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AOHP 2017-2019 Public Policy Statement

Executive Summary
The Association of Occupational Health Professionals in Healthcare (AOHP) is a national association whose members represent thousands of healthcare workers (HCWs). AOHP is dedicated to promoting the health, safety and well-being of workers in healthcare and strives to influence legislation, regulations and public policy that positively affect employee/occupational health in healthcare. To that end, AOHP has developed a Public Policy Statement for 2017-2019 that specifically addresses health and safety concerns in healthcare. These key areas of focus for the next two years have, in part, been identified by the 2015 AOHP membership survey and needs assessment, as well as through the partnerships AOHP has developed. 

 Public policy areas of focus for AOHP from 2017-2019 include:

• Overall HCW safety and health with a focus on The Joint Commission’s (TJC) landmark patient/worker monograph; the Occupational Safety and Health Administration’s (OSHA) guidelines on hospital worker safety; and the National Institute for Occupational Safety and Health’s (NIOSH) Total Worker Health (TWH) initiative and National Occupational Research Agenda (NORA).
Professional development of the occupational health professional (OHP) through education, leadership opportunities, professional advancement and mentoring.
• Promoting initiatives to reduce bloodborne pathogen exposures, including participation in internal and external research efforts such as the AOHP EXPO-S.T.O.P. survey and the newly launched NIOSH Occupational Health Safety Network (OHSN) Bloodborne Pathogen module, leading to the further development of a national database of significant exposures and best practice prevention strategies.
•Safe patient handling efforts, with continued support of regulatory efforts to promote safe patient handling programs in healthcare nationally.
• Supporting efforts to increase influenza vaccination rates among HCWs, including research that will lead to evidence-based best practices for immunization.
• Collaborating with partners in the dissemination of respiratory protection competencies and implementation strategies for respiratory protection programs, including the development of educational resources for HCWs.
• A continuing commitment to working with partners to achieve the goal of a safe and healthy work environment. 

The remainder of this statement will provide background and details in the formulation of these public policy efforts. 

For more information, please call AOHP Headquarters at 800-362-4347 or email info@aohp.org. 

Overall HCW Health, Safety and Well-being
AOHP supports all efforts to reduce and eliminate occupational hazards in the healthcare setting. HCWs continue to experience some of the highest rates of non-fatal occupational injuries and illnesses. TJC’s collaborative document, Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation, is “intended to stimulate greater awareness of potential synergies between patient and worker health and safety activities.”   

OSHA’s Worker Safety in Hospitals - Caring for the Caregivers clearly states the core elements of a successful safety and health management system. These six core elements provide a blueprint to the success of any effort to reduce workplace hazards and injuries. They include: 1) management leadership; 2) employee participation; 3) hazard identification and assessment; 4) hazard prevention and control; 5) education/training; and 6) system evaluation and improvement. AOHP recognizes that facility leadership is faced with many priorities including, and not limited to, achieving the best patient outcomes, budgetary and staffing demands, workplace stress and the emphasis on patient satisfaction, thus increasing the potential for employee injuries and unsafe behaviors. Even with these challenges, healthcare organizations have been successful in reducing injuries by incorporating these elements into injury prevention and reduction efforts. 

AOHP will collaborate with NIOSH on two initiatives that directly affect the health and safety of healthcare workers. These are: 1) the TWH initiative, which is defined as “policies, programs and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being” and; 2) the NORA Healthcare and Social Assistance Sector Council, which scientifically addresses healthcare hazards and transfers research findings to practice. 

These documents and results from these initiatives will continue to be utilized by AOHP and its members to create a safe working environment for staff, reduce injuries and ultimately benefit the patients entrusted to HCWs for care. 

OHP Professional Development
It is important that OHPs be recognized as experts in the field of employee/occupational health. AOHP promotes member advancement and expertise through education, leadership development, professional advancement and support. AOHP cultivates this expertise by offering: a national conference with varied learning levels (beginner, intermediate and advanced); local chapter education programs; mentoring; and leadership development through the Congress of Presidents and initiatives of the national Executive Board members. Professional development is vital to AOHP in demonstrating expertise and promoting recognition of the valuable role occupational health plays in high quality care delivery, in addition to strengthening member value. 

