Healthcare Hazard Research Articles

The clinical pattern of intentional injuries at a primary Saudi Arabian trauma center.

The term "intentional injuries" refers to a spectrum of injuries resulting from self-inflicted injuries, interpersonal violence, and group acts of violence. Intentional injuries are underreported in Saudi Arabia. This study aimed to analyze and evaluate the characteristics of intentional injuries in patients who presented to the emergency department of a primary trauma center in Medina, Saudi Arabia in 2013. A prospective cohort database analysis of the clinical patterns and treatment outcomes of 252 patients who had intentional injuries between January and December 2013 was done. The proportion of trauma patients with intentional injuries was 1.3%. The mean age was 34.2±9.4 years, 141 patients (56.0%) were male, and 111 (44.1%) were female (male to female ratio, 1.27:1). The majority (n=159, 63.1%) of injuries occurred at night. Most occurred outside the home (n=180, 71.0%). Financial problems (n=62, 24.6%) and social disputes (n=61, 24.2%) were the most common reasons. Sharp objects (n=93, 36.9%) were the most common weapons used. The head and neck were the most commonly injured areas (n=63, 54.4%). Superficial cuts (n=87, 34.5%), were the most common type of injury. Suturing of wounds (n=54, 21.4%) and surgical debridement (n=47, 18.7%) were the most commonly performed modalities of management. We conclude that intentional injuries in Saudi Arabia are a health care hazard that is, unfortunately, underreported. The clinical pattern is similar in most aspects to international reports but differs in certain features due to the specific religious and conservative characteristics of the community. Nationwide clinical studies are strongly recommended.

Has the Affordable Care Act Affected Health Care Efficiency?

We utilize health care input and output data to evaluate how state-level efficiency in health care has changed in the wake of the Affordable Care Act (ACA). We use a Stochastic Frontier model to estimate annual measures of technical and cost efficiency before, and after, the implementation of the ACA. Results show that following the ACA, states’ technical efficiency improved and converged across states. However, cost efficiency declines suggest health outputs rose by a proportionally smaller margin than health care costs. Plausible explanations are a lack of substitutability between emergency care and preventive care, the presence of moral hazard in health care markets, and declining marginal returns to increased health care expenditures. The above pattern of results is repeated with greater magnitude for states that expanded Medicaid coverage. The results suggest the ACA represents a package of reforms that present a trade-off between technical and cost efficiency.

Physician Impairment: Exploring the Health Issues and Determinants

Physician impairment is a critical issue in health care setting. Physicians have an exaggerated risk of psychosocial problems. The most common psychiatric problems in the physician can be isolated psychiatric conditions or substance abuse. Physician impairment due to psychosocial problems, substance abuse, burnout or accidental health care hazards can result in adverse personal, social and professional consequences. Due to the nature of the work, physician impairment can result in significant compromise in patients’ health. It is absolute necessary to have a definitive set of programs within each health care facility to target physician impairment preserving the functionality and optimal health output of health care provider and the receiver.

English

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Health information technology safety: the perfect storms.

Health information technology safety: the perfect storms.

Blood and body fluid exposures: consent for source patient testing

Exposure to blood and body fluids (BBF) remains a major occupational hazard in health care. Routine testing of source patients for blood borne viruses where exposure has occurred is recommended in the UK. Whilst in practice source patient identification may be challenging the reasons why identified individuals are not tested, including issues relating to consent and procedure compliance, are not fully understood. To identify the frequency of serological testing in identified source patients and the reasons for not testing, including refusal and absence of consent. A review of all BBF exposure incidents reported to the Sheffield Occupational Health Service between 1 January 2009 and 31 December 2009. Of 490 reported BBF exposure incidents source patients were identified in 87% of cases and tested in 56% of the incidents. Rates of source patient testing were higher following incidents affecting medical (76%) and nursing staff (69%) than those involving non-clinical (36%) and dental staff (17%). Reasons for not testing source serology among identifiable patients (151) were not recorded in 66% of incidents, in 20% there was incapacity to give consent and in 5% testing was refused. This study found that despite guidance, routine source testing is not universal. Incapacity to consent is a contributory factor for some source serology not being tested and clarification of the ethical and legal position would be helpful. Larger studies should explore other reasons why identified source patients are not tested in practice and explore the policy implications of those findings.

Using Online Courseware to Play a Simulation Illustrating the Concept of Moral Hazard in Health Care

This article discusses the use of a popular online instructional management system to teach moral hazard by having students make decisions about whether to seek health care under two simulated scenarios – with and without insurance.

