The 2022 Conference Committee reviewed several posters for the AOHP 2022 National Conference. The selected posters will be open for viewing from Wednesday, September 7 at 6 pm until Friday, September 9 at 11 am. Stop by the poster session and see how these presenters have successfully implemented a program or taken an innovative idea and turned it into a reality. Viewing the posters also provides an opportunity for conference attendees to earn Continuing Education Credits.
A Snapshot of Sharps Injuries to RNs Working in a Large Urban Health System
Chris Stallard, DNP, APRN, FNP-BC, COHN-S, Karen Heaton, PhD, COHN-S, FNP-BC, FAAN, FAAOHN, Aoy Montgomery, PhD, BSN, Roseann Trimble, RN, and Stephanie Hammond, DNP, CRNP, ANP-BC, COHN-S
University of Alabama at Birmingham School of Nursing, Birmingham, AL
Background: Sharps injuries continue to be a high-risk source for occupational exposures despite multiple mitigating strategies. An estimated 600,000 to 800,000 sharps injuries occur in healthcare settings yearly. The estimated cost of a single sharps injury in the United States is $500 - $4,000, with a total economic burden between $118 - $591 million. Methods: Retrospective evaluation of sharps injuries sustained by registered nurses (RNs) from January 2020 through June 2020, including a root cause analysis. Conclusions: Results suggest that tenure, patient behavior, and technique were potential root causes of sharps injuries among RNs during the time frame. Findings: Between January and June 2020, 47 RNs sustained sharps injuries; 68% were between the ages of 19-25, with 54% reporting a job tenure of 1-2 years. Technique was the primary cause of the sharps injuries among the RNs. Implications for Practice: The findings of this study are important to inform administration and occupational health and safety of key areas to focus and prioritize training and education of RNs. Recent RN graduates had the highest rate of sharps injuries in this study. Training and education on sharps injuries and mitigating strategies should be an integral part of orientation for new RN graduates.
COVID-19 Testing Solution = LabGold™ PCR Self-Testing to Improve Access, Compliance, and Satisfaction
Lissa Nelson, RN, MSN, and Viviana Santiago, Lead Coordinator
Northwell Health, Valley Stream, NY
Where can I get tested for COVID-19? That was the resounding question posed throughout the country amid the COVID-19 pandemic. Occupational health professionals (OHPs) were faced with solving for the shortages of testing supplies and resources for the population they serve. Throughout the COVID pandemic, to effectively limit the spread of COVID-19 and maintain the health and wellness of healthcare employees, OHPs needed to ensure timely and reliable testing. According to the Centers for Disease Control and Prevention (CDC), “COVID-19 testing is very important to help reduce the spread of COVID-19.” Occupational programs needed to determine ways to screen, test, and manage their symptomatic and COVID-19 positive employees, while continuing to maintain and offer other occupational health programs and requirements. With the recent Omicron surge in December 2021, the demand for reliable, efficient, and accurate testing was even greater. Northwell Health Occupational Health Services, like many stakeholders in the healthcare industry, scrambled to tackle the long lines of employees with unprecedented demand for COVID testing. To continuously improve and respond to the needs of our employees, COVID-19 self-testing via LabGold™ was introduced in December 2021. LabGold™ is a qualitative RT-PCR assay used for the detection of COVID-19 from anterior nasal specimens. With this test, employees have the capability to leverage smart phone technology to self-register, self-collect, and self-swab 7 days a week/24 hours a day. The employee can also benefit by utilizing the self-swabbing kits to test family members. The LabGold™ is 99% sensitive and better than 99% specific. The employee receives their lab results in 24-72 hours via email or text message in a format acceptable to present as a record of testing.
The benefits of LabGold™ utilization for our occupational health program have included decreased costs in lab processing, decrease in resource and staffing needs, improved turnaround time for results since processing occurs within our lab, and improved customer satisfaction due to ease and availability of testing. For this project, we will present metrics on cost, staffing, and utilization, as well as customer satisfaction results via survey. Our occupational health program’s primary focus is the continued health and wellness of our employees. LabGold™ has allowed for greater access to employee testing and for our OHPs to identify positive cases quickly and mitigate co-worker and patient exposures.
