Employee Health Service Research Articles

The cost of selected tuberculosis control measures at hospitals with a history of Mycobacterium tuberculosis outbreaks.

To determine the cost of nonrespirator-related tuberculosis (TB) control measures at several hospitals, following publication of the Centers for Disease Control and Prevention (CDC)'s revised TB infection control guidelines. Infection control (IC) and TB coordinators obtained cost information on tuberculin skin-test (TST) programs, addition of IC and employee health service (EHS) personnel, and the retrofit or new construction of environmental controls. Four hospitals with, and one community hospital without, prior nosocomial multidrug-resistant TB transmission. During the study period, the TST program costs remained constant at four of five hospitals and increased at one hospital (median 1994 TST program cost: $5,568; range, $2,393-$44,902). Additional IC or EHS personnel were hired at four of five hospitals (median cost increase, $125,500; range, $63,000-$228,000). The median cost of new construction or new equipment purchases (ie, sputum induction booths, ultraviolet lights, or portable high-efficiency particulate air filters) at study hospitals was $163,000 (range, $45,000-$524,000) and $70,000 (range, $31,000-$93,000), respectively. Costs associated with implementing control measures similar to those recommended in the CDC TB IC guidelines varied widely by hospital. Engineering controls involved the largest capital outlay, but increases in personnel were the largest continuing cost. These costs represent improvements made to upgrade selected aspects of hospital TB control programs, not the cost of an optimal TB control program.

Determining Employee Health Services in Pre-hospital, Hospital, and Post-hospital Settings

Determining Employee Health Services in Pre-hospital, Hospital, and Post-hospital Settings

Influenza Vaccination of Medical Residents at the University of Virginia: 1986 to 1994

During the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for hospital personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.

Influenza vaccination of medical residents at the University of Virginia: 1986 to 1994.

During the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for Hospital Personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.

Influenza Vaccination of Medical Residents at the University of Virginia: 1986 to 1994

AbstractDuring the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for hospital personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.

Positive tuberculin skin test reactions among house staff at a public hospital in the era of resurgent tuberculosis

Background: The number and significance of tuberculin skin test reactions were compared with self-reported baseline values among house staff working in a public hospital. High-risk medical specialties, locations, and infection control practices were examined. Methods: House staff interviews, tuberculin skin test applications, review of employee health service records, and environmental monitoring of high-risk areas were performed. Results: Among house staff self-reported as having negative tuberculin skin test status, 46.2% (95% CI 27.0% to 65.4%) of internal medicine house staff, compared with 4.8% (95% CI 4.3% to 13.9%) of house staff from other areas ( p < 0.005), had positive results on a repeat tuberculin skin testing before graduation. These differences were not entirely explained by the use of surgical masks, year of training, or previous vaccination with bacille Calmette-Guérin. Most skin test reactions (69%) occurrred among house staff who had not been vaccinated with bacille Calmette-Guérin. Increased skin reactivity probably represented excess conversions from unprotected exposure. Tuberculosis transmission was facilitated by delays in diagnosis, inadequate isolation facilities, and suboptimal ventilation. House staff did not comply with recommended tuberculosis surveillance because of time constraints, fear, and misunderstandings about tuberculin skin test interpretations in light of previous bacille Calmette-Guérin vaccination. Conclusions: House staff in high-exposure settings with suboptimal environmental controls are at increased risk for tuberculosis infection. Participation in surveillance programs can be increased by enlisting the participation and advocacy of respected medical colleagues, screening house staff differentially according to exposure and job classifications, and more accurately interpreting subsequent test results from baseline two-step testing.

The Future Role of Managed Care and Capitation in Workers’ Compensation

A patient of mine, Mrs. Lopez, suffered a lower back injury while lifting heavy equipment. She sustained the injury while working in the housekeeping department at a local college. I telephoned her supervisor and asked him about Mrs. Lopez’s injury. He assured me that he had forwarded an accident report to the benefits department. He said he was unaware of any employer policies or training programs governing heavy lifting. The college did not have an employee health service, but instead relied on a local law firm to handle the administration of its workers’ compensation. When I informed the supervisor that I thought Mrs. Lopez might be able to return to a restricted duty job soon, he said that he did not want Mrs. Lopez to return until “she was 100%.” I told him that this employee would benefit medically from returning to a restricted duty job as soon as it was reasonable rather than waiting until she could perform heavy lifting again. However, the supervisor replied “Don't you worry about returning her to work so soon. Workers’ compensation will pay for it.”

