Dedicated to the health and safety of healthcare workers

D E P A R T M E N T S

WiNTER 2010 VOL. XXX, NO. 1

9Interview with Ann Scott Blouin, PhD, RN, Executive Vice President, Division of Accreditation and Certification Operations, The Joint CommissionBy Sandra Domeracki Prickitt, RN, FNP, COHN-S

16Germs at Your FingertipsContaminated KeyboardsBy Kathy Espinoza, MBA, MS, CPE, CIE

18Retaining an Aging Nurse Workforce: Perceptions of Human Resource PracticesBy Mary Val Palumbo, Barbara McIntosh, Betty Rambur, and Shelly Naud

25Safe Patient Handling and Movement in a Pediatric SettingBy Kathleen Motacki and Lisa Marie Motacki

30Swine Flu: Reducing Risk, Quelling Fear By Eileen Shue, SPHR

3 President’s Message

5 Editor’s Column

6 Association Community Liason Report

8 Ready to Research

12 Colleague Connection

15 Getting Started on the Road Workshop Announcement

F E A T U R E S

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AOHP 2010 National Conference – BostonSeptember 15-18, 2010

Sailing into the Future: Set Your Course for Success

As the educational activities for this year’s conferencve are set into full swing, now is the time for YOU to budget travel expenses to attend this event. Find a colleague to share a room with. Make travel plans early to get the best rate. Apply for the Sandra Bobbitt scholarship to receive a FREE conference registration and one hotel night – find details on the AOHP Web site under Awards and Scholarships.

We are also looking for• Committeemembers• Speakers• Postersessions• Vendors

If you have suggestions, please contact AOHP Headquarters at 800 362-4347 or email info@aohp.org.

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President’s MessageBy Sandra Domeracki Prickitt, RN, FNP, COHN-S

It was a great honor for me to provide my annual Executive President’s Report at AOHP’s 2009 Annual National Confer-ence in Portland. I want to share it with all of the mem-bership in this edition of the Journal. I thank you whole-heartedly for supporting me with re-election to this office for a second term. I look for-ward to working with you dur-ing the next two years.

I want to again thank you all for joining us at this year’s conference. We realize how busy this year has been with the advent of the H1N1 Novel InfluenzaVirusandthevaccinefor the virus, in addition to the global economy and its effects on your employers and your departments. It has definitely been a year of both challenges and opportunities. I also want to again thank the board of di-rectors for their leadership of AOHP and for all the work they accomplish on an ongoing ba-sis. I give all credit to them for

being the impetus to keep the association moving forward in a strong and healthy manner.

We hear and understand the issues you are facing, and we are doing our very best to meet your needs. We un-derstand that it is difficult for you to leave your workplaces

Thank you for your passion and support of AOHP. Together we can keep the association vibrant and healthy for years to come.

for AOHP chapter meet-ings and the Annual National Conference; chapters are struggling to provide you with continuing education, finances and keeping offices filled. We have implemented what we call “stimulus ac-tivities, products” this year which we hope will be of assistance to you and your chapter in all of these areas, and we plan to continue to evaluate these and develop others throughout the com-ing year.

We have accomplished a great deal in 2009 and have many plans for 2010, includ-ing:•Obtained American Nurs-

es Credentialing Center Continuing Nursing Educa-tion providership from the Washington State Nurses Association.

• Providedanotheramazingposter and letter to your CEO, which we plan to do again for 2010.

• Developed partnershipswith the Association of periOperative Registered Nurses and the American Society for Testing and Materials.

• Launched a new Website.

• DistributedaDVDofonesession from last year’s conference to each chap-ter with the option for dis-counted continuing educa-tion units.

• EnhancedtheSandraBob-bitt Continuing Education Scholarship, which now includes one night of hotel

stay at the National Confer-ence.

•Offeringadiscountedtwo-year membership with re-newal in 2010 for $200, which we have found is particularly helpful for those who pay their own dues.

• Providedchapterpresidentstuition to the conference on a first come first serve ba-sis for a total of four tuitions supplied.

• Published our third PublicPolicy Statement.

• Actively engaged with theCoalition for Healthcare Worker and Patient Safety (CHAPS) regarding the na-tional safe patient handling legislation.

• Instituted the Biweekly E-Newsletter.

• DistributedtheGovernmentAffairs Newsletter monthly.

• Finalized and distributedBeyond Getting Started -A Resource Guide for theGovernment Affairs Com-mittee members.

• Developed and recentlypublished Beyond Get-ting Started - A Resource Guide: Preparing for MassImmunization/Prophylaxis of Healthcare Workers.

• Developed an educationalDVD/e-tutorfromlastyear’sconference sessions and are developing another this year for selected sessions of the conference. Stay tuned for more informa-tion on this educational op-portunity to be shared with members who were unable to attend the conference.

• Planning to conduct ourfive-year survey.

Annual Report

Sandra Domeracki PrickittAOHP Executive President

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• Developed and enhancedour relationship with sev-eral national organizations: OSHA, CDC, NIOSH,ABOHN, AORN, the Joint Commission, the Alliance to Make US Healthiest, AIHA and American Soci-ety for Testing and Materi-als (ASTM).

My focus for AOHP continues to be to help move the asso-ciation forward in becoming a world class organization, and I need your help.• I invite you toRecruitOur

Colleague. The board of directors has chosen to continue the ROC program for another year. There are 7,000+ hospitals in the United States, and our

membership represents about 16 percent (based on 1,077 members) of this number. If each one of us recruited another member, we would double the size of AOHP, which would en-hance the benefits for ev-eryone.

• Consider running for achapter or national office.

• Volunteer for a committeeat the local and/or national level.

• GetinvolvedwithAOHPinwhatever way your time af-fords.

Thank you for your passion and support of AOHP. To-gether we can keep the asso-ciation vibrant and healthy for years to come.

Don’t let this be your last issue of the Journal! The AOHP 2010 membership renewal campaign starts soon. Be sure to renew your membership so that you continue to receive the Journal and other member benefits.

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Editor’s ColumnBy Kim Stanchfield, RN, COHN-S

Kim StanchfieldAOHP Journal Editor

I am certain we were all sing-ingtheBeatlessong“HELP!I need somebody” as we dealt with the H1N1 influ-enza pandemic. Pre-flu, most of us were staffed slim, crazy busy, and simply did not have enough hours in our hectic days to accomplish what was needed. Along came this “new” flu, and we were over ourheads.HELP!!

Help came to me in the form of a true blessing… another RN!!!Actually,myvicepresi-dent came to me in late Au-gust with the promise that, if I would assist him on the hospital Pandemic Flu Com-

mand Center, he would make sure another nurse was hired to “help you with this mess” (his words.) I love that admin-istrator!

The understanding was that Employee Health would be able to hire an RN for three to six months, temporarily, to assist with both influenza vaccine campaigns and all the other “flu business.”

Having been the only nurse – ever – in our facility’s Em-ployee Health office, I was amazed that I did get to hire another nurse, especially in these trying financial times.

But, she did arrive. Again, I was blessed. My new co-worker came with several years experience working at our local health department. In fact, she works with me four days a week and contin-ues to work at the health de-partment one day weekly.

As we worked through this flu pandemic, we not only survived, we thrived. We gave thousands of vaccines, screened hundreds of ill em-ployees, and most of all pro-vided support and care to all on our front lines. We were in our Emergency Departmentone evening administering H1N1 vaccine and saw first-hand just how hard and fast staff members were working. Yet, many took the time to thank us for “looking out for them.” We learned the next day that our EmergencyDe-partment set an all time 24-hour record that day we were there!

I learned many valuable things from my new colleague. Her health department back-ground provided a wealth of information, and her fresh eyes and new perspective in-spired me often.

Although the “help” I re-ceived will end soon (bud-gets, etc.,) what I learned and experienced will continue to sustain and inspire me. Now, if I could just get caught up on my sleep and housework.

“Help!”

AOHP is Now on Facebook

- Let’s be friends!

