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Fall 2005 Volume XXV, Number 4

3President’s Message

4Vice President’s Update

5Editor’s Column

6News & Such

8Association Community

Liaison Report

11Industrial Hygiene Issues

in Healthcare

1 2Talking Points –

Heathcare Ergonomics

1 5Spotlight on a Star

16, 19Colleague Connection

4 62005 Award Recipients

4 7Call for Posters

Journalof the

Association of Occupational Health Professionalsi n H E A L T H C A R E

F E A T U R E S D E P A R T M E N T S

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Exercise OptionsIs an on-site exercise facility or an off-sitereimbursement program better for yourorganization?By Nancy Hatch Woodward

Initiating a Comprehensive Smoke FreeEnvironment for Healthcare WorkersBy Kathy Dandino

Protocol for Safe Use of Patient HandlingSlings - Does One Size Fit All?By Laurette R. Wright, BSN, MPH, COHN-S; Celinda P.Evitt, PT, GCS, PhD; James A. Haley, VAMC; andAndrea Baptiste, MA, CIE

What’s Wrong with Me? Women’sCoronary Heart Disease DiagnosticExperiencesBy Jean C. McSweeney, PhD, RN; Leanne L. Lefler,MSN, APN, CCRN; Beth F. Crowder, PhD, RN, APN

Occupational Safety and Health Reserach

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A O H P J o u r n a l

AOHP Journal Executive EditorKimberly Stanchfield, RN, COHN-SEditor, Journal of AOHP—in Healthcare235 Cantrell Avenue, Harrisonburg, VA 22801(540) 433–4180 kstanchf@rhcc.com

AOHP HeadquartersJudy Lyle, Executive Director109 VIP Drive, Suite 220Wexford, PA 15090(800) 362-4347; Fax: (724) 935-1560E-mail: info@aohp.orgwww.aohp.org

AOHP Editorial BoardExecutive Board Officers

AOHP Executive Board OfficersPresident: Denise Strode

(309) 965-2217 x2586Vice President: Sandra Prickit

(415) 492-4790Secretary: Diane Dickerson

(703) 279-4307Treasurer: Deidre Tyler

(248) 304-4214

Regional DirectorsRegion 1: Rosalic Sheveland

(408) 947-2853Region 2: Lynne Karnitz

(920) 794-5181Region 3: Kim Casey

(618) 283-1231Region 4: Carol Cohan

(516) 663-2534Region 5: Barbara Burnette

(770) 538-7171

Chapter PresidentsAlabama: Felicia Ellison

(205) 750-5221California

Northern: Susan Borrego(831) 625-4646

Sierra: Betty Sumwalt(559) 624-5016

Southern: Diana Anderson(818) 503-6803

Colorado: Dana Jennings Tucker(303) 789-8491

Florida: Christine Stephenson(786) 662-8837

Georgia: Lynn Arndt(706) 655-5186

Illinois: Mary Bliss(309) 672-4894

Maryland: Cheryl LeeHlaston-Haapala(410) 368-2805

Michigan: Chrstine Pionk(734) 936-9242

Midwest States: Tamara Vasta(574) 647-6684

New England: Elizabeth Stowell(207) 791-3484

New York:Nassau/Suffolk: Wendy Bezko-Colligan

(516) 562-6602

North Carolina: Lydia Crutchfield(704) 444-3175

Portland, Oregon: Andrew Walker(541) 812-4182

Pennsylvania: Central: Nancy Hughes

(570) 820-6122Eastern: Stephanie Dillman

(610) 954-4704Southwest: Letitia Goodman

(412) 561-4900 x2425South Carolina: Lauren Harris

(803) 641-5677Virginia: Betsy Holzworth

(540) 829-4102Washington/Seattle: Bevery Hagar

(206) 341-0575Wisconsin: Julie Coppens

(920) 288-3011

M i s s i o nThe AOHP is dedicated to promoting the healthand safety of workers in healthcare. This isaccomplished 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 HealthProfessionals (AOHP) —in Healthcare(© 2005 ISSN 0888-2002) is published quarterlyby the Association of Occupational Health Pro-fessionals in Healthcare and is free to members.

For Information aboutrepublication of any article, visit

www.CopyrightClearanceCenter.com

Statement of Editorial PurposeThe occupational health professional in health-care is in a key position to help insure thehealth and safety of both the employees and thepatients. The focus of this journal is to providecurrent healthcare information pertinent to thehospital employee health professional; providea means of networking and sharing for AOHP’smembers; and thereby improve the quality ofhospital employee health services.

The Association of Occupational Health Profes-sionals in Healthcare and its directors and editorare not responsible for the views expressed in itspublications or any inaccuracies that may be con-tained therein. Materials in the articles are thesole responsibility of the authors.

Guidelines for AuthorsAuthors may submit articles via e-mail attach-ment in Word (version 6) to the editor atkstanchf@rhcc.com.

Manuscript GuidelinesManuscript guidelines are available through yourchapter president or by writing to the editor. (Seeaddress below.)

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

All AuthorsInclude your full name, credentials, and hospital/business affiliation. Include your supervisor’s nameand address so that a copy of your printed articlemay be forwarded.

Send Copy toKimberly Stanchfield, RN, COHN-SAOHP Journal Executive Editor235 Cantrell AvenueHarrisonburg, VA 22801

Publication deadlines for the Journal ofAOHP—in Healthcare:Issue Closing DateSpring February 28Summer May 31Fall August 31Win te r November 30

Subscription RatesOne year (4 issues), $140; Back issues when avail-able, $35.00 each. Reader participation welcome.

Membership/Subscript ionsAddress requests for information to AOHPHeadquarters, 109 VIP Drive, Suite 220,Wexford, PA 15090; (800) 362-4347; Fax:(724) 935-1560; E-mail: info@aohp.org.

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

Moving?Bulk mail is not forwarded! To receive yourjournal, please notify our business office ofany changes: AOHP Headquarters, 109 VIPDrive, Suite 220, Wexford, PA 15090; 1-800-362-4347; Fax: (724) 935-1560; E-mail:info@aohp.org.

Upcoming AOHP Conferences

2006 October 4-7: Sacramento, CA

All material written directly for the Journalof the Association of Occupational HealthProfessionals in Healthcare is peer reviewed.

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President’s Message

QTIP: Don’t stick this in your earBy Denise Strode, RN, BSN, COHN-S/CM

Denise StrodeAOHP Executive

President

One of my duties since becom-ing Executive President of AOHP isto write columns for the e-newsletterand the Journal. This requires that Iwrite eight original pieces every year.It doesn’t sound like a lot, but it canbe stressful; especially when you area procrastinator like me. The idea ofthe column originally was to update youon AOHP items, but I feel I don’t al-ways need to update members in ev-ery column since we have the e-news-letter, website, and other means oftimely updates. Consequently, I havestarted a file of pending ideas for col-umns. I recently came across this term,and it fascinated me. I hope you find itof interest too in your practice and lifesituation.

Quit Taking It Personally (QTIP) wasstarted by Tim O’Brien a columnistand fellow with the American Instituteof Stress in 1989. It can be a valuablekey to improving communication andrelationships. Think about how yourespond to negative feedback. Takingit personally can show up as an inabil-ity to accept professional criticism,blaming others around you for every-thing, being easy to anger, acting likea diva, wanting to win every argument,and having every conflict result in “los-ing it.” Feeling victimized comes fromtaking things too personally. You canavoid this feeling by cultivating com-

passion for yourself and by looking forthe positives in any situation.

Learn to shift perspectives. If you lookcarefully, you will find that the actwhich made you angry has also givenyou certain opportunities, which wouldnot have been possible from solely yourpoint of view. QTIP can help you tocool down when you feel yourselfneeding to “go from 0-60 in 5 sec-onds.” Don’t be hasty to sweep con-flict under the rug. It can be welcomedby learning new behaviors.

Some tips for using QTIPs at work:Recognize that there is something posi-tive in every negative experience.Rather than feeling victimized over thefact that you just lost a document be-cause the computer froze up, take adeep breath, and say to yourself, “It’sjust a stupid machine.” Focus on whatyou have learned from that situation.From now on, you will learn to savedocuments as you work on them. Seethe opportunity as a stepping stone, nota roadblock.

Learn to have compassion for your-self and fellow workers. The supervi-sor who wants everything done yes-terday has a problem with time man-agement and scheduling. You’re morelikely to find a constructive way to dealwith this kind of persistent stress situ-

ation if youQTIP it. Theco-workerwho consis-tently saysyou’re doingsomethingall wrong istelling youmore abouther needs than about your way of do-ing things. Understand that she maybe overworked, overwhelmed and un-der appreciated too. Use her commentsas opportunities to establish dialogues.

Stop seeing your problems at work asunnatural or isolated. Realize it is natu-ral part of the workplace to experiencenegativity. You may be able to usenegativity to your advantage.

Keep a jar of those white cotton tippedapplicators on your vanity or desk sowhen you feel stress, you only need toglance at the container and think “QTIPit” for a quick stress reducer. Considerhaving a place on your bulletin boardfor the “QTIP of the Day.”

Denise StrodeExecutive President

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Vice President’s Update

25 Years of Golden OpportunitiesBy Sandra Prickitt, RN, FNP, COHN-S

As the chairperson for AOHP’sannual national conference for 2006, Iwould like to share with you some ofthe activities that the conference com-mittee is working on and how you canparticipate both before and during theconference.

