Health care workers at serious risk of injury on the job
December 5, 2011 10:00 AM
Pam Panchak / Post-Gazette
Former nurse Lisa Black, now an assistant professor at the University of Nevada, tells her story of contracting HIV and hepatitis C from an accidental needle stick while caring for a patient. She now teaches and advocates for safety in health care workplaces.
By Sean D. Hamill Pittsburgh Post-Gazette
Short of dying, former nurse Lisa Black's story is a worst-case injury scenario for people who work in health care.
Fourteen years ago, while helping to care for a patient infected with AIDS, she was accidentally punctured in the left palm by a needle that had been inserted in the patient's IV line.
Though she thought she was in the clear, nine months later, after she became ill, she found out she was infected with AIDS during the accident.
"There's really not words to describe that moment," Ms. Black, 41, told an audience of 60 nurses and phlebotomists at Westmoreland Hospital in Greensburg during an educational seminar designed to encourage safer use of needles. "But, I thought: At least it's not one of my kids," who were 3 and 7 years old then.
At the time, she thought she was going to become part of a small statistical group: health care workers who die from illnesses contracted on the job.
Instead, thanks to the fast advancement of AIDS treatment, Ms. Black is "as healthy as I've ever been" and is part of a much larger and difficult to reduce statistical group: health care workers who were injured or contracted an illness on the job.
That larger statistic was a focus this year of the U.S. Department of Labor's annual report about workplace injuries and illness.
"We remain concerned that more workers are injured in the health care and social assistance industry sector than in any other, including construction and manufacturing, and this group of workers had one of the highest rates of injuries and illness at 5.2 cases for every 100 workers," Labor Secretary Hilda L. Solis said in October.
That 5.2 rate for 2010 compared to the rate for all private industry of 3.5 cases for every 100 workers.
That glaring disparity caught the eye of former Alcoa CEO and UPMC board member Paul O'Neill, who used it during a talk show on WQED two weeks ago to criticize the health care industry generally and UPMC specifically.
"I've had this conversation with the board of directors at UPMC," Mr. O'Neill said on the WQED-TV program "4802" that ran in November. "They haven't got the foggiest notion what the injury rates are, which tells me they don't really care about the 54,000 people who work there, or they would know, and they would have a deliberate process to eliminate injury rates that occur to nurses and technicians and doctors every day."
UPMC officials disagreed with part of Mr. O'Neill's remarks.
"The safety of our employees and patients has always been paramount at UPMC," said Paul Wood, UPMC's spokesman.
But UPMC officials did concede that Mr. O'Neill was correct in saying that the UPMC board does not get regular updates about its injury and illness rates or other related data. They emphasized, though, that each of its 22 hospitals has its own separate board that regularly monitors such statistics, as do the system's senior staff.
"We go to great lengths to disseminate our reports across the UPMC system," said David Weir, president of UPMC Work Partners, which oversees its injury and illness programs.
Mr. O'Neill was on UPMC's board from 2003 to 2004 before he quit when UPMC would not embrace a plan to reduce medication errors that was proposed by the Pittsburgh Regional Health Initiative, a local organization that he co-founded.
"It's a national scandal that the injury rates are so high in health care," he said, particularly compared to industrial companies such as Alcoa, which has an injury rate below 1 case per 100 workers.
Labor Department statistics show that other major industries such as mining (2.3 cases per 100 workers), construction (4.0) and manufacturing (4.4) had much lower rates in 2010 than health care and social assistance did nationally.
And those rates are much lower than the rates for hospitals (7.0) and nursing and residential care facilities (8.3) -- two of the four subcategories that make up the health care and social assistance category.
What's causing all those injuries and illnesses in health care?
Illnesses are a small percentage of the figure, said Azure Albeck, a Labor Department economist who works with the data, and most of the injuries, year in and year out, fall into the same three categories.
"We see very many back strains, from workers picking up or helping up patients," Ms. Albeck said. "And that makes up a third of all injuries."
