National Nurses United

7 National Nurses United Shortly after the SENIC report was published, OSHA was directed to change their enforcement program. During the 1980's, the federal government was priori- tizing financial costs over health and safety on a federal level. These actions changed the fundamental nature of OSHA that remains in effect to this day. These policies removed some of OSHA's ability to actively create and enforce safety and health standards, requiring instead a pro-business voluntarism approach. This pro-business approach assumes employers will self-regulate to miti- gate health and safety hazards and occupational injuries and illnesses with the assistance of OSHA's research and initiatives, but not requiring any enforcement actions like citations or fines. OSHA was also required to introduce cost-benefit analyses into the decision-making process when establishing new standards. The 1980's promotion of cost-benefit analyses to appraise the value of human lives monetarily undermined many workplace, environmental, and other public health protections, including infection prevention in hospitals and other health care settings. Add to that an overall disregard for the precautionary principle by the CDC in the health care workplace environment significantly influenced the disproportionate rate of exposures and infections sustained in hospital settings by patients and by nurses. We see these kinds of cost-benefit analyses undermine protections. For example, the CDC tuberculosis isolation guidelines written in 1994 first recommended that health care settings should be required to use High Efficiency Particulate Air (HEPA) Filter respirators to reduce patho- gen exposure. But after an analysis showed that it would cost millions of dollars to prevent one occupational infec- tion and one death, the CDC withdrew the guidelines and replaced the recommendation with a lower level of protection that has many disadvantages. Who Bears the Burden of Inadequate Infection Prevention? (Patients) Patients certainly are negatively impacted when hospitals and other health care facilities implement ineffective or incomplete infection prevention programs. The CDC estimates that 1 in 25 hospital patients has at least one health care-acquired infection on any given day. The HAI Prevalence Survey, published in 2014, estimated that 75,000 patients with health care-acquired infections died during their hospitalizations. Other studies show that 1 in 10 adult hospital patients contract an infection before being discharged. About 70% of health care-acquired infections in the U.S. are resis- tant to one or more antibiotics. A patient with a health care-acquired infection is 7.1 times more likely to die than a similar patient without an infection. Additionally, patients who stay in a room where a previous occupant had an infection, such as MRSA, C. diff, or VRE, has a 73% higher risk of getting infected when compared to other patients. Who Bears the Burden of Inadequate Infection Prevention? (Nurses) It is evident that nurses bear a disproportionate amount of occupational exposure to infectious diseases and infec- tion risk. This fact remains despite the shortage of sur- veillance data regarding occupational infections available in the U.S. The U.S. Bureau of Labor Statistics collects data each year on injuries and illnesses that happen at work and that result in workers requiring some time off to recover. U.S. Bureau of Labor Statistics data shows that hospitals are one of the most hazardous places to work. See Table 1. Industry Total recordable cases (per 100 full-time workers) All industries including state and local govern- ment 3.4 Construction 3.6 Manufacturing 4.0 Trade, transportation, and utilities 3.6 Health care and social assistance 4.5 Hospitals 6.2 Leisure and hospitality 3.6 State government—health care and social assistance 8.1 State government— Hospitals 8.7 Table 1: U.S. Bureau of Labor Statistics, 2016 data http://www.bls.gov/news.release/pdf/osh.pdf Registered nurses (RNs) experience high rates of occupa- tional injuries and illnesses. In 2016, RNs had a non-fatal injury and illness rate of 110.1 per 10,000 full-time work- ers. The injury and illness rate for all workers overall in the U.S. was 91.7 per 10,000 full-time workers. Figure 4 details the different types of injuries and illnesses expe- rienced by nurses and reported by employers to the U.S. Bureau of Labor Statistics. Very low numbers of cases are due to infectious diseases, partially because of a lack of recordkeeping by employers, but also because the U.S. Bureau of Labor Statistics only captures occupational injuries and illnesses that result in days away from work or a job transfer to restricted or light duty.

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