2006 is a big year for celebration forAOHP. It is the 25th anniversary yearfor the association. AOHP was incor-porated as a national organization in1981 with the name “Association ofHospital Employee Health Profession-als (AHEHP).” The Northern Califor-nia chapter was the first chapter and thefirst conference was held at KonoctiHarbor in 1981 in Clear Lake, Califor-nia. Topics at this first conference in-cluded Infection Control, SubstanceAbuse, Back Injury Prevention andWellness.

The committee for the 2006 conference– Kim Casey, Andine Davenport,MaryAnn Gruden, Cynthia Harmer,Shari Lyons, Sharon McLendon, MyleneSakamoto, Rosalie Shevland, BeverlySmith, and Dee Tyler, - is working onmaking this a very special conferencefor you. It will be held in Sacramento,CA from October 4th through 7th. Thissite was chosen to honor that the asso-ciation began in Northern California, andalso since it is at the heart of CaliforniaGovernment and legislation.

The Conference will be held at the HyattRegency Sacramento at Capitol Park.This is a very special area and is mir-rored off of the Hyatt Capital Hill in

Washington, D.C. It is situated acrossthe street from the California State Capi-tal building, which has many similaritiesto the Capital building in Washington,D.C. It is open daily with regular tours,a must see! A large park where we cantake our early morning walks surroundsthe Capital.

AOHP has recently visited the area andthere are many things for you and yourfamilies to do and experience. Thereare riverboat rides and restaurants alongthe Sacramento River. The Old Townof Sacramento is nearby with a railroadmuseum. There are also several muse-ums to visit and other attractions withina one to three hour drive – Lake Tahoe,Yosemite, San Francisco, Napa andSonoma’s Wine Country.

The conference committee has chosenthe slogan (25 Years of Golden Oppor-tunities), logo and cover for the brochure.You have seen the slogan and logo inthe previous journal. The committee iscurrently working on speakers for pre-conference workshops, general sessionsand the breakout sessions.

If you would like to speak or have rec-ommendations for speakers, please seethe AOHP website www.aohp.org forsubmission information.

Poster sessions will be offered at the2006 conference after return this year.The poster submission information is alsoavailable via the AOHP website and isin the latest edition of the Journal.

We welcome everyone’s participationand support!! We are looking for newparticipants and hope that you will joinus, particularly if you are involved inHospital Employee Health or the relatedareas:

• Human Resources• Occupation Health• Workers Compensation• Risk Management• Infection Control• Safety• Industrial Hygiene• Case Management

The committee is also working on sev-eral social events for you to participatein. There will be a lot of fun for all!

How you can participate:• Join the conference committee• Volunteer to be a “helper” at the

2006 conference. Many helpers areneeded for the detailed work thatneeds to be done there (i.e. regis-tration assistance, CE assistance atend of conference, etc.)

• Be a speaker and/or poster pre-senter

• Refer speakers and/or poster pre-senters to me

We are very excited about 2006 andhope you will be too. Make plans nowto attend the conference and join in of thecelebration of AOHP’s past and future.

Sandy PrickittAOHP Executive Vice Presidentprickis@sutterhealth.org

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Editor’s Column

By Kim Stanchfield, RN COHN-S“Oldies and Newbies”

Do you remember your first sev-eral months in Employee Health? As a‘newbie” you were most likely over-whelmed with what you needed to learnand uncertain where to start. For mostof us, a wise and experienced “oldie”entered our lives and became a col-league, mentor and friend.

One of the very best of many great ben-efits of this wonderful organization isnetworking with the ever-changing mixof knowledgeable, seasoned occupa-tional health professionals and new en-thusiastic colleagues. Personally, I learnfrom everyone. I realized long ago thatthis is a job where we will never learneverything, not even come close. But thepeople we meet and work with along theway make this job the best it can be andpretty darn fun, also!

I attended my first state chapter meet-ing as a new Employee Health profes-

sional over 18 years ago. Feeling com-pletely over-whelmed and very “dumb”,I wondered what I could possibly con-tribute to that group of experienced pro-fessionals. I was in awe of everyone’sexpertise and envious of their confidence.As I got to know the members better, Ilearned that some were “oldies”, havingbeen in occupational health for many yearsand some were “newbies” like me whohad much to learn.

Our chapter was fortunate to have awonderful leader at that time, Em Hunt.Em had established the Employee HealthProgram at the University of Virginiaseveral years previously and was theobvious chapter leader. I still rememberEm’s words to the group at my firstmeeting, “no matter how long you havebeen doing this job, you all have some-thing you can contribute”. Inspired byher words, I jumped in and became veryinvolved in AOHP on the state level.

Oldies and newbies alike became trustedcolleagues and long time friends. In time,I became more involved with AOHP ona national level and many more oldiesand newbies were added to my list oftrusted colleagues and good friends. Icontinue to learn and be inspired by thesegood people.

Are you a newbie to Employee Healthand AOHP? Are you aware that youhave a whole network of wonderful pro-fessionals that can assist, advise and in-spire you?

Are you an oldie? Have you helped anewbie recently and found that youlearned as much from the exchange asthey did? Do you know how valuableyour experience can be?

Whether you are new to AOHP or havebeen with us many years, you are whatmakes the organization great!

Longmont United Hospital has an opening for aManager of Infection Control/Occupational Health.Duties would include providing infection control surveillance throughout the hospitaland developing, coordinating and maintaining infection control and employee healthprograms for a 160 bed, 1200 employee organization.

The ideal candidate will have a BSN, progressive education and experience ininfection control and employee health, and certification in infection control.

We are a Planetree Affiliate that encourages healing partnerships by integrating conventional medicine with complementarytherapies. We embrace a philosophy of people caring for people - not only patients and families - but also how staff cares foreach other and themselves. Our patient rooms are compared to first-class hotel accommodations and our staff lounges arebeautiful.

We invite you to look at what we have to offer at Longmont United Hospital.

Longmont United Hospital is a non-profit, independent hospital located in Longmont, Colorado. We are a gatewaycommunity to Rocky Mountain National Park; as well as, being close to skiing and metropolitan Denver.

To apply check out our website at www.luhcares.org or call (303)485-4136. Equal Opportunity Employer

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A O H P J o u r n a l

News & Such

NIOSH and AIHA Partner to Ad-vance Research and Promote SafeWorkplace Practices

NIOSH and the American IndustrialHygiene Association (AIHA) havesigned an agreement to advance theprotection of workers, promote thetransfer of research into industrial hy-giene practice and develop new andinnovative prevention strategies andtechnologies.

The partnership will provide outreach,communication, and professional de-velopment opportunities to promoteworker health and safety through:• Developing and disseminating

worker safety and health informa-tion at appropriate conferencesand media outlets

• Participating at conferences, meet-ings, and other key events whereoccupational and environmentalhealth and safety (OEHS) issuesare proactively addressed

• Advancing the effectiveness ofOEHS research

• Promoting and facilitating thetransfer of research results topractice in preventing occupationalillnesses and injuries

• Strengthening recruiting efforts for stu-dents to enter OEHS graduate and un-dergraduate training programs

“NIOSH and the AIHA both work toprevent workplace illness and injury;this partnership is a significant stepforward in preventing health andsafety problems by directly linkingNIOSH researchers and AIHApractioners,” said NIOSH DirectorJohn Howard, MD.

A Quote Worth Quoting

“Ability is what you’re capable of do-ing, Motivation determines what youdo, Attitude determines how well youdo it.”

Anonymous

Curry Spice Found to Fight Cancer

The New York Daily News recentlyreported that turmeric, a spice that isa key ingredient in Indian curry dishes,contains a potent cancer-fightingagent. A study published in Cancermagazine related that curcumin, achemical pigment in turmeric, helpedstop the spread of breast cancer tu-mor cells to the lungs in mice. Earlierstudies suggest that people who eatdiets rich in turmeric have lower ratesof breast cancer, prostate cancer, lungcancer and colon cancer.

Echinacea Has No Clinical Benefitin Rhinovirus Infection

According to the results of a random-ized trial reported in the July 28 issueof the New England Journal ofMedicine, Echinacea angustifolia of-fers no clinical benefit in experimentalrhinovirus infection.

The study, by researchers at the Uni-versity of Virginia, evaluated the ef-fect of three different preparations ofEchinacea. The three extracts had nostatistically significant effects on infec-tion rates, symptom severity, volume ofnasal secretions, ploymorphonuclear leu-kocyte or interleukin-8 concentrations innasal-lavage specimens, or quantitive-virus titer.

Work, Stress and Health 2006: Mak-ing a Difference in the Workplace

NIOSH, the American PsychologicalAssociation, the National Institute ofJustice, the National Institute on Dis-ability and Rehabilitation Research ofthe U.S. Department of Education, andthe U.S. Department of Labor, willconvene the sixth international confer-ence on occupational stress and health,Work, Stress, and Health 2006:Making a Difference in the Work-place in Miami, Florida, March 2-4,2006, at the Hyatt Regency MiamiHotel. The conference is designed toaddress the constantly changing na-ture of work, and the implications ofthese changes for the health, safety,and well being of workers. In keepingwith the conference theme of “mak-ing a difference in the workplace,”there will be particular focus on thetranslation of research to practice andworkplace programs, policies, prac-tices, case experiences, and other ef-forts to prevent stress in today’s work-place. More information about the con-ference can be found at: http://www.apa.org/pi/work/wsh2006.html.

