Search

Objective: To examine violence inspections at the Occupational Safety and Health Administration (OSHA)., Methods: The authors examined all inspections that involved violence against workers begun by January 1, 2019. They conducted semi-structured interviews with compliance officers who had conducted inspections on a sample of facilities that received General Duty Clause (GDC) citations (n = 22) or Hazard Alert Letters (HALs) (n = 22)., Results: By January 1, 2019, OSHA initiated 726 "violence" inspections, with 502 (69.1%) in healthcare. In healthcare, 45 (11.1%) resulted in GDC citations and 241 (67.7%) in HALs. GDC facilities received statistically significantly lower scores in 5 of 6 domains examined through semi-structured interviews than HAL facilities. Both groups of facilities had poorly designed recordkeeping systems., Conclusions: Health care facilities continue to generate worker complaints with poorly designed violence prevention programs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Objective: The aim of this study was to describe risk factors for heat-related illness (HRI) in U.S. workers., Methods: We reviewed a subset of HRI enforcement investigations conducted by the Occupational Safety and Health Administration (OSHA) from 2011 through 2016. We assessed characteristics of the workers, employers, and events. We stratified cases by severity to assess whether risk factors were more prevalent in fatal HRIs., Results: We analyzed 38 investigations involving 66 HRIs. Many workers had predisposing medical conditions or used predisposing medications. Comorbidities were more prevalent in workers who died. Most (73%) fatal HRIs occurred during the first week on the job. Common clinical findings in heat stroke cases included multiorgan failure, muscle breakdown, and systemic inflammation., Conclusion: Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.

Objective: The study examined the relationship between onsite occupational health practice characteristics, provider choice, and workers' compensation outcome metrics., Methods: Cross-sectional survey of 140 medical center occupational health clinics within the Department of Veterans Affairs. Multivariate regression models examined how specific clinical quality factors influenced provider choice and workers' compensation measures., Results: Several practice characteristics were associated with higher rates of in-house care selection-longer hours of operation, greater availability of workers' compensation-related medical services, clinic administration by a board certified physician, physician tenure, and adherence to clinical practice guidelines. Access to onsite, occupational and environmental medicine certified physician-directed care was associated with reductions in disability duration among injured healthcare workers., Conclusions: These findings suggest that occupational medicine board certification can positively impact provider choice among fully insured patients, which may have implications for other healthcare systems.

Objective: The objective of this article is to introduce the reader to this special supplement to the Journal of Occupational and Environmental Medicine regarding Federal Workers' Compensation Programs., Methods: The short history of both the VHA and DoD Federal Workers' Compensation Programs are provided and a short synopsis of each author's article is provided., Results: The lessons learned from the articles in the supplement are summarized in this article and 6 key findings are highlighted., Conclusions: Cooperation between human resources workers' compensation personnel, safety and occupational health personnel is a must for successful management of the WC program. Information and data sharing are critical for root cause and injury prevention, case management, and cost containment efforts. Enhancing efforts in these areas will save an estimated $100 million through cost avoidance efforts.

Background: The Veterans Health Administration undertook a series of performance improvement projects (PIP) using local initiatives identified through a national committee of regional workers' compensation representatives., Methods: A steering committee identified five types of risks and interventions that were considered worthwhile. They defined performance metrics as outcome measures and distinguished short-term from long-term disability management success., Results: Eight specific PIPs were implemented. No statistically significant differences in the planned outcome metrics were identified, although cost-benefit evaluations did identify a benefit., Conclusions: Conducting quantitative PIPs in a large system requires top management commitment, sequestration of funds, and mature systems.

Objective: The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes., Methods: A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases., Results: Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance., Conclusions: Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.

Objective: Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration., Methods: We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified., Results: Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability., Conclusions: The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.

Background: Veterans Health Administration (VHA) is a national health care system with variation in hand hygiene (HH) measurement and improvement practices across its facilities. The objective of this national survey was to characterize this variability and identify opportunities for standardization., Methods: Survey covered 3 major areas of HH: (1) methods of measuring HH compliance, (2) interventions to improve HH compliance, and (3) site-specific targets for HH compliance., Results: One hundred forty-one (100%) VHA medical centers returned the survey. A majority (98.6%) of the medical centers conduct direct observations to measure HH compliance rates. Fewer than half (45.3%) validate the observer process at the onset, and fewer still (39.6%) continue to validate observers. Main behaviors that are considered HH opportunities are room entry (69.1%) and exit (71.9%). Improvement interventions include posters (97.2%), feedback (eg, 98.6% to leadership), and improved access to HH products (eg, 90.6% provide individual hand sanitizers to staff). Mandatory education programs for clinical staff are conducted in 88.5% of the medical centers. The majority of the medical centers (77.3%) set their HH compliance target over 90%., Conclusion: Although HH improvement interventions are relatively similar across VHA medical centers, variation exists in compliance monitoring. Findings will assist in standardizing surveillance and next steps in hand hygiene policy in VHA., (Published by Mosby, Inc.)

