize the ses-sions so that at least 50% of the TSTresults read have a result of >0 mmaccording to the expert TST reader.

• Performing BIDR readings on thelast day of TST training (considermore than 30 BIDR readings out ofthe total 80 readings, if possible).TST trainers should attempt to en-sure that at least 25% of personstested have a TST result of >0 mm,according to the expert TST reader.

• Missing no more than two items onthe procedural observation checklist(Appendix F of the guideline) forthree random observations by anexpert TST reader.

• Performing all procedures on thechecklist correctly during the finalobservation.

Baseline Testing with BAMTThe document reviews the use ofBAMT. When establishing a baseline, asingle negative BAMT result is sufficient

evidence that the HCW is probably notinfected with M. tuberculosis. However,cautions regarding making medical caredecisions for persons whose conditionsare at increased risk for progressing toTB disease from M. tuberculosis infec-tion are listed in the guideline.

Perform and document the baselineBAMT result preferably within 10 daysof starting employment. HCWs with posi-tive baseline results should be referredfor a medical and diagnostic evaluationto exclude TB disease and then treat-ment for LTBI should be considered inaccordance with CDC guidelines. Per-sons with a positive BAMT result do notneed to be tested again for surveillance.For HCWs who have indeterminate testresults, providers should consult the re-sponsible laboratorian for advice on in-terpreting the result and making addi-tional decisions.

Serial Testing with blood assay for my-cobacterium tuberculosis (BAMT) forInfection-Control SurveillanceWhen using BAMT for serial testing, aconversion for administrative purposes isa change from a negative to a positive re-sult. For HCWs who have indeterminatetest results, providers should consult theresponsible laboratorian for advice on in-terpreting the result and making additionaldecisions. Persons with indeterminate re-sults should not be counted for administra-tive calculations of conversion rates.

The full document can be accessed via:http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm . I would stronglyrecommend that you review this guidelinealong with your Infection Control andSafety Peers. There are significant changesthat will effect your current programs.

ReferenceGuidelines for Preventing the Transmission ofMycobacterium tuberculosis in Health-Care Set-tings, 2005. Centers for Disease Control andPrevention, MMWR, December 30, 2005 /54(RR17);1-141.

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Editor’s Column

By Kim Stanchfield, RN COHN-SCelebrating Spring

You will find this Editor’s Columnof our Journal to be a pleasant depar-ture from my usual “chatter.” In celebra-tion of spring and National EmployeeHealth and Fitness Day (May 17) I amdevoting this column to healthy living andeating !!! Please accept the gift of threeof my own healthy recipes (originals de-rived in my own kitchen).

I hope you enjoy the healthy recipes andthen get plenty of enjoyable exercise onthese nice spring days; to quote Dr Ken-neth Cooper, well-known fitness andwellness expert, “Fitness is a journey, nota destination. It must be continued forthe rest of your life.”

Kim’s Low Fat, Low Sugar Pineapple Cake

2 boxes Sweet’n Low Yellow Snack Cake (or 1 box regular yellow cake

mix (has a little more sugar)

1 20-0z can crushed pineapple in own juice

1 tsp pineapple extract

1 ¼ C. water

1 large container Cool Whip Free

1 large pk FF, SF Instant Vanilla Pudding

1 cup low fat milk

Mix with electric mixer cake mixes, water, extract and pineapple (juice

included) for 3 minutes. Pour into a 9/13 pan sprayed with Pam cooking

spray. Bake @ 350 for 30 minutes..test a little before with toothpick in

center.

Cool completely.

Whip milk and pudding whip until blended…you may need to add a little

more milk. Fold in Cool Whip. Spread over cake. Keep chilled in

refrigerator. Tastes best when cold right from refrigerator!! Enjoy!!!

Stanchfield’s Stuffed Chicken Breasts6 boneless, skinless chicken breasts2 boxes frozen chopped spinach, thawed and squeezed dry1 large onion, chopped1 large can sliced mushrooms2 cups feta cheese3 T. Parmesan cheeseI jar medium spicy Mexican cheese sauce (you know, that cheese you get for nachos, in the chip isle next to the salsa)

Brown chicken breasts on both sides in a SMALL amount of extra virgin olive oil (don’t overcook, just brown a

little). Remove chicken and let cool on paper towel. Add onion to skillet and sauté with spinach, mushrooms, and

Parmesan and feta cheeses.Cut a slit almost, but not completely through center of chicken breasts. Place generous amount of spinach

mixture in each chicken breast. Place stuffed chicken breasts in shallow dish prepared with cooking spray.

Cover breasts with jar of cheese sauce. Cover dish with foil and bake at 325 degrees for 45 minutes.

Mr. Stanchfield loves this dish with baked potato wedges, as he dips the potato wedges in the cheese sauce.

Brown or wild rice would be great with this dish also!!

Baked Potato Wedges2 large potatoes, quartered1 T extra virgin olive oil2 T Parmesan cheeseSalt to taste and I use a little Cajun spice mixThrow all ingredients in a big zip lock bag and toss. Bake on a cooking spray cookie sheet at 400 degrees until

fork tender and golden brown (20 minutes more or less)

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Association Community Liason ReportBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

MaryAnn Gruden

OSHA Alliance

Our work continues with the OSHA Alli-ance in 2006. Our quarterly conferencecall was held in January and the renewalof the Alliance was discussed. By the timethe Journal reaches you the renewedAlliance agreement should be finalized.

Work continues on the resource guidefor safe patient handling in the acute caresetting. It is in final draft and should beready soon. We will notify memberswhen it is ready.

North American Occupational Healthand Safety Week - April 30-May 6As an OSHA Alliance partner, AOHPis actively supporting this year’s cel-ebration of North American Health andSafety Week (NAOHS Week), April 30-May 6. This celebration of occupationalhealth was started by our Canadianneighbors and is sponsored by the Ca-nadian Society of Safety Engineeringand includes the United States andMexico as partners. American sponsorsinclude the American Society of SafetyEngineers (ASSE) and the OccupationalSafety Health Administration (OSHA)along with 15 of its’ Alliance partners.

The goal of this observance is to focusthe attention of employers, employees,the general public and all partners inoccupational safety and health on theimportance of preventing injury and ill-ness in the workplace, at home and inthe community. OSHA will kick off thefocus of the observance on May 1, 2006at the Department of Labor in Wash-ington, D.C. with a promotion of a safeand healthy workplace for young work-ers. Many young workers and their par-ents may not be aware of the potential

hazards in the work environment. Thisfocus is designed to get the word out tothe young workers and their parents.

The slogan for NAOSH Week is “Re-view, Refresh. Revitalize.” The logo forthe event consists of an equilateral tri-angle of three hands symbolizing the jointventure, cooperation and commitment tothe common goals shared by all occu-pational health and safety partners. Moreinformation for ideas on how to celebratethis event are available at http://www.naosh.org/english/. Informationavailable through the website includes post-ers, ideas for contests, proclamations, etc.

AOHP Participates in Annual Reviewof Safety and Health Topics PageAs part of the Alliance, OSHA seeksthe input of Editorial Board members onseveral Safety and Health Topic pagesthat are related to healthcare. A reviewof the Bloodborne Pathogens andNeedlestick Prevention page was con-ducted during February and March. Tovisit the updated page, go to the web ath t t p : / / w w w. o s h a . g o v / S LT C /bloodbornepathogens/.

AOHP Presents Statement at NORATown Hall Meeting on HealthcareResearch Needs

AOHP was represented by Jan Frustagliaat a Town Hall Meeting in Texas that fo-cused on research needs in healthcare. TheNational Occupational Health ResearchAgenda (NORA) is entering its seconddecade of research and was seeking inputfrom the various stakeholder sections. Janpresented a five minute statement ofAOHP’s position regarding research in oc-cupational health in the healthcare setting.

A numberof otherhealthcareo r g a n i z a -t ions a lsop r e s e n t e dtheir ideas forthis nationalr e s e a r c hagenda thatis being de-veloped.

6th Annual Safe Patient Handling andMovement Conference Attended byAOHP Members

From February 27 through March 3, 2006,the 6th Annual Safe Patient Handling andMovement Conference sponsored by theUniversity of South Florida was held atthe Hilton Clearwater Beach Resort inClearwater, Florida. Dr. Audrey Nelsonfrom the James A. Haley VA Hospital inTampa, was the organizer of this annualconference. The American Nurses Asso-ciation was also a cosponsor of this inter-national meeting. Several members fromAOHP were in attendance this year. Therewere 750 participates from the UnitedStates and countries around the world in-cluding the United Kingdom, the Nether-lands and Canada. A number of speakersfrom the conference have been frequentpresenters at AOHP conferences,includidng Dr. Nelson, Dr. Guy Fragala,Linda Haney, Ken Aebi, Donald Maynes,and Dr. Michael Hodgson. A new AOHPmember from New York, Mary Ellen Whalen,also presented a poster. Congratulations toher on being a part of the poster sessions!

Research continues to support the use ofassistive devices to reduce the risk of inju-

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Linda Haney (L) and MaryAnn Grudenenjoy the 6th Annual Safe PatientHandling and Movement Conference.

ries to employees and improve patientsafety during handling procedures. In ad-dition, new research in biomechanics isnow able to drill down to the microscopicanatomical changes that occur with backinjuries. Emerging research is also able todemonstrate the psychosocial and environ-mental effects on pain and function.