Working with Partners
AOHP remains committed to working with partners to achieve the goal of a safe and healthy work environment. Partners include TJC's Nursing Advisory Council, the Centers for Disease Control and Prevention (CDC), NIOSH, NORA's Healthcare and Social Assistance Sector, the American College of Occupational and Environmental Medicine (ACOEM), and other accrediting agencies and nursing associations.

Bloodborne Pathogen Exposure
AOHP is concerned about the ongoing occurrence of significant blood/body fluid exposures. Underreporting of significant exposures, timely testing of exposed HCWs and source patients, and the establishment of a current national database of significant exposures are areas that must be addressed. AOHP advocates for policy that supports a more secure environment for employees through the use of safer technology, education, training and prevention regarding sharps injuries. 

The timely testing of the source patient for HIV is critical to the evaluation and management of a HCW who has sustained a blood or body fluid exposure. This shortens the time before necessary HIV anti-viral prophylaxis is delivered, eliminates the need for follow-up testing and reduces the level of worker anxiety regarding the exposure. Currently, Nebraska is the only state that requires special written consent for HIV testing. AOHP supports the 2006 CDC recommendation for HIV testing of adults, adolescents and pregnant women in healthcare settings (Recommendation and Reports, September 22, 2006/55 – RR14); that  HIV screening be incorporated into the general consent for medical care after the patient is notified that testing will be performed unless the patient declines or opts out. 

During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to the CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported (Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data, 2014). The CDC advises that “Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, resulting in approximately 385,000 needlesticks and other sharps-related injuries to hospital-based HCWs each year. Similar injuries occur in other healthcare settings, such as nursing homes, clinics, emergency care services and private homes. Sharps injuries are primarily associated with occupational transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but they have been implicated in the transmission of more than 20 other pathogens.”

To address the lack of a national database of sharps injuries, in 2012, AOHP developed a sharps injury survey for its membership. The survey, EXPO-S.T.O.P., was first distributed to the AOHP membership in early 2013 and then annually since that time, with ongoing analysis of the annual survey data. The survey will continue to be distributed annually to the AOHP membership to gather sharps injury data from the workplaces of AOHP members across the nation. Best practices in EXPO-S.T.O.P. facilities with low significant exposures will be shared with members and non-members alike in an effort to decrease significant exposures to blood/body fluids across the globe. In addition, AOHP will continue its collaboration with NIOSH’s OHSN module related to bloodborne exposures. 

Lastly, based on the magnitude of sharps injuries in the healthcare setting and the potentially life-altering consequence of a blood/body fluid exposure, AOHP supports the ongoing development of user-friendly safety-engineered needles and other sharp devices. 

Safe Patient Handling
AOHP supports efforts to ensure a safer healthcare environment for both the patient and the employee, including utilizing lift/assist devices as the primary method for the prevention of musculoskeletal injuries. More than 40 years of instructing HCWs on proper body mechanics has done little to impact injury statistics. Back injuries and other musculoskeletal disorders related to patient handling are the leading cause of workplace disability for nurses and other direct patient care providers.

NIOSH reports rates of musculoskeletal injuries from overexertion in healthcare occupations are among the highest of all U.S. industries. Data from the Bureau of Labor Statistics (BLS) show that in 2014, the rate of overexertion injuries averaged across all industries was 33 per 10,000 full-time workers. By comparison, the overexertion injury rate for hospital workers was twice the average (68 per 10,000), the rate for nursing home workers was over three times the average (107 per 10,000), and the rate for ambulance workers was over five times the average (174 per 10,000).  The single greatest risk factor for overexertion injuries in healthcare workers is the manual lifting, moving and repositioning of patients, residents or clients, i.e., manual patient handling.

For patient transfers, lifts and repositioning, mechanical equipment must be provided by the facility and used by the caregivers. AOHP advocates for regulations, legislation, education, training, research and prevention activities as related to safer patient handling activities and methodologies. AOHP will work to influence both state and national legislation as it relates to safe patient handling. AOHP was privileged to participate in the national task force that published the Safe Patient Handling and Mobility Interprofessional Standards and Implementation Guide and Implementation Guidelines to Safe Patient Handling and Mobility Interprofessional National Standards. AOHP will continue to advocate the use of these documents for individuals responsible for implementing processes to reduce these injuries. 