After that the next largest category are slips, trips and falls, typically on water spilled on the floors of hospitals or nursing homes or other health facilities.
Another leading category of injury is what led to Ms. Black's injury -- needlesticks, as they're known.
How Pennsylvania as a whole stacks up in those categories is not known because the state is one of eight that do not report statewide statistics to the Labor Department, though the state will begin doing that next year.
The Pennsylvania Health Care Cost Containment Council -- known as PHC4 -- that tracks so many statistics hospital-by-hospital for the state, including infection rates, also does not collect data on health care employee injury and illness.
Karen Wolk Feinstein, executive director of the Jewish Healthcare Foundation in Pittsburgh, sees a disconnect in the fact that the state has been gathering data on patient safety but not employee safety.
"It's all of one piece," she said. "If you're a nuclear power plant company or you're in aviation, your focus on safety extends not only to your clients but your staff as well. It's a culture of safety. The same should be true in health care.
"We need accurate data on patient and employee safety as well."
It's also not a topic hospitals like to talk about.
For this story, the Pittsburgh Post-Gazette contacted the region's four largest private hospital systems -- UPMC, West Penn Allegheny Health System, Excela Health and Heritage Valley -- and two biggest independent hospitals, Jefferson Regional Medical Center and St. Clair Hospital.
Only UPMC and Excela Health made officials available to speak about the issues and provide internal statistics. West Penn and Jefferson Regional gave written statements saying their employees' safety was important to them. And Jefferson Regional said it is below the national average on one measure of federal data, but it provided no figures.
St. Clair said it did not want to comment, and Heritage Valley did not return phone messages left with its spokesman, Dan Murphy.
UPMC said it was proud of its record of improving its worker safety in recent years.
UPMC's "corporate" rate -- which looks at all of its 54,000 employees in hospitals, nursing homes, accounting and other divisions -- was 5.4 cases per 100 workers in 2010 -- compared to the national rate of 5.2 -- but that's down from 7.3 in 2007, Mr. Weir said.
The rate in UPMC's 22 hospitals in 2010 was 6.5 -- compared to 7.0 for the national subcategory of hospitals -- and that is down from 7.2 in 2007.
Mr. Weir said those successes have come thanks to a program that tries to emphasize "the overall health of the employees" in addition to cutting down on injuries specifically.
For example, he said UPMC has managed to cut down on the percentage of employees who smoke, from 20 percent to 13 percent in two years. At the same time it has introduced programs such as "We've Got Your Back" that have helped cut down on workplace strains by not only teaching employees how to better lift and assist patients, but helping them develop better core muscles. UPMC has also added more mechanical devices to rooms that help lift patients.
"It's a continual evolution," Mr. Weir said.
Mr. O'Neill praised UPMC for releasing its internal numbers, even if he was troubled with its comparing itself to the national averages.
"If you know that zero is possible, why would you be satisfied with being at the national average?" he asked.
Excela Health -- which owns Westmoreland Hospital and two others in the region, Frick and Latrobe hospitals -- has made even bigger strides in cutting its workplace injury and illness rate by taking advice from other industries.
It had a rate of 8.1 cases per 100 workers at its three hospitals in 2006 and drove it down to 2.8 in 2010 and 1.5 so far this year, in part by adopting strategies commonly used in places such as Alcoa of assessing each and every injury and finding out why they occurred.
It also created three "safety coordinator" positions to oversee the various programs designed to cut down on injuries, and it designated 60 employees throughout its hospitals as "safety advocates" to encourage employees to mop up spills quickly, lift patients properly or use the proper safety equipment, like Ms. Black was advocating with needles.
Many of those changes were made after John Caverno came to Excela three years ago as its human resources director, after leaving Kennametal Inc.
"Health care in general trails industry in terms of employee safety," he said. "And it was clear to me when I came here that some of the things I took for granted at Kennametal were not around here -- like problem solving for injuries."
"But now we're trying to debunk the myth that accidents happen," he said. "They don't have to."