As more is learned each year, new ques-tions are posed. Then, an action plan isdeveloped to further this paradigm shiftrelated to safe patient handling. An ex-ample of a question being addressed wasthe development of a nursing school cur-riculum. This curriculum was developedand a number of nursing schools pilotedthe implementation of this curriculum inconjunction with the American NursesAssociation’s “Handle with Care” pro-gram and vendor support. The results ofthese pilot programs have been striking.This is definitely where a change in thehealthcare paradigm of manual patienthandling should to begin! Considerationshould be given to the development ofsimilar curriculums for ancillary profes-sionals such as physical and occupationaltherapy students.

A number of wonderful handout wereincluded as part of the conference ma-

terials. Toolkits on patient slings andthe bariatric patient as well as Dr.Nelson’s new book on safe patienthandling were included as part of theconference handouts.

This conference is highly recommendedfor individuals who are either leading theeffort in their facility or who are playing akey role in the development and implemen-tation of a safe patient handling and move-ment program in their organization. It is nottoo early to begin to plan to attend next year!

NAPPSI Update – “EducationMeans Safety” – Excerpt from theNAPPSI Newsletter

One new focus area for the National Alli-ance for the Primary Prevention of SharpsInjuries (NAPPSI) in 2006 is the conceptthat “Education Means Safety.” Through-out the year, NAPPSI will be solicitingeducational grants from our CorporateMembers in order to provide deep dis-counts to our Individual Members for Con-tinuing Education (CE) courses that fur-ther the understanding of primary preven-tion and needlestick safety issues in thehealthcare workplace. We will only presentcourse offerings that are deemed as out-standing by the NAPPSI review board.

The first of these CE courses is now avail-able with a 20% discount, thanks to a gen-erous educational grant from Venetec In-ternational, Inc. The course titled “TheLeading-Edge Symposium” is a DVD-base 4.5 contact hour CE course that ex-plores the role of biofilms, skin coloniza-tion, and catheter motion in the pathogen-esis and prevention of nosocomial infec-tions such as Catheter-Related BloodStream Infections and Catheter-Associ-ated Urinary Tract Infections.

The lecture topics include:• “Biofilms in Device-Related Bacte-

rial Infections” by J. WilliamCosterton, Ph.D.

• “Bugs, Drugs and Devices: Innova-

tive Ways to Prevent Catheter-As-sociated Urinary Tract Infections”by Rabih O. Darouiche, M.D.

• “Interavenous Catheter-RelatedComplications – New Perspectives”by Gregory Schears, M.D.

• “Need for a New Paradigm for Con-trol of Nosocomial Infection in the 21stCentury” by Dennis G. Maki, M.D.

• “Pathogenesis of Catheter-RelatedComplications: An Inside View” Ani-mation Video

Learn At Your Own Pace, When andWhere YOU Want In addition to pro-viding an opportunity to learn the latestscientific discoveries and ground-break-ing clinical findings for controlling de-vice-related infections and complications,this 3 DVD set, can be viewed whenand where you like. At home or in youroffice, you can watch the lectures whenyou have the opportunity. What haveothers said? “The best CE course I’veever taken!” On a scale of 1-5, opinionleaders previewing this course consis-tently rated this course 5+.

Enroll in Three Ways:Through Venetec and NAPPSI, a 20%discount coupon for The Leading EdgeSymposium CE Course module is avail-able on the NAPPSI website NAPPSI,bringing you this course for only $60, pluspostage and handling. To enroll, use oneof three registration methods:1) By Web -To enroll electronically, log onto

Hadaway Associates and navigate to theWebstore. When you are ready to checkout, enter the Code # NAPPSI to re-ceive your 20% discount.

2) By Fax - Pay by credit card by fill-ing out the coupon and faxing it to770-358-6793.

3) By Mail - Mail a personal checkfor the total amount along with thecoupon to Lynn Hadaway Associ-ates, PO Box 10, Milner, GA 30257.

If you are not an individual member ofNAPPSI, you can sign up by going tothe NAPPSI home page atwww.nappsi.org.

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All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

Talking Points – Healthcare Ergonomics

The Other Side of the Bed Rails – Safe Patient HandlingBy Debbie Minzenberg, RN

As nurses, we believe it is important to empathize withour patients and to anticipate their needs. Most of us becamenurses in order to help others. How can we really empathizewith the special needs of our patients unless we have walkedin their shoes? What if it were a requirement that in order tocare for a patient, we must first have to be a patient? How doyou think that would affect our nursing care? I can tell youfirst hand how it will affect my nursing care in the future. Ihave had the opportunity to see what it is like to be a patientwith significant mobility issues and my outlook has changedcompletely.

I have been a Registered Nurse for 30 years. I have workedin Emergency, Critical Care, Occupational Health, and havebeen a consultant for Safe Patient Handling for the last 4years. During the past 4 years, I have assisted in implement-ing 15 Safe Patient Handling Programs in both Hospitals andLong Term Care Facilities. I have always had a dual focusduring the implementation of these programs: patient andcaregivers. Not only are we focusing on providing safe, com-fortable patient handling with an emphasis on rehabilitation,but also a strong focus on safe movement and handling forthe caregivers as well. We, as nurses, have taken for grantedthat we will always be able to care for our patients, but werarely consider caring for ourselves as a part of the equation.

My perspective changed forever in December of 2005. I wason my way home from work, anticipating spending the holi-days with family and friends. I only had a few more presentsto wrap and some last minute cooking to do. My plans changedwhen a large pick up truck suddenly turned in front of mehitting me head on. Thankfully, I do not remember the acci-

The column for this issue is very different from previous columns. Itis a recounting of a first-hand experience with safe patient han-dling from the perspective of a nurse who found herself a patientafter a serious automobile accident. I hope you will read, learn,and take to heart what “safe patient handling” means to the pa-tient. Both patient AND nurse have ergonomic needs. –Linda Haney

dent. I was airlifted via helicopter to a University HospitalTrauma Center. During the crash, I had suffered a compoundfracture of my femur, fracture of my hip and I shattered mypatella. I had also crushed my ribs. As a result, I sustainedbilateral pneumothorax and had chest tubes inserted. I spentthe next 2 weeks on a ventilator barely aware, at short inter-vals, of my surroundings.

Finally I progressed to the point of being able to tolerate lesssedation, and I became more aware of my surroundings. Thefirst thing I remember is being turned to have a dressingchange. True, I could not talk to the nurses, but I was able tocommunicate with hand gestures and by shaking my head,not to mention the facial grimaces I made due to the pain.Sadly, not one of the nurses tried to communicate with meabout the repositioning for the dressing changes. I quicklylearned that the main goal of this was to complete the task asquickly as possible so the nurse could get on to the next pa-tient. I also found this to be true when being bathed or duringany other task that required me to be moved. At times, myfractured femur which now had a steel rod in place wasgrabbed through the bed covers without the staff checkingunder the covers to see what part of my body they weremoving. These were the times that had I been able to, I wouldhave screamed out loud in pain.

After this experience, you can imagine how pleased and sur-prised I was to learn, when I was transferred from the ICUto the Trauma Unit, that this large University Hospital had a“Minimal Lift Program” which included lift equipment as wellas a lift team. I first became aware of this when the youngstrong men from the Lift Team were sent to assist in lifting

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11me out of bed into the chair. I was optimistic in this trans-fer as I noticed the ceiling lift clearly visible above mybed. My optimism dimmed somewhat as I was told this liftwas only for the “obese patients.” I was told by one of themembers of the lift team that I was considered a “MinimalAssist Transfer.” Had I received a hard knock to the headduring the accident that made me forget what I thought Iknew about safe patient handling? Remember, I had a to-tally shattered right leg and no weight bearing. I had noupper body strength due to fractured ribs. I was wonder-ing how I was expected to do most of this transfer alone.This “Minimal Assist Transfer” was accomplished by oneof the members of the lift team lifting my right side whilethe other strong gentleman lifted my left side and bothmanaged to maneuver me into the chair in a very uncom-fortable position where I was informed I must stay for atleast 30 minutes. I made a mental note then, that I was goingto have to plan my pain medications to be taken prior to theselifts, and was surprised and disappointed that my nurse hadnot had the sensitivity to think of this (another lesson).

Forty-five minutes later, two fresh young gentlemen from thelift team arrived to assist me back into bed. Because of myIV’s and Foley catheter and leg immobilizer, they decided touse the lift equipment to assist me back to bed (not sure whythe decision to use the ceiling lift was different when my con-dition hadn’t really changed in the previous 45 minutes). Imade an audible sigh of relief as the ceiling lift was lowered.The tricky part was getting the sling under me. But this wasdone pretty quickly and fairly painlessly. The lift was low-ered and the sling attached. I noticed, and voiced my con-cerns, when I saw that the leg slings were not criss-crossedas most slings do. I was told not to worry by these youngmen. Then, as I was lifted into the air and started the trans-fer back to the bed, I noticed my right side tilting danger-ously toward the mattress. I asked if this was okay andwas again reassured. However, I held my breath and didnot move a muscle until I was safely returned to my bed.When the lift team disconnected the sling, one of themmade the comment that the sling had not been attachedcorrectly to the legs.

