Nearly every type of work brings with it health hazards and risks to safety, but healthcare, especially, involves an array of exposures to infection and danger. Every healthcare manager would like to minimize injuries and illness resulting from the workplace, but keeping up with what to be on the lookout for may be tough. What are the health hazards you must be concerned with today, and what risk-reduction strategies are most effective? Here we'll look at three problems, and discuss plans of action for you to consider.

Musculoskeletal disorders and ergonomics
Moving gurneys, lifting and rolling patients, heaving laundry bags, bending to check blood pressure and reaching to grab charts and adjust monitors. The average nurse works in a repetitive-stress nightmare that makes him or her a prime candidate for a disabling musculoskeletal disorder, such as a serious back or shoulder injury. A recent report by the US Labor Department revealed that registered nurses suffered more musculoskeletal injuries than construction workers in 1999 (incidentally, nursing aides, orderlies, and attendants reported the most injuries). And in addition to the toll on workers in terms of pain and career diminishment, musculoskeletal injuries cost the healthcare industry tens of millions of dollars each year, in insurance premiums, lost work days, personnel replacement costs, and decreased productivity.

Roadblocks to injury prevention are many:

• Nurses have come to expect injury at some point, and crunched for time, are predisposed to taking care of problems with little preparation;
• Supportive accessories, such as backbelts, can offer valuable support, but may only create an illusion of safety if a nurse feels that by wearing such a device, he or she can lift a man two times his or her size with no assistance;
• Many of the facilities were not designed or furnished with ergonomics concerns in mind; and,
• Congress recently overturned the proposed ergonomics standard (though OSHA already has the power to ensure such protection for the workforce through a current statute).

Many nurses as well as ergonomic experts agree that engineering controls such as well- or redesigned workstations would prevent much of the injuries that occur in the healthcare setting, and the American Nurses Association and its constituent member associations continue to support improved staffing levels and injury-prevention practices such as lifting teams, weight-lifting limits, and the use of ergonomically correct equipment.

Many facilities have instituted ergonomics programs with great success. Two examples of the health and financial savings that ergonomics programs can result in:

• The Kennebec Health System of Augusta, Maine, reduced annual lost workdays from 1,097 to 48 after it implemented an ergonomics program and began using lift-assist devices. As a result, its insurance premium fell from $1.6 million annually to $770,293??a cost savings of more than $800,000. Source: OSHA
• A Texas hospital purchased lifting equipment in February of 1994 and implemented a facility-wide ergonomics-based orientation program. The average annual direct cost associated with back injuries resulting from patient handling based on an average of three years experience was $111,159. In the year following implementation of this back-injury prevention program utilizing effective mechanical lifting aids, the direct cost was reduced to $743. Source: Guy Fragala, PhD, PE, CSP, testifying on the OSHA proposed ergonomics standard.

Implementation of controls can be a complex matter. Bruce Bernard, MD, MPH, a medical investigator with the National Institute for Occupational Safety and Health (NIOSH), says that key to addressing the issue in your facility is management commitment to identifying problems, implementing controls that result from employee input, and adjusting your own expectations. "You're dealing with a population that wants to get things done and that is overly dedicated," Dr. Bernard says, referring to healthcare employees, particularly nurses. What that means is that there is no sense in creating a team-lift?only policy if your nurses don't understand that you expect them to wait for help to lift a patient rather than do it themselves when no help is immediately available. Staff members must accept and understand the protocols and believe in your support.

NIOSH suggests the following "seven-step pathway" for evaluating and addressing musculoskeletal concerns.

1. Look for signs of potential musculoskeletal problems in the workplace, evidenced by frequent worker reports of aches and pains or job tasks that require repetitive, forceful exertions.
2. Show management commitment to addressing possible problems and encouraging worker involvement in problem-solving activities. Dr. Bernard suggests, specifically:
   • commiting financial and educational resources for training;
   • providing detailed instructions for new or adjusted duties;
   • creating policy statements that include discussion of management and workforce expectations; and,
   • allowing time for program and practice development.
3. Offer training to expand management and worker ability to evaluate and identify potential musculoskeletal problems.
   Dr. Bernard suggests, in addition to "awareness training," bringing in an educator to discuss "problem-solving and consensus-building" with your staff. This type of education can provide tools to handle workplace risks that go beyond ergonomic concerns.
4. Gather data to identify jobs or work conditions that are most problematic, using sources such as injury and illness logs, medical records, and job analyses.
5. Identify effective controls for tasks that pose a risk of musculoskeletal injury and evaluate these approaches once they have been instituted to see if they have reduced or eliminated the problem.
6. Emphasize to staff the importance of early detection and treatment of musculoskeletal disorders for preventing impairment and disability. Encourage nonavoidance: Assure the staff that you can handle injuries, the sooner the better. Adminstrators should discuss and agree on modified duties for workers who do get injured, so you are prepared for a change in staff roles and can make workplace accomodations quickly, points out Dr. Bernard.
7. Minimize risk factors for musculoskeletal disorders when planning new work processes and operations??it is less costly to build good design into the workplace than to redesign and retrofit later. Good design includes room for lifting devices and other aids for moving patients, and ergonomically correct heights for shelves, monitors, and computer keyboards.

Latex allergy
In 1994, Pennsylvania dentist Lisa Borel was on a quest for latex gloves with less powder, but not for the reason you might think now. She wanted something less messy. "I couldn't stand that the powder got all over everything. I noticed that it was everywhere. If I rubbed my hands on my scrubs during the course of the day, I ended up looking like I worked for Pillsbury." Early in the summer of that year, Dr. Borel noticed that she was developing welts on her neck, the result, she suspected, of not washing her hands immediately after glove removal and scratching her neck. Within weeks, after contact with a new hypoallergenic latex glove at her office, she experienced systemic allergic reactions that included difficulty breathing. By August, she had spent nearly a week in the ICU, and given up practicing dentistry. Local allergists and doctors at the Mayo Clinic agreed that Dr. Borel had developed severe occupational asthma, the result of an allergic reaction to latex exacerbated by repeat exposures.

A former athletic type who had never so much as sneezed at pollen, Dr. Borel has watched her life completely change. Further fallout of her allergy is ongoing cardiac arrythmias. "I've had five cardiac ablation procedures and a pacemaker put in," the 46-year-old says. She has fought back, however, and works to prevent others from having a similar experience. Today she is national director of ELASTIC, the Education for Latex Allergy/Support Team