Biosafety in Health Care Workers

Health care workers (HCWs) are among those at highest risk of occupational biohazards, as they are exposed to human body fluids daily. They are exposed to blood-borne infections by pathogens, such as human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) and other blood-borne pathogens [1]. Needlestick and sharps injuries (NSSIs) have been one of the major issues in the protection of health care workers, and vigorous preventive action has been practiced worldwide in recent decades. NSSIs are an important occupational hazard in health care, and the distribution of risk does not occur at random [2]. The Centers for Disease Control and Prevention [3] have strongly supported the prevention of occupational sharps injuries. However, there are many countries like Portugal where biosafety is still a challenge and there is still a long way to go since there are very few studies conducted in this area. In a recent study of a hospital in this country, 53.7% of HCWs did not identify the symbol of biohazard and 44.9% reported about not having enough knowledge about universal precautions (unpublished data). Biosafety refers to the application of knowledge, techniques and equipment in order to prevent worker exposure to potentially infectious agents or biohazards. The differences in use of universal precautions by HCWs are influenced by their level of knowledge. The use of procedures to control infection and universal precautions is effective in preventing cross-contamination. Risk of exposure is greatly minimized by the use of personal protective equipment, such as masks, lab coats and gloves [4]. A good understanding of the circumstances contributing to injuries among HCWs is also necessary. The availability of open access journals such as Biosafety journal from OMICS Group journals helps researchers in getting an easy access to knowledge in this health care field. Providing free access to all materials published is a strong contribution to health promotion for the health care workers.

Chemical Hazards in Health Care

It is counter-intuitive that the healthcare industry, whose mission is the care of the sick, is itself a "high-hazard" industry for the workers it employs. Possessing every hazard class, with chemical agents in the form of pharmaceuticals, sterilants, and germicidals in frequent use, this industry sector consistently demonstrates poor injury and illness statistics, among the highest in the United States, and in the European Union (EU), 34% higher than the average work-related accident rate. In both the United States and the EU, about 10% of all workers are employed in the healthcare sector, and in developing countries as well, forecasts for the increasing need of healthcare workers (HCW) suggests a large population at potential risk of health harm. The explosion of technology growth in the healthcare sector, most obvious in pharmaceutical applications, has not been accompanied by a stepped up safety program in hospitals. Where there is hazard recognition, the remedies are often voluntary, and often poorly enforced. The wrong assumption that this industry would police itself, given its presumed knowledge base, has also been found wanting. The healthcare industry is also a significant waste generator threatening the natural environment with chemical and infectious waste and products of incineration. The ILO has recommended that occupational health goals for industrial nations focus on the hazards of new technology of which pharma and biopharma products are the leaders. This unchecked growth cannot continue without a parallel commitment to the health and safety of workers encountering these "high tech" hazards. Simple strategies to improve the present state include: (a) recognizing healthcare as a "high-hazard" employment sector; (b) fortifying voluntary safety guidelines to the level of enforceable regulation; (c) "potent" inspections; (d) treating hazardous pharmaceuticals like the chemical toxicants they are; and (e) protecting HCWs at least as well as workers in other high-hazard sectors.

Moral Hazard, Adverse Selection and Health Expenditures: A Semiparametric Analysis

Theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard. However, previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care. We empirically study this question by a using unique data set with confidential information from a large self-insured employer to estimate a structural model of the demand for health insurance and medical care. We propose a two-step semi-parametric estimation strategy that builds on the work on identification and estimation of auction models. We find significant evidence of moral hazard and adverse selection.

A Descriptive Study of the Perceptions of Workplace Violence and Safety Strategies of Nurses Working in Level I Trauma Centers

Workplace violence is a significant occupational hazard in health care. As the largest group of employees in health care, nurses are particularly vulnerable to workplace violence, with those who work in emergency departments being especially at risk. The purpose of this research was to study the phenomenon of workplace violence by interviewing emergency nurses who had experienced violence while on duty. A descriptive study approached the issue of workplace violence from the perspective of 8 registered nurses from 2 level I trauma centers who volunteered to be interviewed. Cross-case comparison of the interview responses was used to analyze the data from verbatim transcripts. Emergency nurses identified specific experiences of violence at work. Inadequate safety measures and vulnerability were the 2 themes that were consistently verbalized through out the interviews. The emergency nurses who were interviewed discussed their experiences with patients, family members, and others who exhibited violent and aggressive behavior. They identified safety measures that they believed were inadequate and discussed their feelings of vulnerability because of violent incidents at work. Further research with larger samples could confirm specific safety problems in emergency departments that must be addressed to provide a safer workplace for emergency nurses, their colleagues, and their patients.

BMA warns of hazards in health care

The NHS Executive should set up a comprehensive environmental policy for the NHS, says a new report on the risks of health care published by the BMA. The BMA is calling on the Department of Health to set quality standards for the health of NHS employees, including their environmental wellbeing, by the end of 1995. Each hospital should appoint an environmental officer with responsibility for coordinating environmental health and developing local policies. The report argues that the cost of failing to …