The next transfer was even more exciting. This included amixture of Lift Team personnel as well as Physical Therapystaff. This team decided I was a Minimal Assist transfer aswell and proceeded to stand and pivot me to the chair. Otherthan the strain on the upper arms due to the rib fractures, thisportion of the transfer was uneventful. However, the transferback to bed is still felt today. Again, the stand and pivot tech-nique was used to assist me from chair to bed. This time, amistake was made in judging distance and I was lowered just

shy of the bed. Suddenly, from out of nowhere appeared oneof the young men from the Lift Team who proceeded to liftme under my arms around my fractured ribs and swing mearound to the bed, in one motion. The pain to my rib area wasso excruciating that I did not even notice the pain to my frac-tured hip and femur.

After this incident, I asked my nurse if there was a mobilityassessment performed on each patient. She assured me thatthis was done on admission and reassessed on a daily basis.However she admitted that most of the lift equipment wasused for the more obese and total care patients. There wasno formal way to communicate this information to the rest ofthe staff. I know from experience that every patient’s dietaryorders is written on a care plan and/or Kardex and formallycommunicated to all staff. I had to wonder, why was my mo-bility level not at least as important as my ability to consumeliquids versus solid foods?

Before being discharged to a Rehab facility, I was transferredto another unit that looked brand new and had ceiling lifts inall of the rooms. However, when the lift team was called fora transfer, they admitted they had never used the ceiling lifts.Apparently there was a hand control needed for the lifts andthis had disappeared long ago. Hmmm, perhaps this couldhave been prevented had other equipment with attached con-trols been considered.

From this Rehab facility, I was transferred to a Rehab fa-cility closer to home. Lucky for me, my thirteen year oldson insisted that my slide sheets I use at work were sent tothe rehab facility. He arrived at the facility and proudlyunpacked my slide sheets. The nurses had no idea whatthey were so my son and I enjoyed showing them howeasy it was to reposition me in bed with my assistance. Wealso used them in Physical Therapy to help make my ROMexercise easier. However, the Rehab staff was most im-pressed when I was discharged home and we used theslide sheets to get me into the back seat of the car thoughI still had no weight bearing on my right leg. Two Physicalaccompanied us to assist me into the car. However, theyjust stood back and watched as my husband and son easilyslid me into the back seat with the slide sheets. We some-times tend to think that slide sheets are only for reposition-ing the total care patient. There are many uses for them inthe Rehab care as well.

Finally, after four weeks, I was discharged home. After 2weeks I returned to the hospital for further surgery. I hadworked hard to strengthen my wasted muscles during these2 weeks. After the second surgery and only 3 days in the

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hospital, I was amazed to realize the impact this small setback had on my mobility. When I returned home the sec-ond time, I found I had regressed significantly. I was de-termined to regain my strength and the mobility I had lost.With the aide of a Sit-to-Stand lift and under the directionof my Physical Therapist, I am able to enhance my strength-ening exercises and mobility by exercising my leg muscleswithout the fatigue and exertion of exercising without theaide of the equipment. This made me realize the opportu-nities the hospital staff missed by not using their lift equip-ment as a part of my rehabilitation. I can’t help but won-der where I would be now if the staff had used the liftequipment as a rehab tool in my daily care.

With nothing but time on my hands as I lay recuperatingfor approximately six more months, I wanted to share myexperience with other clinicians as well as to document itso that I could make some sense of my experiences. Ibelieve that everything happens for a reason. The acci-dent made me re-evaluate my life and come to appreciateand love my family and friends as never before. My hospi-talization made me re-evaluate my nursing and consultingskills. I learned many lessons that will help me be a betternurse and consultant when I am ready to return to work.

Some lessons learned:No matter what our knowledge/skill level is, we should beopen to learning from our patients by listening to them. Evenwhen they cannot verbalize, they can still communicate bybody language and/or facial grimaces.

Getting a patient from point A to point B should never be themain goal - mobility and rehabilitation must always be thegoal. Mobility, quite simply, is a clinical issue and a clinicalskill.

Simply implementing a “Minimal Lift Program” is notenough. Much work and follow up is needed in order toassure that all staff is trained not only in the use of theequipment, but in all aspects of the program including patientassessment, ongoing training, communication of policy andprocedures.

Staff should be included in choosing lift equipment to assurethat it meets their needs as well as the needs of their patients.

Staff should be taught to use the lift equipment as a part of aclinical skill set so that it enhances rehabilitation processinstead of just serving as a transfer device.

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AOHP members now have even more ways to win with AOHP…

Since AOHP began its Recruit Our Colleagues—ROC Campaign in 2004, mem-bers have personally recruited 65 new members! Way to go AOHP members!

Due to this great success, the Board has voted to continue our “ROC” campaignthrough June 2006! AND….some exciting new incentives have been added…

Grand Prize -2006 Conference Registration plus 4 nights hotel accommodationwill be awarded to the one member who recruits the highest number of new mem-bers – 15 or more members through June 30, 2006. If no member recruits 15 newmembers, the member who recruits the greatest number under 15 will receive aconference registration!

2nd Place Prize-The member who recruits the second highest number of newmembers will be awarded a FREE one-year membership to AOHP.

The Chapter who recruits the most members will be awarded $500 to be used attheir discretion to support their members.

KEEP ON RKEEP ON RKEEP ON RKEEP ON RKEEP ON ROC’N FOC’N FOC’N FOC’N FOC’N FOR AOR AOR AOR AOR AOHP in 2006!!!OHP in 2006!!!OHP in 2006!!!OHP in 2006!!!OHP in 2006!!!

Are You Still “ROC” N?

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ChristineStephenson

AOHP and this Journal proudly recognize anotheroutstanding member, Christine Stephenson. Chris is cur-rently the Employee Health Coordinator for South MiamiHospital in the Baptist Health System of South Florida.

Cecelia Graham, Chris’s fellow Florida Chapter colleague,tells us “Chris actively serves as president of the Floridachapter and always keeps fellow members informed ofnew information via emails. She is knowledgeable and verywilling to share that knowledge and experience. Chris isalways friendly and upbeat, with a wonderful positive atti-tude. Her great smile is contagious! Treating all she meetswith kindness, compassion and a feeling of welcoming, ChrisStephenson is a true AOHP Star and my role model.”

Chris has worked at South Miami Hospital for 31 years,having served as the Employee Health Coordinator therefor the past ten. Her current duties include the responsibil-ity for employee health services to all employees, investi-gation, assessment and treatment of worker’s compensa-tion incidents and evaluation and treatment of employeeswith self-limiting conditions. “I enjoy the whole scope ofmy practice,” Chris advises. “The people that work at SouthMiami Hospital are dedicated to providing quality care. Thecaring is not only for patients, but for staff as well. I amfortunate to work with great people from my staff in Em-ployee Health Services to Human Resources, InfectionControl, Employee Assistance and Vocational Rehabilita-tion Services as well as leadership. Because of the colle-gial relationships and group problem solving, many chal-lenging cases have been success stories,” adds Chris.

Serving as past chapter secretary and current chapter presi-dent, Chris credits AOHP with greatly assisting her “learnthe job” of Employee Health. “Ten years ago, I was igno-rant about the workings of Employee Health Services. Idid not know how to apply a TB skin test, know anythingabout worker’s compensation, or vaccinations. I was in-vited to attend an AOHP meeting and found they had theRosetta stone for Employee Health: AOHP’s GettingStarted. Not only was there a written guide, but a roomfull of experts willing to help me find my way. I am espe-cially grateful to Susan Davis who acted as my mentorduring those first couple of shaky years. I knew that if I

Spotlight on an AOHP Star

had a problem, Susan was just aphone call away to directing mein finding a solution. Today, I findthat through computer technologymy fellow AOHP colleaguesacross the country continue to generously exchange infor-mation on the list server. Emails, such as the OSHA up-dates, keep me up to date on the evolving world of Em-ployee Health and government regulations.”

Christine, AOHP has many extraordinary members and weare fortunate to have you among them. It has been ourpleasure to honor you in our spotlight!!

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Industrial Hygiene in Healthcare

Indoor Air Quality in the Healthcare Environment Part 1– General Overview

By George Byrns, MPH, PhD, CIH and Lee Shands, MPH, CIH

All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

At the last conference, attendees were polled abouttheir level of satisfaction with the column and future topics.We are pleased to report that respondents liked the column,and we received some excellent suggestions on topics. Thenumber one request was information indoor air quality (IAQ),including mold. Other requests were for information on lasersafety, general exposure monitoring, anesthetic gases, glut-araldehyde safety, and what does OSHA look for in terms ofindustrial hygiene? These should make excellent future col-umns. IAQ is such a complex topic; we will need to cover it ina three part series. Part 1 is a general overview of the prob-lem. Part 2 will describe the steps in investigating and control-ling the problem, and Part 3 will focus on mold detection, pre-vention, and control.

Why is there an IAQ problem?We spend 80-90% of time indoors. Energy conservation mea-sures in the 1970s lead to reducing the amount of fresh air, sobuildings are much tighter than they were in the past. This,combined with poor building design and poor maintenance,equals poor IAQ. At the same time, we are often introducingnew technologies that may produce indoor pollutants. For ex-ample, surgical laser plumes may contain viable infectiousagents and a mixture of toxic chemicals. Lastly, increasedpublic awareness may also be a factor. There have been sto-ries on news shows suggesting that exposure to Stachybotrysmold spores will cause permanent health effects. Most ofthese reports have been anecdotal with little scientific sup-port.

