National Nurses United

11 National Nurses United providing nursing procedures. The researchers report that "body movements during nursing procedures may increase the risk of face seal leakage." Employers should ensure that nurses and other health care workers are effectively and fully protected from occupational hazards. These common issues with PPE underline the impor- tance of other protective measures, such as ventilation systems, screening protocols, etc. Tracking nurses' occupational infections In a meta-analysis of studies published from 1983 to 1996 examining the literature related to occupational acquired infections in health care, the researcher found greater than 20 different airborne, blood-borne, and contact-transmissible pathogens were represented in the cases reviewed. He determined that the attack rate of most of these outbreaks affected between 15-40% of the total number of workers included in the studies. Nurse cases were represented in almost all of the different types of occupationally-acquired diseases included in the extensive review, and were often the worker group most frequently affected when compared with doctors, den- tists, laboratory workers, and technicians. Tracking and reporting work-related injury and illnesses incidences relating to communicable disease transmis- sion and exposures is a mandatory OSHA standard for hospital employers (29 CFR Section 1904). However, an investigation by the U.S. Government Accountability Office (GAO) indicates that an alarming percentage of employers and employees under-record and underre- port incidence. This report, titled "Enhancing OSHA's Records Audit Process Could Improve the Accuracy of Worker Injury and Illness Data," makes several rec- ommendations on how occupational injury and illness recordkeeping could be improved. Many of the disincen- tives to record and report worker injury or illness cited in the report were due to worker fear of employer reper- cussions and employer reluctance to disclose data that would increase worker compensation costs or damage their abilities to attract future business. Additional studies confirm the U.S. GAO's findings. For example, one study anonymously surveyed health care workers to compare the reports of work-related sharps injury and splash exposures made to their employer's occupational health surveillance systems versus their actual experience. This study found that 5 to 60% of these exposures go unreported to their employer. Studies exploring this phenomenon through anonymous surveys found the following reasons common for underreporting: the inconvenience of the reporting process, insufficient time to report, social stigma for reporting, and altered personal risk perception. But the lack of data is not just due to pressures for employees not to report. One researcher found that even when employees did report injuries to their employer's occupational health services, only 28 injuries of 62 reported were documented by the employer over a 12 month period. The implications of this lack of recordkeeping are espe- cially important for the safety of nurses, who experience sharps injury and mucocutaneous exposures to poten- tially infectious material at astonishingly higher rates than other employees in health care. One prospective, 30-day study asked U.S. hospital nurses to confiden- tially track the frequency of blood-contaminated sharp medical device injuries sustained on a total of 14,379 shifts worked. Upon analysis of the prospective data, the researchers found that the incidence rate ratio of these exposures to staff nurses was 0.8 injuries per nurse year for each of the study participants. This means that the study participants could on average expect to encounter a blood-contaminated sharps injury more than once every two years during their career. Obscuring matters further, there is evidence from mul- tiple recent systematic reviews and a major study con- ducted by the National Institute for Occupational Safety and Health (NIOSH) that almost no studies exist which measure actual infection outcomes when studying these exposure impacts on health care workers. Pressure not to report combined with employer underrecording of sharps injuries and other exposure is a widespread issue. This issue is compounded by the lack of research assessing nurse morbidity and mortality caused by sharps injuries and other exposures. These missing pieces undermine employers' incentives to identify and change environ- mental factors, policies, procedures, and other elements of protection. This contributes to nurses' widespread exposure to infectious diseases. Voluntary reporting for hospitals and other health care facilities Even when occupational disease exposure and related morbidity and mortality are accurately recorded by employers, there are varying laws that mandate reporting of this data to state agencies. Reporting of such data to state agencies could allow for public accountability and transparency around infectious diseases in health care settings and could support enforcement activities. Because laws vary by locality, state, and federally, there is a lack of consistency on this point. The agencies and organizations that are responsible for oversight of occupationally acquired infections reporting and collection are severely fragmented and often operate in silos. The resulting dataset compiled is thus extremely heterogeneous and incomplete. This leads to an underes- timation of the true magnitude of occupational infections in addition to supporting a misunderstanding of the causal pathway between health care worker exposure to infectious diseases. In 2005, two researchers set out to evaluate the true mortality due to HIV, hepatitis B and C, and tuberculosis infection exposure for health care workers. They estab- lished this study after confirming that there is no country in the world which has a surveillance system in place that effectively tracks and records the morbidity and mortality incidence of all occupationally acquired infec-

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