“Shoes For Crews” May PreventSlips and Falls at Work

SHOES FOR CREWS (registeredtrademark) manufactures slip resistantfootwear for workers in food service,healthcare and industrial work placesthat are at risk for falls on greasy andwet floors. Information may be ob-tained at their website http://www.shoesforcrews.com.

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7Special Publication Seeks to UnifyBiomeds, Nurses

A new publication has been released thatseeks to improve the important relation-ship between nurses, clinical engineers,biomedical equipment technicians, andother managers of medical technology.

The magazine, Healthcare TechnologyHorizons, features timely and impor-tant articles on issues such as clinicalalarms management, wireless solu-tions, radio-frequency identification,and robot assisted technology.

To obtain copies of Healthcare Tech-nology Horizons, visit the Associa-tion for the Advancement of MedicalInstrumentation’s Marketplace atwww.aami.org or call (800) 332-2264.The order code is HTH and the sourcecode is PBFE.

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Association Community Liason ReportBy MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM

OSHA AllianceOne of the objectives of the OSHA Alliance is to developeducational tools related to our objectives of patient handling,bloodborne pathogens and emergency preparedness. AOHPis in the initial stages of developing a “resource guide” forsafe patient handling. The resource guide will be for the oc-cupational health professional who is faced with developingthis type of program for his/her facility. A draft will be avail-able for review by the Implementation team in early Septem-ber with a final document late in the Fall.. The plan is to takeour “Getting Started” approach a step further in the develop-ment of the resource guide. I invite your input for inclusioninto the guide. If you have implemented such a program andhave processes that have helped, it is not too late to sharethem with me.

At press, an AOHP Alliance Implementation Team memberis planning to attend the National Conference for Hospital-Based First Receivers October 6-7, 2005 at George Wash-ington University, Washington D.C. OSHA and JCAHO willbe joining forces to provide information and guidance to healthcare professionals on the protection and training of first re-ceivers from a mass casualty incident involving the release ofchemical, radiological, or biological material. We will providea report of this conference in the next issue of the Journal.

Summary of the Venetec Leading Edge SymposiumExecutive President, Denise Strode and myself were privi-leged to be invited and to attend the First Annual LeadingEdge Symposium sponsored by Venetec International held onApril 1-3, 2005 in LaJolla, California. This symposium brought30 nurse-opinion leaders and educators in vascular access,infusion therapy, occupational health and infection control to-gether to share information on the current research findingsrelated to the use of vascular and urinary catheters and otherrecent finding related to infection control in the healthcaresetting. Representatives from APIC, INS, AVA and AOHPparticipated in the symposium that included a format of for-mal presentation followed by open question and answer sessionwith each speaker. Participants also had the opportunity to brain-storm and share ideas as to how to communicate this informationwith colleagues and ultimately improve patient outcomes.

Presentation #1: The Character and Ubiquity of Bacterial

Biofilms by J. William Costerton, PhD, Director of Centerfor Biofilms, School of Dentistry, USC School of Medicine

Dr. J. William Costerton was the first speaker. His topic wasa startling overview of biofilms and what we know about them.In a nutshell, biofilms are everywhere: on your teeth, in pipes,on river rocks and in and on catheters and other implanteddevices. Biofilm – or, slime, as it is commonly called – is acomplex community of one or more microorganisms and its/their byproducts: glycosolated proteins, peptide messengers,bacteria, fungi – all forming stems, channels and plateaus.On the surface of indwelling devices, biofilms form rapidly,often lacing themselves over and through fibrin sheaths. Suchbiofilms offer mutual protection to both host and bacteria. Intheir “sessile” form (i.e., mature, attached to a surface, non-infectious) biofilm are remarkably stable and may not seedthe host with “planktonic” (i.e., free-floating, unattached, in-fectious) bacteria. Biofilms-protected bacteria, on the otherhand, can be remarkably impervious to antiobiotics – explain-ing why device-related infection is so refractory, requiringremoval of the devices for cure. In addition, some infectionssuch as osteomyelitis, pneumonia associated with cystic fi-brosis, chronic otitis media, tonsillitis and are now being at-tributed to biofilm formation.

Dr. Costerton’s presentation lead to attendee questions re-lated to the effects of flushing catheters on biofilm stabilityand subsequent infection as well as the accuracy of culturingcatheter tips. We do not have complete answers to these anymany other questions related to biofilms as this is an emerg-ing science. Research will continue at Montana State Uni-versity, the leading center in the country for biofilm research.Here engineers, working with other health scientists such asmicrobilogists have, and will continue to lead the researchefforts in this area. More information regarding biofilims isavailable at www.erc.montana.edu.

Presentation #2: Catheter-Associated UTI: A Model ofBiofilm/Catheter Interaction by Rabih O. Darouiche, MD,Director, Center for Prostheses Infection, Baylor Collegeof Medicine

Catheter-associated urinary tract infection (CAUTI) was thearea of research presented by Dr. Darouiche. There are

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9over 30 million catheters inserted each year. Of those 30million catheters approximately one million urinary tract in-fections (UTI) occur with a cost of over $400 million. Stud-ies have shown that 50-90% patients that have an indwellingurinary catheter develop asymptomatic bacteruria if the cath-eter is in place for seven days. One in 10 patients withbacteruria will develop symptomatic UTI. Asymptomaticbacteuria should only be treated in children, pregnant womenand renal transplant patients. Currently, preventive measures forUTI include aseptic technique during insertion, utilizing gravity andunobstructed drainage, avoidance of unnecessary catheter insertionand consideration of an alternative drainage method such a s externalcatheter or intermittent catheterization.

Dr. Darouiche’s research has demonstrated that UTIs thatbiofilms play a major role in bacteruria. Several approacheshave been studied to prevent CAUTIs. One approach hasbeen the development of catheters with antibiotic coatings.The limitation of these types of catheters is that the antibioticmust leach off the catheter to provide sustained effective-ness and resistant organisms may develop. Varied resultshave shown not more than a 21% rate of effectiveness inreducing CAUTIs.

A second approach that Dr. Darouiche has undertaken withhis research is called bacterial interference. The questionthat triggered this research was, if biofilm formation is inevi-table, why not introduce a nonpathogenic bacterium before apathogenic one has a chance to establish itself? This is thequestion that is currently being studied in a large clinical trial. Atthe time of the symposium the results were pending, howevertwo pilot studies have suggested some efficacy with this method.

The third approach has been to evaluate the effectiveness ofcatheter securement. The rationale for this approach wasthat shear forces on a urinary catheter related to patient move-ment causes biofilm particles to dislodge causing infection.In a recent two year, multi-center, randomized, prospective,controlled study utilizing a Foley catheter securement device,there was a 45% decrease in CAUTIs which was felt to beclinically significant.

The results that the type of urinary catheter securement canreduce CAUTIs offers an alternative to traditional taping.The high incidnece of CAUTIs continues to present opportu-nities for further research in the area of emerging bacterialinterference and the use of securement devices.

Presentation #3: Mechanical Aspects of Adverse Cath-eter-Related Events by Gregory Scheears, MD, Assistant

Professor of Anesthesiology & Pediatrics, Mayo ClinicDr. Schears discussed the research related to complicationsrelated to peripheral line insertion. He is considered the “fa-ther of securement science.” He has studied a number ofissues related to catheter motion and its direct and indirecteffects on the vasculature. The findings from his researchlead to the science of catheter securement including examin-ing how much force is needed to loosen securement materi-als such as steri strips, tegaderm and the Statlock securementdevice. In three studies using the Statlock securement de-vice there were decreased unscheduled restarts, decreasedtotal complications, decreased dislodgements and increaseddwell time.

An incidental finding of the studies related to central venouslines was that there were less catheter related blood streaminfections (CRBSI) when using a securement device. Re-sults of the research conclude the CRBSI begins at the site ofthe insertion because of catheter movement due to traditionalmethods of securement.

For more information, Dr. Schears had a review article pub-lished in the February 2005 issue of Managing InfectionControl. This article summarizes six studies related to stan-dard catheter stabilization methods.

Open Discussion ForumOn Saturday afternoon there was an open forum among theattendees to discuss ideas as to how this leading-edge infor-mation could be shared with colleagues. Collaborating withthe professional organizations that were in attendance wasdiscussed. One idea was the development of a “review ar-ticle” for the various journals. Association practice guide-lines and “spreading the word” to other organizations associ-ated with positive patient outcomes were other possible meth-ods to disseminate these findings.

Presentation #4: Novel Approaches to PreventingCatherter-Related Bloodstream Infections by Dennis G.Maki, Ovid O. Meyer Professor of Medicine, InfectiousDiseases and Critical Care Medicine, University of Wis-consin Medical School

The closing speaker was Dr. Dennis Maki a well-known andleading researcher in nosocomial infections. Hi presentationcovered a wide array of issues that impact nosocomial infec-tions. Based on the evidence classic infection control meth-ods are failing to reduce these infections. He believes that anew paradigm is needed to reduce nosocomial infections thatwould include 1) more effective hand washing techniques, 2)

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computer-assisted antibiotic treatment to improve outcomes, 3)pre-emptive barrier precautions, 4) innovative technologies withassistive devices and 5) novel securement devices. He sharedthe favorable results of his clinical trail related to the use ofBiopatch, positive outcomes of securement devices and otherfindings related to emerging technologies to reduce infections.