Do Actions to Improve Healthcare Worker Safety Also Improve Patient Safety: A Challenging Question to Tackle
Barbara I. Braun, PhD, Meghann L. Adams, MPH, Michele R. Bozikis, MPH, Katherine Orze, MLIS, and David M. DeJoy, PhD
The Joint Commission, Oakbrook Terrace, IL
Background: This scoping review of systematic reviews addresses whether actions taken to improve healthcare worker health and safety also improve patient safety processes and outcomes. Methods: Structured search strategies were applied to identify systematic reviews published between 2011 and 2020 from key databases: MEDLINE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews. Abstracts were uploaded into DistillerSR® software.1 A multi-stage review approach was used. Two independent raters were used at each level, and disagreements were resolved at team meetings. Based on a work systems conceptual model, included reviews had to address both worker and patient safety, employ objective measures for each, and draw conclusions for each component. Preliminary Findings: The search yielded 1,060 abstracts. As of 4/7/22, 537 abstracts and 165 articles have been reviewed. Relatively few articles could be screened out based on title/abstract. Existing research has largely focused on the patient safety side. Challenges arose from the broad scope of topics, variation in terminology, and discipline-specific author perspectives. Articles often purport to establish a relationship between worker and patient safety but do not actually include measures of processes and/or outcomes for both groups. Healthcare safety culture measurement requires workers to report perceptions of their work environment (teamwork, communication, leadership, etc.) but typically only draw conclusions regarding patient safety. Most systematic reviews acknowledge the predominant use of cross-sectional designs. As such, strong evidence for causality is often lacking. A further limitation is the lack of detailed information for the source articles included in these systematic reviews. Our findings will be used to identify patterns and gaps in research, and to map out a future research agenda. Funder: Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH), Contract # 75D30120P08556
1. DistillerSR. Version 2.35. Evidence Partners; 2022. Accessed 2021-2022. https://www.evidencepartners.com
Fugitive Emissions in Sterile Processing Areas: Mitigating Workplace Ethylene Oxide (EtO) Exposure With Real-Time Indoor Air Quality Monitoring Systems
Picarro, Santa Clara, CA
Indoor air quality is highly correlated with the health and well-being of employees in a variety of industries where toxic gases may be present and pose a risk for inhalation. In certain industries where ethylene oxide (EtO) is used, such as hospital sterile processing departments, commercial medical device sterilizers, and spice fumigation, there has been a significant level of scrutiny toward exposure risk in the workplace. Growing concern, along with litigation toward companies using EtO, has driven the need for precise EtO-specific measurements, without interferences, to analyze multiple sample points across an entire facility. In 2016, the Environmental Protection Agency (EPA) effectively lowered their estimated tolerable levels for EtO by several orders of magnitude from previous assessments. This is particularly important for companies using EtO, as other regulating agencies across the globe are also expected to re-evaluate exposure limitations. For example, the Occupational Safety and Health Administration (OSHA) has stated that many of its permissible exposure limits (PELs) are outdated and inadequate for ensuring the protection of worker health. Most of OSHA's PELs were issued shortly after the adoption of the Occupational Safety and Health (OSH) Act in 1970 and have not been updated since that time. This presentation will review a prudent approach taken by many facilities to modernize their air quality monitoring systems for early detection with precise and targeted technology to gather actionable and defensible data in real time. As a leading provider of real-time analyzers for monitoring concentrations well below OSHA action levels, Picarro’s G2910 and G2920 EtO analyzers are designed with both specificity and sensitivity to low levels of EtO down to parts-per-trillion (ppt) without the need for preconcentration or chromatographic separation.
Lovenox and Generic Enoxaparin Prefilled Safety Syringes: The Good, the Bad and the Ugly! What You Need to Know
Lydia Crutchfield MA, BSN, RN, CLC, President Emeritus, Association of Occupational Health Professionals in Healthcare (AOHP), MaryAnn Gruden MSN, FNP, RN, COHN-S/CM, Occupational Health Consultant, Terry Grimmond FASM, BAgrSc, GrDpAdEd&Tr, Director, Grimmond and Associates, Microbiology Consultancy and Bobbi Jo Hurst MBA, BSN, RN, COHN-S, Community Liaison AOHP, Employee Health/Infection Control Orthopedic Associates of Lancaster
Based on results of a 2020 AOHP member online survey reporting sharps injuries (SI) with Lovenox (enoxaparin syringes), an investigation was conducted to determine the extent of SI related to these pre-filled safety syringes. Three US Food & Drug Administration (FDA) databases, FDA MAUDE, FDA FAERS, and FDA MedSun, were searched for brands and mechanisms of injuries between 2010-2021 in pre-filled safety syringe preparations. In addition, reports submitted to the ECRI/ISMP were reviewed and evaluated. Reports mentioned excessive activation force, disassembly upon activation, forceful needle ejection, and non-activation. There have been increased reports in the past several years, and no medical device alert has been published. The mechanism and requirements to report adverse events with these devices can be cumbersome and time consuming for the occupational health professional. Root cause analyses should be conducted on all SI. If the root cause of the SI is related to device failure, the manufacturer should be notified and a report submitted to ECRI/ISMP. Additional follow-up is needed with manufacturers to redesign/replace the current devices and with the FDA to request a product alert, and users are to document the evaluation of safer alternative devices on an annual basis as required by the Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Standard.
