Study: Non-Hospital RNs' Bloodborne Pathogens Exposure 'High'

About 40 percent of the 2.3 million registered nurses in the United States are employed in non-hospital settings, and while these workers face many of the same risk factors as their hospital-based counterparts, they actually are often in more danger from bloodborne infections because of their non-hospital work environments, which typically have less safety controls in place and poorer reporting systems. These are among the findings of a study conducted by the Columbia University Mailman School of Public Health that included more than 1,100 non-hospital based nurses, nearly one-tenth of whom reported at least one needlestick injury in the previous 12 months. Extrapolated to the entire non-hospital based U.S. RN workforce, the researchers estimate that the annual number of needlesticks in the non-hospital RN workforce may be in excess of 145,000 per year, most of which are never reported. Findings of the study are published in the December issue of Industrial Health.

According to Robyn Gershon, DrPH, principal investigator and professor of Sociomedical Sciences at Mailman, "These rates of exposure are surprising since they are similar to rates reported for hospital-based nurses, even though hospitalized patients generally have high levels of acuity of patient care (i.e., more procedures, including more invasive procedures), than are typically performed in community healthcare settings." But, as Gershon and colleagues point out, these findings are not completely unexpected since patient care, including more complex types of care, is increasingly delivered at non-hospital based healthcare facilities, including out-patient clinics, nursing homes, doctor's offices, patients' homes, and public health clinics.

Importantly, the researchers found that 70 percent of the exposed nurses were never seen by a healthcare provider at all, even though appropriate and timely follow-up of these incidents can reduce the risk of infection. Findings from the study also suggest that many of the exposed nurses may be at increased risk of infection with serious bloodborne pathogens, such as the HIV, hepatitis C virus and hepatitis B virus, since only 65 percent of these serious exposures were ever formally reported to the nurse's administrator. Fear of getting into trouble, not having enough time to report, and not knowing how to report an exposure, were the three most common reasons given for not reporting.

The researchers found similar risk factors in the non-hospital based nurses, including heavy patient loads, long working hours, poor safety climate, inadequate training and lack of safety devices. "While the risk factors may be similar for both hospital-based and non-hospital based registered nurses, there are numerous barriers to effective infection control and safety programs in non-hospital settings," Gershon said. A large proportion (approximately one-third) of non-hospital RNs work in establishments with fewer than 100 employees, and 16 percent work in places with fewer than five employees. "As a result, many of these facilities lack on-site infection control and employee health programs," the report notes.

"With nearly 900,000 registered nurses employed in a wide range of non-hospital settings, and patient prevalence rates for certain bloodborne pathogens similar or even higher in non-hospital based settings, it is important to develop and implement targeted risk reduction strategies that are tailored to these unique non-hospital settings," Gershon said.

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