Just click on the link onwww.AOHP.org

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MaryAnn GrudenAssociation CommunityLiaison

tion. A number of the edu-cational tools are available in English and Spanish. OSHA issued the following new or updated compliance assis-tance and alliance program participant products for FY 2009. For more information, see the New Compliance As-sistance Products page on the OSHA Compliance Assistance Web page at www.osha.gov/complianceassistance or Al-liance Program Participants Developed Products Webpage at www.osha.gov/dcsp/alliances/alliance_products.html. The products include:

eTools - Hospital eTool: Meth-icillin-resistant Staphylococ-cus aureus (MRSA) module Safety and Health Topics Pag-es: Pandemic Influenza Other Web Pages: OSHA’s Role in the American Recov-ery and Reinvestment Act of 2009

QuickCards• PandemicInfluenza

o How to Protect Yourself in the Workplace during a Pandemic (OSHA Pub-lication 3365)

o Pandemic Influenza: Respiratory Protection (OSHA Publication 3366)

• Process Safety Manage-ment Depends on You!(OSHA Publication 3315)

• Protecting Worker Safetyand Health Under the Na-tional Response Frame-work (OSHA Publication 3356)

Fact Sheets• PandemicInfluenzaoWhatEmployersCanDo

to Protect Workers from Pandemic Influenza

o Healthcare Workplaces ClassifiedasVeryHighorHigh Exposure Risk for Pandemic Influenza

o Respiratory Infection Control: Respirators Ver-sus Surgical Masks

Posters: Process Safety Man-agement Depends on You!(OSHA Publication 3316) Publications and GuidanceDocuments• Guidance on Preparing

Workplaces for an Influ-enza Pandemic – Spanish translation (OSHA Publica-tion 3364)

• InformationforEmployers:Complying with OSHA’s Bloodborne Pathogens Standard (flyer developed by the National Institute for Occupational Safety and Health and OSHA)

Cards (OSHA and American Association of Occupational Health Nurses Alliance)• Violence Prevention inHealthcare IDCard (March2009)

•Workplace Violence inHealthcare Quick Tip Card (March 2009)

OSHA issues H1N1 Compliance DirectiveOn November 20, 2009 OSHA issuedaComplianceDirectivefor H1N1 titled, CPL-02-02-075 - Enforcement Procedures for High to Very High Occupational Exposure Risk to 2009 H1N1 Influenza. The purpose of the directive is to ensure uniform procedures when conducting inspections to identify and minimize or eliminate high to very high risk occupational exposures to the 2009 H1N1 influenza A virus.

By MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

Association Community Liaison Report

OSHA Alliance UpdateOn November 9, 2009 the AOHP Alliance Implementa-tion Team and OSHA held a quarterly conference call. Items discussed included OSHA’s participation at the AOHP National Conference in Portland, Oregon and the ge-neric respirator fit testing and training card that was jointly developed. The card is avail-able on the AOHP Web site. Sheila Aubury from the OSHA Office of Occupational Health Nursing shared that the Inter-national Safety Equipment As-sociation is embarking on the development of a voluntary industry standard for eye and face protection. A stakeholder meeting was held in Novem-ber to kick off the formation of the standard. Conference calls will be held on a monthly basis to create the standard. AOHP plans to be a part of this effort.

Medical Laser Safety Training Course DevelopedTheLaser InstituteofAmeri-ca has developed a four-hour laser safety course as part of their OSHA Alliance. The MedicalLaserSafetyTrainingCourse was presented at the Association of periOperative Registered Nurses (AORN) 56th Annual Congress, McCor-mick Place, Chicago, Illinois, in March 2009. The availability of this information can be shared with the surgical departments in our facilities.

New OSHA Compliance Assis-tance and Alliance Program Par-ticipant ProductsThe following products may be useful resources for prac-tice and/or employee educa-

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The directive closely follows theCentersforDiseaseCon-trol’s(CDC)guidance.

The directive was developed in response to complaints. OSHA inspectors will ensure that healthcare employers implement a hierarchy of con-trols and encourage vaccina-tion and other work practices recommended by the CDC.Where respirators are required to be used, the OSHA Respira-tory Protection standard must be followed, including worker training and fit testing. The directive also applies to insti-tutional settings where some workers may have similar ex-posures, such as schools and correctional facilities.

The CDC recommends theuse of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact (within six feet) with patients who have suspected or confirmed 2009 H1N1 in-fluenza.

Where respirators are not commercially available, an employer will be considered to be in compliance if the em-ployer can show a good faith effort has been made to ac-quire respirators.

Where OSHA inspectors de-termine that a facility has not violated any OSHA require-ments but that additional mea-sures could enhance the pro-tection of employees, OSHA may provide the employer with a hazard alert letter out-lining suggested measures to further protect workers. For more information, visit www.osha.gov.

NiOSH UpdateRecently, AOHP provided comments on two NIOSH documents. The first was the

NIOSH National Occupational Research Agenda strategic goals of the National Health-care and Social Assistance Agenda developed by the Healthcare and Social Assis-tance Council. The goals have been divided into the follow-ing five broad categories and address a variety of healthcare hazards:

Strategic Goal 1: Promote safe and healthy workplaces, and optimize safety culture in healthcare organizations.

Strategic Goal 2: Reduce the in-cidence and severity of mus-culoskeletal disorders among workers in the healthcare and social assistance sector.

Strategic Goal 3: Reduce or eliminate exposure and ad-verse health effects caused by hazardous drugs and other chemicals.

Strategic Goal 4: Reduce sharps injuries and their im-pacts among all healthcare personnel.

Strategic Goal 5: Stop transmis-sion of infectious diseases in healthcare and social assis-tance settings among work-ers, patients and visitors.

AOHP supported the research activities for each of the goals and requested that the issue of slip/trip/fall prevention be includedinStrategicGoal2.

The second document that AOHP responded to was the NIOSH Request for Infor-mation on Alternative Duty:Temporary Reassignment for Health Care Workers Who WorkwithHazardousDrugs.NIOSH requested the com-ments because it intends to publish a Current Intelligence Documentonalternativedutyand other forms of adminis-trative controls for healthcare

workers who work with haz-ardous drugs and are trying to conceive, are pregnant and/or are breast feeding. Visitthe AOHP Web site at www.aohp.org to see the full com-ments on both of these docu-ments.

Risk of Serious Illness Among Healthcare Personnel Associ-ated With 2009 H1N1 Influenza: What Is NIOSH Learning?Reports in the media have as-sociated the deaths of at least four nurses with 2009 H1N1 influenza. Efforts to gain a full-er understanding of the preva-lence of serious H1N1 illness and fatalities among nurses, as well as other healthcare personnel, have been limited due to a lack of occupational data in existing healthcare surveillance systems. More efforts are needed to fully appreciate the prevalence of severe H1N1 illness among healthcare workers.

NIOSH is working with its partners to gather more infor-mation about deaths and seri-ous illness among healthcare personnel associated with 2009 H1N1 influenza. These surveillance activities are aimed at better understanding the factors that may heighten the risk of severe work-related 2009 H1N1 infection among healthcare personnel, as well as identifying the factors which affect risk of transmis-sion of 2009 H1N1 influenza to healthcare personnel.

Healthcare personnel are at increased risk of occupational exposure to the 2009 H1N1 virus based on their likelihood for encountering patients with 2009 H1N1 illness. In contrast to seasonal influenza virus, 2009 H1N1 influenza virus has caused a greater relative burden of disease in younger people, which includes those in the age range of most healthcare personnel. For

some healthcare personnel, this higher risk of exposure and illness may be compounded by the presence of underlying illness, which places them at higher risk of serious flu com-plications, such as asthma, diabetes or neuromuscular disease. Of particular concern to the healthcare workforce, which is largely female, is the fact that pregnant women are among those groups consid-ered to be at higher risk of severe infection from 2009 H1N1.

NIOSH Seeks Test Sites for Study on OR Personnel Exposure to Chemo DrugsNIOSH is seeking test sites to analyze operating room per-sonnel exposure to chemo-therapy drugs, many of which are known to be carcinogenic.

The objective of the study is to characterize how operating room personnel are exposed to chemotherapy drugs used to treat specific cancers with a treatment procedure known as intraperitoneal chemother-apy, which is being used more frequently. This procedure involves pre-heating a che-motherapy drug solution and then introducing the drug so-lution into the peritoneal cav-ity of the patient. The study will examine both the “open” technique and the “closed” technique and is designed to identify potential exposure pathways and enable develop-ment of improved work prac-tices and recommendations for proper types of personal protective equipment and en-gineering controls.

Healthcare facilities interest-ed in participating in the study should contact Thomas Con-nor,PhDbye-mail at tmc6@cdc.gov. Read more about operating room exposure to chemotherapy drugs in the November issue of AORN Connections.

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Ready to ResearchBy Linda Good, RN, PhD, COHN-S

Linda GoodColumn Editor

As I write this column, we are in the middle of a historic event – a worldwide influ-enza pandemic. Occupational health has been impacted sig-nificantly, faced with:• Double flu immunization

campaigns.•Worldwide backorders on

N95 respirators.• Asurgeinsick-callsandthe

need to manage frequently changing return-to-work cri-teria.

• Juggling administrativebusiness: continuity needs, infection control directives, and generalized staff and management anxiety.

• Communication issues –Balancing between too much information and too little information.

