Ergonomic and Psychosocial Risk Factors for Injuries in Healthcare Work

Transcription

1 Ergonomic and Psychosocial Risk Factors for Injuries in Healthcare Work Laura Punnett, Jon Boyer, Manuel Cifuentes, Angelo d Errico, Rebecca Gore, Jungkeun Park, Jamie Tessler, and the PHASE in Healthcare Research Team University of Massachusetts Lowell Supported by the National Institute of Occupational Safety & Health Grant #R-OH78, Health Disparities Among Healthcare Workers PHASE Study Facilities and Population Healthcare workers in Merrimack Valley region (northeastern MA) privately-owned hospitals nursing homes All employees on payroll and 8+ years old. Not restricted to direct patient care jobs Sources of Data () Sources of Data () OSHA logs of occupational injury/illness Workers compensation claims and First Reports of Injury Facility workforce rosters Job titles coded by U.S. Standard Occupational Classification (SOC) Questionnaire surveys of current employees Self-administered (only of hospitals) Occupational exposures Demographics; mental and physical health; etc. ONET (v.): Ergonomic and organizational job features, from expert or worker rating, by job title U.S. Department of Labor Replaces Dictionary of Occupational Titles Nationally representative, on-line database Might miss local differences in working conditions? Sources of Data () Workplace observations of physical ergonomic exposures, safety hazards, work organization PATH (Postures, Activities, Tools and Handling) Continuous visual observation on-site (-8 hours) Fixed-interval (9-second) sampling to record task and exposures Workplace features evaluated include. Physical and psychosocial exposures Job control, demands, social support Ergonomic job features Family-work balance Organizational climate and policies Support for diversity Safety climate Organizational responsiveness

2 On Your Feet in Healthcare Work Key Exposure Variables for Risk of Back Problems Clean, transport. Trades. Technicians 7. Moderate pt handling 8. Heavy pt handling 9. Managers. Clerical (Reference) Trunk Posture Severe flexion Bend/twist and flex Trunk Angle (Degrees) > > and > Manual Handling Moderate to heavy All Weight - lbs > lbs Hospitals Nursing Homes Severe flexion Bend/twist/flex Handle - lb Handle > lb Heavy Lifting Observed for Selected Job Groups Non-Neutral Trunk Postures in Selected Job Groups % of observations (weighted average of all jobs in the group) 6 8 Hospitals Nursing Homes Lifting lbs or more. Clean, transport. Trades 7. Mod pt handling 8. Hvy pt handling Reference Grp Any non-neutral (bending, twisting) Severe non-neutral / standing. Clean, transport. Trades 8. Hvy pt handling Reference (clerical) Upper Extremity Exposures in Selected Job Groups PHASE Categories of Socio- Economic Status (SES) Keyboard-intensive. Mixed clerical. Skilled trades. Technicians Label (Sample Job/s) Administrator (H.R. Director) Professional (Registered Nurse) Semi-professional (Lab technician) Skilled (Patient care assistant, clerk) Keyboard use Arm > shldr Wrist deviation Semi-skilled (Patient/dietary aide, receptionist)

3 Hand Activity Level (HAL) and Socioeconomic Status (SES) (Hospitals and Nursing Homes Combined) Upper Extremity Exposures by SES (II) 6 Median HAL Score PHASE SES Hand Activity Level Scale: Latko et al., 997 % of Observations PHASE SES Pinch Grip Contact Stress Keyboard Use Who participated in the questionnaire survey? Injury (incident) at work in past year and safety hazard score 8 7 people responded; 8% women Average age = years (± ) Average work week in the primary job = hours (± ) About % held a second job Slightly better self-rated health than U.S. general population About % had high job strain (high job demands and low decision-making at work) Safety Hazard Score 7 6 N = 7 No incident 6 One or more incidents Sum of 8 items from questionnaire: safety hazards, lack of training, understaffing, etc. Logistic regression standardized coefficient =.8 (p <.) Psychosocial Exposures: Job Control and Job Demands Job Control and Job Demands in Healthcare Work [US QES, 977] Job Control (Decision Latitude) Ability to use skills & knowledge on job Flexibility in how to meet job demands Opportunities for decision-making Psychological Job Demands Mental work load Time pressure Conflicting demands (tasks or supervisors) Decision latitude Physician Nurse Health Tech Billing Clerk Dispatcher Janitor Nurse's Aide Job demands

4 Job Control and Job Demands in Healthcare Work [ONET, ] Average Exposure Ratings (ONET) by Socioeconomic Status Decision latitude. Nurse. Dialysis or PF Tech. Radiologic Tech. Amb. Dispatcher Billing Clerk -. Janitor -. Nursing Aide Job demands Psychological demand Decision latitude Rewards Coworker support Supervisor support Pause frequency Force exertion Administrators Professionals Nurses Semi-professionals Skilled workers Semi-skilled workers High-risk jobs (OSHA logs for two hospitals, 997-) Among jobs with at least injuries (in yrs), all those with annual rates / FTE were in the two lowest SES categories: Standard Occupational Classification Injury rate (/ FTE) Janitors and building cleaners. Electrical and electronics repairers. Cooks 7. Cafeteria attendants. Maids and housekeeping cleaners.6 Nursing and psychiatric aides. Relative Risks of Injury by SES (Reference group = Administrators) Professionals Nurses Semi-professionals Skilled Semi-skilled All injuries Non lost-time injuries Lost-time injuries p <. Occupational Injuries by SES: Lost work days Relative Risks of Injury by Socio-Economic Status Socioeconomic Status (n) Administrators (9) Professionals (7) Nurses (6) Semi-professionals () Skilled (96) Semi-skilled () Average # lost days Nurses Skilled Professional Semiprof. Semiskilled Unadjusted Adjusted for force exerted, decision latitude, supervisor support, facility per FTEs (998-) Reference group = Administrators

5 Conclusions Jobs with lower socio-economic status had higher physical demands, lower decision latitude, and higher risk of injury Some of the jobs with highest physical exposures in this study were cleaning and maintenance (risk of back problem) and keyboard-intensive clerical work (risk of hand, arm, shoulder problem) Nurses have disproportionately high exposures for their socioeconomic status