Major Article
The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector

https://doi.org/10.1016/j.ajic.2008.10.022Get rights and content

Background

Patients continue to enter home health care (HHC) “sicker and quicker,” often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted.

Methods

A convenience sample of HHC RNs (N = 738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure.

Results

Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P = .019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P = .016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P = .005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P = .001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P = .006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P = .004; 95% CI: 1.21-2.91) among others.

Conclusion

The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

Section snippets

Methods

Because of the well-known difficulty in recruiting workers employed in HHC, and to ensure a widely representative sample of HHC RNs, a multifaceted recruitment strategy was implemented. A convenience sample of HHC RNs was recruited from 32 participating home care agencies affiliated with collaborating organizations, including the Home Care Association of New York State, Jewish Homes and Hospitals, the New York State Nurses Association, and the Visiting Nurse Services of New York.

Demographic and job-related characteristics

Data from 738 complete questionnaires were analyzed. RNs were predominantly female (n = 701; 95.1%), with a mean age of 49.9 years. On average, responders worked 33 hours per week, providing care to 17 patients. RNs indicated that most of the time their job duties included education of patients and family member (n = 536; 74.0%), coordination of care (n = 520; 72.8%), wound care (n = 305; 42.2%), and handling of needles and other sharps (n = 216; 29.7%). A description of the sample can be found in Table 1.

Discussion

These findings indicate that HHC RNs may be at risk of exposure to blood/body fluids, especially if their job duties involve the frequent handling of contaminated sharps and the provision of wound care. The rate of PIs found here (76 PIs per 1000 RNs), although lower than previously published rates for a small pilot study (153 PIs per 1000 RNs),7 is still substantial. Extrapolated to the entire HHC RN work force in the United States, these rates suggest that roughly 9500 PIs occur in home care

Conclusion

Going forward, clearly, much work remains to be accomplished. Additional studies, especially prospective studies with random selection, are needed to better quantify the risk. Intervention studies are also needed to begin to address some of the difficult but potentially modifiable risk factors, including the risk factors for nonreporting. As health care increasingly moves out from the acute care setting and into the home setting, efforts to improve the health and safety of workers in this

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  • Cited by (0)

    Supported by Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health (5 R01 OH008215-03).

    Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency. The authors report no conflicts of interest.

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