Symposium Closing: Dr. Steve Bierman, MD, Founder andMedical Director Venetec InternationalDr. Bierman summarized the three days as at time of tremen-dous learning and thinking. He stressed that “old habits diehard and that with good science and a community that sharesthe information well, we can move quickly to the evidence-based practice we all aspire to.”

Conclusion:It was an honor and a great opportunity for AOHP to beinvited to this symposium and to lend its support to efforts thatnot only improve patient outcomes and patient safety but alsoimprove the health and safety of the healthcare worker. Asoccupational health professionals we have the opportunity andresponsibility to keep abreast of the latest evidence-based prac-tice findings and share them with the key players in our facilities.

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Industrial Hygiene in Healthcare

Safe Use of Germicidal ChemicalsBy George Byrns, MPH, PhD, CIH and Lee Shands, MPH, CIH

All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

Do you have any industrialhygiene concerns or

questions that you wouldlike addressed in the

Journal? Please forwardyour questions or

requests to the JournalEditor at

kstanchf@rhcc.com.

In this column, we will describesome of the advantages and disadvan-tages of chemicals commonly used forsurface disinfection. There is no suchthing as a perfect germicide, and theremust be a balance between efficacy(does it do the job) and safety (does itdo the job without harming the patientor others). So, our goal should be touse the least toxic chemical that willaccomplish desired task.

Halide compoundsHalide compounds such as chlorine andiodine are fast acting, broad spectrumgermicides that may be irritating to skinor corrosive to metals and other equip-ment. Exposure to chlorine can resultin respiratory irritation, and high ex-posures can lead to pulmonary edema.Another potential hazard exists whenchlorine solutions are mixed with othercompounds and chlorine gas is re-leased. Personal protective equipmentshould be used when working withchlorine. Chlorine is not generally usedfor routine surface or instrument dis-infection due to the corrosive natureof the chemical. A one to ten dilutionof household bleach and water is fre-quently used to disinfect surfaces af-ter a blood spill. Tincture of iodine isa mixture of alcohol and iodine thatmay be used as a skin disinfectant.Other products called iodophors mayalso be used for both surface disinfec-tion and as a skin antiseptic.

Phenolic compoundsPhenolic compounds are used as gen-eral purpose surface disinfectants be-cause they are non flammable and areeffective in killing a relatively widerange of bacteria. However, thesechemical are severely irritating to theskin, are toxic to the liver and kidney,and will permanently destroy skin pig-ment (see figure #1). This chemicalis readily absorbed through intact skinand is especially toxic to infants caus-ing a potentially life threatening con-dition called hyperbilirubinemia .

For these reasons, this chemical shouldnot be used in any areas where new-borns may be present. It is also notapproved for use on any food contactsurfaces.

Quaternary ammonium compoundsQuaternary ammonium compounds(aka Quats) are more frequently usedfor general surface disinfection be-cause they are less toxic than phenolicgermicides. Exposure to quaternary

Editor’s Note: Lee Shands,MPH, CIH co-authored theIndustrial Hygiene in HealthcareColumn on Safety IssuesRegarding Waste AnestheticGases in the Summer issue of theAOHP Journal. We regret the

omission.

(Figure 1 – phenol damage to skinpigment, courtesy of NIOSH)

ammonium com-pounds in use dilu-tion concentrationscan cause mild irri-tation, but exposureto concentrated solu-tions can causeburns to the skin andthe mucous mem-branes. Therefore, exposure to eventhese less toxic germicides should becontrolled through the use of personalprotective equipment.

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All product information is not endorsed by the author or AOHP but merely is a resource for individuals.

Talking Points – Healthcare Ergonomics

Reducing the Risk in HousekeepingBy Linda Haney, RN, MPH, COHN-S, CSP

Eight percent of housekeepers are employed by hospi-tals and another eight percent are employed by nursing andother residential care facilities.1 While hospital direct-careworkers capture significant attention because of the very highrate of musculoskeletal injuries, non-clinical or ancillary work-ers are also at high risk for these types of injuries as well asmany other health/safety injuries and illnesses. For manyreasons, the ergonomic issues of these workers often do notreceive the same level of attention. This column will discusssome of the work tasks of housekeepers, job safety analysis(JSA), and possible risk-reducing solutions framed by the safety“hierarchy of controls.”

Evaluating the TasksTypical tasks of these workers include: accessing and movingcleaning carts to designated locations, filling/emptying of mopbuckets, cleaning floors using a mop, washing walls and glass,disinfecting all surfaces such as mattresses and bed framesusing a hand cloth, stripping beds and taking the laundry to acentralized collection on the unit, emptying trash cans, clean-ing and replenishing bathrooms, and using large/vibrating floorbuffers. The number of patient rooms cleaned per day variesbetween twelve and twenty. Many tasks, such as disinfect-ing surfaces and mopping, require constant bending, twisting,stooping and stretching. Others require extreme postures suchas cleaning the under side of a bed, and still others requiresignificant force such as lifting a bariatric mattress to clean abed frame. In some hospitals, housekeepers are also consid-ered a part of the unit team and are “on call” to assist nurseswith tasks such as stabilizing a bed during a transfer, holdingan IV bag until the pump can be brought in, etc.

Performing a Job Safety Analysis (JSA)/Job HazardAnalysis (JHA)Although JSA/JHA is usually used to document all hazardsof a given job, the tool can be adapted to focus on ergonomichazards and works well in designing jobs for safety. JSA/JHA is a technique of breaking down a given job into each ofits component steps, determining the risk of each component,and recommending appropriate solutions for risk/hazard re-

duction. JSA/JHA is typically done inthe following situations in order to pre-vent injuries: (1) prior to the start of anew job, (2) prior to the start of areconfigured job, (3) after anindividual(s) has been injured on a job,and (4) any job where there have beena significant number of injuries. TheOSHA publication “Job Hazard Analy-sis,”2 provides detailed information on conducting a JHA andprovides a form for the process. Another good publication, ata reasonable cost is Job Safety Analysis Made Easy, avail-able from http://www.ccohs.ca/products/publications/JSA.htmlOnce each step and its hazards have been identified and ana-lyzed, hazard control measures are recommended. OSHAalways prefers (1) engineering controls to reduce hazards.This is because they are consistently a more effective solu-tion than all others. The possible downside to an engineeringcontrol, however, is short-term expense. On a long-term ba-sis, however, engineering controls are almost always cost-effective. An engineering control eliminates or minimizes thehazard and may be achieved by designing the facility, equip-ment, or process to remove the hazard, or substituting pro-cesses, equipment, materials, or other factors to lessen thehazard.3 Another good rule of thumb is to think of your oldestemployee who may have some personal medical issues suchas arthritis – if the job can be designed to be safe for thatindividual, it will be safe for everyone. An example of anengineering control in housekeeping is the use of microfiberflat mops.

If there is no engineering control available or until an engi-neering control can be purchased or obtained, task-reductioncan sometimes be achieved through (2) administrative con-trols. Administrative controls include the following: exposuretime limitations, signs and warnings, and training. An exampleof an administrative control might be training in body me-chanics when lifting a mattress or using two people. Theleast effective control measure is (3) personal protective equip-ment such as protective clothing, gloves, safety glasses, etc.

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13Sample Job Hazard Analysis Form(from Appendix A – OSHA, Job Hazard Analysis)

Exploring Potential Housekeeping EngineeringControl Measures with Samples• Mops

o Single-Use Microfiber flat mops rather than tradi-tional mops – lighter, less water, no wringing

o Adjustable handles – length of handle can fit the sizeof the housekeeper

o Padded handles – opens up grip, provides cushioninghand surface, and eliminates slips

o Administrative control – “dance with the mop” usingmore hips and legs rather than just arms.

• Chemical dispenserso Pre-filled cartridges – reduces need to lift chemicals,

potential for spills and incorrect dilutions.• Buckets

o Fill by hose – eliminates need to lift on and off carto Empty by tap at bottom – eliminates need to lift off

carto Placement on cart such that the employee does not

need to bend to use• Deep sinks

o Place overturned basin in bottom - reduces the depthand need to bend over

• Cartso Frequently used items placed within easiest reach –

eliminate bendingo Smaller carts – streamlined for essentials only to re-

duce push/pull forceso Frequent maintenance on cart wheels – to reduce

push/pull forces

• Foldable plastic safety stoolso Use for reaching - reduce need

to reach overhead for high sur-faces

o Use for sitting – to reduce needto stoop or get on knees to cleanunder the bed

• Mattress jigo Use to hold mattress – to elimi-

nate stress of holding mattressup with one hand and clean un-derneath with the other

• Linen Containerso Reduce size of bags – to elimi-

nate collection of linens tooheavy

o Frame for removal – to allowside removal rather than lifting

o Lower laundry chute openings– to eliminate lifting laundrybags up

o Automated system of collection and dumping – smallpowered carts pick up linen containers and automati-cally dump them into laundry collection or into laun-dry machines.