IAQ health effects:It is important to distinguish between two similar soundingissues (BRS vs. BRI). Building related symptoms (BRS) wasformerly called sick-building syndrome. BRS means that atleast 20% of building occupants are complaining about airquality. Individuals may report a wide range of complaints(headache, respiratory irritation, nausea, etc.). Building re-

lated illness (BRI) means that the problemcan be directly attributed to the building, andLegionaries disease is the classic example.BRS is by far the most common problembecause humans have a relatively narrowrange of tolerances for changes in envi-ronmental conditions, include temperature and humidity lev-els. The other problem is that people suffering from BRSmay be anxious and highly stressed, and this can aggravatepre-existing conditions or exacerbate otherwise minor irrita-tions.

Key elements in IAQ:There are four key elements to consider in assessing IAQ:• Sources of contamination• The heating, ventilating, and air conditioning (HVAC) sys-

tem• Pathways of exposure• The occupants of the building

It is important to note that the HVAC and the building occu-pants can serve as both sources of contaminants and path-ways of exposure. The indoor air environment is not a staticsituation, but a set of constantly changing interactions betweena number of factors. Therefore, identifying a specific prob-lem is not always the outcome of an investigation, but ratherimproving the perceived indoor air quality should be the goal.

Evaluate the elements:Sources of contaminants can be outside, beneath or insidethe building. For example, if HVAC fresh air intakes arelocated at ground level, mold spores, gases, or vapors, suchas vehicle exhaust, could be pulled into the building. Evenif they are located on the roof, there must be at least a 10ft. vertical or a 75 ft. horizontal separation from hood ex-hausts, sewer vents or other contamination sources to avoidre-entrainment of these contaminants.

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Do you have any industrial hygieneconcerns or questions that you would likeaddressed in the Journal? Please forwardyour questions or requests to the Journal

Editor at kstanchf@rhcc.com.

A common cause of poor IAQ is insufficient numbers offresh air exchanges. This can be a problem because asnatural gas prices increase, there may be an incentive toincrease the amount of recycled air by closing outdoor in-takes. In some cases, you may never identify the sourceof the contamination, but complaints may be resolved bysimply increasing the amount of fresh air entering the build-ing. Other problems with the HVAC system may includecontaminants or moisture in drip pans and the ductwork

In Part 2 of this series, we will describe a systematic ap-proach to the investigation and control of these elements.

EMPLOYEE HEALTH NURSEVail, Colorado

Vail Valley Medical Center, located just 1 1/2 hrs. fromDenver, in the heart of the Rocky Mountains, is seek-ing a FT Employee Health Nurse. Position includesmanagement of all integrated services available toemployees and their designated affiliated site andpoint of entry care for all new employees at time ofhire. Also acts as a consultant to the OccupationalHealth leadership for issues relating to these servicesin cooperation with the Infection Control Nurse,JCAHO written standards, and OSHA. 3-5 years clinicalnursing required. Certified Occupational Health Nurseis strongly preferred or equivalent experience in OccHealth. Current State of Colorado Nursing License &CPR. Periodic travel between facilities will be required.

Apply online at www.vvmc.comor call (800) 524-7106.

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Ready to ResearchBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM, Column Editor

“The main goal of nursing re-search is to help find ways to achieve ex-cellence in nursing care” (Kartes andKamel, 2003). A journal club, a gatheringof professionals discussing a written pieceof work, is one means of promoting criticalthinking in our clinical practice. A journalclub is a venue to review current nursingresearch, find evidence to support yourcurrent practice, or find evidence to ex-amine your current practice more closely.

The goal of a journal club should be to im-prove your critical thinking skills as you im-prove patient outcomes through evidence-based practice. Evidence-based practiceis defined as “the use of current best evi-dence in making decisions”. A journal clubwill give you the opportunity to keep cur-rent with the “best evidence” needed tomake decisions in your clinical practice.

MaryAnn Gruden

It is a pleasure for me to introduce our first guest author. Jeanne Clancey, RN, MSN,CNRN is an Education and Development Specialist at the Western PennsylvaniaHospital, West Penn Allegheny Health System in Pittsburgh, Pennsylvania. Ms.Clancey’s specialty is neuroscience nursing and she became interested in research aspart of her nursing practice with her physician colleague. She currently is the Co-Chairof the Nursing Research Committee and has been instrumental in assisting the staff ininitiating Journal Clubs. Many thanks go to Ms. Clancey for being our first guestauthor. The Executive Board and Research Committee encourage you to considerstarting a Journal Club. Consider a journal club at both your worksite and as part ofyour Chapter Meetings. It is a great way to begin to analyze research as it relates tooccupational health in healthcare and to generate ideas for future research to advancethis specialty.

Note: In this article, our “patients” are healthcare workers entrusted to our care.

Journal Clubs: Bringing Research to our Clinical PracticesBy Jeanne K. Clancey, RN, MSN, CNRN

Why join a journal club?

A journal club will……• increase your professional confi-

dence and self-esteem through theknowledge that your practice isbased on scientific findings.

• provide you with an avenue to learncurrent patient care methods

• increase your confidence in thejustification and explanation ofstandards and procedures basedon research results

• improve your critical appraisalskills for assessing the validity andapplicability of research results

• promote team building amongpeers

• improve your communication andleadership skills

• stimulate ideas for nursing research

As you begin your journal club, the se-lection of nursing research is impor-tant for its success. Select your articlebecause it is concerning an issue inyour daily clinical practice, somethingnew in your specialty area, or a con-troversial topic. Every article in thenursing literature can not be weighedequally. For this reason, you will needguidelines for critiquing the articles andto guide the discussion. All nursing lit-erature, nursing research includedshould be critically read. Use guide-lines to assist you in this process anddirect the questions you should ask asyou keep current with the nursing lit-erature.

Beyea and Nicoll (1997) listed “tenquestions that will get you through anyresearch report.”

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171. What is the research question?2. What is the basis for this research

question?3. Why is this research question im-

portant?4. How was the research study studied?5. Does the study method make sense?6. Were the correct subjects selected

for the study?7. Was the research question answered?8. Does the answer make sense?9. What is next?

10. So what?

The table (to the right and continued onthe next page) condenses guidelines forreviewing research articles that werecomplied from a number of references.These guidelines are being used withsuccess in my institution for unit-basedand department-based journal clubs.Over 75% of the nursing units conductjournal clubs now and the article se-lection indicates an interest in theirspecialty and the advancement of theirclinical practice.

Keeping up with current nursing litera-ture can be a formidable task for theprofessional nurse. A scheduled jour-nal club can make this task lighter bysharing the responsibility of keepingcurrent with the nursing literature. Asthe volume of nursing literature andnursing research increases, the shar-ing of this responsibility becomes evenmore important.

Your professional growth and account-ability will be enhanced by involvementwith a scheduled journal club. Journalclubs provide you with an opportunity toutilize nursing research- bringing nurs-ing research to your clinical practice. Youare bridging the research–practice gapby utilizing evidence in your clinical prac-tice. As a professional nurse, you areheld accountable to use evidence basedpractice in your clinical practice. Jour-nal clubs is one means to accomplish thisgoal for the professional nurse.

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ReferencesBeyea, S. C. & Nicoll, L. H. (1997). Tenquestions that will get you through any re-search report. AORN Journal, 65, 978-979.

Hagman, J. & Krugman, M. E. (2003). Journalclubs. In K. S. Oman, M. E. Krugman, & R.M. Fink (Eds.). Nursing Research Secrets (pp.47- 51). Philadelphia: Hanley & Belfus.

Kartes, S. K. & Kamel, H. K. (2003). Geriat-ric journal club for nursing: Aforum to enhanceevidence-based nursing care in long-term set-tings. Journal of the American Medical Direc-tors Association, 4, 264-267.

Kirchhoff, K. T. & Beck, S. L. (1995). Using thejournal club as a component of the research utili-zation process. Heart and Lung, 24, 246-250.

Klapper, S. J. (2001). A tool to educate, cri-tique and improve practice. AORN Journal, 74,714-715.

Koziiol- McLain, J. & Tanabe, P. (1996). Re-viewing the research literature: You don’t haveto do it alone. Journal of Emergency Nursing,22, 352-355.

Speers, A. T. (1999). An introduction to nurs-ing research through an OR journal club. AORNJournal, 69, 1235-1236.

Valente, S. M. (2003). Creative way to im-prove practice: The research journal club.Home Healthcare Nurse, 21, 271-274.

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Call for Award NomineesNominees for the following awards are being sought.

Ann Stinson President’s Award for Association Excellence-recognizes a chapter that has demonstrated outstandingperformance and enhanced the image of occupational health professionals in healthcare.

Joyce Safian Scholarship Award- recognizes a past or present association officer who best portrays an occupationalhealth professional in healthcare role model.

Extraordinary Member Award-recognizes a current association member who demonstrates extraordinary leadership.

Honorary Membership Award- recognizes a person (s) who has made a significant contribution to the field ofoccupational health in healthcare.

Nominations need to be submitted to the national office by July 15th. You may contact your chapter president or regionalrepresentative for award criteria.

2006 Call for NominationsExecutive Vice President – Executive Treasurer

Regional Directors for Region 1, 3 and 5Would you like a great opportunity to use your experience and commitment to AOHP in a leadership role? Now is an excellent time to acceptthe challenge and take advantage of this opportunity for professional growth and networking! AOHP is seeking leaders to fill the aboveExecutive Board of Directors’ positions for a two-year term (October 2006 – October 2008).

