Employee Health Service Research Articles

Significance of fever in hospital employees

Hospital employees are exposed to a variety of occupationally related hazards that can be categorized as infectious or noninfectious. Lost work time often results from these problems. Infection control practitioners receive many telephone calls of inquiry about these employees in terms of their transmissible infections. Little has been written concerning fever in the employee health setting. To determine the frequency of febrile illness in hospital employees, we conducted a prospective study of the employee health service from January to December 1987. Winthrop-University Hospital is a 533-bed community teaching hospital with approximately 2400 employees. During 1987, 2974 visits were made to the employee health service. Of these, 879 (30%) were for occupationally related illness or injury. Oral temperatures of greater than or equal to 100 degrees F were noted in 25 (2.8%) of the 879 visits. Fever occurred predominantly in employees with infections. Upper respiratory tract infection accounted for 268 of 544 (49%) visits for infection. In addition, 11 of 22 (50%) febrile episodes were related to upper respiratory tract infections. A total of 963 work days were lost because of illness or injury. Of these, 743 (77%) were related to an infectious illness; 67 sick days (7%) were attributed to infections with a febrile response. We conclude that fever is uncommon in our employee health care population and that upper respiratory tract infections were the single most common cause of fever. When an employee had a febrile illness, the lost work time was 9% of the total time loss because of infection.

Hypertension and sodium transport in 390 healthy adults in Chicago

A total of 390 people undergoing routine examinations at the Portes Center, a screening center in Chicago, and at the Northwestern Memorial Hospital employee health service, underwent an in-depth battery of tests designed to explore the relationships of both intracellular erythrocyte sodium and sodium-lithium countertransport with age, race, gender, body mass index, pattern of alcohol intake, exogenous hormone use and the presence of hypertension. Erythrocyte sodium was significantly higher in blacks than in whites and in men than in women aged 20-39 years. Relationships of erythrocyte sodium with race and gender, as well as inverse associations with alcohol intake in men, and positive associations with age and the presence of hypertension in women were significant on multivariate analysis after control for other variables. Sodium-lithium countertransport was significantly higher in whites than in blacks and in men than in women aged 20-59 years. Associations of sodium-lithium countertransport with race and gender as well as positive associations of sodium-lithium countertransport with body mass index in men and women were significant on multivariate analysis after control for other variables. Age-related gender differences in both sodium-lithium countertransport and erythrocyte sodium, as well as the association of erythrocyte sodium with the presence of hypertension in women but not in men, suggest a hormonal interaction with sodium transport in the development of hypertension.

Infection of the health-care worker by HIV and other blood-borne viruses: Risks, protection, and education

Transmission of the human immunodeficiency virus (HIV) and other blood-borne viruses in hospitals is discussed, and the infection control system and worker protection and education plan at San Francisco General Hospital (SFGH) are described. The acquired immunodeficiency syndrome (AIDS) epidemic has led to increased concern about occupationally acquired infections in health-care workers. As the number of HIV-infected persons increases, so does the risk of infection. Occupationally acquired HIV infection of health-care workers occurs principally in nurses, phlebotomists, and laboratory technicians through accidental subcutaneous injection of contaminated blood; splashing of blood onto open skin lesions, the eyes, and mucous membranes represents another route of exposure. The risk of infection from a single needle-stick exposure to HIV-infected blood is about 0.4%. Other blood-borne viruses to which employees are vulnerable include hepatitis B virus and human T-cell lymphotropic viruses, which may cause leukemia and lymphoma. SFGH has a comprehensive infection control system. Specimen containers are enclosed in transparent secondary containers, the worker is encouraged to wear protective clothing when necessary, and specific needle-stick precautions are promoted. There is also a health-care worker protection and education plan. The employee health services department provides immunizations, keeps records on accidental exposures, and operates a hot line. The education committee disseminates educational materials and arranges lectures. Infection control and education provide simple but effective measures for protecting hospital employees against HIV and other occupationally acquired infections.

