Comments on "Reliability and Validity of an Adapted Questionnaire Assessing Occupational Exposures to Hazardous Chemicals among Health Care Workers in Bhutan"

Background: Collection of reliable and valid occupational history data is of utmost importance to assess work-related exposures and their health effects. Few standardized questionnaires are available for the collection of occupational history data in low-and-middle income countries. Objective: To adapt and test a validated questionnaire developed in the United States by the National Institute of Safety and Health, in order to assess occupational chemical exposures among health care workers in Bhutan. Methods: The questionnaire was first adapted to suit the Bhutanese context with the advice of an expert review committee. 30 health care workers then completed the questionnaire at baseline and 10–14 days later. Test-retest reliability was assessed by calculating Cohen's κ and percentage agreement. Results: The questionnaire had high test-retest reliability. Cohen's κ ranged from 0.61 to 1.00, and percentage agreement ranged from 86.7% to 100%. Further adaptations included omitting questions on chemicals not available in Bhutan. Conclusion: The adapted questionnaire is appropriate for assessing occupational chemical exposures among health care workers in Bhutan.

Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.

The novel coronavirus SARS-CoV-2 has rapidly spread across the world from its origin in Wuhan, China in late 2019. The resultant disease (COVID-19) has placed an enormous burden on healthcare systems because of the high transmission rates, prevalence of severe disease and mortality [1]. The risk of viral transmission to healthcare workers has been a concern since the start of the outbreak and the first person to raise concerns about the illness to the international community was Dr Li Wen-Liang, an ophthalmologist in Wuhan who sadly died of the disease that he likely contracted whilst at work [2].

Notes From the Field: Occupationally Acquired HIV Infection Among Health Care Workers—United States, 1985–2013

The "GRAS" status of women's work.

From the International Healthcare Worker Safety Center, University of Virginia Health System, University of Virginia, Charlottesville. Received December 6, 2006; accepted December 6, 2006; electronically published January 3, 2006. Infect Control Hosp Epidemiol 2007; 28:1-4 2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2801-0001$15.00. This issue of the journal reflects broadly upon the risks of bloodborne pathogen exposure—risks faced by healthcare workers (HCWs) everywhere. The articles cover an array of issues, including the impact of work schedules, healthcare settings, culture-specific practices, and the implementation of safety-engineered sharp devices on the occupational risk of injuries from sharp devices and blood contact. It is a fitting occasion to reflect on the state of the art in providing a safe working environment for HCWs and to consider a future path towards equitable access to its basic elements. It has been more than 2 decades since the first case of needlestick-transmitted infection with human immunodeficiency virus (HIV; then referred to as “human T-lymphotropic virus III”) was reported in The Lancet, triggering a high alert for the exposure risk faced by HCWs. Although lifethreatening bloodborne pathogens had been a recognized risk to HCWs for at least a century, it was the epidemic of acquired immunodeficiency syndrome (AIDS) that delivered the wakeup call leading to remedial action. Today, infection from bloodborne pathogens, primarily HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), remains the most lifethreatening occupational risk for HCWs. Despite this fact, we can take heart from the dramatic reduction that has occurred in the magnitude of this risk as a direct result of effective prevention initiatives during the past 20 years. It constitutes one of the remarkable success stories in the annals of public health practice. As a public health target, HCWs are usually considered to be (and treated as) a narrow subset of the general population. But globally, their numbers are large and their impact is felt everywhere. The total number of HCWs worldwide is estimated to be 35.7 million, which is greater than the population of Morocco, the 35th most populous nation in the world. HCWs provide care in every country and to every social and cultural group, in sophisticated and humble settings alike. Their global reach is matched only by the significance of their work. In all corners of the globe we depend on them for lifesustaining services. The effective assault on bloodborne pathogens that plague HCWs began with the availability of the hepatitis B vaccine in 1982. In the United States in 1983, the incidence of HBV among HCWs was 3 times higher than the incidence in the general population; by 1995, it was 5 times lower. The annual incidence fell from 386 to 9 infected HCWs per 100,000. In the early 1980s, it was estimated that more than 12,000 HCWs were occupationally infected with HBV annually, resulting in an estimated 250 deaths per year. Between 1990 and 1998, during which time high rates of HCW vaccination were achieved in the United States, only 13 cases of acute HBV infection in HCWs were reported. The advent of the hepatitis B vaccine was a major advance in preserving the health and lives of HCWs. The risk of occupational infection with HIV, although alarming, has never reached the scale of hepatitis B. As of 1997, a total of 94 documented and 170 possible cases of occupational HIV infection had been identified worldwide; nearly two-thirds of cases were reported from the United States. Since then, 15 more documented cases have been identified. However, most countries, especially those with a high population prevalence of HIV infection, have never instituted surveillance systems that would capture data on such cases. Although the development of an AIDS vaccine still eludes us, new treatments for HIV infection appear to have had an appreciable impact on the risk of occupational exposure and infection. In 1997, it was shown that postexposure prophylaxis with zidovudine alone after occupational blood exposure to HIV reduced the risk of seroconversion by more than 80%. Combination antiretroviral drug regimens, introduced in 1997, are believed to be even more effective at preventing seroconversion in HIV-exposed individuals. Combination treatment has altered the risk equation for HCWs in other ways, as well. Shortly after these drugs became widely available in 1997, there was a precipitous drop in the number of HIV-positive in-patients in US hospitals. The risk of HCWs being exposed to HIV dropped in direct proportion to the decline in the number of HIV-infected patients in hospitals. Furthermore, a low viral load, which is common in patients receiving combination drug therapies, is associated with reduced transmission risk when an occupational exposure to