Executive Vice PresidentProvides support to the executive president, represents the executive president when called upon, chairs the governmental affairs committeeand coordinates political action activities for the association. Chairs Sandra Bobbitt continuing education scholarship. Chairs annual Congressof Presidents meeting.

Executive TreasurerInsures the fiscal accountability of the Association. Prepares the annual budget; oversees line items are appropriated to correct account;responsible to prepare financial reports to the Executive Board and general membership. Chair of national finance committee.

Regional DirectorProvides leadership through effective communication to the designated chapters and chapter presidents by supporting the development,planning, coordination, and evaluation of regional activities; promotes the association’s philosophy, objectives and goals.

Additional information may be obtained from your chapter president or the business office. If you are a qualified candidate, wish to nominate aqualified member, or would like to explore being nominated please contact:

AOHP Nominations ChairpersonDee Tyler, RN, COHN-SE-mail: dtyler@mha.orgPhone: 248-304-4214Fax: 517-327-4573

All nominees shall be verified by telephone. Nominees who agree to run for office:� Will be provided with a complete job description� Shall submit a brief (2 paragraph) philosophy and platform statement, and� Shall submit a curriculum vitae to the nomination chairperson by June 16, 2006.

Election shall be held in August 2006. Elected officers shall be installed at the annual membership meetingheld during the national conference in October 2006.

Nominations will be accepted until Friday June 16, 2006.

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Colleague Connection

Hospital Patient Lift & Transfer Equipment – an OverviewBy Ken Aebi, BS, Don Maynes, and Jan Frustaglia, RN,BS,CCM,COHN-S

Critical to the development of any comprehensiveinjury reduction program in a healthcare facility is a thor-ough review and analysis of the various patient-handlingrequirements. No one type of equipment meets the needsof today’s diverse patient population.

The two critical factors in a successful safe patient-handlingprogram are staff compliance and having the appropriateequipment easily accessible and functional one hundred per-cent of the time. The clinical staff must be involved early todefine the types of patient movement risks, to develop thepolicy to address those risks, and in selecting the equipmentthat they feel will best mitigate the risks. Including the clinicalstaff early in this process will help develop their buy-in to thetotal program. Equally important is the daily reinforcement ofthe program by the hospital’s senior management. This rein-forcement needs to be in the form of active promotion of thepolicy by acknowledging successes in reducing injuries, anddisciplinary actions when the policy is not followed.

A comprehensive department survey to determine the Mini-mum Clinical Requirements (see Additional Resources)of patient lifts and transfers performed in each departmentmust be done as the first step in safe patient handling. Thereport from a survey will lead to policy development andspecifications of appropriate lifting equipment. MinimumClinical Requirements has determined the five basic ele-ments to a survey:

1. The dependency level of the patients being transferred2. The staff perception of the difficulty of the transfer3. The frequency of the transfer or activity4. The working environment in which the task is being

performed5. The weight and weighing requirements of the patients

Other considerations such as room size, storage space, floorcovering, and ceiling integrity must be considered.

Types of EquipmentThe two major categories of patient lift and transfer equip-

ment used in hospitals for patients with some level of de-pendency are vertical lifts and lateral transfer devices.There are also several other useful devices that can beused to assist patients that are ambulatory. Each of thesetools is further outlined below.

Vertical LiftsVertical lifting equipment is widely used in healthcare en-vironments. A sling is positioned under the patient, and thenattached to the device to allow the patient to be lifted fromone surface and lowered or transferred to another. Oftenpatients are lifted from their bed and placed in a chair, on acommode, or in a bathing tub. The vertical lift is very usefulfor patients who require considerable assistance, but do nothave other significant complications. The vertical lift is oftenthe best choice for lifting a patient who has fallen to the floor,removing a patient from a car in the ER, or moving a patientfrom a wheelchair to a stretcher or bed.

Mobile Floor LiftsThe most common type of vertical lifting equipment is themobile floor lift that can be moved to the patient locationas required. There are numerous manufacturers of mobilefloor lifts, and virtually all of the equipment performs thesame basic functions. These devices lift and lower thepatient with a sling. The legs of most lifts spread to straddleother devices such as wheelchairs or commodes. Mostequipment has a patient weighing option. These lifts mayhave other features, such as gait training capability, to preventa patient from falling to the floor during mobility exercises.

There are two additional considerations when selecting mo-bile floor lifts: patient weight capacity, and battery versusmanual operation. Typical patient weight capacities aver-age around 350 to 450 pounds. New devices are able toaccommodate patient weights as high as 1000 pounds. Theone thousand pound floor-lifts can sacrifice significant ben-efits in terms of mobility, storage and sling cost. In a largehospital it may be appropriate to own one heavy-duty floor-lift, with an appropriate sling, to accommodate the needsof heavier patient populations.

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21Battery-powered vertical floor-lifts are simple to operate,and convenient for the staff. However, it is necessary thatthe batteries be routinely recharged and periodically re-placed. If such devices are to be employed in the workprocess of a hospital, it is necessary to have clearly de-fined procedural guidelines to assure the functionality ofthe lift. In actual use, some hospital departments withoutsuch policies have found that battery-powered vertical liftsare not used because the batteries are depleted or staff isunable to locate the device when it is needed. Extra bat-tery packs with a charger kept at the nurses’ station, and aspecified storage space for the floor lift are ways to en-sure that the system is always charged and available.

In order to avoid the battery maintenance issue altogether,a manual powered vertical lift might be considered. Thesesystems utilize hydraulic pressure which is supplied by theoperator pumping a pedal or cranking device. The battery-powered lift – versus a manual powered lift – is the typeof mobile lift to have in a department that performs nu-merous patient lifts. Rooms and hallways that are carpetedaffect the performance of this device by increasing thepush-pull weight of the device itself. Storage space, al-ways a premium in a hospital, should also be consideredboth for convenience to staff, and because of fire codes incertain jurisdictions.

Ceiling Track LiftsAn alternative to the mobile floor vertical lift is the ceilingmounted track lift system. The CTL consists of a battery-powered motor with varying patient weight capacities thatis mounted to a track. The track is permanently attachedto the ceiling and is available in a wide variety of configu-rations depending on the design and size of the patient roomand typical needs of the patients being served in specificunits. A strap is attached to the lifting motor to which isattached a sling mounting bar. The bar is electronically low-ered to the patient. The sling is then attached to the bar,and the patient is raised and moved along the track to thedesired surface and then lowered.

Ceiling track lift systems have the significant benefit ofalways being available when required. This eliminates theneed to search throughout the department for lifting equip-ment, which helps enhance staff compliance with the in-jury reduction program. Findings of studies performed bythe Veterans Administration show a direct correlation be-tween the distances that a nurse has to travel to get a liftdevice and utilization rate of that device. Optional featuresthat manufacturers offer include motors that are poweredlaterally as well as vertically, motors that automatically re-

turn to the recharging station, scales, and a combination ofdifferent ceiling track configurations. As with floor lifts,lifting capabilities are determined by patient weight, with amaximum capacity of 1,000 pounds. Since the CTL is per-manently installed, a nurse never needs to look for the de-vice. It is always right above the patient and ready to go. TheCTL is the optimal device to assist a patient with in-roomrepositioning, toileting activities, bathing, and lateral transfers.The CTL does not require additional storage space.

In departments such as radiology and an operating room,other equipment may be housed in the ceiling, thus pre-cluding the installation of a CTL. These departments pri-marily perform lateral transfers, so it is important to deter-mine installation feasibility prior to equipment purchase.

Vertical Lift SlingsSlings are a critical component of any vertical or repositioningsystem. Made of reinforced fabrics, slings attach to the armsof either CTLs or mobile floor lifts. Like the lifting deviceitself, it is critical that slings be available at the time needed.Establishment of laundering and storage protocols must bemade in advance to assure usage of the parts of the equip-ment already present. Absent such procedural methods, slingsmay be lost in the laundering process, or simply placed in anunidentifiable location within the department.

The most important factor in selecting a sling is sling design.In order to ensure high staff compliance, the sling should besimple to understand and use; easy to position on the patient;and comfortable for the patients during the transfer.

Slings are available in a variety of sizes and materials depend-ing on the patient and the application. Most slings raise thepatients into a sitting or slightly recumbent position, but supineslings are also available. Most manufacturers are now pro-ducing a sling specifically to address patient repositoning. Theslings are designed like a bed sheet, and lay under the patientat all times. These slings are easily attached to the sling barwhen the patient requires repositoning. Special applicationslings can also be used for a myriad of unique needs includingbathing, amputees, and burn patients. High quality disposableslings are now being produced by several manufacturers. Eachpatient has their own vertical and repositoning sling, which isdiscarded when soiled or no longer required by the patient.This type of sling is often used when laundry cannot servicethe slings, or there are infection control issues.

Lateral Transfer DevicesRecent studies indicate that many of the high-risk activi-ties that occur in hospitals involve laterally transferring a

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patient from one place to the next. Patients are generallytransferred from a bed to stretcher, transported to anotherarea of the hospital for a procedure or evaluation, and thenreturned to bed. Lateral transfer products are ideal for thistype of process, particularly for those patients who cannottolerate slings, or whose medical condition precludes themfrom being suspended by a vertical lift. These systems areparticularly effective in imaging departments, operatingrooms, and the emergency department. Because highlydependent patients frequently move between these threedepartments, hospitals should select one lateral transferdevice that can be used in all three departments.