My challenge to you today is to seize this unprecedented opportunity and view it as a chance to contribute to the occupational health body of knowledge. Let’s shift ourthinking from “This has been the worst year of my life!”to “I’ve just accomplished

the impossible and have best practicestoshare!”Principleslearned from this unique ex-perience have the potential to impact not only our occupa-tional health niche but far be-yond by filling in the evidence-based practice gaps in other realms:

Disaster Preparedness: The pandemic represents a type of biologic, mass-casualty scenario. Lessons learnedcould be applied beyond the current natural disaster to ac-cidental and intentional expo-sure events.Business Continuity: Sick-call patterns can give valuable insights into report-to-work intentions, projected staffing patterns in direct care and support departments, and establishment of alternative staffing plans.Communication: The pandemic made it necessary to provide messaging to staff on every-thing from sick-call criteria to immunization clinics to respi-rator fit testing. What meth-odology was best received? Was the frequency too much (causing distress,) too little (causing suspicion,) or “just right” (feeling supportive)? Take-away lessons could be applied to other high-alert events, from the arrival of The Joint Commission to a mass-casualty disaster.Human Resources: We all want our hospitals to be great plac-es to work and magnets to attract the best and brightest talent. Examining staff reac-tion to mandatory vaccination, availability of antivirals, work-ers’ compensation coverage boundaries, availability of fam-ily vaccinations, and the sup-port of co-workers and lead-ership could provide useful insights into what the frontline staff truly value.

The Pandemic Research ChallengeYour first-person account of this pandemic experience is invaluable and needs to be shared. Consider gathering your observations and prepar-

ing an article for the Journal or a poster or breakout session for the 2010 AOHP National Conference. Consider jotting down your experiences and ideas and e-mailing them to me. A compilation of lessons learned would make a terrific Journal article, not only for sharing among ourselves, but publishing it as guidance from theexperts–us!

To stimulate your brainstorming:Report Innovations: How did you deal with census and/or sick-call surges to maintain business continuity? Did youuse electronic record-keeping to track sick-calls, vaccination consent/declination, supply inventory or antiviral prescrip-tion?Didyouusebarcodeorother unique technology? Examining Best Practices: How didyoumotivatestaff?Didyoufind a way to give a less painful shot by varying the gage, arm position or scripting? Compare FluMist® vs. injection, includ-ing observations and lessons learned.Didyouuseanycre-ative strategies for immuni-zation or fit testing, such as “SWAT Teams,” department “DesignatedExperts,”mobileclinics, drive-through clinics or other innovations?Identifying Issues: Did you ex-perience vaccine shortages or delays?Didyouneedtotriagethe order of vaccination?Didyou experience shortages of N95s or other supplies? Didyour facility mandate “shot or mask,” and if so, how was this received?

So, let’s make history! Takethe Pandemic Research Chal-lenge and invest some time sharing your innovations, best practices and issues: good.linda@scrippshealth.org.

Researching the Pandemic

“Great leaders are almost always great simplifiers, who can cut through argument, debate, and doubt, to offer a solution everybody can understand.”General Colin Powell, Chairman (Ret.), Joint Chiefs of Staff

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Interview with Ann Scott Blouin, PhD, RN, Executive Vice President, Division of Accreditation and Certification Operations, The Joint Commission

By Sandra Domeracki Prickitt, RN, FNP, COHN-S

AnnScottBlouin is theExecutiveVicePresident in the Division of Accredita-tion and Certification Operations at The JointCommission.Dr.Blouinisrespon-sible for oversight of the accreditation and certification of more than 17,000 healthcare organizations and programs, including all activities related to surveys and the accreditation and certification processes, sentinel events, complaints and performance measurement require-ments. She also oversees the standards interpretation function, surveyor man-agement and development, customer relationship and account management, and the ongoing development and re-finement of the priority focus process and the periodic performance review.

The Mission and Vision of The JointCommission are:

Mission: To continuously improve health-care for the public, in collaboration with other stakeholders, by evaluating health-care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

Vision: All people always experience the safest, highest quality, best-value health-care across all settings.

Question: Can you explain the goal(s) of The Joint Commission’s Nursing Advisory Council?

Answer: The role and function of the Nursing Advisory Council is to help ad-vise The Joint Commission on key is-sues that affect patient care quality and safety from the view of professional nurses. But, the Council’s role is really much broader. The Council also looks

at how interdisciplinary teams function toward patient care quality and safety and how nurses work as team mem-bers. This occurs across the continuum of organizations providing patient care to include hospitals, home care, hos-pice, ambulatory centers and clinics. The Council consists of members from nurs-ing administration, research, education and clinical areas.

Question: What is your role with the Nursing Advisory Council (NAC)?

Answer: I am the senior staff member assigned from The Joint Commission to help support the work of the NAC. Based upon my background as a regis-tered nurse with experience in clinical practice, education, administration and consulting, I endeavor to help support discussion on key healthcare issues of interest to the Council. In addition, I work together with the chairperson, Marilyn Chow, RN, DNSc, FAAN. Wemeet several times per year and annu-ally assess the most important and chal-lenging issues. There are many salient issues this year that we are working on, including healthcare policy at the nation-al level, 2009 H1N1 influenza, seasonal influenza, workplace safety issues and aging of the workforce. For example, the NAC discussed preparing and providing testimony for the Robert Wood Johnson InstituteofMedicineGranton“TheFu-ture of Nursing.” This is something the NAC is proud to be addressing. We are in the process of consolidating the po-sition statements to present testimony, adding the context of the NAC and The Joint Commission.

Question: What do you see as the role of the NAC moving forward with issues for healthcare work-ers in the hospital setting?

Answer: Healthcare worker safety is key to patient safety. The NAC continues to be involved in critical areas that influ-ence patient safety:• Infection Prevention and Control is

ever present and includes properly performing flash sterilization, hand hy-giene, preparing for and managing the 2009 H1N1 influenza vaccination and worker safety (including vaccines.)

•MedicationManagementincludesde-vice administration safety and medi-cation reconciliation processes. The latter is currently under evaluation by The Joint Commission. By mid 2010 or 2011, there will be a revised National Patient Safety Goal on medicationsafety.

• ElectronicMedicalRecord(EMR).Cur-rently, in most healthcare facilities, documentation is done electronically and on paper. This poses several chal-lenges in locating and communicating key patient information.

• PatientFlow.Emergencydepartmentsacross the nation are experiencing increased patient flow due to the economy with patients lacking primary care access, along with the surge of the 2009 H1N1 influenza. Because ofEMTALA,emergencydepartmentscannot turn anyone away before they are triaged, medically evaluated and able to determine the correct level of care. Thus, emergency departments are overwhelmed, and bed availability has become even more challenging. In this stressful situation, healthcare workers are exposed to potentially in-creased risks of breakdowns in safety

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due to the volume of patients present-ing for care.

• SkinCarehasalwaysbeen importantand is one of the Nurse Sensitive Performance Measure Set Indicators (prevention of decubitus ulcers) which has been endorsed by The Joint Com-mission’s Board. NAC and the Perfor-mance Measurement Work Group,both led by nurse board members, was instrumental in supporting these efforts.

•Othersafetyissuesthataffectboththepatient and the nurse are, of course, needle sticks and patient falls.

Question: What does The Joint Commission believe are and will be the most important issues for occupational health professionals to be focused on for healthcare workers in the hospital setting?

Answer: One crucial issue is the aging of the healthcare workforce. Increas-ingly, the demographics are showing a higher percentage of older adults in the workforce, and the average age contin-ues to increase. Some nurses stay in the workforce due to the economy and the recent decrease in retirement savings. Other nurses who were away from the workforce are coming back or adding to their part-time hours. One concern related to aging of the workforce is the acute and chronic illnesses that older healthcare workers are more likely to ex-perience, such as arthritis, diabetes and hypertension. Of particular concern for aging healthcare workers in the hospital setting are back injuries related to patient handling and lifting in general.

The Joint Commission strongly believes that healthcare workers play an integral role in identifying, establishing and main-taining a culture of safety within their or-ganizations. Nurses especially see many opportunities to improve safety for their patients, as well as for themselves and their co-workers.

Question: What recommenda-tions do you have, on behalf of The Joint Commission, for AOHP to support its members to best serve their hospital population?

Answer: Help work on identifying a culture of safety for nurses, including an extension into their personal lives. There is a need to be sensitive as to how this affects patient safety and vice versa. Re-search shows that with increased trust in the healthcare setting, employees will tend to report concerns more read-ily, whether related to a faulty piece of equipment, the height at which a sharps container is mounted, etc. The Joint Commission is discussing the issue of transparency a great deal. Transparency needs to be a part of the culture of a healthcare setting. Transparency allows for all members of the healthcare team to communicate more openly about challenges versus being fearful and hid-ing issues or concerns. Currently, this is one of The Joint Commission’s biggest goals. Two significant areas of concern where The Joint Commission feels im-proved transparency is needed are hand-off communications problems and wrong site surgeries. Patient adverse events re-main prevalent despite the many efforts targeted at improvement.

Question: What will be the pri-orities in your area at The Joint Commission over the next two to four years?

Answer: •Moveintoa“relationshipbased”mod-

el with customers to improve safety and quality, decrease risks and increase transparency with The Joint Commis-sion and its customers. Healthcare organizations should feel comfortable contacting The Joint Commission with their concerns and challenges. We are currently in the process of building a database that will be a repository for leading practices such as those being developed collaboratively with par-ticipating healthcare systems in the Center for Transforming Health Care. The goal is to launch a new database in January 2010 for the surveyors to populate; by July 2010, it should be available to The Joint Commission’s customers.