Prediabetes Screening Among Commercial Motor Vehicle Drivers
Erin Ruiz, MSN, CRNP, Lori Parke, DNP, CRNP, and Kimberly Olszewski, DNP, CRNP, COHN-S/CM, FAAOHN, FAAN
DISA Global Solutions, Lewisburg, PA
Background: Commercial motor vehicle (CMV) drivers have an elevated risk of diabetes due to multiple occupation-related factors. CMV drivers are required to undergo periodic fitness for duty physicals at least every two years by a certified medical examiner. Federal regulations pertaining to CMV driver physicals require a urine glucose dip, which is a test with low sensitivity. The purpose of this quality improvement (QI) initiative was to determine if using the American Diabetes Association’s Type 2 Diabetes (ADA T2DM) Risk Test as a screening tool was more effective at identifying CMV drivers at risk of diabetes versus sole reliance on glycosuria. Methods: Quantitative measures were used to evaluate CMV drivers in an occupational health clinic by comparing urine glucose dip results to those of the ADA T2DM Risk Test; point of care A1C was used to measure accuracy of the screening tests. Results: Chi-square tests and Fisher’s exact tests were used to evaluate association between screening tests and A1C level. Based on 117 participants, both screening tests had a poor diagnostic measure. Conclusion: Although the ADA T2DM Risk Test was not an accurate diagnostic measure, it created discussion with participants about the importance of diabetes screening among CMV drivers.
Prevalence of COVID-19 in Unvaccinated Healthcare Workers
Jason Sandler, APRN, Lynda Streett, MD, and Asha Shah, MD
Stamford Health, Stamford, CT
During the COVID-19 pandemic, various mitigation methods were used to prevent the spread of COVID-19 in the community as well as within healthcare organizations. Once vaccination became available, many organizations encouraged and mandated receipt of one of the approved vaccinations as an additional step to protect their workforce, patients, and community. As required by ADA and Title IX, individuals can apply for and be granted exemptions from this vaccination for specific reasons. Concern with emerging variants has always been that with increased transmissibility, those without protection from an up-to-date vaccination series would be at increased risk during COVID-19 surges. During the 2021-2022 Omicron wave, and subsequent BA.2 variant surge, weekly surveillance testing through polymerase chain reaction (PCR) assay was conducted on all unvaccinated healthcare workers in a small community hospital system. It was determined that through mitigation methods such as social distancing, daily symptoms screening, universal masking, and hand hygiene, unvaccinated healthcare workers were not at an increased risk of developing COVID-19. It was found that this group had a lower positivity rate compared to the overall hospital positivity rate, which included vaccinated staff and community members.
Reasonable Suspicion/Drug Diversion/Under the Influence “For Cause” Testing in a Box Protocol
Jennifer Seidenberg, BSN, RN
Flagstaff Medical Center, Flagstaff, AZ
Medication diversion among healthcare workers is substantially underestimated, undetected, and underreported. It’s a far-reaching hazard with legal and financial implications that threaten patients, medical facilities, healthcare workers, and the public. Awareness and recognition are the first steps to prevention. At Northern Arizona Healthcare (NAH), colleagues commit to integrity and compliance as outlined in our Code of Conduct. Medication diversion is not only a violation of the Code of Conduct, it’s illegal. The poster will provide a step-by-step guide on how to implement a “For Cause Testing” protocol if you do not have an existing program in your organization. This protocol is derived from an existing process used successfully at Northern Arizona Healthcare. The Protocol provides guidance on: 1) creating a drug and alcohol policy; 2) selection of key stakeholders on a Diversion Committee; 3) the investigation process; 4) collection of urine drug screens (UDS); 5) a power point template of the importance of having a Diversion Committee; 6) stress management resources that should be provided for staff; and 7) follow-up meetings to debrief on how to improve the process.