Tuberculin skin test conversion in hospital employees vaccinated with bacille Calmette-Guérin: Recent Mycobacterium tuberculosis infection or booster effect?

Objective: A rise in the incidence of purified protein derivative (PPD) skin test conversions among employees at our medical center between 1991 and 1993 prompted an examination of factors associated with PPD skin test conversion. We focused on the effect of bacille Calmette-Guérin (BCG) vaccination on PPD skin test conversion because of changes in employee health service policies in 1990 regarding testing of persons who had received BCG vaccination. Methods: The study took place in a university teaching hospital employee health service. Charts of employees who had PPD skin test conversion (> 10 mm increase in induration of the PPD response within 2 years if younger than 35 years of age or > 15 mm if older than 35 years of age) between 1988 and 1993 were reviewed for factors that could have influenced PPD skin test conversion and compared with data from 271 randomly selected charts of employees who underwent annual employee assessments in 1993 but did not have PPD skin test conversion. Results: PPD skin test conversions rose from 0.06% ( 1 1604 ) to 1.3% ( sol22 1760 ; p = 0.000001) in employees tested between 1988 and 1993. Of 41 persons with PPD skin test conversion between 1991 and 1993, 29 (71%) had received BCG vaccination. Only 21% of control subjects ( 56 271 ) had received BCG vaccination ( p < 0.000001 for comparison of BCG vaccination among those with PPD skin test conversion with that among control subjects). When BCG recipients were not included as having PPD skin test conversion, there was no significant increase in PPD skin test conversions. Twenty-three BCG recipients had PPD skin test conversion on their second PPD skin tests. Conclusion: A large proportion of PPD skin test conversions at hospitals that employ large numbers of health care workers who have received BCG vaccination may not represent recently acquired tuberculosis. Rather, these conversions may be effects of previous BCG vaccination. Two-step initial PPD skin testing may help to eliminate nearly 80% of such false-positive conversions.

Employee health and infection control.

Hospital employees are at risk for exposure to a variety of communicable diseases, which they may transmit to patients and other workers. The employee health service plays a critical role in an effective infection control program. In this article, we outline the major responsibilities of the employee health service and summarize key current recommendations for management of exposures.

Percutaneous Injuries on the “Front Line”: A Survey of Housestaff and Nurses

Our objective was to assess the frequency of work-related percutaneous injuries in two high-risk groups and to compare patterns of injury and reporting in these groups. Data were collected through an anonymous, self-administered survey distributed to all full-time nurses and housestaff. The survey results were compared to Employee Health Service records. Surveys were returned by 258 of 330 housestaff and 455 of 593 nurses for a response rate of 77% (housestaff = 78%; nurses = 76%). The respondents were highly representative of the nursing divisions and residency programs surveyed. The percentage of nurses who had ever sustained percutaneous injuries was 64.7%; for housestaff it was 74.1% (prevalence difference = -9.4%, 95% confidence interval [CI] = -16.4%, -2.4%). The percentage of nurses who had sustained recent injuries was 34.6%; for housestaff it was 43.0% (prevalence difference = -8.4%, 95% CI = -15.9%, -0.9%). Injuries with syringe needles were the most common, followed by injuries with suture needles, scalpels, and then a variety of other sharp objects and instruments. The nurses were more likely to seek care as directed by hospital policy at the Employee Health Service (reporting difference = 29.7%, 95% CI = 19.5%, 39.9%) or the Emergency Room (reporting difference = 11.9%, 95% CI = 8.1%, 20.0%). Knowledge of policy increased the probability of reporting by nurses. The housestaff were more likely to evaluate injuries themselves (reporting difference = -16.7%, 95% CI = -26.8%, -6.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

The ‘Roving Team’ Employee Health Service in the Workplace

The ‘Roving Team’ Employee Health Service in the Workplace

The 'Roving Team': Employee Health Service in the Workplace

The 'Roving Team': Employee Health Service in the Workplace

Results of a rubella screening program for hospital employees: a five-year review (1986-1990).