• Continue the work The Joint Com-mission has initiated this past year to redevelop its processes by using

SixSigma,LeanThinkingandchangemanagement tools.

• Implementmoreeffective,user-friend-ly electronic applications for Joint Com-mission customers.

• Redesign an interim intracycle moni-toring tool, the Periodic Performance Review, focusing on high-risk areas.

• FocusThe JointCommission’s tracermethodology review on emerging high-risk clinical and administrative ar-eas such as contracted services.

Question: Are there other com-ments you and/or The Joint Com-mission would like to make to the AOHP membership?

Answer: The Joint Commission has just revised or “refreshed” its vision and mission. I strongly believe in the changes which have been made. The Joint Com-mission’spresident,MarkChassin,MD,MPP, MPH, believes The Joint Com-mission should focus not just on what healthcare organizations need to do, but help them learn how to do it effectively and efficiently. The “how” is the art to improving and maintaining safety and quality.

I encourage AOHP to talk with members about how their healthcare organizations are evaluated and inspired by The Joint Commission. “Inspiration” is the key word and most exciting aspect of The Joint Commission helping to improve patient care. Inspiring includes coaching, teaching, guiding and sharing leading practices. AOHP members play an im-portant role in spreading these practices throughout the country.

I invite you to visit http://www.center-fortransforminghealthcare.org/ to learn more about The Joint Commission’s Center for Transforming Healthcare. Established in 2009, the Joint Commis-sion Center for Transforming Healthcare aims to solve healthcare’s most critical safety and quality problems. The Cen-ter’s participants – some of the nation’s leading hospitals and health systems – use a proven systematic approach to analyze specific breakdowns in care and discover their underlying causes to de-velop targeted solutions that solve these

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complex problems. In keeping with its objective to transform healthcare into a high reliability industry, The Joint Com-mission will share these proven effec-tive solutions with the more than 17,000 healthcare organizations and programs it accredits and certifies.

The Joint Commission Center for Trans-forming Healthcare is introducing an in-novative approach to identify, create and implement consistent safety solutions that address quality and safety chal-lenges facing healthcare organizations. These challenges threaten lives and in-crease costs.

Historically, The Joint Commission has led the way nationally and internationally to identify the highest priority healthcare quality and safety problems and to ad-dress them. With National Patient Safety Goals, coremeasures and state-of-the-art accreditation standards which exceed the CMS Conditions of Participation, hos-pitals and other healthcare organizations

know where they should be focusing their efforts to gain the greatest improve-ments in safety and quality. Many already devote sizable resources to this end. Yet, major shortfalls in quality and safety continue to persist. The Joint Commis-sion Center for Transforming Healthcare aims to address critical safety and quality problems, such as healthcare-associated infection (HAI), wrong site surgery, and medication errors. Healthcare-associat-ed infection (HAI) is among the top 10 causes of death in the U.S. Nearly two million patients contract an HAI annually, and in hospitals, this adds nearly $9,000 in expenses per impacted patient. Surgery performed on the wrong site, body part or patient occurs less frequently, but still at an unacceptable rate. Every day, there are about a half-dozen of these incidents in hospitals nationwide, and every one of them is preventable. More than 400,000 harmful medication errors occur in hospi-tals annually, adding an extra $3.5 billion to the cost of hospital care.

The Center is developing solutions through the application of the same Robust Process Improvement™ (RPI) methods and tools that other industries have long relied on to improve quality, safety and efficiency. Currently, the lack of convincing data is a key weakness in efforts to improve safety and quality. Current projects the Center is working on are hand hygiene, hand-off commu-nications and the Rhode Island Universal Protocol Project.

On behalf of AOHP, I would like to thank Ann Scott Blouin and her staff for their time, expertise and responses to this interview. AOHP looks forward to its ongoing work and opportunities with its partnership with Dr. Blouin and The Joint Commission’s Nursing Advisory Council.

Thank you!

Are you a hospital occupational/employee health nurse? If you answered, “Yes”,youshouldgivestrongconsiderationtobecomingcertified!Why?

Read on for the Top 10 reasons to become a certified occupational health nurse.1. Certification is a mark of prestige.2. Certification is a significant personal and professional accomplishment.3. Certification can advance your career.4. Certified OHNs earn significantly more.5. Employers regard certification as a mark of quality and rely on certification when making employ-

ment decisions.6. The certified OHN provides knowledgeable management of occupational injuries and illnesses

and facilitates early return to work processes.7. The certified OHN can reduce the employer’s legal exposure through management of regulatory

requirementssuchasOSHA,FMLA,ADA,DOT,HIPAA,etc.8. Certification enhances your disease management and health promotion skills.9. Certified OHNs make a positive impact on the employer’s financial bottom line.10. Certification augments competence and on-the-job productivity.

In addition, the American Nurses Credentialing Center will require certification for Magnet Status. For further information please contact www.abohn.org or call the ABOHN office at 888-842-2646 or 630-789-5799.

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Colleague Connection

The Home Health Worker – A Population Vulnerable to Patient Handling Injury

By Esther Murray, RN, COHN-S

The growth of the home health sector is being driven by the aging of the baby boomer in the United States. The Insti-tute of Medicine’s report – Retooling for an Aging America (2008) reports that the baby boomers will begin to turn 65 by 2011, and that by 2030 will number 70 million and make up 20 percent of the U.S. population (Institute of Medicine, Nationalacademies.org.)

Home healthcare is the fastest grow-ing segment of the healthcare industry and an underexplored subpopulation of healthcare professionals (Waters, Collins, Galinsky & Caruso, 2006.) TheHome Healthcare Worker (HHCW) per-forms the duties of lifting, transferring and moving the patient alone. Often, the duties the HHCW performs are with a patient who is in a bed that is not ad-justable, in a crowded room, thus mak-ing the environment less than ideal for difficultpatienthandlingtasks(Galinsky,Waters&Malit,2001.)

The National Institute for Occupational Safety and Health (NIOSH) is evaluat-ing and researching this population. The home health environment is a unique healthcare situation. Each home is dif-ferent, and some homes are safer than others. The home is the patient’s prop-erty and in essence, the patient is the king of the castle. The HHCW is a guest working in the home with no control over the work environment. The under-lying struggle is who is responsible for safety in the home health environment, the employer or the patient who may own the property?

Meyer (1999) reported, in the first study of HHCWs, that the bulk of the home

healthcare workers were women, of ethnic minorities beginning with an entry-level job with minimal training. A recentstudybyGong,Baron,StockandAyala (2009) reported that 90 percent of HHCWs are women, 50 percent are minorities, and 25 percent speak a lan-guage other than English at home.

The central health issue that drew the fo-cus of researchers over the last decade was the HHCW’s risk of overexertion injuries as demonstrated by the injury rates. First, Meyer (1999) reported that despite the higher rates of injury of the nursing home worker, the HHCW had a more severe injury resulting in more lost work days. More recently, the rate of injury among the HHCW has soared. Galinsky,WatersandMalit(2001)statedthat musculoskeletal injury rates have been shown to be higher in HHCWs than in many other groups studied, in-cluding construction workers. These au-thors went on to report that the rate for HHCWs is 161 injuries per 10,000 work-ers. This is compared to the national rate of overexertion injuries at 54 per 10,000 workers, and the general healthcare in-dustry rate of 100 per 10,000 workers. The rate of overexertion injuries for HH-CWs is three times the national rate.

This rate of injury is alarming and has resulted in several other initiatives by NIOSH in researching the home health work setting. One study focused on HH-CWs in California. The program’s goal was to empower the HHCWs to initiate safety changes with their clients while incorporating the cultural value of re-spectingelders (Gong,Baron,Stock,&Ayala, 2009.) These studies, although slow and difficult to conduct, are making

a difference in understanding the home healthcare environments.

Barriers to Safety in the HomeThe barriers that HHCWs face in making the environments safer for themselves, as well as for the clients and caregivers’ spouses, are becoming clearer, and cre-ative ways to change the workplace are being discovered. Gong, Baron, Stockand Ayala (2009) report several barriers that the HHCW perceived in approach-ing their clients and families in making safe changes (2009.) Power dynamics between the patient and HHCW may leave the HHCW unwilling to commu-nicate with the client. The HHCW faces many fears, one of which may be job loss. Another is the perception that the client does not demonstrate an interest in the safety of the HHCW.

The client is often an elderly patient who may be unwilling to make changes in their surroundings to promote a safer environment. Clients may also be un-able to afford to make changes, such as a hospital bed purchase. These barriers, including power dynamics and physical environment issues, pose difficulties for the HHCW without the assistance of an RN supervisor.

Long-term effects of musculoskeletaldisorders in healthcare workers have spurred research in this general area of healthcare workers and their exposure to high weight limits. The rate of expo-sure to high weight lifts, awkward posi-tions and overexertion are compounded by the psychological demands of the job duties. The home healthcare sector has a high level of absence related to poor health, such as long term sick leave,

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disability pension and occupational dis-orders (Dellve, Lagerstrom&Hagberg,2003.) These factors compound the al-ready unusual physical workload and can lead to a more severe injury.