• Vacuuming and Buffing Floorso Use light-weight equipment – reduce need for push-

ing, pullingo Adjustable-height handleso Pad handles – reduce vibrationo Use small figure 8 motions to reduce side-to-side

twisting• Hand Cleaning tools

o Adjustable handle tools – to minimize reaches to highareas.

o Hand adjustable “grabber” tool for picking up debrisfrom the floor

• Bathroom cleaningo “No touch” bathrooms – combines power-spraying, rins-

ing, squeegeeing and blow-drying all in one machine.3

o “Touchless” sinks – reduces need to clean

Developing a Participative Ergonomic ApproachAs in all departments, it is a forward-thinking manager that gainsthe trust of their employees and uses that trust to empower themto identify and solve many of their ergonomic problems. At thevery least the manager needs to listen to their work-related is-sues and enlist them as partners in determining solutions. Par-ticipative ergonomics may involve better tools, education andbehavioral changes. The University of Waterloo Ergonomic Pro-gram states “Participation by workers can lead to improvement

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in self-confidence, competence, and attachment of more impor-tance to self-determination. In addition, a participatory processcould lead to increased perceptions of job control and influence,and increased feelings of importance and recognition. Beyondthe physical benefits of each specific change project, improve-ments in these psychosocial elements should further enhanceworkplace morale and reduce the risk of injury for workers.”4

A participative ergonomic program reduces some of the needto sell “change” to employees. As Stephen Covey says “Noparticipation, no buy-in. Period.”5

Resource Information that HelpsCal/OSHA4 has a particularly good publication on safety (in-cluding ergonomics) for Custodians, Janitors and Housekeepersentitled “Working Easy” available through their website. Thereis also a good series of posters for janitors, custodians and house-keepers, written both in English and in Spanish available, one permonth, on the Cal-OSHA website.5 Another good source of

information is Housekeeping professional organizations – ask yourHousekeeping Department Heads if they belong and whetheryou can access information from the organization.

In summary, there are clearly risk-reduction benefits from devel-oping a participative ergonomics program within the housekeep-ing department. Employees will find reasonable solutions toproblems if they believe that management is truly interested intheir welfare and will give strong consideration to their ideas.

References1 http://www.cleanlink.com/hs/article.asp?id=2547, “Protect Your Staffwith a Strong Ergonomics Program, Dianna Bisswurm, accessed on 9-5-052 www.ahs.uwaterloo.a/~wells/making_ergonomics_changes.htm3 Covey, Stephen, “7 Habits of Highly Effective People” A Fireside Book,Simon & Shuster, 19894 “Working Safer and Easier, for Janitors, Custodians, and Housekeep-ers,” http://www.dir.ca.gov/dosh/dosh%5Fpublications/janitors.pdf, 2005,accessed 9-5-055 http://www.dir.ca.gov/dosh/dosh%5Fpublications/janposter1.pdf, Cal-OSHA

Announcement

Your Help Is Needed to DirectOccupational Safety and Health Research

If you could design the future of occupational safety and healthresearch in the nation, what would it look like? What goals wouldyou set? What issues would be the most important?

Nearly a decade after NORA was established, NIOSH is seek-ing the help of the Association of Occupational Health Profes-sionals in Healthcare (AOHP) to build on the previous successof NORA while preparing for future workplace safety and healthchallenges. NIOSH has adopted a new sector based approachto better guide research to practice within workplaces. NIOSHand its partners will form eight sector research councils, whichwill include participants from academia, industry, labor, and gov-ernment. Each council will identify the top safety and healthconcerns in their industry sector, and then draft research goals,objectives, and action plans for stakeholder comment. The sec-tor research councils will include:• Agriculture, forestry, and fishing;• Construction;• Health care and social assistance• Manufacturing;

• Mining;• Services;• Transportation, warehousing, and utilities; and• Wholesale and Retail Trade. In addition to the eight sector research councils, a cross-sec-tor group will be formed. This council will include the coordi-nators from the eight sector councils and will identify oppor-tunities for common research across sectors.

Please share your vision about the future of occupationalsafety and health research by visiting the NORA website atwww.cdc.gov/niosh/nora. There you will find a stakeholderfeedback form where you can submit your comments elec-tronically. And if you have not already done so, please sub-scribe to NIOSH eNews (www.cdc.gov/niosh/enews) wherenew information about NORA will appear continually overthe next few months.

NIOSH values the partnership of AOHP and will continue tokeep you informed about the next phase of NORA.

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15

PhyllisBerryman

AOHP shines its spotlight on another worthy mem-ber, Phyllis Berryman. Phyllis is a Senior Disability Pre-vention Consultant with Employee Safety & Disability Man-agement Services for the Michigan Health & Hospital As-sociation-Service Corporation. Her supervisor, Dee Tyler,nominated Phyllis.

Dee shares “Phyllis is a role model in occupational healththrough her commitment to the nursing profession. Sheshows commitment by membership in occupational asso-ciations, volunteering to work for these organizations, herability to network, creative thinking, and simple kindnessto all individuals. She volunteers at the AOHP and AAOHNconferences, as well as she has held positions on theAAOHN board and is Chapter Secretary for the MichiganChapter. Phyllis was selected by her peers to be a Fellowin Occupational Health Nursing. She was recognized as aFellow at the AAOHN Symposium in Minneapolis, MN inMay of this year.”

“Phyllis is a master networker,” adds Dee. “She is out-standing at identifying needs that clients have and thenmatching the client up with someone who can fulfill thatneed. Her ability to easily engage others in conversationand draw them out is part of the reason Phyllis is so suc-cessful with networking.”

Phyllis began her occupational health career in 1972 as anLPN with Robbins & Myers Corp in Springfield, Ohio. AnRN since 1978, Phyllis completed her Masters of BusinessAdministration degree in 1999.

Having worked at her current position for four years, Phyllisenjoys many aspects of her role. She especially likes see-ing patients get better and return to work as well as thevariety of her cases and the mobility to travel to patienthomes, locations and offices. Phyllis takes great pleasurein those insightful “ah ha” moments when something clicks,events begin to make sense and she can finally get thatpiece of the puzzle that takes her in the right direction tosolve the problem.

Phyllis enjoys a busy life outside of work. A member of herchurch’s women’s ministry, she also is a volunteer usher forthe Detroit Symphony and the Masonic Temple theatre, a

Spotlight on an AOHP Star

hostess for Advent by Candlelight,and enjoys spending time with herthirteen-year-old granddaughterand daughter who have movedback to her state. Se also shares anew house with a much-loved yellow lab named Pearl.

Serving currently as the Secretary of the Michigan Chap-ter of AOHP, Phyllis has been an AOHP member for fouryears. She has been a volunteer at AOHP national confer-ences and published two articles in the AOHP Journal.Phyllis credits AOHP with assisting her to do her job bet-ter by providing quality education at the conferences onboth the national and state levels.

AOHP is fortunate to have an extraordinary member likePhyllis and we are very pleased to let your stardom shinein our Journal!

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Colleague Connection

Vector Borne DiseasesBy Lynn Arndt, RN

I recently attended an excellent lecture on Vector BorneDiseases sponsored by the Georgia AOHP chapter. ChristinePasa, an epidemiologist from the Georgia Coastal Health De-partment, spoke on the history of Vector Borne Diseases andtheir impact on our past, our present, and our future.

The class began with a review of past epidemics starting withthe Plague or “black death.” The first outbreak actually wasin China in the 1330s followed by the more publicized out-break in Europe in 1347. This outbreak was the result of mer-chant ships coming in and bringing the infected rodents andtheir guest of infected fleas. Between 1347 and 1352 morethan 25 million people (1/3 of Europe’s population) died fromthis dreaded disease.

In the 1600s doctors and scientists began to understand moreabout Plague and it’s transmission, and in turn began to con-trol the transmission by reducing the amount of rodents in popu-lated areas. There is still the occasional case reported in the U.S.but globally only 1000-3000 cases are reported per year.

Yellow Fever was the next disease presented for discussion.This disease is transmitted by the bite of an infected “day-biting” mosquito. Yellow Fever affected people mostly in theheavily populated bay areas of the country mainly due to moistenvironments associated with the sea and shipping lanes. Sa-vannah, Georgia was a target because of the low-lying, waterretaining terrain, which was a mosquito-producing haven. Over700 people died during the mid 1800s of Yellow Fever.

Fever, chills, a “fuzzy tongue” and Faget’s sign characterizeYellow Fever. Faget’s sign presents as a very slowed heartrate and respirations. This phase of the disease was the rea-son for many people to be “buried alive.” Once the town’speople discovered this they began to burry people with air ventsand a string attached to a bell above their grave. This was doneso if they were not really dead and they survived this period ofthe disease they could “ring the bell” and be brought up. This iswhere the stories of the Grave Watchers began.

Malaria was the third disease presented for discussion and itproved to be as interesting as the first two vector born dis-

eases. Malaria is also carried and transmitted by mosquitoes.It is an ancient disease that primarily affected Africa, specifi-cally the Europeans trying to settle Africa.

The local tribes seemed to be immune to the disease or it’s deadlyaffect and the physicians of the time were trying to figure outwhy. They discovered that the locals knew about the bark of atree that produced quinine. This extract reduced the deadly ef-fects of the disease. The discovery of this extract decreased thedeath tolls of the Europeans and lead to the discovery of otherantimalarial drugs such as Chloroquine and Atovaquone/Proquanil.

Malaria has been eradicated in the US since 1951. This wasachieved by the use of DDT, a pesticide that has since beenbanned. DDT was not only sprayed on fields it was alsosprayed in over 4.6 million homes across the US by the end of1949. No endogenous cases of malaria have been reported inthe US since that time.