An Employee Health Service in Saudi Arabia

Health services for employees of this 500-bed tertiary care hospital include programs normally available to employees at hospitals in the United States. These programs include primary care, health promotion, health surveillance, and pre-employment health screening. The most pervasive influence on the health care provided is Islam. Saudi Arabia is a conservative Muslim country and all health care activities must be accomplished within the religious and cultural norms of the country. Communicable diseases endemic to this part of the world are of special concern in employee health. Special programs are in place for the prevention and control of tuberculosis, hepatitis B, brucellosis, ophthalmic chlamydia, malaria, and meningococcal disease.

Medical Consumer Education

The need for health promotion programs in the workplace is more important today than ever before in these times of increased costs of health care. It is essential for corporations to develop efficient and effective health programs which will reduce the costs of employee health services while providing quality care. Occupational therapists can make significant contributions to the development and implementation of health promotion and health education programs in the corporate world. The Medical Marketplace project described was a federally funded research project designed to assess the effectiveness of a health consumer education and training program on the reduction of health care costs. The training was intended to increase the knowledge and skills of employees, making them wise and informed consumers of health services; to improve the quality of health care by helping consumers find appropriate care more quickly and directly; and to reduce employee health costs by eliminating the use of unnecessary or inappropriate services. The occupational therapist was the principal investigator of this project.

Incidence, Prevalence, and Variables Associated with Low Back Pain in Staff Nurses

The morbidity, lost work time, and interference with effective work due to low back pain are markedly underestimated when only employee health service data are used. Injured subjects averaged more years of generic, orthopedic, and rehabilitation nursing experience than the non-injured group. Of the studied nurses who experienced work related low back pain within the past 6 months, 78% did not report it to management. More attention should be given to adequate staff availability for shared lifting activities, better design and use of mechanical lifting aids, and further research in how to safely perform tasks from the side of the bed.

The Nonutility of Chest Roentgenographic Examination in Asymptomatic Patients With Positive Tuberculin Test Results

To determine the value of chest roentgenograms in the management of asymptomatic persons with positive tuberculin skin test results, we undertook a retrospective review of all tests administered by our Employee Health Service, North Shore University Hospital, Manhasset, NY, between July 1, 1983 and November 1, 1987. Of 5200 tests, 247 results were positive. Two hundred twenty-one of these charts were reviewed for roentgenographic results and the presence of symptoms. All persons were asymptomatic. Chest roentgenograms revealed the following: normal, 188; unrelated abnormalities, 24; apical pleural thickening, 5; granulomas, 2; calcified hilar node, 1; and calcified node plus granuloma, 1. We noted no active tuberculosis, nor did the chest roentgenographic results influence recommendations for isoniazid prophylaxis. We conclude that chest roentgenograms are of value in 0% to 1.3% of asymptomatic people with positive tuberculin test results. A larger study should be undertaken to further define the usefulness of chest roentgenograms in this population.

Expanding roles of hospital epidemiology: quality assurance.

The role of hospital epidemiology is expanding. Today's hospital epidemiologists are being asked for advice by hospital administrators for matters outside of infection control. The latter relate to the optimal use of drugs, the level of health care provided by the employee health services and a number of issues related to the distribution and determinants of health care in the institution, all of which fall under the umbrella of quality assurance (QA). There is no doubt about the national preoccupation for monitoring health care and health care providers.

Susceptibility of hospital based health care personnel to varicella-zoster virus infections

Varicella-zoster virus (VZV) transmission poses a major infection risk for health care workers in the hospital environment. Immunologically normal adults who contract varicella have 9 to 25 times the risk of major morbidity or death from infection compared with healthy children. Moreover, varicella infection during pregnancy is associated with a high rate of complications and the risk of the congenital varicella syndrome. To evaluate susceptibility to VZV infection among hospital workers, the employee health service screened 241 personnel for VZV antibody by the indirect fluorescent antibody technique. Overall, 7 (2.9%) of 241 personnel lacked VZV antibody and were therefore presumed susceptible to infection. Susceptibility varied dramatically by age and was significantly higher among persons 35 years of age and younger (7/93 = 7.5%) than among those aged 36 years and older (0/148 = 0%, p = 0.001). Persons 35 years old or younger with a clinical history of chickenpox or herpes zoster were much less likely to lack immunity (3/71 = 4.2%) than those stating they had no history of either (4/11 = 36.4%, p = 0.005). Screening strategies for VZV immunity in hospital employees could be made more efficient by performing serologic tests only on those persons aged 35 years or younger with a negative or uncertain history of the disease. Persons who lack antibody may be considered for preexposure immunization with live attenuated varicella vaccine as an alternative to varicella-zoster immune globulin or enforced absence from patient care after exposure to a VZV-infected patient.