The ANA conducted a survey in 2001 and found that 83 percent of respon-dents complained of back pain during work but continued working (Menzel, 2008.) Healthcare workers avoid report-ing their injuries by being very creative about rescheduling their shifts and working around the injury due to peer pressure and frustration with the work-ers’ compensation system. The nurse may be the only indicator of what the home health aide is experiencing. HH-CWs may be concerned about taking time away from work and may believe that they could lose their job if they re-port an injury.

The Family Caregiver The family caregiver mentioned earlier is another part of the home caregiving equation. This population is under re-searched as well, but organizations such as the American Association of Retired Persons (AARP) are taking up the cause and giving voice to family caregivers. Houser and Gibson (2008) estimatedthat the dollar value each year for fam-ily caregiving is more than $365 billion (AARP.org/ppi.)

Suggested Areas for Change in the Home Health EnvironmentSeveral studies have suggested areas for changes in the home health envi-ronment.Parsons,GalinskyandWaters(2006) outline some different assistive tools to improve the ergonomic design of the home environment. Most assis-tive devices suggested are low cost and easily adaptable to the home. Gong,Baron, Stock and Ayala (2009) studied a group of HHCWs and found that as-sisting the focus groups with finding community resources, as well as role playing to practice effective communica-tion, were creative measures that could change the home care environment for the better.

Gong, Baron, Stock and Ayala (2009)reported on several strategies to imple-

ment safety behaviors across a cultur-ally diverse group of home healthcare workers in California. Training was given to assist the HHCW in approaching the patient about unsafe or risky situations inthehome.Duringthetraining,theem-ployees were given the opportunity to role play their reactions and possible re-sponses to client responses. The HHCW could present safe alternatives like a lift, and assistive devices such as friction reducing devices, in addition to demon-strating how everyone’s safety could be enhanced. Family caregivers may not, at first, embrace the assistive device, but as patients and caregivers seek to remain safe at home, the resistance is lowered.

The work being done by healthcare equipment manufacturers, and the utili-zation of lifts and other devices to the home care environment, are critical to keeping HHCWs and family caregivers safe. Ceiling lifts and other ergonomical-ly assistive devices such as friction re-ducing devices in many different styles are being promoted for use in the home environment. Traditional lift equipment, such as floor lifts, is usually too large for the home to accommodate. The chroni-cally disabled client does not have ac-cess to the bathroom with most floor lifts. Ceiling lifts are useful devices for patients, as well as the family caregiver. The strategies for change in the home health environment would be imple-mented by the employer, and the meth-ods would need to be approved and fi-nanced with agency funding. But, safety interventions for HHCWs are challeng-ing at best, as each home is individual and the strategies for one client may not require the same interventions that are needed for the next patient. Some strat-egies to promote safety can be standard-ized as they apply to the employee.

Home Health is a New Safe Patient Handling FrontierThe home healthcare setting is a rela-tively new setting for the implementa-tion of safe patient handling programs. Long term care facilities implementedsafe lift programs more than a decade ago. Hospitals have also implemented safe patient handling (SPH) programs

throughout their organizations for many years.

However, home health agencies have only begun to identify the need and implement the use of assistive devices forhigh-risktasks.Duetothedifficultyof mandating changes to the home en-vironment, it has been difficult to make the monetary investment in SPH devic-es needed to assist with changing lifting behaviors. Family caregivers have been struggling to give care to their loved ones in the home for years. Often, the family must obtain the funds needed to bring about changes in the home lifting environment.

The implementation of a SPH program needs to be multi-faceted. Multi-media material, as well as addressing different training styles, help to familiarize staff and family caregivers in the use of dif-ferent assistive devices. Consideration needs to be made regarding language barriers, as well as the potential literacy barriers to learning. The skills that are needed to operate the equipment also need to be considered. Typically, the SPH training is comprised of a video, a short lecture, some discussion and at least half of the time devoted to hands-on practice with the equipment so the employee is comfortable and competent with the operation.

Goals for a Home Health SPH ProgramThe goals of any SPH program would be to decrease the injuries of the patients in transfer while providing a safer envi-ronment for employees. Another goal would be to increase the retention and recruitment of new employees. Before these benefits are realized, the home healthcare worker must recognize that there is a hazard present in the patient’s home.

The employer will provide a safer work environment and may see that their workers’ compensation premiums de-crease in response to the decrease in injuries. Implementing a SPH program represents a focused period of training in the classroom and at the bedside. For the home health worker, there may be

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an additional component of training to introduce the equipment to the home health client. Fong, Baron, Stock and Ayala (2009) suggest that role playing and social marketing be used to dissemi-nate information about the availability of equipment and other resources.

Several hospital systems have imple-mented SPH programs in their home health services. The goals for each SPH programaresimilar.GoalsfortheKalei-da Health SPH program for home care were listed as decreasing employee injury, increasing safety for other care-givers and increasing the safety for the client (Pless, 2008.)

A hospital in Wisconsin reported their safe patient handling program focused on patient safety (Biese, 2007.) Middle-sex Hospital in Connecticut reported a 66 percent reduction of patient handling cases over their three-year intervention, a 50 percent reduction in the total num-ber of injuries, and a 75 percent reduc-tion in the number of average lost work days (Smart Moves, 2007.) These SPH programs demonstrate that the goal of reducing employee injuries while pro-viding for patient safety is an attainable goal.

The implementation of a SPH program in any healthcare organization should be tracked over time to prove effective-ness. The organization should celebrate incremental successes that follow the hard work of achieving positive changes (Fragala, 2003.) Several outcomes can be measured fairly easily as the employ-ee injury reports (providing that the em-ployee reports the injury) can be tracked through the workers’ compensation carrier. The number of injuries, the type of injury, the cost of the injury and lost workdays all give indicators of the ef-fectiveness of a SPH program (Fragala, 2003.)

Additionally, there are other benefits that are not so easily measured, but still need to be quantified to see the prog-ress that is being made. These addition-al benefits are employee satisfaction, patient satisfaction and employee turn-over (AOHP, 2006.) By measuring these

outcomes, the effectiveness of the SPH program takes shape and bolsters the confidence to continue the journey of change. Changing a deep seated habit such as manual lifting is a long process that takes consistent review, followed by communication of outcomes to all who will listen.

Suggested project goals may include re-ducing employee injuries by 50 percent over three years. Another reasonable goal could be to increase employee sat-isfaction as evidenced by lowering em-ployee turnover by 25 percent over three years. A patient centered goal might be to decrease patient falls in transfer by 50 percent over three years. Program goals may be integrated with the use of assis-tive devices.

Sustaining a Home Health SPH ProgramSustaining a SPH program requires com-municating the results, as well as train-ing and retraining. In the home health environment, problems could present as staff are working in the field alone and usually don’t have available staff support to problem solve. The Middlesex Hospi-tal presentation points out several mea-sures taken (Smart Moves, 2007.) One of the measures paired a home health aide with an occupational therapist, es-pecially when training on new equip-ment. Second, the aide was empow-ered to recognize dangerous situations. Third, the licensed staff communicated and carried out the plan of care, which included outlining the proper equipment used with the patients. Owens and Stae-hler-Skalitsky (2003) reported that the nurses in their study were asked to com-plete a home safety assessment where they would identify the need for the use of assistive devices. If the home safety assessment is conducted but not com-municated by adding the information to the plan of care, the aide is not prepared to use assistive devices. If the nurse has done the safety assessment but hasn’t followed up to get the proper equipment sent out to the house, the aide arrives for the next visit and the equipment is not available.

Journey of ChangeDuring implementation, nursing staffhave been overwhelmed at how easy assistive devices make it to move and care for patients. In some cases, staff has expressed anger that their organiza-tion has taken so long to bring them safe lifting equipment.

Some issues that need to be addressed include: slings have to be washed sepa-rately, lifts have to be made available, and as such, assessments must be done consistently on every new patient as well as done periodically during their time of care. RNs and therapists must learn a new skill in matching the equip-ment with the patient’s mobility level (Owen and Staehler-Skalitsky, 2003.) The change in routine is not always easy, and auditing helps the manager to understand how the process of change is proceeding.

Assigning the SPH program to an em-ployee who can consistently work with the staff in problem solving, training/ retraining and communicating results to administrators is essential. Training the employees to recognize a risk and then match the risk with the proper assistive device is essential. Communicating pro-gram goals to other staff, as well as to the client and family caregiver, is part of the empowerment of the staff to take an ac-tive role in their own safety. Making rou-tine rounds to see the employees at work and talk with clients is part of the auditing oftheprogram.Documentingpatientandfamily satisfaction is also a component of a successful SPH program.

There have been moments when a fam-ily caregiver will confide that they were thinking of placing the patient in a long term care center, but because of assis-tive devices or addition of a ceiling lift, they are able to continue to give care with the help of the home healthcare worker. These moments represent the successes of a SPH program that has reached out into the home. The fam-ily caregiver experiences the benefit of identifying the risks and meeting those risks with an assistive device, and as an outcome they stay together in the home as a family.

