TAKING CARE OF THOSE
Who Take Care of Us
Healthcare workers and fire and rescue personnel provide vital services to our communities. Healthcare workers care for the sick, the injured, the old or infirm, while fire and rescue personnel protect our loved ones and keep them out of harm’s way. Like any other occupation, these two come with their own sets of workplace risks. But unlike other job risks, injuries to individuals in these occupations may affect their ability to care for and protect the public.
With support from Washington State Department of Labor & Industries (L&I) Safety and Health Investments Project (SHIP) grants, our researchers teamed up with Washington state organizations and agencies to develop resources to reduce work-related risks associated with these two occupations.
Safe patient handling
Manual handling of patients, lifting or transferring them, is potentially hazardous to healthcare workers as well as to their patients. The L&I Safety and Health Assessment and Research for Prevention (SHARP) program investigated issues related to safe patient handling in healthcare in response to a request from the Washington State House of Representatives Commerce and Labor Committee.
SHARP found a close relationship between patient and staff safety. The number of patients who are older, heavier, and have more serious illness is increasing. Patient injury, such as from falls or skin scrapes, can result from manual patient handling mishaps.
Inadequate resources or procedures to properly lift patients can also harm the healthcare worker. In 2003, the number of workers’ compensation claims for back injuries from hospitals and nursing homes was nearly four times higher than claims for back injuries from all other sectors combined. SHARP reports that nursing staff have among the highest back and shoulder injury rates of any occupational group in Washington state.
In recognition of the risks that healthcare professionals face, a 2006 Washington state law required acute care hospitals to implement a safe patient handling program. The law also prescribes necessary equipment and provides hospitals with a tax credit for patient handling equipment purchases.
A Safe Patient Handling Steering Committee made up of representatives from hospitals, health care unions, and SHARP was formed to assist hospitals. Our Continuing Education (CE) program worked with the committee to organize a 2008 conference, “Creating a Culture for Safe Patient Handling.” Subsequently, under a SHIP grant, CE redesigned a central online resource website and created a downloadable manual, Best Practices for Safe Patient Handling, to assist Washington hospitals in implementing cost-effective patient handling programs that protect both patients and healthcare employees.
Safe breathing air
Self-Contained Breathing Apparatus (SCBA) is essential personal protective equipment used by firefighters and rescue personnel. When fire and smoke in a burning building make the air unsuitable to breathe, firefighters wear SCBA, a face mask coupled with a tank of compressed air. It is also used for protection from toxic fumes or an oxygen-deficient atmosphere. Divers use a slightly different apparatus to accommodate breathing in deep-water operations.
Equipment failure is relatively rare, considering the number of times that SCBA is used. Yet, a technical report issued by the US Fire Protection Service in 2001 cautions that SCBA can fail and recommends that equipment be regularly inspected, maintained, and upgraded. Federal regulations enforced by the Occupational Safety & Health Administration (OSHA) require breathing air tanks to be tested quarterly and when any breathing air system is modified. Many fire departments test their own tanks using commercial measurement kits. Oxygen, carbon monoxide, carbon dioxide, condensed oil, and water content are all measured.
Water content can become a significant issue for rescue teams working in colder climates. Under typical conditions, breathing air from the tank cools when it expands and is released through the regulator. Water vapor may then condense, and if the temperature of outside air is cold enough, the condensed water can freeze, slowly build up, and ultimately block the valve’s release of air.
OSHA requires the water content to be less than 24 parts per million (ppm), or even lower, depending on the outside temperature where the tank is used. Our Environmental Health Laboratory (EH Lab) has been testing breathing air for 30 years. Accredited by the American Industrial Hygiene Association, the EH Lab offers a wide range of services in analytical chemistry and instrumentation to Washington state organizations and agencies. Submitted air samples frequently failed to pass because the measured water vapor content exceeded OSHA standards.
With funding from a SHIP grant, EH Lab staff worked with four fire departments in Snohomish county, Yakima, and on Camano Island, and with the Global Diving & Salvage, Inc. in Seattle to test six different commercial measurement kits.
Water vapor is the most difficult component of breathing air to analyze accurately. Frequently, failure to pass the water vapor requirement is caused by the sampling itself, concludes EH Lab Director Russell Dills. He explains that sampled breathing air can be easily exposed to ambient air, which holds a great deal more water vapor than the sample itself, and thus can contaminate the sample and distort the final measurement. For example, air on a typical 50°F day could hold anywhere between 7,600 and 12,300 ppm of water vapor.
Dills found a great deal of variety in the commercially available methods used to collect and measure breathing air samples. He plans to develop best practices guidelines to help agencies and organizations better identify the quality and competency of kits used to measure compressed breathing air.
For further reading
Safe Patient Handling in Washington state
OSHA respiratory protection standards
Photo by Jeannette Murphy, St. Luke's Rehabilitation Institute, Spokane, Washington
