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Occupational Safety and Health Problems

Nursing homes and residential care facilities employ about 2.8 million people at 21,000 worksites. There is a considerable amount of strenuous physical labor involved, especially in the moving of patients from one place to another and in helping them with their routine daily hygienic practices. The injury rates at these types of facilities are double those in other occupations. There are healthcare facility hazards which occur in all areas such as potential contamination with blood-borne pathogens, ergonomic problems where the job should be matched to the worker including physical requirements and the physical capacity of the worker, and in the handling, removal, and washing of laundry. There are special occupational health and safety problems: in dietary areas; with all types of maintenance work; within the nurses’ station; in the pharmacy; in housekeeping; and in the use of whirlpools or showers for patients. Violence is increasing and may cause serious injuries not only to patients but also to employees. (See endnote 52.)

Best Practices for Other Healthcare Options

Note: There will be several Best Practices for Other Healthcare Options, but the major source of

Best Practices by area and situation will be found in each individual section related to the acute

hospital situations previously discussed.

  • • Improve home healthcare personnel by providing proper training, increased salaries, and proper supervision by highly skilled, licensed individuals.
  • • Reduce the amount of cases that a caseworker has to deal with on a weekly basis in order for the individual to make repeat unannounced visits in situations that are poor or deteriorating to prevent disease and injury and protect the health of the person, family, and community.
  • • Where necessary, bring in clean-up crews to remove potential environmental hazards from homes and establish a clean and sanitary situation.
  • • Immediately investigate all adverse events in nursing homes and other healthcare facilities to determine the cause of the event and how best to correct it. Do not assess blame but rather use the situation as a teaching moment to correct the problems now and into the future for all patients.
  • • Establish a comprehensive medication program supervised by registered nurses and evaluate each patient individually and have a physician determine appropriate quantity, schedule for delivery, and type of medication which will be combined with all other medications taken by the individual. Report side effects immediately to supervisors for action.
  • • Highlight on the top sheet of the patient chart special needs including fluid and electrolyte maintenance, kidney injury or insufficiency, embolisms, pressure ulcers, skin breakdown of any type, surgical site infections, urinary tract infections, respiratory tract infections, other infections, etc. Train all personnel to check these situations each time they see the person and report any changes immediately to supervisory personnel.
  • • Train all personnel in methods of fall prevention. Determine if medical treatment, the patient’s physical condition, or environmental changes are the cause of the problem. Provide appropriate rehabilitation activities and supervision when the individual might most frequently fall. (See endnote 51.)
  • • Conduct routine surveillance of all patients for infections including available microbiological data. If an individual has a serious infection problem and it may spread to others, utilize appropriate isolation techniques or remove the individual to an acute care hospital for treatment.
  • • Teach all personnel preventive health care to keep these workers from becoming infected, or spreading the disease to other patients.
  • • Conduct a comprehensive survey of patient safety and quality care by using the “Nursing Home Survey on Patient Safety” and utilize the results to make changes at the facility. (See endnote 53.)
  • • Utilize the Occupational Hazards in Long-Term Care: Nursing Home eTool provided by OSHA to determine: potential hazards and possible solutions for healthcare-wide hazards such as blood-borne pathogens; ergonomic problems facing employees; and safety and health problems in the dietary department, laundry, nurses’ station, pharmacy, housekeeping department, and maintenance department. Also utilize the etools established for workplace violence, helping patients in the whirlpool and shower, and in dealing with tuberculosis and Legionnaires’ disease. (See endnote 52.)
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