Safety Series: Worker Safety

Safety First
Manufacturers and hospital systems continue to prioritize worker safety.

Caring for patients is rewarding. It can also be dangerous. But group purchasing organizations (GPOs), integrated delivery networks (IDNs) and manufacturers all seem to agree that risks exist, and have taken steps to transform hospitals into safer work environments.

The hazards and issues associated with hospital jobs are many, ranging from needlesticks and latex allergies to mercury, toxic chemicals and PVC/DEHP. Nursing and hospital associations’ efforts to educate the public and inspections by the Occupational Safety and Health Administration (OSHA) have boosted the demand for safer healthcare products.

“There has definitely been improvement in safety over the last five years,” says Dionne Williams, an industrial hygienist for the Office of Health Enforcement Dictorate at OSHA. Following revisions in blood-borne pathogens standards, safer, more user friendly devices are available in hospitals. “And the introduction of safety devices has greatly reduced the risks for hospital workers,” she adds.

Latex and beyond
While needlestick hazards have been one of the most talked about issues, others have gained attention in recent years. “Hospitals have become much more aware that latex is a very real issue for patients and employees with latex allergies,” says Williams. “We are seeing more and more compliance with standards.”

Data supports that between 8 percent and 12 percent of healthcare workers who use gloves are sensitized to natural rubber latex, according to Consorta Inc. in Schaumburg, Ill. This compares to 1 percent to 6 percent for the general population. Latex allergy reactions include skin disease, asthma and anaphylaxis, which can result in chronic illness, disability or death. Powdered latex gloves are considered hazardous as well, because the latex proteins in the glove powder may become aerosolized and affect latex-sensitive workers.

Other worker safety hazards that have drawn recent attention include exposure to mercury and PVC/DEHP. Mercury is a nontoxic heavy metal, and exposure to it can cause tremors, impaired vision and hearing, paralysis, insomnia, developmental deficits during fetal development, emotional instability, attention deficit and developmental delays during childhood, according to Consorta. When mercury is released into the environment, it remains indefinitely in land and surface waters. Consorta says hospitals contribute to up to 5 percent of the total wastewater mercury load. Eliminating even small amounts of it can have a positive effect on the environment.

Bethlehem, Pa.-based B. Braun has recognized the hazards associated with PVD and DEHP since the early-1980s. PVC is a chlorinated plastic polymer adapted for a variety of uses. DEHP is a compound used as a plasticizer in some medical devices made of PVC plastic.

“We offered our first PVC/DEHP-free, small-volume container in 1983 and a large-volume container in 1989,” says Sophie Dolezel, product manager for fluid therapy at B. Braun. “It was just recently proven in animal studies that PVC and DEHP can hurt the reproductive system in neonates, but B. Braun was dealing with this issue years ago.”

“DEHP doesn’t bond to the PVC,” explains Dolezel. “So, during transport or storage, the DEHP structure can float into the drug solution (in the container) before migrating back to the PVC. This also can happen when the container is heated to an extreme temperature.

“Also, certain drugs are not compatible with PVC, and this can compromise the therapeutic dosage,” adds Dolezel. “The drug may be absorbed by the walls of the container.”

Dolezel says the FDA issued a draft guidance concerning PVC/DEHP in 2000 but has not yet finalized it. The agency also issued a public health notification recommending substituting DEHP with DEHP-free products for the general population.

Proceed with caution
In spite of the reasons for transitioning to safer products, some hospitals have yet to do so for various reasons. Williams says in a surgical suite, the surgeons may have hospital privileges, but they aren’t hired by the hospital. If the surgeon comes with his own devices, the hospital must deal with this.

“Also, different doctors prefer different devices, and everyone must be trained on these devices,” she adds. What’s more, it is difficult to phase out one type of device for a safer one.

Hospital finances are always a major issue. And, Dolezel says contractual obligations can hold hospitals back from switching to new products.

Still, in general, hospitals consider worker safety to be an important issue. “They are guided by official mandates by organizations such as OSHA and JCAHO,” says Dolezel. “Some proactive hospitals take action, even before formal regulations are out.”

Williams believes manufacturers are working hard to make safer products available to IDNs. “When a manufacturer hones in on a particular safety technology, such as retractable needle technology, it will try to apply this technology to other products and areas as well,” she says. “This makes the technology more cost effective and affordable to hospitals.”

Dolezel concurs. “B. Braun continuously evaluates its existing safety technology to see if it can be applied to other product areas,” she says.

B. Braun recently entered a Premier contract with Baxter Health for IV solutions among other products. “Premier recognizes its members’ right to have a choice of DEHP-free products,” says Dolezel.

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