Survey of Occupational Health Nurses (OHN): An Exploration of How OHNs Were Impacted by the COVID-19 Pandemic
Lisa Hunwardsen, BS, RN, Lucy Carlson, MPH, MS, RN, COHN-S/CM, FAAOHN, Karen Monsen, PhD, RN, and Carolyn Porta, PhD, MPH, RN
American Board for Occupational Health Nurses, Inc. (ABOHN), Palos Heights, IL
Summary: Working as an occupational health nurse (OHN) during the COVID-19 pandemic has been a challenging experience. To understand the OHN experiences since the onset of the pandemic, a 45-item survey was developed and deployed to OHNs in the United States and Canada. The survey responses showed how OHNs adapted their work to include new tasks to accommodate the needs within workplaces during a rapidly changing local, regional, and global environment. Findings from the surveys demonstrate the importance of continuing to study the OHN role, their needs, and how they contribute to employee health and safety.
- A 45-question survey was deployed to over 5,500 occupational health nurses in the United States and Canada. Responses were received from 565 OHNs.
- A second survey was sent to 106 employers. Responses were received from 30 employers. Results:
- 353 (68%) of those responding were certified OHNs.
- 478 (92%) were from the United States.
- 142 (27%) work in the hospital or clinical business sector.
- 198 (38%) work in manufacturing or production.
- 322 (62%) of OHNs are between the ages of 46 – 65.
- 344 (67%) state they work > 40 hours per week.
- The survey uncovered the need for more pandemic planning.
- 49% of the OHNs stated they had a pandemic plan prior to onset of the pandemic.
- 28% stated they did not have a pandemic plan prior to onset of the pandemic.
- 65% of OHNs stated they frequently or often felt overwhelmed during the pandemic.
- Only approximately 28% of the OHNs felt frequently supported by their employers.
- 16% of OHNs stated that they did see an increase in threats of violence during the pandemic.
- 28% of those working in businesses with more than 2,500 employees answered that they saw an increase in threats of violence.
- OHNs stated they helped about 60% of employees with their health or well-being during the pandemic.
- 109 OHNs stated they needed additional help with their job.
- 21 out of 30 employers stated that they frequently contacted the OHN about questions or concerns regarding COVID-19.
- 11 out of 30 employers stated that a significant contribution by the OHN was assisting in advising leadership and employees on Centers for Disease Control and Prevention (CDC) guidelines.
The two surveys demonstrate the value of OHNs within the workplace by their ability to adapt to the needs of the employer during a global pandemic. OHNs played a significant role in developing new workplace practices, creating policies, and communicating new requirements to employees for supporting safety and well-being in the workplace. The two surveys additionally show the way OHN work responsibilities and personal well-being have been impacted by the pandemic. Future research is needed to identify opportunities for health and safety efficiencies in diverse workplace settings.
Virtual Onboarding – An Innovative and Effective Pre-Placement Experience
Caitlin Hainy, DNP, CNP, APRN, Jacie Ferrie, RN, and Katie Elwood, RN
Mayo Clinic, Employee Occupational Health Services, Rochester, MN
Purpose: The COVID-19 global pandemic has disrupted historical processes of many healthcare organizations, forcing significant change related to both recruitment and retention of valued employees. As a result, Employee Occupational Health Services has developed transformative methods of onboarding strategies to offer greater flexibility and convenience to candidates while maintaining a personalized connection between applicants and the organization. With the shift to telework positions, decreased interest in traveling by candidates, desire to rapidly onboard essential job roles, and the need for conservation of both human and financial resources, virtual onboarding solutions are required. Solutions: An online candidate portal was created where individuals could asynchronously complete onboarding paperwork and screenings. The onboarding forms and screenings were evaluated by employee occupational health staff. Required testing and immunizations were conducted in the candidate’s home location. Findings: The virtual onboarding solution expedited the onboarding process, added convenience for candidates, improved the customer experience while avoiding the need to travel, and promoted stewardship across the organization. Conclusions: Innovative onboarding solutions are a critical competency for institutions that aim to hire top candidates and adjust to the changing workforce. Virtual onboarding solutions provide candidates with a seamless and efficient solution to complete required paperwork, testing, and immunizations.