West Nile virus is a disease that primarily affects birds but istransmitted to humans by a mosquito that has bitten an infectedbird. The disease presents with symptoms much like encephalitisand is often more severe in senior citizens. West Nile first ap-peared in the US in 2000. It manifested in the North East regionbut spread to the Eastern half of the US by 2001. In 2002 therewere reported cases of West Nile in all but 9 US states. In 2004,Washington was only one that had no reported cases.

This increased spread of West Nile has caused a massiveincreased awareness of the need to eliminate the spread ofdisease by preventing the mosquito bite using repellants thatcontain 20%-50% DEET. Wearing long sleeves, light coloredclothing and avoiding being outside during the mosquito’s peakfeeding times of “dawn” and “dusk” are also encouraged.

The final diseases discussed were those spread by ticks. TheSouth Eastern US has several ticks that carry diseases. Theyare the deer tick that carries Babesiosis and Lyme disease,the rocky mountain wood tick that carries Rocky MountainSpotted Fever and the Lone-Star tick that transmits Ehrlichiosisand the newly discovered Stari (Southern Tick AssociatedRash Illness) disease.

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17Stari is a new disease that presents a “bulls-eye rash” at thesite of the tick bite, and produces a flu-like illness, meningitisand cranial neuropathy just like lyme disease, however it is adifferent organism that produces the disease. Both diseasesrequire long- term antibiotic therapy to eradicate the diseasefrom the body. The more the disease has progressed beforediagnosis the longer the therapy may be. Four to five monthsof IV antibiotic therapy is common.

Any one that spends time outdoors around grass, shrubs, woodsand over-grown brush is at risk for exposure to ticks. Youshould monitor yourself and your family daily for ticks on theskin and for any that may have bitten. If you find a tick thathas become attached, remove the tick with a pair of tweezersby getting as close to the skin as possible to ensure removal ofthe “mouth-parts” of the tick. Once the tick is removed putthe tick in a clear zip-lock type bag in less that 1 ounce ofrubbing alcohol and set aside while you clean the bitten areawith a disinfectant. Mark on your calendar the day you re-move the tick just in case you become ill in a few days-weeks.

Retain the tick in case you become ill so it can be tested forany of the 7 diseases that ticks carry. It is recommended tolabel the bag with the date the tick was removed as well.

If you live in Georgia and remove a tick that had been “at-tached” you can participate in a study with the CDC by call-ing the Poison Control Center at 1-800-222-1222. A few ques-tions are asked and instructions are given on sending in thebagged tick for evaluation. Monitor for any symptoms of thesetick borne diseases. In about 3 weeks you will receive a callto ask another series of questions and to see if you have hadany symptoms. Also, if they discover that your tick was acarrier they will notify you immediately.

The best prevention is to avoid being exposed to tick by wear-ing light clothing, tuck your pants in your socks and wear longsleeves if you are in the woods and wooded areas whereticks live. Adding the use of repellants that contain 20%-50%DEET will also help deter tick exposure.

I found this presentation to be very enlightening and hope thatthe information I share is helpful to you.

Lynn Arndt, RN, is the Employee Health Nurse at RooseveltWarm Springs Institute for Rehabilitation in Warm Springs,GA. She has been in the field of occupational health nurs-ing and active in AOHP for three years, and is the cur-rent Chapter President of the Georgia Chapter of AOHP.

AOHP PUBLICATIONS

Getting Started ManualThis valuable resource is availablein 3-ring binder, CD and a combinationpackage

AOHP Member ratecall AOHP Headquarters1-800-362-4347 for discounted prices.

Non member rates(includes shipping & handling):Binder - $200CD $140Binder & CD - $290

The 2005 AOHP NationalConference SyllabusNow available in both CD and binder format.

Syllabus BinderMember price $40 (includes shipping & handling)Non-member price $50 (includes shipping &handling)

Syllabus CDMember price $20 (includes shipping & handling)Non-member price $30 (includes shipping &handling)

To order either of these publications, visit www.aohp.org or call AOHP Headquarters 1 800 362-4374

Association of Occupational Health Professionals in Healthcare109 VIP Drive, Suite 220, Wexford, PA 15090800 362-4347 Fax 724 935-1560 www.aohp.org info@aohp.org

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A O H P J o u r n a l

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19

AOHP, AOHN, NIOSH, OSHA, CDC, EPINET,VDOH, Ohmygosh!! I will never be able to remember whatis what and who is who! That was my initial reaction whenattending the Getting Started Program last October in Tampa.I was simply overwhelmed by the amount of information re-lated to my new position.

I quickly learned the role of occupational health nurses variedgreatly from institution to institution. The realm of responsi-bilities included infection control, case management, healthpromotion, worker’s compensation management and manymore! As an experienced nurse and teacher I was thrilled bythe new opportunity of entering Occupational Health but Ihad NO idea how information intensive it would be. I felttimid and concerned about what I was to encounter. When Iattended the Annual AOHP conference last year, I had notstarted my new position. My Employee Health work did notbegin until after my return. I was so in awe of the friendly,welcoming, encouraging nurses from all over the United StatesI met at the conference. Although I left bogged down withinformation, I also had established a wonderful network ofcolleagues to call on when advice was needed.

Time has flown by the last nine months! The job of EmployeeHealth Nurse has been an exciting challenge. I appreciateand enjoy that every day I meet someone new, learn some-thing I never knew and seek out resources I didn’t knowwere available. Working in the same hospital for over twentyyears was a definite advantage in settling into my new role.Knowing who to go to, how to find them, where to find themand when to get them involved was very valuable. The ad-vantage of “knowing the system” allowed me to spend mytime learning my new role. Learning how to best fill the shoesof a very efficient, well-loved and well-respected predeces-sor would need to be a slow careful process. Since my role inEmployee Health at my institution encompasses worker’scompensation coordination, annual health screening, new hirephysicals, daily health evaluations, and OSHA record keeping Ihave tried to focus my energy in learning these particular areas.

Once beleaguered by all the acronyms and web sites, I havelearned how to navigate them and utilize the resources at

Colleague Connection

New to It AllBy Sarah M Parris, RN MSN

hand. I also learned there are more to explore! It is clear thisis a long, mind-numbing process, one which is constantly evolv-ing. As in all areas of healthcare we are constantly learning,developing and establishing new ways of doing things. Ihave been introduced to many community resources that havebeen very helpful in assisting me to learn about how the com-munity and hospital work together. Some of these agenciesI have been referred to, others I have “tripped” over intrying to sort out data. I have been overwhelmed by howhelpful every agency has been. I have never been turnedaway; each contact has either assisted me or directed meto help elsewhere.

I have also learned to team up with different resources withinmy hospital. The value of the resources within my agency isamazing! Again, something I never realized until I took on thisrole. I have joined up with the Infection Control Nurse topromote good hand hygiene, with Quality Resource manage-ment on safety trends, and physical medicine to form a taskforce on employee safety related to Bariatric patients. I amlooking forward to many more coordinated efforts.

Lastly, the significance of the local AOHP chapter has beeninvaluable to me. I have been fortunate to attend two areaconferences held by the chapter for continued developmentin areas of worker’s compensation, drug testing and workingwith impaired staff. The advice I have received from myonline queries has been terrific (practical and supportive).The approachableness and helpfulness of all members hasbeen great.

In conclusion I am thrilled to be here and I am enthusiasticallylooking forward to many years of growth in the area of Em-ployee Health. I am so thankful to all the wonderful col-leagues who have patiently guided me this far! What a won-derful group of caring conscientious professionals!

Sarah Parris, RN MSN, is the Employee Health Nursefor Virginia Hospital Center in Arlington, Virginia. Sa-rah has over twenty years nursing experience. She hasbeen in occupational health and an AOHP membersince October 2004.

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Exercise OptionsIs an on-site exercise facility or an off-site reimbursement

program better for your organization?By Nancy Hatch Woodward

Copyrighted content. Please contact AOHP Headquartersat 800-362-4347 or info@aohp.org to purchase a copy of

this Journal issue.

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A O H P J o u r n a l

AOHPNational C

NancyOsborn (l),Line DanceInstructor

Business Luncheon Meeting & Sessions

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25P 2005Conference

Dee Tyler (l) receives 2005 Joyce Safian Award

Lydia Crutchfield(r) receives 2005

ExtraordinaryMember Award

AOHP Journal “Stars”

BusinessLuncheonMeeting GrandPrize Winner

Liko’s IPod Winner

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Initiating a Comprehensive Smoke Free Environmentfor Healthcare Workers

By Kathy Dandino

Without a doubt, nurses should be the least likelyconsumers of tobacco products. On a daily basis, they seethe ravaging effects of smoke and nicotine – emphysemavictims slowly traversing long hospital halls while pullingtheir oxygen tanks beside them, cancer patients undergo-ing painful surgeries in an attempt to prolong their lives,and asthma patients struggling for breath. But, as JosieHoward-Ruben, RN, MS writes 1, “It is the height of irony:With the same hands they use to suction patients’ trachs,deliver lifesaving doses of medication, or resuscitate new-borns, RNs who smoke light the cigarettes that may some-day rob them of their own lives.” So, how does a healthcareorganization combat this and encourage their employeesto “kick the habit?”

