Browsing by Subject "Occupational Health and Safety"

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    Patient Handling, Workplace Violence, and Contact-Related Occupational Injury Among Residential Care Workers
    (2024-05) Moskowitz, Adam
    Background: The Healthcare and Social Assistance industry, which employs over 21 million private sector workers in the United States, has some of the highest rates of occupational musculoskeletal disorders (MSDs) and injuries of the back or trunk out of any industry, 1-3. These injuries largely result from the physical strain and awkward postures associated with lifting, moving, or otherwise assisting patients with limited mobility, 4. Several states have attempted to regulate these hazardous job duties, known as Safe Patient Handling and Mobility (SPHM), yet many healthcare workers are employed in long-term and residential facilities that are excluded from these regulations, 5. Workplace violence (WPV) is another major cause of healthcare worker injury that arises from the uniquely intimate settings and job duties in direct care work, with over 70% of all non-fatal instances of WPV recorded in the US occurring among healthcare workers6. Like SPHM, WPV is especially pronounced among lower levels of healthcare worker certification and in long term or residential settings7. With the understanding that SPHM and WPV injuries are shaped by common factors, research is needed to analyze the gaps and areas for increased coverage in existing SPHM policy, compare injury reduction among workers that are covered by existing policy with those that are not, and characterize SPHM and WPV injury burdens in the overlooked long-term residential care sector. Objective: This research aims to characterize the landscape of patient contact-related injury among the wider healthcare workforce in Minnesota, with a focus on workers at long-term residential disability facilities, also known as group homes. Results can inform holistic policy approaches to reducing SPHM and WPV injury, which are interrelated with the uniquely intimate tasks and responsibilities of healthcare workers. Manuscript 1: Aim: Create a policy map of all state-level SPHM laws in the United States, noting their scopes of coverage and common elements. Methods: A legal assessment was used to collect and characterize all state-level SPHM policies according to a coding protocol. Two researchers coded all state laws for their scopes of coverage, legal requirements, and avenues for enforcement. Results: Between 2006 and 2023, eleven out of fifty states enacted SPHM policies to protect healthcare workers from injury. All state policies covered general hospitals, with policies favoring higher-acuity settings over lower-acuity settings. Common interventions included administrative controls such as SPHM committees, safety trainings, and hazard assessments. Required engineering controls such as purchasing SPHM equipment and modifying physical work spaces were less common. Manuscript 2: Aim: Evaluate the 2007 Minnesota Safe Patient Handling Act’s effectiveness in reducing SPHM injury, and investigate its effects on WPV injury, by comparing injury trends in workers covered by the policy with workers in control industries that were not covered by the policy. Methods: Negative binomial regression was used to calculate rates of SPHM and WPV injury from Minnesota’s workers’ compensation claims database, the US Census Bureau’s Quarterly Workforce Indicators, and the US Bureau of Labor Statistics’ Occupational Employment and Wage Statistics. Baseline and follow-up rates were calculated to track the impact of the law over time. Results: Workers that were covered the Act experienced greater relative reductions of SPHM injury than workers that were not covered by the Act, but injury decreases were not uniform between industries. The Act did not appear to be protective for rates of WPV injury. Manuscript 3: Aim: Assess the severity and cost burden of injury relating to SPHM, WPV, or both in Upper Midwest group homes. Methods: Free text incident descriptions from a private insurer’s dataset of 4,364 group home workers’ compensation claims were read by researchers and coded for evidence of SPHM, WPV, or both. Log binomial and log linear regressions with GEE were used to compare risk of incurring lost time and risk of incurring greater mean cost for claims relating to SPHM/WPV injury compared to other injury claims. Results: Claims that were associated with SPHM were more likely to result in lost time and higher mean costs than claims that involved WPV or claims that did not involve contact between workers and group home residents. Using the same metrics, claims that involved both SPHM/WPV were less severe than SPHM-only claims. Conclusion: Although Minnesota regulates SPHM in a broader range of healthcare-related industries than most states, it still faces challenges for reducing SPHM and WPV injury. In general, SPHM regulations in the United States focus on lower-cost yet less effective administrative controls and higher acuity, shorter-term settings8. There is evidence that Minnesota’s SPHM law was effective in reducing SPHM injury rates for the workers that it covered when compared to SPHM injury trends among workers not covered by the law. Healthcare’s WPV injury rates continue to rise despite possibly beneficial changes in SPHM workflow brought by the law. Workers in group homes, an industry excluded by Minnesota’s SPHM law, are at risk of severe injury from SPHM and experience alarmingly high rates of WPV. Policymakers should consider wider definitions of healthcare to incorporate more direct care workers under SPHM protections. Researchers can investigate factors that influence both SPHM and WPV injury, such as safe staffing levels or retaliation protection, to strengthen policy approaches for reducing direct care worker injury.