Air Flow SystemsAir flow systems consist of a perforated mattress con-nected to an electrically powered air supply by a flexibleribbed hose. The patient is “log rolled” and the deflatedmattress is spread under the patient. The air supply pumpsair through a hose into the mattress which is subsequentlyreleased through the perforations. This action creates acushion of air which helps eliminate much of the friction oflaterally sliding the patient over to another surface. A bridgeis often used between the bed/stretcher and the other sur-face to fill the gap between the two transfer surfaces.

When this type of system is used, it is necessary to plugthe air supply into an electrical outlet and to inflate themattress in order to transfer the patient. Usually the mat-tress is covered with a coverlet, but if the mattress itselfbecomes contaminated, it can be wiped down or cleanedin the laundry. The advantage is very heavy patients canbe easily moved. The disadvantage is getting the mattressunder the patient initially, as well as finding an electricaloutlet at the location the transfer.

Integrated Transfer SystemsThree of the most common patient transfers in the hospitalare moving a patient from bed to stretcher, bed to chair,and from a stretcher to treatment or procedural tables. Afew manufacturers offer hospital stretchers and/or chairsthat are available with two different types of lateral trans-fer systems that allow patients to be transferred withoutthe traditional methods of manual lifting or sliding.

The first type, a transfer stretcher or chair, is positionednext to the bed. The top of this device is then moved out tothe center of the bed by turning a hand crank. The patientis “log rolled” and the transfer pad is tucked under thepatient. The top is then cranked back to the center of thechair or stretcher. The patient can then be moved to a

sitting or reclining position in the case of the chair, or trans-ported within the hospital on the stretcher. Simply reversethe process to return the patient to bed.

The second system works in the same manner except thatthe chair employs a mechanical draw sheet (see mechani-cal draw sheet described below). The advantage of thissystem is that you do not have to log roll the patient.

These types of systems increase the likelihood of staff com-pliance for chair orders and off the floor transfers, be-cause everything needed to complete the transfer is incor-porated into the chair, and it is always available.

Mechanical Draw SheetsAnother method of transferring patients laterally is a de-vice that is attached to a plastic sheet that is impregnatedwith silicone. The silicone sheet is slipped under the pa-tient, and a stretcher or specially designed chair is posi-tioned next to the bed. A pulling device (transfer bar) isthen placed next to the side of the stretcher. Three to fourstraps are extended from the bar, across the stretcher, andattached to the sheet. Using a hand-crank, the straps arethen retracted and the patient is comfortably transferredacross the bed and onto the stretcher. Upon return theprocedure is reversed attaching the transfer bar to the bed.

When the patient is transported to another department, thetransfer bar fits underneath the stretcher, and can be usedto make an additional transfer. It is also possible to trans-fer patients utilizing only the patient draw sheet and at-taching it to the transfer bar with specially designed hooks.The flexibility of this system allows it to be used with mostof the commercially available stretchers, beds, and proce-dural tables.

Other Patient Assist DevicesIn addition to the equipment described above, there areseveral products that can be very useful in safe patienthandling and further reducing staff injuries.

Simple transfer boards can be useful when helping a pa-tient slide from one surface to another. One transfer boardincludes a pivot that is helpful when the patient is in a sit-ting position and being moved to or from a wheelchair.Transfer boards are the most popular transfer devices andare used within most hospitals. Since transfer boards onlyslightly reduce the friction between surfaces, they still re-quire multiple lifters to complete the transfer. Further, trans-fer boards require that you “hold” the patient in place on

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23the board, and that the patient maintain trunk stability. Thesedevices require considerable force to move the averagepatient, sometimes create awkward positions, and thus of-ten defeat the goal of reducing staff injuries.

Slip sheets, and other friction reducing devices, can be usedwhen transferring a patient, or to reposition a patient inbed. These can be very effective in repositoning patients,especially in a department where the patients can assistwith the transfer (such as labor and delivery). Staff doesnot need to hold the patient, as is done with a transferboard. These sheets can be used with totally dependentpatients, while a transfer board requires trunk stabilitywhen transferring from a stretcher to a bed.

Gait belts are extremely helpful for patients who are am-bulatory and are highly recommended as part of a backinjury reduction program. Belts that include handles arepreferable because they are easier to use and providegreater control to the caregiver. They are a widely used onmany floors during gait training activities. Unfortunately,without proper training and certification in their use, a pa-tient can still pull the caregiver down in the event of a fall.

Hospitals have numerous options when evaluating andselecting patient lift and transfer equipment. Equipmentproviders must be responsible for providing initial in-ser-vice training for the hospital staff. The hospital must de-velop internal training capabilities to address staff changes,and to determine staff competency in the usage of newlyinstalled equipment. During the evaluation process it isimperative that the staff actually use the equipment. It isincumbent on nursing management to ensure that effec-tive patient assessment or evaluation protocols are in place.It is also important to have policies for maintenance andservice of the equipment, and that preventative mainte-nance steps are established prior to purchase.

Finally, staff compliance is essential to the success of anyinjury reduction plan, so it is critical that equipment be evalu-ated by the end-users prior to purchase. This will ensurethat the devices are appropriate for the application andmeet the needs of the staff. After the appropriate equip-

ment is selected, use of the equipment must be mandatoryfor all personnel responsible for transferring, lifting andmoving patients.

Additional Resources:Equitable Safety Group has developed a risk assessment re-port called “Minimum Clinical Requirements.” Contact Equi-table Safety Group (503)720-0637 for further information.

A new book, Safe Patient Handling: A Practice Guidefor Nurses and Other Health Care Providers, by AudreyNelson, PhD, RN, FAAN. 2006 ISBN 0-8261-6363-7. Cur-rently available for $40.00 at www.springerpub.com.

Referenceswww.bartonmedical.com

www.liko.com

www.guldmann.com

www.arjo.com

http://ergosafe-products.com

http://www.ezlifts.com

www.hovermatt.com

www.slidersheets.com

Patient Care Ergonomics Resource Guide: Safe Patient Handling andMovement. developed by the Patient Safety Center of Inquiry, Veter-ans Health Administration and Department of Defense, October 2001(rev.8/31/05)

Guidelines for Nursing Homes, OSHA 3182,2003 at www.osha.gov

Ken Aebi is the Managing Director for Equitable SafetySolutions, Inc. and resides in Portland, Oregon. Kenreceived a BS from University of Oregon. Ken can becontacted at kenequitablesafetygroup@earthlink.net.Don Maynes is a Risk Analyst Consultant for EquitableSafety Solutions, Inc. and lives in Des Moines, Iowaand can be contacted at donmaynes@msn.com. JanFrustaglia is an AOHP member and an IndependentConsultant, consulting on occupational health andsafety. Jan is a recent past AOHP Regional Directorand the current Continuing Education Chair. She re-sides in Albuquerque, New Mexico and can be con-tacted at jfrustag@comcast.net.

The Salary and Staffing Excerpts from 2005 Membership Survey & Needs Assessment

is now available for AOHP members. You can download from AOHP website

http://www.aohp.org/MembersOnly/Survey-Results.asp.

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Maintaining the Safety and Health of a Diverse WorkforceBy Linda Tapp, ALCM, CSP

Today’s workforce is more diverse than ever. Employ-ers must be aware and take actions to help provide a safeworkplace for everyone—regardless of their age, language,body shape or size. Particularly, there are more women work-ers, workers with English as a second language and olderworkers than ever before.

Youth in the WorkforceMillions of young people work during the school year andeven more during the summer months. They may be in theworkplace as part-timers or as interns. Younger employeesare usually very eager to learn and to try new things but theirlack of experience can lead to injuries that could stay withthem for a lifetime. Every year, about 70 teens die and ap-proximately 100,000 teens aged 15 to 17 visit emergency roomsfor work-related injuries. It is estimated that 230,000 workingteens may be working each year. This means that there areapproximately 42% of 16 and 17-year-old teens in the laborforce at any one time. Additionally, 80% of teens are em-ployed at some time before they leave school.

Provisions of the Fair Labor Standards Act, the OccupationalSafety and Health Act and State Child Labor Laws are de-signed to protect young workers by stating limits on hoursworked and prohibitions on certain types of tasks. Teens areinjured at a higher rate than adults even though they are notallowed employment in hazardous industries. One reason maybe that studies have found that 19% to 41% of all teen workerinjuries occurred in jobs at which it is illegal for teens to work.

What are the characteristics of teens in the workforce? Gen-erally, the teens are inexperienced enthusiastic, self confi-dent, eager to prove themselves, and accustomed to change.

What does this mean for their safety at work? Since teenslack work experience and may be more emotional, they mayexperience more accidents. They may also have some physi-cal issues since their bodies are still developing. Additionally,they are usually given the worst and /or most hazardous jobs.All of these factors could have a negative effect on teenworkplace safety.

Older Employees in the WorkplaceAs Americans in general get older, so does the workforce. In

2004, the number of workers aged 55 and older was 15.6%or about 23 million workers. By 2012 this number is expectedto reach 19% of the population. Additionally, studies haveshown that more than three-quarters of today’s baby boomers(i.e., those born between 1946 and 1964) plan to work be-yond age 62.

