Home is where the hazards are

When addressing healthcare workplace safety concerns, most executives immediately think about hospital safety. They rarely think about one of the most hazardous professions in healthcare—the home healthcare aide.

Home health workers provide hands-on, long-term care and personal assistance to people with disabilities or other chronic conditions. They provide it in the clients' homes. These health professionals include personal aides, nursing assistants or home health nurses, who either work directly for their clients or for an agency or business that sets up appointments and visits.

Because of the varied work environments that exist in clients' homes, these workers are exposed to multiple workplace hazards. The U.S. Department of Labor's Bureau of Labor Statistics recently released data showing that nonfatal occupational injuries and illnesses for healthcare support workers increased at almost two-and-a-half times the rate for all private and public sector workers in 2010.

There are a number of hazardous conditions that can exist in clients' homes. Home health workers can encounter residences without water or with extreme temperatures. They sometimes face unsanitary conditions and hostile pets.

Unsanitary conditions may cause the presence of rodents or other pests. Those conditions may cause the contamination of medical supplies and help spread disease and infection. Hostile pets carry the risk of a home healthcare worker being bitten, feeling threatened or otherwise injured.

It's important for home health workers to understand what conditions are acceptable for a work environment, as well as when they should remove themselves from such conditions. Home healthcare workers should be encouraged to talk with supervisors about any unsafe conditions in their clients' homes, and they should be educated on the process to report such conditions.

The hazard of bloodborne pathogens is well-known in the healthcare industry and can pose an even greater danger in nonhealthcare settings such as individuals' homes. Disabled or ill clients often require medication, which may be in the form of injection. Hepatitis B, hepatitis C and HIV are just some of the more common bloodborne pathogens that home health workers can be exposed to. Exposure may occur through needles, sharp injuries, mucus membranes and skin exposures.

The key is to reduce an employee's risk of exposure. Personal protective equipment, such as gloves or goggles, can help reduce the risk and should be worn at all times. When home healthcare workers handle blood or other body fluids, certain protocols should be followed to ensure there is no direct exposure. Containers should be completely sealed, and proper medical procedures should be followed.

The Occupational Safety and Health Administration recommends that healthcare workers be educated about exposure control plans that have detailed instructions on employee protection measures.

Violence is another problem faced by home healthcare aides. A home healthcare fact card created by the Centers for Disease Control and Prevention notes that these workers are vulnerable because they face changing and unpredictable environments. The violence can include verbal abuse, threats of violence, physical abuse to homicide.

It is important to maintain a zero-tolerance policy for any instance of workplace violence. Workers must be instructed that any cases should be reported immediately.

Home healthcare workers should know how to identify a potentially dangerous situation, and they should be trained in how to manage hostile and violent situations. If they feel uncomfortable at any time, they should remove themselves from the environment.

Finally, because of client lifting and moving, home-care workers may experience work-related musculoskeletal disorders, such as low back pain or rotator cuff injuries. These can be caused by excessive force to the back when lifting a client, the repetition of the movement if it is repeated on a regular basis, or assuming an awkward position when performing these tasks and placing stress on the body.

Several factors should be considered when determining the proper method for moving patients. These include the level of assistance the patient requires; the size and weight of the patient; the ability of the patient to understand and cooperate; and any medical conditions that the patient may have.

The ultimate solution is to minimize or eliminate the manual lifting of patients when possible.

The more home healthcare workers are prepared to protect themselves against these hazards, the more productive and safe the environment will be for them and their clients.

Steve Bills is senior manager of loss prevention for Texas Mutual Insurance Co., an Austin-based provider of workers' compensation insurance.