Medical Consumer Education

The need for health promotion programs in the workplace is more important today than ever before in these times of increased costs of health care. It is essential for corporations to develop efficient and effective health programs which will reduce the costs of employee health services while providing quality care. Occupational therapists can make significant contributions to the development and implementation of health promotion and health education programs in the corporate world. The Medical Marketplace project described was a federally funded research project designed to assess the effectiveness of a health consumer education and training program on the reduction of health care costs. The training was intended to increase the knowledge and skills of employees, making them wise and informed consumers of health services; to improve the quality of health care by helping consumers find appropriate care more quickly and directly; and to reduce employee health costs by eliminating the use of unnecessary or inappropriate services. The occupational therapist was the principal investigator of this project.

Benefits of a back care and light duty health promotion program in a hospital setting.

Back injuries are a common and expensive problem in industry in terms of both direct and indirect costs. A dramatic increase in the costs of workers' compensation for work-related back injuries occurred from 1981-1985 in a hospital setting. During this five-year period, costs of back injuries rose from $36,384 to $272,751, a 750% increase, and the incidence per thousand employees rose from 21 in 1981 to 33 in 1985. A back care education program was instituted by the Physical Therapy Department and Employee Health Service for all departments within the hospital, with content tailored to individual job requirements. Because employees who have had one back injury are at risk for reinjury, an "at risk" program was also developed. For those injured employees without time off work and without need for medical care, a private session with a physical therapist is required to assess musculoskeletal problems and to review posture and body mechanics directly related to specific job tasks. Those employees unable to work in their usual positions are assigned to temporary modified jobs as part of the Light Duty Program. In 1986, following the institution of these two programs in the hospital, the cost of back injuries dramatically decreased to $72,296, a $200,000 drop, and the incidence per thousand employees fell to fifteen. The efficacy of this health promotion intervention program was confirmed both in the cost benefit to the hospital as well as in reduction in incidence of low back injury.

Effect of Laboratory Error on the Identification of Persons with Hypercholesterolemia in an Employee Health Service

Cholesterol is a major risk factor for coronary heart disease. Of 117 employees seen consecutively in the Tennessee State Employee Health Service voluntary screening program, 86 (74%) had cholesterol levels above the reference range reported by a commercial clinical laboratory. This was three times greater than the calculated expected number of 29 (25%, 17 at moderate risk, 12 at high risk for coronary disease). Age and sex adjustment using Lipid Research Clinic guidelines reduced the number with elevated cholesterol to 55 (47%, 24 at moderate risk, 31 at high risk). Split sample cholesterol assays run independently by the commercial laboratory and a university laboratory showed excellent correlation (r = 0.99, commercial laboratory = 1.0 (university laboratory) + 10.8), but a systematic difference of 12.4 mg/dL (SD = 6.4 mg/dL, paired-t = 9.63, p less than 0.00001) between the two laboratories. Further adjustment for this difference reduced the number with elevated cholesterol to 41 (36%, 26 at moderate risk, 15 at high risk). This experience illustrates how small systematic laboratory errors in cholesterol determination can greatly exaggerate the number of persons reported to have clinically important cholesterol elevations. Clinical laboratories should report age and sex adjusted cholesterol reference ranges and provide clients periodic quality assurance reports that their measurements of cholesterol levels are accurate.

Activities of Occupational Health Professionals in Academic Environments

We surveyed American and Canadian medical schools to assess the extent to which occupational health professionals provided services to their own institutions. Ninety-two of 155 schools (60 percent) responded to a mailed questionnaire. Forty-six (51 percent) of the respondents had an occupational health service distinct from an employee health service. Two thirds of the respondents provided occupational health services to business and industry. Such professionals based in nonclinical departments were more likely to provide educational and epidemiologic services for hospital employees than were professionals based in clinical departments. In those institutions with risk management, biohazards, or health and safety committees, less than one half of the occupational health professionals in those institutions were members of those committees. Five respondents felt that there were financial disincentives to providing occupational health services to their institution's employees. We conclude that academic-based occupational health professionals have inadequate input into the provision of such services at their own institutions.