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ReferencesAOHP-OSHA Alliance Implementation Team. (2006.) BeyondGetting Started: A resource guide for imple-menting a safe patient handling program in acute care settings. Retrieved from: http://www.aohp.org/About/documents/GSBeyond.pdf

Biese, A. (2007.) Safe patient handling in home health. Retrieved from: www.dwd.state.wi.us/healthcare/powerpoint/biese_uwm042007.ppt

Dellve,L.,Lagerstrom,M.,Hagberg,M.(2003.)Work-system risk factors for permanent work disability among home-care workers: a case-control study. Inter-national Archives of Occupational and Environmental Health,Vol.76,pp.216-224.

Department of Veterans Affairs. (2005.) Ergonomicsguide book part one. Retrieved from: http://www1.va.gov/visn8/patientsafetycenter/resguide/ErgoGu-idePtOne.pdf

Fragala, G. and Pontani-Bailey, L. (2003.) Addressingoccupational strains and sprains: Musculoskeletal inju-ries inhospitals.AAOHNJournal,Vol.51(6),pp.252-259.

Galinsky,T.,Waters,T.,Malit,B.(2001.)Overexertioninjuries in home healthcare workers and the need for ergonomics. Home Health Care Services Quarterly, Vol.20(3,)57-73.

Gong,F.,Baron,S.,Stock,L.,Ayala,L.(2009.)Forma-tive research in occupational health and safety inter-vention for diverse, underserved worker populations: a homecare worker intervention project. Public Health Reports,Vol.124(1,)pp84-89.

Houser,A.,&Gibson,M.(2008.)Valuingtheinvaluable:the economic value of family caregiving, 2008 update. AARP Public Policy Institute. Retrieved from: http://www.aarp.org/research/ppi/health-care/health-costs/articles/i13_caregiving.html

Institute of Medicine. (2008.) Retooling for an aging America. Retrieved from: http:// books.nap.edu/cata-log.php?record id_12089

Kendra, M. (2002.) Perception of risk by administra-torsandhomehealthaides.PublicHealthNursing,Vol.19(12,) pp 86-93.

Meyer, J., Muntaner, C. (1999.) Injuries in home health-care workers: an analysis of occupational morbidity from a state compensation database. American Jour-nalofIndustrialMedicine,Vol.35:295-301

Menzel, N. (2008.) Underreporting of musculoskeletal disorders among health care workers. AAOHN Journal, Vol.56(12,)pp487-494.

Owen, B., Skalitsky-Staehler, K. (2003.) Decreasingback stress in home care. Home Healthcare Nurse, Vol.21(3,)pp180-186.

Pless, P. (2008.) Safe patient handling for all health-care workers, understanding the risk associated with working in the home care industry. Retrieved from: www.labor.ny.gov/workerprotection/safetyhealth/ppt/Paula%20homecare.ppt.

Parsons, K., Galinsky, T.,Waters, T. (2006.) Sugges-tions for preventing musculoskeletal disorders in home healthcare workers. Home Healthcare Nurse, Vol.24(3,)pp159-164.

Smart Moves. (2007.) Middlesex hospital homecare approach to clinical staff injuries related to patient han-dling. Retrieved from: http://www.ctsmartmoves.org/doc/SPH_Middlesex.pdf

Ulatowski, T. (June 10, 2009.)Warning Letter. FoodandDrugAdministration.Retrievedfrom:http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm183985.htm

Waters, T., Collins, J., Galinisky, T., and Caruso, C.(2006.) NIOSH research efforts to prevent musculosk-eletal disorders in the healthcare industry. Orthopaedic

Nursing,Vol.25(6,)pp380-388.

Esther Murray, RN, COHN-S, is the As-sistant Director of Clinical Services for Prism Medical, Ltd., based in St. Louis, MO. Esther has been an Occupational Health Nurse for 24 years, with 10 years focused on occupational health of the healthcare worker. Prism Medical is a U.S. manufacturer of patient lifts and as-sistive devices for safe patient handling in all healthcare settings. Esther is cur-rently a member of the AOHP PA-SW Chapter.

AOHPGETTINGSTARTEDOn-The-Road Workshop

A One-Day Workshop – Getting Started in Employee Health

Plainfield, iN (near indianapolis airport)Friday, June 18, 20108:30 am to 5:30 pm

Location: Hendricks Regional Occupational Medicine 1100SouthfieldDr.PlainfieldIN46168Cost: Member $305 Non-member $345 (IncludesBoxLunch)Register by: May 28, 2010Site Coordinator: DeborahA.Plummer,BSN,RNRegistration: AOHP Headquarters 800 362-4347, info@aohp.org and on www.aohp.org/education

Make My Job Easier!

This 8-hour program offers valuable resources to new and seasoned occupational health professionals. Register today!

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Germs at Your FingertipsContaminated Keyboards

By Kathy Espinoza, MBA, MS, CPE, CIE

Say the word “keyboard,” and you have most ergonomists thinking about repeti-tive motion injury prevention. But, add the words “H1N1 and keyboards” in the same sentence, and you have the atten-tion of the workforce. Quick poll ques-tion: How often do you disinfect/clean your keyboard? Once a day? Once a week? Once a month? Was I supposed to?

Here’s another poll question: Which has more germs per square inch? …A toilet bowl,cellphone,Blackberrydevice,TVremote control or your computer key-board? Am I making my point? If not, try these…Doyoueatwhiletypingonthecomputer? Do you put your fingers inyour mouth while thinking? If your eyes feel tired, do you rub your eyes with yourhand?Doyouhavecoldsymptomstoday? Do you blow your nosewith atissue and go right back to working on thekeyboard?DoIhaveyourattentionnow?

While repetitive motion injury prevention from computer keyboard and mouse us-age is important to ergonomists, pre-venting the spread of flu via the key-board should be important to everyone. In light of the present pandemic flu sea-son with a Spring surge expected, one must consider how easily colds, flu and other infectious diseases are transferred from contact with all office equipment. This includes phones, desks, keyboards and computer mice. Realizing just how often fingers touch computer keyboards, it’s not surprising that research studies are finding that keyboards host a galaxy of germs just waiting for transport from the keys into your body via your nose, mouth and eyes. Workers coming to work with symptoms (presenteeism)

can infect others in the office and leave a trail of viruses on every surface they touch, some which can survive up to three days.

GermstudiesconductedbyDr.CharlesGerba,UniversityofArizona,foundthatphones, desktop surfaces, keyboards, mice, fax machines, copy machines and toilet seats all contain germs that can make us sick. In Gerba’s 2006 study,samples were collected from private offices and cubicles in office buildings located in Washington, D.C., Los An-geles, San Francisco, Oregon and New York City. A total of 113 surfaces were tested and analyzed at the University of Arizona laboratories. Here is the germ count found: 1. Phone: 25,127

germs per square inch

2.Desktopsurface:20,961 germs per square inch

3.Keyboard:3,295germs per square inch

4. Mouse: 1,676 germs per square inch5. Toilet seat: 49 germs per square inch

From a health and safety standpoint, it makes sense because custodial/EVScrews clean toilet seats frequently, us-ing strong disinfectants that kill germs. Keyboards and other computer equip-ment rarely get cleaned for fear of dis-turbingsomeone’swork.Keyboardandmouse cleaning/sanitizing is usually left up to the employee, often as they feel necessary.Keyboardsarereceptaclesofcoughs and sneezes, as well as germs from unwashed fingers and hands from poor hygiene. This human factor/ma-chine germ exchange not only occurs at work, but at home and in schools as well. Most schools and family house-holds have more than one shared com-puter.

Exposure: In February 2007, the Cen-tersforDiseaseControlandPrevention(CDC)documentedanoutbreakofgas-trointestinal disease attributable in part to a norovirus found on a shared ele-mentary school computer keyboard and mouse (Morbidity and Mortality Weekly Report, CDC, Jan. 2008.) The diseasewas contracted by 27 students and two facultymembersataWashington,D.C.elementary school. Samples were taken from surfaces including toilets, faucets, water fountains, doorknobs, mice, key-boards, school utensils and toys. The CDCfoundthatalltheinfectedpersonshad been in one first grade classroom where teachers and students shared computers. One computer mouse and keyboard in the first grade classroom had a norovirus identical to the virus contracted by the students and teach-ers. This 2007 outbreak was the first re-port of norovirus, commonly referred to as the stomach flu, detected on a com-puter mouse and keyboard.

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Lunchtime Picnic with the Germ Family: Poll question:Doyoueatlunchatyourdesk?A 2006AmericanDieticianAssociationsurvey found that 57 percent of workers eat/snack at their desks at least once a day. As our current economy pressures the workforce into working longer hours, coming to work when sick and packing a lunch to eat at the desk, our office can become known as the “Bacteria Cafete-ria,” where germs are happy to partake in your delectable breakfast, lunch and dinner menu.

