703729
research-article2017
AJMXXX10.1177/1062860617703729American Journal of Medical QualityBinder and Favret
Commentary
Closing the Gap Between Health
Care Worker and Patient Safety
Leah Binder, MA, MGA1, and Ben Favret2
It is well documented that the health care sector is
plagued by high rates of worker injuries and illnesses,
absences from work, and related costs. This is often
related to the unique risks, unpredictable circum-
stances, and unique culture of patient care.1 As a result,
a large portion of registered nurses are retiring early,
citing difficult working conditions as a major cause.2
The recent Ebola outbreak highlighted the safety risks
faced by health care workers as the majority of patients
with Ebola in the United States contracted the infection
providing patient care.
The Leapfrog Group is a national nonprofit founded
by employers and other large purchasers of health bene-
fits and is one of the nation’s premier advocates of patient
safety and transparency. Leapfrog asks hospitals to vol-
untarily report to the annual Leapfrog Hospital Survey,
and then publicly reports hospital-specific safety and
quality metrics. On October 27, 2014, the Leapfrog
Group issued the following statement:
When patients are endangered, so too are the workers who
care for them. For too long, the standard practice in many
hospitals has been to assign infection control to just a few
specialists. Ebola reminds us that infections don’t announce
themselves at the hospital door and an infectious disease
specialist may not be available or nearby. Everyone in the
hospital—from housekeepers to dieticians to nurses to
physicians—needs to have enough awareness to protect
themselves and their patients and prevent the spread of
infection.
The Leapfrog Group board of directors convened a work-
group to research and identify measures of patient safety
that are directly contingent on worker safety, which can
be referred to Leapfrog Expert Panels for possible inclu-
sion in a future Leapfrog Hospital Survey of hospital
policies and practices. A literature search was conducted
via Google Scholar, and the expertise of Hospital
Corporation of America, Cancer Treatment Centers of
America, Nemours Children’s Clinics and Hospital, and
the International Safety Center was consulted. The work-
group identified 3 areas in which patient safety is depen-
dent on health care worker safety: safe patient handling,
vaccination for preventable disease (specifically influ-
enza and hepatitis B), and infectious disease exposure
prevention.
American Journal of Medical Quality
1­–3
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DOI: 10.1177/1062860617703729
https://doi.org/10.1177/1062860617703729
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Safe Patient Handling
Patient falls and other trauma are the most common hos-
pital-acquired conditions reported to Centers for Medicare
& Medicaid Services (CMS), resulting in approximately
41 fall-related deaths per 100 000 people per year.3 One
third of employer-recorded “days away from work” inju-
ries result from interactions with patients and 25% of
claims are related to unsafe patient handling.1
Because patient handling is a high-risk hazard, organi-
zations such as the Occupational Safety and Health
Administration (OSHA), The Joint Commission, labor
unions, professional societies, and the World Health
Organization have all published guidelines and programs
regarding safe patient handling. The guidelines often
include recommendations concerning equipment and
proper training, lift policies, and patient assessment tools.
By instituting more rigorous standards around training
and equipment, hospitals can protect patients from poten-
tially debilitating falls while also preventing serious
injury to health care workers themselves. However, the
programs in place lack measurability and specificity and
no predetermined standard measures beyond OSHA mea-
sures could be found.
Vaccination for Preventable Disease
Vaccines are among the greatest achievements of bio-
medical science and public health, stimulating protective
immune responses against acute and chronic infectious
diseases, as well as some infectious diseases that result in
cancer and other conditions. In the United States, vacci-
nation programs have made a major contribution to the
elimination of many vaccine-preventable diseases and
significantly reduced the incidence of others.4
Despite global recognition that vaccines are safe,
effective, and economical, health care worker immuniza-
tion rates remain suboptimal.4 The Healthy People 2020
1
The Leapfrog Group, Washington, DC
2
Vestagen Protective Technologies, Inc., Orlando, FL
Corresponding Author:
Ben Favret, Vestagen Protective Technologies, Inc., 1301 W Colonial
Dr, Orlando, FL 32804.