Surprisingly, injury rates are higher for younger workers thanolder workers. Research studies have shown that as peopleget older and lose some of their strength and cardiovascularcapacity, they do not experience a greater number of muscu-loskeletal disorders. But, if the older worker gets hurt, medi-cal costs are generally higher due to other factors.

Why do older workers get injured less? Some say that it maybe because older workers frequently get placed out of physi-cally demanding jobs because of seniority. Others say thatolder workers, having more experience, just work smarter byusing good work techniques and/or material handling equipment.

What does this mean to employers? We must develop waysthat will allow us to accommodate the aging worker. We mustall learn more about the aging process and what we can do tocontinue to provide a safe and healthy workplace for all em-ployees regardless of age.

Risk factors associated with all aging people include decreasedcardiovascular function, decreased lung and respiratory ca-pacity and a decreased ability to oxygenate red blood cells.This means that the older worker will get more fatigued, morequickly. Older workers also lose some of their strength sodepending on the physical characteristics of the job; olderworkers may need to take more breaks.

Older workers also have decreased ability for thermoregula-tion, which means they are more sensitive to hot and coldextremes. The way jobs are performed in very hot or coldenvironments may need to be addressed.

Older workers also have decreased bone density, muscle mass,strength and fitness. This translates to a decreased reflextime, decreased coordination and slower reaction speed. Thedecreased bone density and muscle mass leads to a decreasedability to maintain a healthy posture and this is what helps to

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25protect the spine from injuries. The older worker may alsohave greater difficulty completing tasks that require overallstrength, grip force, and exertion or repetitive motions.

Other risk factors include chronic diseases and other condi-tions such as obesity, arthritis and other degenerative diseases,heart disease, high blood pressure, diabetes, eye disease, anddepression. Many older people with these chronic diseaseshave declining physical capabilities and energy levels. Olderpersons with chronic conditions do not have the stamina toremain active and maintain their health through physical ac-tivity. Poor health can lead to workplace injuries and illnesses.

Older workers also often have a loss of visual acuity anddecreased hearing, which can also affect workplace safety.

Fortunately, many of the changes related to aging can be pre-vented, or delayed. Much of what we once thought normalfor an aging person is now being disputed. Evidence is strongthat taking care of yourself adds years to your life and life toyour years. Exercise is considered the greatest single ele-ment in reversing the effects of aging.

Language DifferencesMany workplaces in the United States are no longer onlyEnglish speaking. Due to the history of the United States andits location, the U.S. has not addressed multi-languageworksites as well as many other countries. This has manyramifications but probably most importantly, non-Englishspeakers can pose serious safety concerns. Many people thinkthat the issue of non-English speaking workers only refers toSpanish speakers but this is not true. Especially in urban ar-eas, there can be a great variety of languages spoken. Addi-tionally, dialects vary from country to country and region toregion and this must also be considered.

In 2000 and 2001, while overall workplace fatalities werefalling, deaths among Hispanic workers were rising – by12% in 2000 and 10% in 2001. Most of the increases oc-curred in the service and agricultural industries – on top ofincreases in earlier years in construction. Although His-panics account for only 18% of the construction workforce,they account for 21% of the deaths. OSHA’s data showsthat about 25% of the fatalities they investigate are in someway related to language or cultural barriers. Also, immi-grant workers are often at greater risk since they takemore dangerous, labor intensive, lower paying jobs withlittle or no safety training. Studies have also shown thatMexican workers place a higher value on their economicstatus than they do on personal safety.

In July 2004, OSHA launched a Hispanic Employees andWorkers website. The website features outreach activities,best practices, bulletins, English-Spanish and Spanish-Englishdictionaries, public service announcements, and e-Tools inSpanish. OSHA is also currently forming a translation workgroup from different area offices. The group will prioritizepublications for translation.

Many of the safety efforts that try to include non-Englishspeakers wrongly rely on one thing – that all workers canread. There are many native born and immigrant workerswho cannot read English or their native language. So, simplytranslating safety training materials and safety signs into otherlanguages doesn’t always work.

Obesity IssuesSixty-five percent of Americans are overweight or obese.Obesity is defined by body mass index (BMI). A BMI > 30 isconsidered obese. Obesity can have serious effects for com-panies such as greater insurance costs due to associated con-ditions. Some of these are Type 2 diabetes (which can alsolead to degenerative diseases of the hips, knees, and spine);Physiologic Effects, Psychological Effects/Stress, a greatersusceptibility to Neurotoxic Chemicals and Sleep Apnea.

The obesity epidemic can have negative affects on compa-nies such as greater worker’s compensation costs, increasedemployee benefits, and higher absenteeism. Obesity can alsohave an effect on workplace safety. Personal protective equip-ment may not be available that fits larger workers properlyand in turn, they may not wear it properly or at all. Equipmentsuch as fall protection and ladders may have weight limits aswell. It should be determined if the assigned equipment isappropriate for the individual employee to which it is issued.Other jobs, like confined space entry and many maintenancejobs that involve work in tight spaces are obviously much moredifficult for obese workers.

Women and PregnancyForty-six percent of the workforce is currently female andthis number is expected to grow. It is estimated that at anyone time, there are one million working pregnant women. Whyis a pregnant worker different from any other worker? Forstarters, pregnancy changes balance, reach distance and lift-ing. Additionally, hormonal changes that occur with pregnancyeffect ligaments and joints which can cause postural prob-lems, backache and impairment of dexterity, agility, coordina-tion and balance. Pregnant women may be more affected bysome ergonomic hazards such as awkward postures, heavylifting, repetitive forces and limited rest periods. Some of thepossible adverse outcomes of these ergonomic hazards in-

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clude pre-term delivery, low birth weight, spontaneous abor-tion, and stillbirth.

Reach Distance is affected in pregnant women because ofthe increased distance they must reach to handle objects dueto their increasing size. This additional stretching can affectthe arms, shoulders, and lower back. Increased reach dis-tance can make lifting tasks particularly hazardous at this time.Not only can there be greater back pain, but the load must becarried farther from the body.

Heavy lifting tasks also cause the flow of blood in the body tobe altered, which can affect the fetus. Intra-abdominal pres-sures are also increased during heavy lifting and there mayalso be hormone disturbances as well as nutritional deficits.Studies have also shown that pregnant women are able to liftless than non-pregnant women. Medical groups such as theAmerican Medical Women’s Association does not set rigidguidelines such as lifting limits but does propose that work-place modifications should be based on baseline fitness, ergo-nomic demands of the job (such as the amount of exertionrequired, the shift duration and break frequency), and whetheror not the pregnancy is high risk.

Excessive standing during pregnancy can also cause concern.Standing for long periods of time can cause lower back pain.Prolonged standing can cause serious risk. For example, stand-ing more than 36 hours a week or more than 10 hours a day,can lead to a variety of problems.

Addressing the ChallengesA safer workplace can be achieved by implementing goodworkplace design principles and programs. This would en-sure help for older and younger workers, overweight workers,non-English speakers, and women by not only making it safer forthese diverse populations but for all employees as well.

Some ways to do this include using material handling equip-ment whenever possible and practical. Material handling equip-ment reduces the need to lift, lower, push, pull or carry heavymaterials. Forklifts and other powered trucks should be usedto eliminate manual handling of heavy bags, pails and othermaterials. Carts, conveyors, ball caster tables and hand trucksshould be used to eliminate carrying materials greater than 20feet. Reducing the weight of objects that must be handled notonly makes the task easier for older and women workers butmake the job safer for everyone.

To help workers with decreased vision, and all workers ingeneral, the use of small print size or small font sizes shouldbe avoided. High glare on monitor screens can also lead to

problems. Reading areas with shadows or poor lighting shouldbe improved with additional lighting. Emergency alarms shouldbe easy for everyone to see, hear and understand.

The risk of handling materials can be lowered for all workersby ensuring good housekeeping practices are followed. Floorsurfaces should be kept dry and free of debris, clutter, oil,chemicals, water and other slippery materials. Pallets shouldbe in good condition without broken boards or protruding nails.There should also be on-going safety/ergonomics training onmaterial handling techniques that covers body mechanics andpreferred postures. Employees should be encouraged to re-quest assistance if they feel any object is too heavy or bulkyto move it by themselves.

To help accommodate workers with hearing loss, noise re-duction in the work environment can eliminate noise sensitiv-ity, increase focus and increase concentration. Using prod-ucts that possess sound dampening properties will help ac-complish this. Warning lights and sounds should be effectivefor the employees with the worst case of hearing and/or vi-sion loss.

To decrease the chances of teen workers getting injured onthe job, there are several things employers can do. First, in-teractions with supervisors can be increased so the supervi-sor can observe the teen working and then make correctionswhen work is not done safely. Instructions should be “hands-on” and procedures should be repeated often. The more of-ten and the more ways they hear something, the better. Thereshould be a greater use of written procedures, SOPs andchecklists. If possible, teens should be assigned a mentor orsomeone to serve as a role model for them.

Knowing and understanding the law governing teen employ-ment benefits employers. Understanding the viewpoint of thedifferent generations may also help to ease tension and im-prove communication in our workplace. By increasing theamount of time experienced workers spend with the teens,employers can help assure their safety.