Here is another poll question: Doyoucleanyour desk before you eat/snack at the desk?TheADAsurveyalsofoundthatmore than 75 percent of workers “only occasionally” clean their desks before eating, and 20 percent never do. One cause of a bug-infested keyboard is eat-ing lunch at your desk where food de-posits encourage the growth of millions of bacteria. Poor personal hygiene such as not washing your hands after going to the restroom can also contribute.

Sexist Germs: I looked at who was germier at work, men or women, and I naturally assumed that males would win. So, if men are fromMarsandwomenarefromVenus,which planet has a germier office envi-ronment?

Most germs found:Phone: Women Keyboard:WomenComputer mouse: WomenDesk:MenExclamation key on keyboard: WomenPens: Women

Interesting note: Although this looks like women tend to corner the market on germs at work, men lost the battle when itcametotheirwallets.Gerbafoundthatmen’s wallets were the single germiest itemintheoffice,ha!Theirwalletshadfour times more germs than a woman’s purse.

Cleaning the Dirty Qwerty: (means key-board…Ergo Humor!). Employers maybe able to reduce absenteeism by en-

couraging regular cleaning of often-touched work items and surfaces. Here are a few suggestions for cleaning and protecting yourself.

Keyboards:Commercially, there are disinfecting wipes that aim to get rid of bacteria con-taminantsonkeyboardsandmice.Lookfor ones that remove dirt, dust, dander and biological contaminants. Be sure to checkwithyourITDepartmentfortheirrecommendations on which products to use, as wet materials may interfere with keyboard functionality. For shared com-puter keyboard use, consider an antimi-crobial computer keyboard, where silver ions are embedded into the plastic to resist bacteria. If this option is not avail-able, be sure you take personal respon-sibility to wipe the shared computer key-board down before you use it. To help remind yourself to sanitize regularly, try scheduling your email reminder program to alert you at regular intervals.

Desktop items:Commercial disinfectant wipes are effec-tive in reducing germs and should be read-ilyavailableoneverydesktop.Getintoahabit of wiping down the entire desk and desktop items (phone, light switches, handles, etc.) at the beginning and end of each day, as well as before eating at the desk. As there is a tendency to use one wipe on consecutive surfaces, be aware that this can spread bacteria from one location to another. Studies recommend using one wipe for one application on one surface, then discarding.

Hand Washing:It is a well documented fact that frequent hand washing is one of the best ways to avoid getting sick and spreading illness (Mayo Clinic.) It requires only soap and water or an alcohol-based hand sanitizer — a cleanser that doesn’t require water.

Hand Washing with Sanitizers: Alcohol-based hand sanitizers, which don’t re-quire water, are an excellent alternative to soap and water. Be sure to choose a commercially prepared hand sanitizer that contains at least 60 percent alcohol (Mayo Clinic.)• Apply enough of the product to the

palm of the hands to wet completely.

• Rubhands together, covering all sur-faces, for up to 25 seconds or until dry.

Although keyboard usage is typically known for its repetitive motion injury po-tential, it is now being recognized as a vector in the transmission of flu germs to users. With seasonal flu and H1N1 scheduled to make their appearance shortly, it is prudent to take precautions to protect yourself and your staff from contagious diseases. Although there are no surfaces under the sun absent from germs, taking a few simple steps can substantially reduce the risk of disease transmission from computer and office equipment.

Kathy Espinoza is a Board Certified Pro-fessional Ergonomist, with an MBA and a Master’s Degree in Work Science/Physiology. She has worked at Keenan & Associates for seven years providing injury prevention training to office per-sonnel, hospital workers, Special Edu-cation staff, municipalities and custodial grounds employees. Kathy also teaches Ergonomics in the Workplace at UC, Riv-erside and has 33 articles published in the field of ergonomics.

References1.CDC.Norovirus: technical fact sheet.Atlanta,GA:USDepartmentofHealthandHumanServices,CDC;2006. Available at http://www.cdc.gov/ncidod/dvrd/revb/gastro/noro-factsheet.pdf.

2. CDC. A list of cleaning products effective againstnorovirus approved by the Environmental Protection Agency is available at http://www.epa.gov/oppad001/list_g_norovirus.pdf.

3.Gerba,Charles,UniversityofArizona,2006.

4.MayoClinic.HandWashingDo’sandDon’ts.http://www.mayoclinic.com/health/hand-washing/HQ00407/METHOD=print.

5. Morbidity and Mortality Weekly Report: Norovirus OutbreakinanElementarySchool-DistrictofColum-bia, February 2007. http://www.cdc.gov/mmwr/pre-view/mmwrhtml/mm5651a2.htm.

6. Po-Liang Lu, L. k Siu, Tun-Chieh Chen, Ling Ma,Wen-GinChiang,Yen-HsuChen,Sheng-FungLinandTyen-Po Chen. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association withclinical isolates.BMC InfectiousDiseases2009,9:164doi:10.1186/1471-2334-9-164. www.endonurse.com.

7. Reinberg, Steven. Stomach Flu Spread by Contami-natedComputerKeyboards,2007. http://health.msn.com/health-topics/infectious-diseases.

8.RutalaWA,WhiteMS,GergenMF,WeberDJ.Bac-terial contamination of keyboards: efficacy and func-tional impact of disinfectants. Infect Control Hosp Epi-demiol 2006; 27:372-7. http://www.ncbi.nlm.nih.gov/pubmed/16622815?dopt=Abstract.

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Retaining an Aging Nurse Workforce: Perceptions of Human Resource Practices

By Mary Val Palumbo, Barbara McIntosh, Betty Rambur, and Shelly Naud

Copyrighted content. Please contact AOHP Headquarters at 800-362-4347 or info@aohp.org to

purchase a copy of this Journal issue.

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CALL FOR SPEAKERSAOHP 2010 NATiONAL CONFERENCE

Boston, MA September 15-18, 2010

Doyouhaveasuccessstoryofhowyouconqueredachallengeorprobleminyourclinicalpractice?Doyouknowsomeonewhowouldbe a great presenter at the AOHP 2010 National Conference? The AOHP 2010 Conference Committee invites those interested in pre-senting at the National Conference to submit a proposal.

Topics may include any of the following:• Immediateoradvancenewtreatment;post-exposureprophylaxis• Wellnessintheworkplace• Effectofwellnessondisabilitycosts• Makingtheappropriatereferrals-• Needlesticks• ReturntoWorkPrograms• DisabilityManagement• PreplacementExamination&FitnessforDuties• Influenzavaccination• FitnessforDuty• BloodAssayforTB-QuantiFERON-TBGold

These are just a few suggestions. Speaker application form is avail-able on the AOHP Web site at www.aohp.org/education/national-con-ference or send your abstract to info@aohp.org.

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Winter 2010

Safe Patient Handling and Movement in a Pediatric Setting

By Kathleen Motacki and Lisa Marie Motacki

Copyrighted content. Please contact AOHP Headquarters at 800-362-4347 or info@aohp.org to

purchase a copy of this Journal issue.

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of the Association of Occupational Health Professionals in Healthcare

Swine Flu: Reducing Risk, Quelling Fear A good offense is the best defense.

By Eileen Shue, SPHR

Copyrighted content. Please contact AOHP Headquarters at 800-362-4347 or info@aohp.org to

purchase a copy of this Journal issue.

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of the Association of Occupational Health Professionals in Healthcare

Julie Schmid Research ScholarshipAOHP is accepting proposals for original research projects on current and/or anticipated issues in hospital-related occupation-al health. The Research Scholarship Award is $2,000. For more details, visit Awards and Scholarships at www.aohp.org or call Headquarters, 800 362-4347.

DeadlineforsubmissionsisJuly1.

Call for Award NomineesNominees for the following awards are being sought:

Ann Stinson President’s Award for Association Excellence –recognizes a chapter that has demonstrated outstanding performance and enhanced the image of occupational health professionals in healthcare.

Joyce Safian Scholarship Award – recognizes a past or present association officer who best portrays an occupational health professional in healthcare role model.

Extraordinary Member Award – recognizes a current association member who demonstrates extraordinary leadership.

Honorary Membership Award – recognizes a person(s) who has made a significant contribution to the field of occupational health in healthcare.

Business Recognition Award – recognizes a business(es) that supports occupational health professionals, and membership and participation in AOHP.

Nominations need to be submitted to the national office by July 1st. Contact your chapter president or regional director for award criteria, or visit www.aohp.org.

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Winter 2010

AOHP Solicits Poster Proposals2010 National ConferenceSeptember 15-18, 2010Boston

Posters are an excellent, low stress venue in which to present your research and innovations. A poster is an opportunity to publish a very short article and discuss it with your peers. It may be an overview of a technical topic, problem, question, research, case study or success story. Your poster will be viewed throughout the conference, so the main ideas should be clear without explanation.

Posters will be displayed nearby the registration area and exhibit hall. This will give all conference attendees the opportunity to read your post-ers, and/or for you to discuss your posters with your colleagues. Poster authors are responsible for setting up and taking down their poster. All posters are judged and eligible for recognition.