Influenza
In 2011, AOHP published a position statement on influenza vaccination for HCWs. AOHP will continue to support efforts to provide influenza vaccine, free of charge, to HCWs on an annual basis. AOHP supports continuing research to develop evidenced-based practice related to influenza transmission in the healthcare environment and vaccination of HCWs. Prompt communication of current study findings to AOHP and partnering organizations is critical in improving influenza prevention programs. In addition, AOHP will seek opportunities to evaluate the tracking of HCW influenza vaccination rates as they become available through the CDC's National Healthcare Safety Network. 

Respiratory Protection
AOHP supports efforts to ensure a safer workplace for employees by utilizing systems and processes that are evidence-based and supported through research. AOHP advocates for increased research, training and education related to respiratory protection for tuberculosis (TB), other airborne respiratory transmissible diseases and emerging infectious diseases such as Ebola. AOHP developed its position statement titled Respiratory Protection for HCWs in 2015. 

With the AOHP/NIOSH Memorandum of Understanding, a collaborative relationship has continued with the National Personal Protective Technology Lab (NPPTL) in Pittsburgh, PA, where groundbreaking healthcare-related research continues to be conducted on the need for annual fit testing, general respirator use, and respirator use in pandemics and other related areas in healthcare. AOHP strongly supports NIOSH’s efforts to scientifically determine the need for annual fit testing, as well as the need for training and education regarding respiratory protection according to OSHA’s Respiratory Protection Standard and the CDC’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. 

AOHP collaborated with NIOSH and the American Association of Occupational Health Nurses to develop the Respiratory Protection Education and Resource Webkit, a free educational resource for respiratory protection program administrators. In addition, the NIOSH Hospital Respiratory Protection Program Toolkit was disseminated to AOHP members in May 2015. TJC created another valuable resource, Implementing Hospital Respiratory Protection Programs: Strategies from the Field. 

The above tools are the foundation for building competency and confidence when occupational health professionals in healthcare are responsible for respiratory protection. AOHP will continue to collaborate with TJC on a project assessing utilization of these tools and with NIOSH on the development of educational and training products for respiratory protection. 

Workplace Violence
Workplace violence (WPV) can range from offensive or threatening language to homicide. NIOSH defines WPV as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty. In 2014, the Healthcare and Social Assistance sector sustained WPV injuries at an estimated injury rate of 8.2 per 10,000 full-time workers, a rate over four times higher than full-time employees in the private sector. Psychiatric hospitals had WPV injury rates 64 times higher than private industry, while nursing and residential care facilities had rates 11 times higher than private industry. Seventy-nine percent of the violent injuries were caused by interactions with patients. Although the vast majority of events are non-fatal, there were 14 fatal events due to homicide in the sector. HCWs who provide direct care have a high risk for WPV due to the populations they serve, including those who may have altered mental status related to the influence of drugs and alcohol, psychiatric disorders, pain, multiple psychosocial stressors or grief. 

AOHP supports implementing comprehensive violence prevention programs that are risk specific to the healthcare organization or facility. A comprehensive violence prevention program must include: a written program; management commitment; employee participation; hazard identification; safety and health training; and hazard prevention, control and reporting. Periodically, it is critical that the healthcare organization’s violence prevention program be evaluated and updated. These violence prevention programs need to address co-worker or lateral violence, as well. Case reports of prevention strategies that have reduced WPV in the healthcare setting include installing metal detectors at Emergency Department entrances, establishing a violent patient database, and limiting visitor access to specific floors or areas via a GPS tracking badge. AOHP supports and encourages healthcare organizations to endeavor to protect their patients, employees and visitors from acts of violence, as well as to advocate for further research on prevention strategies for WPV. 

AOHP responded in April 2017 to OSHA’s Request for Information regarding a possible WPV standard. The association will continue to advocate for violence-free workplaces, participate in the regulatory process as it moves forward and seek collaborative opportunities with organizations such as TJC that are focused on decreasing WPV events. 

