| Abstract |
Home care/hospice nurses are at risk of infection from human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through exposure to patients' blood. They routinely perform complex medical procedures that formerly were mostly performed in hospitals and that involve potential exposure to blood and bloody body fluids. Furthermore, home health care nurses work under conditions that are often conducive to exposure and unfavorable to preventive actions. Very little is known about the extent to which home health care nurses are exposed to blood, factors contributing to their exposure, or current prevention practices in this population. Methods: A mail survey (n=1,473) was conducted among home care/hospice nurses in North Carolina in 2006. Results: The adjusted response rate was 69%. Nine percent of nurses had at least one exposure/year. Overall incidence was 27.4 (95% confidence interval: 20.2, 34.6)/100,000 visits. Nurses who had worked in home care <5 years had higher exposure rates than other nurses-seven times higher for needlesticks and 3.5 times higher for non-intact skin exposures. Nurses who worked part time/contract had higher exposure rates than nurses who worked full time-seven times higher for needlesticks and 1.5 times higher for nonintact skin exposures. The rates for part-time/contract nurses with <5 year's experience were extremely high. Sensitivity analysis showed that it is unlikely that response bias had an important impact on these results. Safety-engineered medical devices were always provided by the employer to only 45%-80% of the nurses, depending on the type of device. Nurses who were always provided with safety-engineered medical devices by the employer were much more likely to use the safety devices than nurses who were not always provided with the devices. Over 90 percent of nurses who had the devices always provided reported using them, compared to 20 - 50 percent (depending on the device) of nurses who did not have the devices always provided. Moreover, among nurses who did not use the devices, the primary reason given for not using them was that they were not provided. Conclusions: Approximately 150 North Carolina home care/hospice nurses are exposed to blood annually. If these results are representative of other states, then approximately 12,000 home care/hospice nurses are exposed each year nationwide. Providing nurses who are new to home/hospice care with more training, orientation, and supervision would potentially reduce their occupational blood exposure. OSHA standards requiring employers to provide safety-engineered medical devices to home care/hospice nurses are apparently not being enforced. Bringing employers into compliance with these standards would potentially reduce occupational blood exposure among home care/hospice nurses. Future research should aim to develop interventions to reduce the high exposure rates among part-time/contract home care/hospice nurses. |