Objective: To describe a 15-year process creating an industry standard of practice without regulatory support through organizational leadership., Methods: Description of the development and rollout of a safe patient-handling program, including the initial scientific development, a cultural history, and agency data., Results: Patient-handling injuries represent more than 20% of injuries to nurses. These declined by more than 40% throughout the program. In parallel, program scope and implementation evolved through collaboration across facility program managers in one organization, among various organizations, and between users and equipment manufacturers. Program success required a shift from a technology focus to culture change and behaviors., Conclusion: Program evolution arises from collaborative practice and interactions between individual practitioners, organizational needs and interests, and manufacturers. Creation of a public forum was critical to changes in a meanwhile internationally accepted standard.

Background: We sought to describe the components and processes in a violence risk assessment and management system, including electronic record requirements in the Veterans Health Administration (VA). We present information on system-level variation among program elements and their association with perceived and measured effectiveness., Methods: We conducted a cross-sectional survey of Chiefs of Staff (COS) at 140 VA hospitals across the United States about specific disruptive behavior program elements, such as committee processes, patient referrals, and outcome patterns. We assessed COS perceived effectiveness of the processes. We compared COS perceptions with employee-reported assault-related incident rates and workers compensation lost time claim rates for assault-related injuries for 2009 and 2010., Results: We found the violence risk assessment and management system is heavily used, often with guidance to provide police protection for providers. COS respondents were generally satisfied with design and performance of the system. Committee processes and perceptions of effectiveness were associated with reduction in assault-related incident rates., Conclusions: VA's system was considered effective by system owners and users may be effective at reducing assaulted-related injuries., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: The main objectives of our study were to explore reasons for seasonal influenza vaccine acceptance and declination in employees of a large integrated healthcare system and to identify underlying constructs that influence acceptance versus declination. Secondary objectives were to determine whether vaccine acceptance varied by hospital location and to identify facility-level measures that explained variability., Design: A national health promotion survey of employees was conducted that included items on vaccination in the 2009-2010 influenza season. The survey was administered with two other institutional surveys in a stratified fashion: approximately 40% of participating employees were randomly assigned to complete the health promotion survey., Setting: National single-payer healthcare system with 152 hospitals., Participants: Employees of the healthcare system in 2010 who responded to the survey., Methods: Factor analysis was used to identify underlying constructs that influenced vaccine acceptance versus declination. Mean factor scores were examined in relation to demographic characteristics and occupation. Multilevel logistic regression models were used to determine whether vaccine acceptance varied by location and to identify facility-level measures that explained variability., Results: Four factors were identified related to vaccine declination and were labeled as (1) "don't care," (2) "don't want," (3) "don't believe," and (4) "don't know." Significant differences in mean factor scores existed by demographic characteristics and occupation. Vaccine acceptance varied by location, and vaccination rates in the previous year were an important facility-level predictor., Conclusions: Results should guide interventions that tailor messages on the basis of particular reasons for declination. Occupation-specific and culturally appropriate messaging should be considered. Continued efforts will be taken to better understand how workplace context influences vaccine acceptance.

Objective: To determine baseline prevalence of health behaviors and chronic health conditions in Veterans Health Administration (VHA) employees and highlight disparities by occupation group., Methods: There were 29,834 responses to the survey. Age-standardized prevalence estimates for VHA employees were compared to national estimates from BRFSS surveys. The VHA estimates were analyzed for physicians and dentists; physician assistants and nurse practitioners; registered nurses; licensed practical nurses and nursing assistants; other clinical; nonclinical; and wage grade staff. Multilevel regression explored the effect of worksite., Results: The VHA employees have higher rates of unhealthy behaviors and chronic health conditions than US adults, except for smoking. Results illustrated significant disparities between occupation groups by demographics and variability by worksite., Conclusions: Veterans Health Administration's population appears less healthy than the US general population. Disparities between occupation groups support the establishment of targeted health promotion programs, with attention paid to differences in local culture.

Objective: To determine relations between sick leave use and the 2009 novel influenza A (H1N1) influenza pandemic among clinical and nonclinical staff in the Veterans Health Administration (VHA)., Methods: Aggregate sick leave use for all VHA employees was monitored in near-real time during the 2009 H1N1 influenza pandemic and compared with historical data from 2004 to 2008. The ratio of sick leave use between clinical and nonclinical staff was examined. An autoregressive integrated moving average model was used to assess whether the pandemic had a significant effect on sick leave use., Results: The H1N1 influenza pandemic was associated with a significant effect on sick leave use in the VHA during the second wave of the pandemic. During this wave, the ratio of clinical to nonclinical sick leave use changed; clinical staff began taking more leave than nonclinical staff for 3 successive 2-week pay periods, with ratio measures of 1.004, 1.018, and 1.011, respectively. Using an autoregressive integrated moving average model with a pulse variable representing the pandemic, there was a significant effect on sick leave use. The average hours of sick leave used per full-time equivalent staff member per month increased by 0.3904 hours (P = .003) for clinical staff and 0.3898 hours (P = .01) for nonclinical staff over previous months during the first month of the second pandemic wave., Conclusions: Work loss associated with a pandemic is an important indicator of disease activity and may be a more sensitive indicator of emerging strains than deaths. Monitoring sick leave use in near real time in a large national health care system may be an important early indicator of pandemic severity with practical implications that should be considered in addition to more traditional measures of influenza epidemic and pandemic severity.