The Barnes Hospital Employee Health Service (St. Louis, Missouri) rubella screening program was evaluated over the 5-year period between January 1, 1986, and December 31, 1990. A total of 6,969 new employees were hired, and 6,115 (87.7%) were screened for evidence of rubella immunity by the Employee Health Service. Rubella serology was performed on 5,893 (96.4%) of the screened employees, while 222 (3.6%) had documentation of prior rubella vaccination or rubella infection. The absence of immunity was identified in 325 employees or 5.3% of all those screened. Women were more frequently screened by the Employee Health Service than were men (p < 0.0001), and blacks were more frequently screened than were non-Hispanic Caucasians (p < 0.0001). Physicians were less frequently screened than were other departmental groups (p < 0.0001). The rate of seronegativity for each year of hire varied from 4.45 to 6.76%, but these differences were not significant. Logistic regression analysis demonstrated that 5-year birth cohorts correlated significantly with serologic status. Employees born in 1960-1964 were least likely to be seronegative, and employees born in 1970 or later were most likely to be seronegative. Sex, race, and department group were not predictive of serologic status, although significant differences in results from different rubella assays were detected. Only 13.8% of seronegative employees were subsequently vaccinated by the Employee Health Service. This study demonstrates a lower seronegativity rate than did previous studies. It identifies groups of employees likely to escape rubella screening and low vaccination rates. It finds increasing seronegativity among employees born after 1964 that correlates with the reported increasing rates of rubella in the United States.

The use of needles in the practice of anesthesiology and the effect of a needleless intravenous administration system.

Anesthesia personnel are at risk for occupationally acquired blood-borne infections transmitted through needlestick injuries. To formulate strategies for the prevention of needlestick injuries, it is necessary to identify the types of needles used by anesthesia personnel and the devices associated with injuries. The introduction of a needleless intravenous (i.v.) administration system provided an opportunity to assess its effect on needle usage in the practice of anesthesiology. The contents of needle disposal containers placed in the preoperative holding area and five operating rooms before (control) and after the introduction of a needleless administration system (study) were categorized by needle type. The information on needles used by anesthesia personnel was compared with that on needles purchased for the entire hospital. During the control period, most of the needles used were 18-23-gauge hollow needles (51.6%), i.c. catheter stylets (23%), and 25-26-gauge small-bore hollow needles (17.1%). There was no difference in the total number of needles collected after the introduction of the needleless administration system, but there was an increase in capped 18-23-gauge hollow needles. Anesthesia personnel used a relatively greater number of small-bore hollow needles (25-26 gauge), i.v. catheters, and spinal and epidural needles, but fewer hollow needles (18-23 gauge) than were purchased for hospital-wide use. Small-bore hollow needles (25-26 gauge) were responsible for 31.6% of the 19 needlestick injuries reported by anesthesia personnel to the Employee Health Service.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Healthcare Personnel regarding Influenza Immunization

To survey the attitudes of healthcare personnel regarding influenza immunization. A questionnaire was given to all hospital employees. A 650-bed community teaching hospital. Employees were offered an in-service regarding influenza immunization in October 1991. Influenza immunization was given free of charge by Employee Health Services from October to December 1991. One thousand fifty-six employees (30.2%) received influenza vaccines. Survey forms were distributed with paychecks to all employees during the second half of January 1992. Completed survey forms were returned during the next 2 weeks. One thousand two hundred three of the 3501 (34.3%) questionnaires were returned. Some of the survey forms were not completely filled out. A total of 28.1% of male employees (202/717) and 35.4% of female employees (987/2783) (p < .01) responded. Mean years employed were 11.35 +/- 7.57 for respondents and 9.30 +/- 7.39 for all employees (p < .001). Four hundred sixty-one respondents (38.4%) received the influenza vaccine and 734 (61.4%) did not. Among the respondents, employees who were older or working full time were more likely to receive the vaccine. Proportionally, more respondents who received the vaccine attended the in-service, although only 8.7% of those immunized attributed their receiving influenza vaccine to the in-service. More physician respondents were vaccinated. The respondents who received influenza vaccine were more likely to have received the vaccine during the past 2 years (p < .001). The major reasons given for not receiving the vaccine were "bad side effects" and "do not like shots." The major side effect of influenza immunization was a "sore arm." Multivariate analysis suggested that the in-service was not associated with obtaining the vaccine. The in-service regarding influenza immunization seemed to have a negligible influence. Most employees who received the vaccine had previous influenza immunization. There were no major side effects of influenza immunization. "Bad side effects" and "do not like shots" were major reasons given for not receiving influenza vaccine.