Email: ben.favret@vestagen.com
2 American Journal of Medical Quality
program recommends that 90% of health care workers
receive an influenza vaccination. Unfortunately, the cur-
rent vaccination rate has stalled at 75.2%.5
The impact of a vaccinated workforce on patient safety
is powerful. Hospitalized individuals—especially the
elderly or those with chronic disease—often have fragile
immune systems and are at heightened risk for contract-
ing diseases and suffering debilitating or even deadly
consequences. By vaccinating health care workers, as
supported by all infectious disease professional societies,
facilities could dramatically reduce the transmission of
disease and prevent outbreaks.5
Voluntary programs, educational programs, and tar-
geted outreach for health care workers do not consistently
achieve adequate vaccine coverage levels. In some health
care facilities, mandatory immunization programs may
be required, but rights and options with regard to manda-
tory immunization vary widely. Immunization require-
ments are effective in increasing vaccination rates as
demonstrated by near universal compliance with vaccina-
tion for measles, mumps, and rubella. Requiring influ-
enza and hepatitis B vaccine should be similarly highly
effective.5
Infectious Disease Exposure
Prevention
The prevention and control of multidrug-resistant organ-
isms is a national priority.6 Infectious microorganisms do
not discriminate between patients and workers, and a
horizontal approach to infection prevention is essential to
hospital safety.7 Blood and other body fluid exposure can
transmit microorganisms that cause colonization, infec-
tion, or illness in patients and staff.
According to data from the International Safety
Center, the primary location in the hospital of blood and
body fluid exposures is in the patient room or at the bed-
side. Because of the unexpected nature of these expo-
sures, in only about 20% of blood and body fluid exposure
cases are workers wearing any kind of barrier garment or
personal protective equipment (PPE).8 However, PPE is
not intended to be a first line of defense for exposures,
and current compliance with PPE protocols is stagger-
ingly low.9 In addition, blood and body fluids penetrate
protective apparel by soaking through or failures in more
than 10% of reports, and cross-contamination to skin and
clothing has been shown to occur more than 40% of the
time when doffing PPE.8
Basic scrubs and laboratory coats are common apparel
choices by health care workers, but these were never
intended to function as protection against a hazard.9 Prior
to donning PPE, health care workers are asked to follow
Standard Precautions and assess the likelihood of contact
with blood and body fluids or pathogens and anticipate
exposure. This means that when the assessment is wrong,
or when there is no time for an accurate assessment,
health care workers are at high risk of exposure through
splashes and splatters of blood and body fluids to all parts
of their body.
A comprehensive proactive strategy that protects work-
ers and patients from infectious disease is achievable and
can include practical steps to minimize this risk. Sharps
safety devices and active barrier worker apparel can
reduce unanticipated exposures to infectious pathogens.10
These relatively simple measures have the potential to
reduce patient and worker risks from pathogen exposure,
especially when they are implemented in the context of a
more comprehensive infection prevention program.
The link between patient and worker safety in these
areas allows for best practices and measures to be identi-
fied and referred to Leapfrog Expert Panels for possible
inclusion in a future Leapfrog Hospital Survey. Examples
of existing publicly reported or easily gathered and calcu-
lated measures to compare hospital health care worker
safety include OSHA reports of work-related injury and
illness data that can be used to calculate specific estab-
lishment incidence rates such as Total Case Rate (TCR);
Days Away, Restricted, and Transfer (DART); and the
Days Away from Work (DAFWII) case rates. Public
reporting by CMS for flu vaccination rates is now avail-
able, allowing patients to compare health care worker
influenza immunization rates. Health care worker expo-
sure data can be gathered from the National Healthcare
Safety Network, a voluntary surveillance system man-
aged by the Division of Healthcare Quality Promotion
and the International Safety Center’s EPINet (Exposure
Prevention Information Network), a sharps injury and
blood exposure surveillance system that meets OSHA
requirements.
Possible inclusion of such measures as part of the
Leapfrog Hospital Survey may create more diligence in
adherence to best practices and allow consumers make
informed health care choices. The Leapfrog Group wel-
comes suggestions for specific measures at the intersection
of patient safety and worker safety and can be contacted at
http://www.leapfroggroup.org/about/contact-us.
Authors’ Note
Source of work: Leapfrog Healthcare Worker Safety Work
Group.
Acknowledgments
The authors extend thanks to the dedicated health care workers
who make it their mission to help patients—often putting them-
selves at personal risk—and the Leapfrog Healthcare Worker
Binder and Favret 3
Safety Work Group Members: Ben Favret, Vestagen Protective
Technologies; Stephan Lawless, Patricia Mullan, and Terri
Young, Nemours Children’s Hospital; Diane Denny and Debbie
Allan, Cancer Treatment Centers of America; Jill Fainter, Scott
Cormier, and Tim Protale, Hospital Corporation of America;
Jillian West, The Leapfrog Group, as well as Amber Mitchell,
International Safety Center.
Declaration of Conflicting Interests
The authors declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of
this article: Ms Binder is employed by The Leapfrog Group,
whose survey is discussed in the commentary. Mr Favret is
employed by Vestagen Protective Technologies, Inc., a medical
technology company that develops and markets high-perfor-
mance textiles for health care.
Funding
The authors received no financial support for the research,
authorship, and/or publication of this article.
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