Objective: This study examined the relationship between changes in assault rates over time and the implementation of a workplace violence prevention (WVP) program in 138 Department of Veterans Affairs health care facilities., Methods: Data on WVP implementation were assessed for each facility by a three-person team. We computed three WVP dimension scores: training, workplace practices, and environmental control and security. We obtained 6 years of assault rate data from the national injury system. Using a linear mixed model, we analyzed whether the WVP implementation was associated with lower assault rates controlling for time and organizational characteristics., Results: Training implementation was negatively associated with assault rates. Facilities with smaller bed sizes and without academic affiliates had lower assault rates., Conclusions: Particular attention should be given to these dimensions because they may be associated with lower facility-level assault rates.

Goals: The authors examined assault frequency and risk factors in health care., Methods: The authors conducted a cross-sectional questionnaire survey in 142 hospitals. Analyses are presented at the level of the individual and aggregated by facility., Results: Thirteen percent of employees described at least 1 assault in the last year; the proportion assaulted per facility ranged from 1% to 26%. Patients were the most common assaulters. Working in geriatrics, mental health, and rehabilitation or in nursing represented a high risk for assault. Hours of work and work patterns represented major risk factors for assault, as were higher measures of organizational stress. The penetration of training in alternate dispute resolution strategies was associated with lower rates of assaults., Conclusions: Although work in health care is associated with high rates of assaults, closer scrutiny suggests specific possible intervention strategies.

Background: Despite the recognition of chemical emergencies, terrorist events, and ongoing threats, little practical guidance exists for healthcare facilities., Methods: An approach and materials developed by the Veterans Health Administration in a five-element program over the last 2 years to enhance the existing emergency management program is outlined. Nine steps to the development of a comprehensive all-hazards, emergency plan and program, with auditing and improvement tools are offered., Results: Cognitive aids for clinical use are available on-line and in hard copy. A hazard assessment modeled patients as emission sources documenting the operations strategies under which level C personal protective equipment will protect healthcare workers. The development of this response program appears to support a broader, long-standing VHA approach to problem solving. This involves bringing together individual talented field staff, representing specific skills, geographic regions, and work styles; investing in face-to-face consensus development; and developing programs with extensive internal peer-review ("field-based," "bottom-up and top-down," and external reviews)., Conclusions: Comprehensive and effective programs can be constructed at low cost with reasonable speed within large systems with a public mandate, leading to responsible use of public funds internally, and as models for private sector programs. It is the long-term operational cost implications, under budget constraints in health care, which often present the true challenge., (Copyright 2004 Wiley-Liss, Inc.)

The 535 reports of nonoccupational/nonagricultural poisoning with malathion in the Pesticide Incident Monitoring System (PIMS), a data base maintained by the Environmental Protection Agency, were coded and classified to describe the occurrence and to determine risk factors for poisoning. Between 1966 and 1980, 335 (63%) of reported incidents were associated with at least one symptomatic person, with a total of 670 persons exposed. Home exposures accounted for 92% of reports and arose from improper use and labeling problems in 61% and 3% of reports, respectively. Seventeen reports (3%) were associated with commercial extermination at home. One third of the 18 fatalities from malathion were unintentional and, therefore, preventable. The relative risks of fatal outcome from suicidal intent and labeling problems were, respectively 41 (P less than 10[-6]) and 4.8 (P = .09). When data from a previously coded data set on diazinon were added, the odds ratios were 20 and 6.7 (both P less than .0003). This suggests that public health measures aimed at safer use of pesticides outside the workplace are needed and that the PIMS data are a valuable source of epidemiological data on pesticide poisoning.

Complaints in modern buildings have been attributed to inadequate ventilation for the last 20 years. Few data exist to support this claim. In fact, few studies have actually looked at ventilation and complaints at the same time. These missing studies indicate a failure of three groups of professionals, physicians and health scientists, architects and engineers, and scientists knowledgeable in exposure assessment, to study the topic together. This article will provide a conceptual framework for each of the three approaches and give some guidance on preventing problems.

Five occupants of an office developed symptoms compatible with organophosphate intoxication after application of chlorpyrifos, a moderately toxic pesticide. Recovery of erythrocyte cholinesterase levels occurred during the subsequent three months but followed an exponential distribution rather than the constant rate of recovery most investigators have assumed. This pattern suggests redistribution of the active organophosphate after absorption to a second body compartment with subsequent slow release of the still active substance into the bloodstream.