To help keep larger workers safe on the job, employers firstmust realize that education and awareness is very important.It may be difficult to bring up the subject but obesity is a factthat employers must consider when designing safe workplacesand programs. Education and awareness programs on propernutrition and the importance of exercise should be offered toall employees. It is also important that the purchasing depart-ment or inventory/supply personnel understand the need tohave personal protective equipment in a wide variety of sizes– one size does not fit all. Companies can also encourage

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27employees to eat well by offering healthier options in vendingmachines and in company cafeterias, providing walking pathsand/or exercise programs and on-site weight control classes.

For pregnant women, employers can assign less physical tasks,restrict lifting, adjust work and breaks, and vary the employee’stasks if possible. Foot rests for use when standing and sittingcan also help with circulation. Obstacles, especially those atfloor level, should be removed if possible since it will be moredifficult for very pregnant employees to see these things.Additionally, employers should limit standing time for preg-nant workers and try to arrange their work so that it is keptclose to the body. Finally, good support for the back is essential.

What can we do in general to accommodate today’s diverseworkforces? Applying good ergonomic principles is a greatfirst step. Ergonomics is the science of improving employeeperformance and well-being in relation to job tasks, equip-ment and the environment. Ergonomics is a continuous im-provement effort to design the workplace for what people dowell and to design against what people don’t do well, and thisincludes all populations. The goal of workplace ergonomics isto minimize the effects of workplace stressors and adapt jobsto meet worker needs. Equipment should be designed to opti-

mize human efficiency and reduce musculoskeletal strain.Ergonomics has many benefits. By applying good ergonomicprinciples, employers can reduce injury rates, contain worker’scompensation costs, increase productivity, and improve prod-uct quality.

With the current and the future workforce continually ex-panding to include a more diverse workforce than ever, it isimportant that safety and health programs are continually re-evaluated and revised as well so that all employees are pro-tected from workplace hazards. Through awareness and edu-cation about the different risks and needs of various groups,injuries and illnesses can be prevented.

Linda Tapp, ALCM, CSP is the President of Crown Safety.She is a Certified Safety Professional, ComprehensivePractice, with a specialty in ergonomics. A graduate ofTemple University, with a MS in Environmental Health,Linda was recognized by The American Society of SafetyEngineers in 2003 as the Safety Professional of the Yearfor Region 8.Crown Safety is on the web atwww.crownsafety.com. Linda may be contacted by phoneat 856-489-6510 or email Ltapp@crownsafety.com.

2007 National ConferenceWill be held on

September 26-29, 007 At Marriott Savannah Riverfront100 General McIntosh Boulevard

Savannah, Georgia 31401

Savannah, the sultry andmysterious “Belle” on theSoutheastern coast. Savannahcaptivates the suitors with hernatural beauty, eccentric charmand traditional SouthernHospitality — becauseSavannah is genteel, graciousand captivating. Savannah is the beautifully preservedhidden [* File contains invalid data | In-line.JPG *]treasureof the Low Country. Come unlock the history, romance andbeauty that lies within. Explore every nook and crannybecause you are her guest and Savannah loves sharingher treasures with you..

Savannah Awaits Your Arrival!

Mark Your Calendar for Our2007 National Conference

Recognizing

Occupational

Health Nurse

April 17 - 21POSTER FOR OHN WEEK

AOHP is very pleased to send you this commemorative poster toobserve AOHP’s 25th anniversary and to recognize the contributions theoccupational health professional makes in creating and maintaining ahealthy and safe work environment. We feel this poster acknowledgesyour role in caring for healthcare workers and demonstrates variousroles such as educator, clinician, and case manager.

A copy of this poster was sent to you the end of March. Please post inyour clinic area or in a prominent area in your health care facility. Usethis poster to acknowledge this special week in April which honors alloccupational health nurses, but please consider displaying it for the restof the year to celebrate AOHP’s 25th year of providing support to ourmembers. Additional posters are available through AOHP Headquartersfor $5.00 each for members or $8.00 each for non member. Call 800-362-4347 or email info@aohp.org to place an order.

AOHP has also mailed a letter to your CEO to highlight the role of theoccupational health nurse in your organization. Please let AOHPHeadquarters (info@aohp.org) know of any recognition or commentsthat you receive as a result of this letter.

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Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

Challenges for Nursing in the 21st CenturyBy Sister Rosemary Donley

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A O H P J o u r n a l

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

Risk Factors for Group B Streptococcal Genitourinary TractColonization in Pregnant Women

By Renee D. Stapleton, MD, MSc, Jeremy M. Kahn, MD, MSc, Laura E. Evans, MD, MSc,Cathy W. Critchlow, PhD, and Carolyn M. Gardella, MD, MPH

Spring 2 0 0 6

41

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

Reduction in Injury Rates in Nursing Personnel ThroughIntroduction of Mechanical Lifts in the Workplace

By B. Evanoff, MD, MPH, L. Wolf, MS, CPE, E. Aton, MS,J. Canos, MPH, and James Collins, PhD

Spring 2 0 0 6

47

Plan to attend the 2006 national AOHP

conference October 4-7 in Sacramento,

California….or you will miss all the updated

information, education and fun!

The education includes pre-conference workshops on:� Getting Started Program• A Five Step Approach to Protecting Diagnostic Imaging Staff� JoAnn Shea’s “Best Practice” Lift Team Program at Tampa General Hospital� ACOEM Guidelines Workshop� Chronic Pain Advanced Practice Workshop� Accurate Diagnosis of Extremity Pain

.

The updated information includes general session speakers:� Keynote speaker Joyce Safian PhD – first AOHP President and founder, President and CEO of North Bay Corporate

Health Services, Inc. speaking on the historical perspective of AOHP and its impact on Hospital Employee Health� John Howard, MD, JD, Director of NIOSH discussing 21st Century Issues in Occupational Safety and Health� Marguerite McMillan Jackson, PhD, FAAN of University of California, providing updates on the CDC Guidelines for

Preventing the Transmission of TB in Health-Care Settings.� Elise Beltrami, MD, of the CDC updating us on immunizations for healthcare workers.� The Honorable Patricia Hunter of Government Relations Group, Inc., leading a session on politics and nursing

including a tour of the California State Capitol

Plus expert presentations on The Aging Workforce, Non-Traditional Approach to Worksite Health Promotion, Absence Reportingand Surveillance of Employee Illness, A Smoke Free Zone, TB Screening With QuantiFERON, and much, much more.

The fun includes:• Several pre- and post-conference events, including a tour of San Francisco as well as a tour of the wine country in the

foothills• Shuttle bus to Old Sacramento and Mall Shopping• Wednesday evening vendor reception with food, fun and prizes including a free registration for the 2007 conference.• A very special Anniversary Gala to celebrate AOHP’s 25 years of service to the health care community. This formal

event includes cocktails, hors d-oeuvres, buffet style dinner, cash bar, casino theme, music and dancing. Spouses areinvited. Julia Riley, a world-renowned speaker will lead the night’s festivities.

In addition…• The ABOHN certification exam will be offered on Saturday October 7.• The local highlights of Sacramento’s great location……..just halfway between San Francisco and Lake Tahoe and just

an hour from California’s Wine Country.

For more information about the conference, visit the AOHP website (www.aohp.org).Don’t miss this empowering educational event that is sure to both update and inspire your employee health practice.Call Sandy Prickitt, AOHP’s Conference Chair at 415-492-4790 or email her at prickis@sutterhealth.org with your ideas,any help that you may want to provide or other thoughts to make this year’s conference a truly memorable and enrichingexperience.

PRSRT STDU.S. Postage

PAIDWarrendale, PAPermit No. 20

Association of Occupational Health Professionals in Healthcare109 VIP Drive, Suite 220Wexford, PA 15090

Address Service Requested

Location: Children’s Mercy Hospitals & Clinics : 2401 Gillham Road, Kansas City, MO 64108 Cost: $295Complimentary Food & Beverages from Children’s Mercy Hospitals & Clinics

(Morning: Coffee, tea, juice and rolls; Lunch: Assorted box lunches and beverages; Afternoon: Beverages and cookies)

PRESENTERSCarolyn Amrich, RN, COHN, Jan Frustaglia, BS, RN, CCM, COHN-S and Deborah Rivera, RN, COHN

DESCRIPTIONBack By Popular Demand! This comprehensive, informative course, designed for the occupational health professional new to the field. Coursecontent is practical and up-to-date, presented by a team of experienced experts. All participants will also receive the 2004 edition of “Getting Started”resource manual in CD format.

COURSE OBJECTIVES1. Describe how the occupational health professional interacts in the health care facility’s organizational structure.2. Discuss areas of medical-legal confidentiality in occupational health.3. Identify the federal, state, and local regulatory requirements as related to job placement, physical hazards, and biological and chemical exposures.4. State current infection control practices related to infectious disease.5. Identify strategies to utilize health teaching in infection control and safety.6. Describe the effectiveness of case management in loss control.7. Explain how to communicate the value of an occupational health professional service and continuous quality improvement.

Please see attached registration form. If you have any question, please contact Jan Frustaglia, AOHP Continuing Education Chair atjfrustag@comcast.net phone 505-890-4055 or cell 505-301-0868. For workshop registration, please contact AOHP Headquarters at info@aohp.orgor phone 800-362-4347.

If you are interested to host the Getting Start On-The-Road Workshop in your area, please contact Jan Frustaglia for details.

GETTING STARTED On-The-Road! Next stop at Kansas City, MOGetting Started In Employee Health Workshop

A One-Day Program FRIDAY, May 12, 2006 ~ 8:00 am to 5:00 pm