Tag Archives: Amber Mitchell

‘Un-Healthcare’ Work Deserves Focus

Some, like me, who have dedicated their lives to the maintenance and improvement of physical and mental health, may not consider themselves traditional, clinical “healthcare workers.” We may feel as if we work on the fringe, on the outside. We are not nurses or physicians. We work in public health, wellness, nutrition, occupational safety, health economics, fitness, risk management, pharmacy, laboratory, research, insurance and other similar non-traditional clinical professions. We may feel we make a lesser impact on patient care and overall community wellness and vitality. Given historical reference, however, this is absolutely untrue.

The term “healthcare” (whether one word or two) has not been used at all in books, papers, references or published text over hundreds of years, until the mid-1980s. But since the late 1700s, those of us “living on the fringes” have been healthcare workers in the true sense of the practice.

We may not provide bedside patient care in a healthcare or hospital setting, but we do:

  • Prevent infectious disease by promoting the use of vaccines;
  • Protect the public from pathogenic organisms through water and food sanitation;
  • Prevent addiction and antibiotic resistance through pharmaceutical stewardship;
  • Manage repercussions from post-traumatic stress with mental health interventions;
  • Research global disease trends to stop them in their tracks;
  • Manage risk by improving safety, security and improving quality;
  • Decrease work-related injury and illness by creating safe workplaces, and
  • Prevent heart disease and weight-related cancers by promoting regular exercise.

Those efforts ensure that a population’s health (both physical and mental) does not suffer, that it is either maintained or, better yet, improved. We are the “Un-Healthcare Workers.”

It is especially important that traditional healthcare organizations and healthcare workers know this now. As healthcare systems around the world are caring for patients with emerging infectious diseases like Ebola and re-emerging vaccine-preventable diseases like measles, they need to consider that we un-healthcare workers have responsibility for protecting our communities. If we can prevent diseases from becoming epidemic in our communities, healthcare providers working in healthcare settings like hospitals can focus more on providing needed care to those with emergent injuries and chronic disease.

The American Public Health Association (APHA), which has represented people protecting the public since 1872, announced a policy in November on preventing Ebola and “globally emerging infectious disease threats” that marked a significant change in the recognition of the “un-healthcare worker.” The APHA identified the need to focus efforts on preventing infectious disease in the community and workplaces as a means to protect healthcare systems from exposure to diseases that may change the overall landscape of inpatient care. In the process, the APHA advocates for the role that we “un-healthcare workers” have in maintaining and improving the physical and mental health of our population so that healthcare workers can focus on medical interventions for those who really need it.

Sound, science-based public policy and fiscally grounded public health funding can do what it did for the hundreds of years prior to the mid-1980s; it can protect our communities from disease, so that we can protect the vitality of our healthcare systems.

OSHA Should Help on Infectious Diseases

OSHA’s promulgation of an infectious disease rule/standard to protect healthcare workers and employees in healthcare facilities from microorganisms that cause illness and infection would be a welcome expansion of the work OSHA has already done related to bloodborne pathogens.

A standard of national caliber would not apply any more pressure to healthcare employers than they already place on themselves to protect the patients and healthcare workers they serve. On the contrary, a rule would highlight the importance of the safety and health of healthcare workers.

However, just when we, as a nation, are designing programs to protect healthcare workers from exposure to emerging infectious diseases, like Ebola virus, small businesses say, “No thanks, OSHA, we’re all good.” Just recently, the Small Business Advocacy Review (SBAR) Panel issued a report to OSHA Assistant Secretary Dr. David Michaels that said small healthcare businesses (to include ambulatory surgery, doctors’ offices, dental offices, specialty clinics and dialysis centers, to name only a few) weren’t interested in better protections for their workforce.

Small entity representatives (SERs) decided that the guidance that is already in place is good enough and that OSHA would just be adding more requirements. The SBAR report stated:

Many SERs felt that this rule would overlap with and/or duplicate other relevant guidelines and regulations, including, for example, materials issued by the Centers for Medicare and Medicaid Services (CMS), the Joint Commission and other voluntary accrediting organizations, and state accrediting boards.

SBAR has a point: Guidance is in place from CMS, the Joint and others, like CDC. But the guidance is almost completely to protect the patient, not the worker.

The American Public Health Association (APHA) disagrees with the SBAR panel and firmly believes that an OSHA standard should be fast tracked to protect the working public. The APHA issued a national policy statement just last month.

We learned from the Ebola exposures in Dallas that those infected after exposure were the healthcare workers, not other patients. If a patient enters an emergency department feeling generally ill, it is not typically the other patients who are potentially exposed to a yet-to-be-identified pathogen; rather, it is the string of healthcare workers with whom the patient comes into contact. Those include workers who examine the patient, take vitals, take blood or other specimens, assess, diagnosis and eventually treat. In the case of the Dallas Ebola victim, that was dozens of healthcare workers both in and outside of the hospital over more than a week’s time.

The population of healthcare workers that a standard like OSHA’s infectious disease standard could protect is vast. It is typically in smaller healthcare settings that greater protections are needed, as these operations often intersect more closely with the community and have lesser controls in place compared with hospitals or larger health systems. In fact, nearly 10% of the U.S. working population is employed in healthcare settings of all sizes, and healthcare will generate millions of new jobs through the next decade (Bureau of Labor Statistics 2013). This sector of the workforce represents the largest segment of employment growth in the U.S. and serves the largest proportions of Americans, ensuring proper and timely diagnosis, treatment and care. Healthcare employment is marked as the industry sector with the largest growth (2.4%).

Better controls to protect our most important healthcare assets — its workers — are needed now.

OSHA’s bloodborne pathogens standard (BPS) alone will not address these important and constantly emerging occupational risks associated with hazards that are not often visible to the naked eye.  Promulgating an infectious disease role nationally, much like CalOSHA did with its aerosol transmissible diseases standard (ATD, §5199), would provide OSHA the opportunity to work with healthcare facilities and providers of care to develop standards that protect their employees from not just physical or chemical hazards, but biologic ones. Healthcare facilities would have the ability to control the environment of patient care and make it safer for all who enter: patients, family, friends, volunteers, contractors and caregivers alike.

This standard, if done right, has the potential to provide the following benefits:

–       Prevent transmission of microorganisms that cause illness and infection

–       Improve safety for healthcare workers

–       Make care for patients safer

–       Increase the viability of the healthcare work force and the healthcare economy

–       Reduce costs associated with workers’ compensation, time away from work, staff turnover

–       Provide a collaborative, bridge-building role with other U.S. agencies like CMS, CDC and the Food and Drug Administration (FDA)

–       Serve as a model for other countries

OSHA’s continued journey down the path of promulgating an infectious disease standard illustrates the role that it can play in bridging the gap between infectious disease and occupational safety and health experts.