MediCorp Health System in Fredericksburg, VA, has initi-ated a unique, proactive program to accomplish the goal ofsignificantly reducing tobacco consumption by employees.In 2002, we instituted a smoke-free policy to include theentire hospital campus, as well as all off-site locations, in-cluding office buildings, an assisted living facility and anursing home. This began with a directive from the Boardof Directors to investigate and implement a plan to makeour organization tobacco free. The first step was to con-duct a survey of employees to see how many actually usedtobacco products. Recognizing that there would be signifi-cant physical and psychological difficulties presented bythis new policy, it was suggested that nicotine replacementtherapy and counseling be offered free of charge to allthose wishing to quit. To maintain the fiscal integrity of theinstitution, a breakdown of costs was done for lost productivetime (sick days, call-outs), higher use of insurance benefitsdue to increased risk factors, time spent for “smoke breaks,”etc., with an estimate of costs for a six month period. Theresults showed it was far cheaper to provide employeeswith nicotine replacement and that the benefits would faroutweigh the costs incurred. Initially, many people tookadvantage of their employer’s generosity, but used the as-sistance mainly to remain comfortable at work, while con-tinuing their tobacco use after hours. Gradually, many dis-covered that the patches, gum and lozenges helped to di-minish their desire to smoke or chew, resulting in a signifi-cant number choosing to become smoke and tobacco-free.

Shortly after the program began,it was noted that many partici-pants expressed frustration withtrying to quit in a householdwhere a spouse or grown chil-dren also smoked, seriously en-dangering their earnest efforts.MediCorp recognized this as alegitimate risk factor and, sub-sequently, offered the same ces-sation assistance to family mem-bers living with the employee. Thefamily member is counseled and also provided with nicotinereplacement therapy at no charge.

Eventually, after a two year period, the program evolvedinto its current form, which is a three month commitmentto come in for counseling, properly use the selected formof nicotine replacement therapy and check in every twoweeks for refills and support. At the end of three months,participants are expected to have gradually reduced theamount of nicotine required and are assessed for readi-ness to discontinue the replacement therapy. If tobaccouse has been completely curtailed, but the individual is notready to be totally nicotine free, additional therapy may beindicated, at the discretion of the counselor. If the indi-vidual is still using tobacco products, any continuation ofnicotine replacement therapy must be at his or her ownexpense. However, these individuals may be evaluatedfor readmission to the program at a future date.

Program costs are budgeted to the Associate Wellness De-partment, the health office for MediCorp’s almost 4000employees. Intake information is collected, and then a staffnurse takes blood pressure/pulse and talks to the potentialparticipant about any current health problems that may berelated to tobacco use. I am responsible for the evaluation,counseling and follow-up. By far, my most valuable assetis my status as a former smoker. No amount of educationcan replace the experiential knowledge of having walkedin the shoes of those entering the program. An instant bondis easily established when the individual learns that I do,

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27indeed, understand and respect the enormity of the jour-ney they are about to undertake.

In 2005 alone, about 50 people have taken the plunge andconquered their nicotine addiction, both at work and athome. They consistently extol the obvious benefits of climb-ing stairs without having to stop and rest, having more en-ergy to enjoy participating in sports, playing with their chil-dren, etc. Most of all, the experience of smelling and tast-ing food, having clean-smelling clothes, hair and skin, andno longer being “controlled” by tobacco products gives thema renewed sense of accomplishment and freedom.

Research proves that nicotine addiction is as difficult tobreak as a crack cocaine or heroin habit2, but replacementtherapy has been shown to be extremely effective in re-ducing withdrawal symptoms. Unfortunately, many healthinsurance companies give premium reductions to non-smok-ers and pay for expensive surgeries resulting from tobaccouse, yet refuse to pay for nicotine replacement that couldhelp their clients free themselves from their destructiveaddiction. These products are expensive, but MediCorpHealth System believes it is definitely reaping the benefits

of a more productive and far healthier workforce. I ap-plaud them for stepping up to the plate to deal with a highlyemotionally charged healthcare issue, then hitting ahomerun by providing tangible cessation education and as-sistance, thereby playing a lifesaving role in caring for itsemployees and the members of the community it serves.

Kathy Dandino is the Office Manager in AssociateWellness for MediCorp Health System inFredericksburg, Virginia. Kathy has completed theMayo Clinic Tobacco Cessation Training Program inNovember 2002, served as an Adult Smoking Cessa-tion Facilitator and currently works with parents ofteenagers referred by schools for an alternative to sus-pension Teen Smoking Cessation Program. She has alsobeen Secretary of the Rappahannock Coalition AgainstTobacco for five years, has worked in the healthcarefield for 20 years, and is a former 25-year smoker.

References1. Nursing Spectrum Website

2. Guide for Quitting Smoking, American Cancer Society

Prevent, Inc. & Liko, Inc.

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“Caring for the Caregiver”

AOHP extends a special thank you to Prevent, Inc. and Liko Inc.,Platinum Sponsors for the second year, for their generosity in

underwriting AOHP’s Annual Business Luncheon at the 2005 NationalConference.

To learn more about Prevent, Inc. and Liko Inc., visit www.getalift.comand www.liko.com.

28

A O H P J o u r n a l

Protocol for Safe Use of Patient Handling Slings- Does One Size Fit All?

By Laurette R. Wright, RN, MPH, COHN-S; Celinda P. Evitt, PT, GCS, PhD; andAndrea Baptiste, MA, CIE

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the VHA.

Acknowledgements: The authors wish to express sincere appreciation to Marylou Muir, Winnipeg Regional HealthAuthority and Dr. Audrey Nelson, Patient Safety Center of Inquiry, for their contribution and support in editing this article.

Lifting and handling of patients during the course of an8-12 hour shift entails a host of skills complicated by factorssuch as an aging RN workforce, nursing shortages in hospi-tals, higher patient acuity level, an increasing prevalence ofobese patients, and limited work space within patient roomsEvery manual lifting/repositioning /transferring task is uniqueand physically challenging for the healthcare provider, so it isnot surprising that injury and illness statistics report that nursesare ranked sixth among any profession within the United Statesas having the highest number of strains and sprains within theworkplace (Bureau of Labor Statistics, 2002). Back injuriescost between $24 billion and $64 billion dollars annually indirect and indirect costs, of which up to $20 billion dollars isattributed to the health care industry (Fragala, 1992; Fragala,1993; Garrett, Singiser, & Banks, 1992; Williamson, Turner,Brown, Newman, & Sirles, 1988).

Within the past few years, there has been an increase in evi-dence-based documentation suggesting that use of mechani-cal lifts and other patient handling devices within U.S. hospi-tals and long term care facilities has a significant impact inreducing lifting-related musculoskeletal injuries amonghealthcare providers, particularly nursing personnel (Fragala,1996; Fragala & Santamaria, 1997; Nelson & Baptiste, 2004).In addition to employer efforts to reduce and/or eliminate pa-tient handling incidents, other entities driving our “culturechange” regarding manual handling practices are evidencedby professional organization activities such as the AmericanNurses Association’s Handle With Care campaign, and regu-latory standards such as those introduced in the United King-dom and in the United States (American Nurses Association(ANA), 2004; Evanoff, Wolf, Aton, Canos, & Collins, 2003;Ronald, Yassi, Spiegel, Tate, Tait, & Mozel, 2002; Health &Safety Executive (HSE), 1992; Occupational Safety & HealthAdministration OSHA, 2004).

Although the hazards of manually lifting in healthcare arewell-covered in the literature few articles have focused onsling design, selection criteria, or its application in providingcare to patients with varying medical conditions. New tech-nology introduces the potential for new and different errorsand slings are no exception. (Hignett, 2003; OSHA, 2004,Nelson, Lloyd, Menzel, & Gross, 2003; Battles & Reyes,2002). Nelson and colleagues found that the correct opera-tion of all patient handling equipment is not intuitively obvi-ous to staff and that staff have found some attachmentmechanisms significantly more stressful than others to use(Nelson, Lloyd, Gross & Menzel, 2001). Serious adverseevents to patients, caregivers, or others following use of ahoist and sling are typically attributed to one or more of thefollowing factors: (1) Incorrect selection of equipment, (2)Lack of/or improper patient assessment, (3) Malfunctioningand/or damaged slings/sling attachments/lift, (4) Insufficientuser training, and (5) Incompatibility of sling and hoist. (Ali,& Glenister, 2001).

The purpose of this article is to acquaint the reader with abrief overview of types and uses of slings and to providesafety and comfort suggestions for choosing the optimal slingbased on the patient’s condition. It is important for the readerto understand that slings are not functional without a mechani-cal lift and that it is important to use a sling and lift from thesame manufacturer to maintain a safe patient transfer.

Sling DefinitionAn operational definition of a patient care sling is a fabricdevice that is used with mechanical lifting equipment to tem-porarily lift or suspend a body or body part in order to per-form a patient handling task (VA Patient Safety ResearchCenter, 2005). For the purpose of this article, the term lift-

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29ing refers to a procedure used by the nurse or clinician to liftor carry the patient’s full body weight or extremity upwardsbefore moving downward or horizontally (Coleman, 1999).Transfer refers to a procedure used to move a patient fromone surface, or position, to another, and repositioning is usedto adjust a patient’s position on the same surface. (HealthCare Health and Safety Association of Ontario (HCHSA),2000). Patients may or may not be able to assist with trans-fers and/or repositioning, depending on their diagnosis andcurrent medical status.