Conclusion
AOHP is recognized as the definitive resource for issues related to workers in the healthcare setting and holds the exclusive mission of addressing the needs and concerns of OHPs in healthcare. As the leading authority for occupational health in healthcare, AOHP is dedicated to promoting the health, safety and well-being of workers by:

·         Advocating for employee health 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. 

For more information, please call AOHP Headquarters at 800-362-4347 or email info@aohp.org. 

References
Department of Health and Human Services. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health:

• Hospital Respiratory Protection Program Toolkit. Retrieved 4/27/17 at http://www.cdc.gov/niosh/docs/2015-117/?s_cid=3ni7d2hospitalresp06012015
• National Healthcare and Social Assistance Agenda. Retrieved 4/27/17 at https://www.cdc.gov/niosh/nora/comment/agendas/hlthcaresocassist/
• Occupational Violence Training and Education - Workplace Violence Prevention for Nurses. CDC Course No. WB1865 - NIOSH Pub. No. 2013-1. Retrieved 4/27/17 at http://www.cdc.gov/niosh/topics/violence/training_nurses.html.
• Safe Patient Handling and Mobility (SPHM). Retrieved 4/27/17 at https://www.cdc.gov/niosh/topics/safepatient/default.html 
• Stop Sticks Campaign. Retrieved 4/27/17at http://www.cdc.gov/niosh/stopsticks/.
• Total Worker Health. Retrieved 4/28/17 at https://www.cdc.gov/niosh/twh/totalhealth.html.
• Workplace Safety & Health Topics. Occupational Violence. Retrieved 4/26/17at http://www.cdc.gov/niosh/topics/violence/
•Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013. January 9, 2015 / 63(53), 1245-1246. Retrieved 4/26/17 at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a4.htm.
• Department of Health and Human Services. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. December 30, 2005. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. Vol. 54 / No. RR-17. Retrieved 4/26/17at http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf.
• Department of Health and Human Services. Centers for Disease Control and Prevention. State HIV Testing Laws: Consent and Counseling Requirements. Retrieved 4/26/17 at http://www.cdc.gov/hiv/policies/law/states/testing.html.
• Institute of Medicine. Occupational Health Nurses and Respiratory Protection: Improving Education and Training – Letter Report. August 11, 2011. Retrieved 4/27/17at http://www.nationalacademies.org/hmd/Reports/2011/RespiratoryProtectionNurses.aspx 

The Joint Commission:
Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. 2012. Retrieved 4/27/17 at https://www.jointcommission.org/improving_patient_worker_safety/
Workplace Violence Prevention Resources. 2017. Retrieved 4/26/17 at https://www.jointcommission.org/workplace_violence.aspx.

U.S. Department of Labor. Bureau of Labor Statistics:
Industries at a Glance - Hospitals. Retrieved 4/26/17 at http://www.bls.gov/iag/tgs/iag622.htm.
Bureau of Labor Statistics-2014:
TABLE R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury and illness, 2014. Retrieved 4/26/17 at  https://www.bls.gov/iif/oshwc/osh/case/ostb4370.pdf
TABLE R100. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by occupation and selected events or exposures leading to injury or illness, private industry, 2014. Retrieved 4/26/17at https://www.bls.gov/iif/oshwc/osh/case/ostb4466.pdf 

Bureau of Labor Statistics-2015:
BLS Census of Fatal Occupational Injuries Summary. 2015. Retrieved 4/27/17 at https://www.bls.gov/news.release/cfoi.nr0.htm
Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work. 2015 https://www.bls.gov/news.release/pdf/osh2.pdf
Survey of Occupational Injuries and Illnesses Summary Estimates Charts. October 27, 2016. Retrieved 4/26/17 at https://www.bls.gov/iif/oshwc/osh/os/osch0057.pdf 

U.S. Department of Labor. Occupational Safety and Health Administration.
Respiratory Protection. – 29 CFR 1910.134. 1998. Retrieved 4/27/17 at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716&p_table=standards.
Worker Safety in Hospitals - Caring for the Caregivers. Retrieved 4/28/17 at https://www.osha.gov/dsg/hospitals/index.html

Approved: June 2017

 

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