Assessment of Management Policies and Practices for Occupational Exposure to Bloodborne Pathogens in Dialysis Facilities

Background: Healthcare workers (HCWs) have experienced sustained occupational exposure to SARS-CoV-2 throughout the COVID-19 pandemic. While infection prevention and control (IPC) practices have been widely implemented, limited prospective data exist on how occupational exposure risk and adherence to protective practices evolve over time, particularly beyond the acute phases of the pandemic. This study aimed to prospectively assess occupational and community exposure risk to COVID-19 among HCWs and to evaluate temporal changes in adherence to IPC practices during routine care and aerosol-generating procedures. Methods: A prospective observational study was conducted among HCWs from four public hospitals in the region of Thessaly, Greece. Eligible participants were HCWs who reported contact with suspected or confirmed COVID-19 cases. The data were collected at baseline (January-March 2022) and at a six-month follow-up using the World Health Organization's "Risk Assessment and Management of Exposure of Health Care Workers in the Context of COVID-19" questionnaire. The instrument captured demographic characteristics, professional roles, occupational and community exposure, and adherence to IPC practices. Results: A total of 203 HCWs participated in the study. The overall proportion of HCWs reporting occupational exposure was 72.9% in both assessments. Among HCWs with occupational exposure (n = 148), the proportion classified as high-risk showed a statistically significant increase from 76% (95% CI: 0.6951-0.8320) at baseline to 88% (95% CI: 0.8258-0.9310) at follow-up (p = 0.010). This shift reflects a substantial effect size, with the odds of high-risk classification being more than double at follow-up (OR = 2.24). Nurses consistently demonstrated higher risk compared with physicians. The overall use of personal protective equipment remained high. However, adherence to several IPC practices declined over time, including removal and replacement of PPE according to protocol and frequent decontamination of high-touch surfaces. Conclusions: Occupational exposure risk among HCWs remained substantial and increased over time despite stable occupational exposure estimates. The observed decline in adherence to key IPC measures highlights the need for continuous monitoring and reinforcement of protective practices in healthcare settings.

Knowledge, Attitudes, and Beliefs of Pediatric Health Care Workers: Understanding the Response to COVID-19.

Occupational health risks associated with use of environmental surface disinfectants in health care.

Occupational health disparities: The pandemic as prism and prod

Why Won’t It Stop: Workplace Violence in Emergency Care

Moving from awareness to action on preventing patient exposure to toxic environmental chemicals

The 1964 report of the US Surgeon General on smoking and health made an authoritative case that tobacco smoking was a cause of premature deaths from lung cancer and chronic bronchitis. It justified the practice of drawing causal inferences from epidemiological studies, specified influential criteria for doing so, and made use of an early form of meta-analysis.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.