Abstracts are due by March 31, 2010. We peer review all abstracts for relevance to enforce health protection and the author’s area of expertise. We will notify you by April 15, 2010, the status of your submission and will include information in our conference brochure.

BeyondGettingStarted–AResourceGuide:Preparingfor Mass Immunization/Prophylaxis of Healthcare Workers Healthcare Workers are among the most important individuals to protect in the event of an infectious disease outbreak. AOHP has developed a resource guide for your use in the event of a mass immunization/prophylaxis. This document is provided in pdf format. The sample pages are also provided in Word format so that you may tailor for use at your institution.

ThisresourceisfreetomembersontheAOHPWebsiteunderMarketplace/BeyondGettingStarted.

A New Website

Resource!

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AOHP Journal Executive EditorKimberlyStanchfield,RN,COHN-SEditor, Journal of AOHP—in Healthcare235CantrellAvenue,Harrisonburg,VA22801(540) 433–4180 kstanchf@rhcc.com

AOHP HeadquartersJudyLyle,ExecutiveDirector109VIPDrive,Suite220,Wexford,PA15090(800) 362-4347; Fax: (724) 935-1560E-mail: info@aohp.org Web: www.aohp.org

AOHP Editorial BoardExecutive Board Officers

President:SandraDomerackiPrickittdomeras@sutterhealth.org

VicePresident:AlfredCarbutoacarbuto@montefiore.org

Secretary: Betsy Holzworthbholzworth@culpeperhospital.com

Treasurer: Christine Pionkcpionk@med.umich.ued

Regional Directors

Region1:ShariLyonsShari_Lyons@elcaminohospital.org

Region 2: Carolyn Amrichcarolyn.amrich@childrens.com

Region3:DelynnLamottdlynnrlamott@msn.com

Region4:LindaWyliewyliel@acmh.org

Region5:LydiaCrutchfieldLydia.crutchfield@carolinas.org

Chapter Presidents

Alabama:KellyWhittenkwhitten@uabmc.edu

CaliforniaNorthern:DianeHogandhogan@svmh.com

Sierra:CharleneLundclund@childrenscentralcal.org

Southern: Christine ShiosakiChristine.shiosaki@verizon.net

Colorado: Heidi Bouwensheidibouwens@centura.org

Florida: CathyMcCullochcathy.mcculloch@tenethealth.com

Georgia:SusanMeierSusan.crozier-meier@northside.com

Heart of America:KansasCity:ShellieAndramandra@saint-lukes.org

Houston Area: Maitine Riveramaitine.rivera@hcahealthcare.com

Illinois:DeniseKnoblauchDenise.K.Knoblauch@osfhealthcare.org

Maryland: Cheryl Hlaston-Haapalachaapala@stagnes.org

Michigan: Peggy Anderson Andersp2@oakwood.org

Midwest States: Mary CoyleMCoyle@ecommunity.com

NewEngland:MaggieKelleymkelley@suscom-maine.net

New York:Nassau/Suffolk: Wendy Bezko-ColliganWendy.Bezko-Colligan@chsli.org

NorthCarolina:EllenGlovereglover@halifaxrmc.org

Oregon:Portland:LindaBeasley-Freemanlbeasley@lhs.org

Pacific Northwest: Beverly Hagarbeverly.hagar@vmmc.org

Pennsylvania: Central: Bobbi Jo Hurstbjhurst@lancastergeneral.org

Eastern:StephanieDillmandillmas@slhn.org

Southwest:DeborahGrupacdgrupac@wpahs.org

South Carolina: Julie AndersonJulie.anderson@ oconeemed.org

Virginia:NancyPikenpike@culpeperhospital.com

Wisconsin: Carla CislerCisler.carla@marshfieldclinic.org

MissionThe AOHP is dedicated to promoting the health and safety of workers in healthcare. This is accomplished through:

Advocating for employee and safety•Occupational health education and •networking opportunities.Health and safety advancement through •best practice and research.Partnering with employers, regulatory •agencies and related associations.

Journal of Association of Occupational Health Professionals (AOHP) —in Healthcare (© 2010 ISSN 0888-2002) is published quarterly by the Association of Occupational Health Pro-fessionals in Healthcare and is free to members. For Information about republication of any article, visit www.CopyrightClearancecenter.comThe AOHP JournalisindexedintheCINAHL®database.

Statement of Editorial Purpose The occu-pational health professional in healthcare is in a key position to help insure the health and safety of both the employees and the patients. The fo-cus of this Journal is to provide current healthcare information pertinent to the hospital employee health professional; provide a means of network-ing and sharing for AOHP’s members; and thereby improve the quality of hospital employee health services.

The Association of Occupational Health Profes-sionals in Healthcare and its directors and editor are not responsible for the views expressed in its publications or any inaccuracies that may be contained therein. Materials in the articles are the sole responsibility of the authors.

Editorial GuidelinesAOHP Journal actively solicits material to be considered for publication. Complete Editorial Guidelinescanbefoundathttp://aohp.org/pages/member_services/journal.html.

Advertisement GuidelinesAdvertisement guidelines are available from AOHP Headquarters (800) 362-4347; Fax: (724) 935-1560; E-mail: info@aohp.org.

Send Copy to KimberlyStanchfield,RN,COHN-SAOHP Journal Executive Editorkstanchf@rhcc.com

Publication deadlines for the Journal of AOHP—in Healthcare:Issue Closing DateSpring February 28Summer May 31Fall August 31Winter November 30

Subscription RatesOne year (4 issues), $150; Back issues when available, $35.00 each. Reader participation welcome.

Membership/SubscriptionsAddress requests for information to AOHP Head-quarters,109VIPDrive,Suite220,Wexford,PA 15090; (800) 362-4347; Fax: (724) 935-1560; E-mail: info@aohp.org.

Journal AdsAddress requests for information to AOHP Headquarters at (800) 362-4347

Moving?Bulkmailisnotforwarded!ToreceiveyourJournal, please notify our business office of any changes:AOHPHeadquarters,109VIPDrive,Suite 220, Wexford, PA 15090; 1-800-362-4347; Fax: (724) 935-1560; E-mail: info@aohp.org. Upcoming AOHP Conferences

2010 – Sept. 15-18 - Boston

2011 – Sept.28 - Oct. 1 - Minneapolis

All material written directly for the Journal of the Association of Occupational Health Professionals in Healthcare is peer reviewed.

109 VIP Drive, Suite 220Wexford, PA 15090

www.aohp.org

Address Service Requested

PRSRT STDU.S. Postage

PAIDWarrendale, PAPermit No. 20

Who? Other Occupational Health Professionals in your area who don’t enjoy the advantage of AOHP membership. What? You will be eligible to win a special reward in our Recruit Our Colleagues (ROC) campaign!•GrandPrize–Free2010AOHPNationalConferenceregistrationPLUSfournights’hotelaccommodations.Justrecruit10newmembersbyJune30,2010!(IfnoAOHPmember recruits at least 10 new members, the AOHP member who recruits the greatest number of new members under 10 will receive a free 2010 AOHP National Conference registration.)

•2ndPlace–Thememberwhorecruitsthesecondhighestnumber of new members will be awarded a free one-year AOHP membership.

•ChapterAward–Thechapterthatrecruitsthemostnewmembers will be awarded $250 to be used at their discretion.

When? At your earliest opportunity!

Why? Membership has advantages. Founded in 1981, AOHP is the only national professional organization that exclusively addresses the needs and concerns of the occupational health professional in healthcare. AOHP is recognized as the definitive resource for issues related to employees in the healthcare setting. Through conferences, continuing education, publications and legislative advocacy, AOHP keeps its members updated and involved. AOHP membership benefits include:

RECRUiT OUR COLLEAGUES CAMPAiGN CONTiNUES iNTO 2010…

COME ON, EVERyONE, AND “ROC” FOR AOHP!• Networkingatchapterandnationallevels.• Continuingeducationopportunitiesthroughchaptersandthe

Annual National Conference. AOHP is a continuing nursing education provider.

• GettingStartedManualandworkshopfornewcomerstooccupational health in healthcare.

• Quarterlypeer-reviewedJournaloftheAssociationofOccupational Health Professionals in Healthcare.

• Quarterlye-newsletter.• MonthlyAOHPe-Bytes.• Accesstopositionstatementsandstandardsofpractice.• LegislativerepresentationthroughtheGovernmentAffairs

Committee at the national level as pertinent issues emerge. • Personalopportunitiestodevelopleadershipskillsand

professional growth. • Scholarshipopportunities.• Listserv.• DirectlinkstoWebsitesofinterest.

How? Give these professionals a call, send them a note and direct them to our Web site: www.AOHP.org. Be sure that your new member lists you as their recruiter on their membership application. (In the event of a tie, a drawing will be held to select the winners.)

Betsy Holzworth, RN, BSN, COHN-S/CMHuman Resources Committee Chair