In keeping with other technological advances, patient han-dling slings have greatly improved. Early versions of slingswere made from ship’s canvas andrecycled fire hoses (Grant, 1961).Today, slings are made from light,durable materials such as washablenylon, polyester, or even materialswhich may be disposed of followingsingle patient use. A one-piece slingis standard and some slings haveplastic stays at one end to offer morehead support (Simonton, K. &Wilcox, D., 1999). Slings can becategorized into these five types:(1) seated, (2) standing, (3) supineor stretcher, (4) ambulation, and (5) limb support slings. De-velopment of limb support slings has not been addressed asfully by manufacturers as other types of slings, although pro-totypes have been used in other countries to suspend an ex-tremity for prolonged periods while performing prolonged treat-ment tasks such as dressing changes. (National Back PainAssociation (NBPA), 1998, & Royal College of Nursing(RCN), 1998).

Sling TypesSitting SlingsA seated sling is used when a patient is not physically able toassist with transfers, is unable to understand simple direc-tions, is unable to bear weight on at least one extremity; or isunable to maintain upper trunk stability while in a seated posi-tion. Typically, the seated sling is styled from a single ham-mock-like rectangular piece of fabric but may also be a U-shaped piece of fabric with a divided leg section. There areadvantages to both styles depending on an individual’s condi-tion. For example, split-leg slings are easily applied to thepatient while he/she is sitting or lying. Additionally, havingdivided leg straps enables the patient’s legs to be supported inan adducted or abducted position (NBPA, 1998; RCN, 1998).Seated slings are available with or without head support. Head

support is an added feature that is important to consider be-cause almost all slings for seated transfers give a backward,semi-inclined body position during the transfer (Mutch, 2004;HCHSA, 2000). For orthopedic patients, some seated slingsmay result in a trunk-to-thigh angle of more than 90 degrees,which is a problem for patients with hip pain, reduced hipflexion, and/or hip replacement surgery. For patients who mayexperience respiratory distress, placement of the patient atleast 45 degrees upright is suggested to maximize lung func-tion, offer better respiratory mechanics, and increase patientcomfort (Burns, Egloff, & Ryan, 1994; Edlund, Harms-Ringdahl, & Ekholm, 1998). In selecting a sling for abilateral amputee, cautionary measures should be takendue to the amputee’s altered centerof gravity. If the amputee patientis placed into a standard sling thereis an increased likelihood that theresidual stump may slip through theleg opening. To avoid potential slip-page of the stump and prevent for-ward loss of balance, an amputeesling should be used along with a liftthat tilts or reclines the patient tomaximize comfort (ARJO/Diligent,2005).

Stand-Assist SlingPowered stand-assist lifts typically use a narrow one-pieceband sling designed to fit under the arms and around the backof the patient, at about waist level, to assist with standing fortransfers, repositioning in chairs, or for rehabilitative therapy.When considering rehabilitation tasks such as a patient’s ini-tial standing/weight-bearing session, therapists may prefer aharness-type of standing sling to ensure both patient safetyand comfort in very weak patients and to avoid excessivestaff lifting. Harness-style slings are placed on the patientsimilar to a vest or parachute harness and can be used withsome floor or ceiling lifts as well as specialized, mobile, free-standing lifts (NBPA, 1998; RCN, 1998) The harness-stylesling is predominately used whilea patient is receiving rehabilita-tion such as gait training, balance/ambulation practice, or sit tostand transfer practice. Patientsusing stand-assist lifts should bealert, cooperative, able to bearsome weight on at least one legand one arm, and able to under-stand and follow simple com-mands (Mutch, 2004; Nelson, et

Standard SlingAmputee Sling

Sit to Stand Sling

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Walking Sling

2-Point 4-Point Stretcher Attachment

al., 2003). When using astand-assist sling, it is impor-tant that the nurse or therapistnot position the sling directlyunderneath the patient’s arm-pits and that any flaccid ex-tremities be stabilized and/orsupported during the standingto avoid painful subluxation ofthe shoulder joint (NBPA,1998; RCN, 1998).

Supine or Stretcher SlingSupine or stretcher full-body slings are used to provide fullbody support for patients who are highly dependent or forpost-mortem transfers. Typically tasks involving stretcherslings include transferring out of bed to a gurney/stretcher,making an occupied bed, repositioning a patient in bed, andfall rescues (Nelson, Owen,Lloyd, Fragala, Matz, Amato,Bowers, Moss-Cureton,Ramsey & Lentz, 2003). Thepatient is usually unable to pro-vide any assistance with thelift or transfer, or must remainsupine for medical reasons.There are three types of su-pine slings: soft supine slings, strap slings, and scoop slings.There are also specialized rigid stretcher slings for use in hy-drotherapy. The type of supine sling selected will dependupon the needs of the healthcare provider. For example, thestrap stretcher may be found in intensive care and orthopedicunits where it is useful in changing bed linen and allows easieraccessibility to wounds for dressing changes.

ADDITIONAL SLING FEATURESSpreader Bar DesignThere are a variety of spreader bars with 2-point, 4-point, or6-point suspension available on the market. Spreader bardesign choice is vital to patient safety because the spreaderbar/ sling combination determines the degree/angle of thepatient during the lift and therefore the patient’s safety andcomfort (Edlund, et al., 1998). Literature suggests that anincrease in number of attachments is positively correlated toan increase in patient comfort in the sling (NPBA, 1998; RCN,1998). It is strongly advised NOT to “mix and match” prod-ucts from different manufacturers. Attachments for mostslings are either loop or clip in nature. Loop or clip sling-at-tachments may be incompatible from one manufacturer toanother, creating the risk of equipment failure and voiding war-ranties. It is strongly recommended that clinicians or product

management supervisors contact specific manufacturers todiscuss any problems and concerns they have about matchingappropriate slings and spreader bars (Ali & Glenister, 2001).Some would suggest that the benefits of using clips versusloops is that clips minimize “swing and sway” of your patientwhile they are positioned in the sling (McGuire, Moody, Hanson,& Tigar, 1996

Sling MarkingsEach sling should be clearly labeled to identify size, safe maxi-mum weight capacity in pounds and kilograms, and laundryinstructions (NBPA, 1998; RCN, 1998). If a sling becomesworn to the extent that information is difficult to read on thelabel, there is a chance that the sling fabric may be wornenough to be compromised, creating a safety risk. Nursingstaff should have a policy that includes criteria that will assiststaff with identification of worn slings for disposal, and a methodfor replacing worn slings with functional ones free of unduesigns of wear that still retain an attached, legible label.

PATIENT CONSIDERATIONSTo promote caregiver safety and patient mobility, the caregivershould conduct a patient lift assessment every time a lift isperformed. This should include consideration of the patient’smental and physical acuity. A patient lift assessment can be“formal” or “informal”. Formal assessments may includedocumentation on a patient’s plan of care, use of algorithms,and/or visual display of icons designating lift-status in thepatient’s room. Informal assessments may include verbalexchange of information among staff, as well as staff-patientinterchanges, prior to every lift or transfer, and prior to shiftchange. It is important to include patient feedback regardingcomfort and experiences during lifts in any assessment. Re-gardless of the assessment procedure selected, it should besimple and easy to use. Staff should have the flexibility andresponsibility to apply, modify, or adapt their assessments tosituations as they unfold (Blamire, 1995).

Some healthcare providers have reported that their sling se-lection consists of placing the sling alongside the patient tomake a visual determination and “best guess” as to whichsling is the best fit. This is not the most reliable method forensuring proper fit and there have been numerous advisoriesand warnings reported through oversight agencies such as

Stretcher Sling

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31the Food and Drug Administrationand Health Canada alerting healthcare professionals of the dangersresulting from improper using and/or application of slings. (http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/m e d e f f / p a t i e n t _ l i f t s -leve_109_nth-ah_e.pdf)

To better assist healthcare providers in sling selection andfitting, some manufacturers provide charts and other guide-lines for determining the appropriate size sling (e.g. use ofmeasuring tapes). Figure 6. For example, some patients arelong-legged and short-waisted, while others may be short-legged and long-waisted. If a sling is too short under the legportion, the patient may feel like he/she is slipping through thesling. If the patient’s thighs are very large, a split sling mayadd comfort by reducing the possibility of pinching. Patientssurveyed indicated a comfort preference for supine lifts, buta supine position may not be advisable for some patients es-pecially those with respiratory distress, airway, or swallowingproblems (Jacobs, 1994; Ronald, Yassi, Spriegel, Tate, Tact,& Mozel, 2002). When considering patient size, it is essentialthat the safe working loads for both lift and sling are not ex-ceeded. To determine the safe working load of most lifts andslings, healthcare providers can refer to the label located onthe lift and sling, or consult the manufacturers’ operatingmanual. If loads are not clearly labeled on all equipment, thehealthcare provider should remove equipment from use untilsafe working load-limits are identified, properly labeled on theequipment, and properly communicated to all caregivers.

Infection Control Guidelines for Sling UseSling shortages and the custom of sharing of hoists, fabricslings, low friction slides, sliding sheets, and turning aids be-tween patients have been determined to be problematic formost healthcare environments, particularly in view of the ris-ing statistics on drug-resistant organisms and nosocomial in-fections (Weiss & McMichael, 2004). Health care providersbear the responsibility for preventing adverse events includ-ing iatrogenic infections. Standard infection prevention pre-cautions, especially hand washing, and equipment steriliza-tion/disinfection procedures can control and