Implementing a Hepatitis B Program

Implementing a Hepatitis B Program

Management of varicella-zoster virus-exposed hospital employees

Emergency physicians frequently manage hospital employee health services. A common hospital infection control problem is varicella-zoster virus infection. We reviewed the literature to determine a rational basis for the management of the varicella-zoster virus-exposed hospital employee. Exposed employees include those with direct face-to-face contact with an infected person. The immune status should be determined in those employees with a negative or uncertain history of varicella infection by using a sensitive and specific technique such as the FAMA or ELISA tests. Employees with a positive history or a positive titer are immune and can return to work. Those with a negative titer are susceptible and should avoid patient contact from day eight to 21 following exposure. High-risk, susceptible contacts should be given varicella-zoster immune globulin. Varicella infection will become much less common after the release of varicella vaccine.

Guidelines for Employee Health Services in Health Care Institutions

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Health Risk and Occupational Category

This study seeks to determine the influence of occupational category on health risk by utilizing a corporate-wide health risk appraisal (HRA). A subgroup of the corporate population, 10,124 college-degree employees, completed a health risk appraisal and comparisons were made between the male subjects' (6,553) and female subjects' (3,571), occupational categories, and estimated health risk. For the males, significant differences were found between the six occupational categories; clerical, professional and craft categories exhibited greater health risk. The females displayed no significant differences between occupational categories. The authors suggest that occupational variables are likely to have an influence on health risk when mean age for the occupational category is adjusted and educational level of subjects is controlled. Findings are discussed regarding significance to employee assistance providers and other corporate personnel involved in employee health services.

Employee health service for teaching and nonteaching staff: A needs assessment

This paper reports the results of a needs assessment conducted for an Employee Health Service in a metropolitan school district. Survey questionnaires were distributed to the entire district staff with a return rate of 49% (n = 2,268). In order to identify the subgroups of employees who may be at greatest health risk, data were analyzed utilizing an Automatic Interaction Detection Analysis technique. As a means of determining whether particular subgroups perceive stress differentially, multivariate analyses of variance were also performed. Results indicate that “degree of stress” is the health risk variable which can best differentiate employees on the basis of health risk predictors. In general, for teachers, coping ability differentiates those who have high versus low stress, whereas for nonteachers, satisfaction with social support shows the strongest relationship to stress. Furthermore, classification of individuals by job category results in the most pronounced differences between groups on ten stress subdomains. Overall, task-based stress is deemed to be the most stressful of the subdomains. Results are discussed with regard to planning prevention and intervention efforts.

Amphotericin--how safe and effective?

Over a period of 35 days beginning July 23, 1984, the Infection Control Section of the Nassau Hospital, a 535-bed community teaching institution received reports of an unusually high number of PPD tuberculin skin test conversions among employees from Employee Health Service personnel.The first case involved a registered nurse who, upon receiving a routine annual Mantoux skin test on July 23, converted from the previous year's negative reaction to a significant reaction (20 mm induration) with a greater than normal area of erythema. When she reported this to her private medical doctor prior to beginning INH prophylaxis, she was retested by the physician. This test was read as nonreactive.

The CDC guidelines for prevention and control of nosomial infections: View from the trenches

The first CDC guidelines were published by the Centers for Disease Control (CDC) in February 1981. These were Prevention of Catheter-Associated Urinary Tract Infections and the first three sections of Hospital Environmental Control. They were sent in a notebook entitled “Guidelines for the Prevention and Control of Nosocomial Infections” to the administrators of all of the acute care hospitals in the United States-probably about 7000. They were subsequently published in the March/April 1981 issue of Infection Control and several other publications since then. The most recent CDC guidelines, Isolation Techniques and Employee Health Services, were published in the July/August 1983 issue of Infection Control. In between, there have been published guidelines on the remaining sections of Environmental Control, Intravascular Infections, Nosocomial Pneumonia, and Surgical Wound Infections.