Attitude of Healthcare Personnel Regarding Influenza Immunization

AbstractObjectives:To survey the attitudes of healthcare personnel regarding influenza immunization.Design:A questionnaire was given to all hospital employees.Setting:A 650-bed community teaching hospital.Intervention:Employees were offered an in-service regarding influenza immunization in October 1991. Influenza immunization was given free of charge by Employee Health Services from October to December 1991. One thousand fifty-six employees (30.2%) received influenza vaccines. Survey forms were distributed with paychecks to all employees during the second half of January 1992. Completed survey forms were returned during the next 2 weeks.Results:One thousand two hundred three of the 3,501 (34.3%) questionnaires were returned. Some of the survey forms were not completely filled out. A total of 28.1% of male employees (202/717) and 35.4% of female employees (987/2783) (p&lt;.01) responded. Mean years employed were 11.35 ± 7.57 for respondents and 9.30 ± 7.39 for all employees (p&lt;.001). Four hundred sixty-one respondents (38.4%) received the influenza vaccine and 734 (6 1.4%) did not. Among the respondents, employees who were older or working full time were more likely to receive the vaccine. Proportionally, more respondents who received the vaccine attended the in-service, although only 8.7% of those immunized attributed their receiving influenza vaccine to the in-service. More physician respondents were vaccinated. Tbe respondents who received influenza vaccine were more likely to have received the vaccine during the past 2 years (p&lt;.001). The major reasons given for not receiving the vaccine were “bad side effects” and “do not like shots.” The major side effect of influenza immunization was a “sore arm.” Multivariate analysis suggested that the in-service was not associated with obtaining the vaccine.Conclusions:The in-service regarding influenza immunization seemed to have a negligible influence. Most employees who received the vaccine had previous influenza immunization. There were no major side effects of influenza immunization. “Bad side effects” and “do not like shots” were major reasons given for not receiving influenza vaccine.

Employee Health Nurse Counselor Roles in the Hospital Setting

Hospitals have diverse employee populations and environmental hazards such as bloodborne pathogens, chemicals, gases, radiation, chemotherapeutics, and heavy/repetitive lifting which require a situation specific approach in counseling and assessment. A major frustration in hospital employee health practice is insufficient staffing. Hospital worksites have excellent staff resources to channel employees and facilitate counseling and health teaching when EHS staff are limited. EAPs in hospitals are logical extensions of the employee health service either as direct providers of the service or as referral sources.

Infection Control Strategies Relevant to Employee Health

A well organized employee health service is a key component of an effective infection control program. All health care providers should be immune to mumps, measles, rubella, tetanus, and polio. Hepatitis B vaccine should be offered to all workers who have contact with blood. Employees with signs and symptoms of infectious diseases should be evaluated by Employee Health and follow work restrictions. Employees with exposure to communicable diseases should be evaluated for prophylaxis.

Occupational Health Services for Hospital Workers: Who Does it Best?

Occupational health services in hospital do not carry the same clout as clinical departments and are regarded by the medical staff as peripheral functions at best. Although some large teaching hospitals have recognized the need to put occupational health services for employees under medical directors trained in occupational health, most community hospital and long-term care facilities have not. These institutions need to reassess their occupational health program if hospitals, which are committed to healing, are not to be viewed as backward, regressive employers.

Excessive roentgenograms and employee health

To the Editor.—The article by Gottridge et al1on over utilization of chest roentgenograms in tuberculin reactors may or may not be doing a service for overworked and underfunded hospital employee health services. We2and others3have long held concern about proper use of the chest roentgenogram, but must caution that staff tuberculin testing and roentgenograms are currently theonlyway to control tuberculosis in a medical institution. The one tuberculin-positive employee who fails to receive a roentgenogram may well be the one who is a nurse in the newborn nursery or a resident in the immunosuppressed ward. Presumably, the individuals tested and followed by Gottridge et al were healthy and employed (ie, not a very sick population), but the occasional case of active tuberculosis picked up in a skin testing survey still cannot be avoided. A more important concern, however, is that the authors studied 221