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Veille documentaire Médecine du travail du personnel hospitalier - Juin 2005 - CHU Rouen
Veille documentaire
Médecine du travail du personnel hospitalier
Objectif
L'objectif de ce travail est de fournir un outil de veille aux médecins du travail concernant les nouvelles
connaissances scientifiques relative à la santé au travail des personnels de soins. La priorité est
donnée aux documents en français. Ce travail est réalisé par les documentalistes de l'équipe CISMeF
et et le service de médecine du travail et de pathologie professionnelle du CHU de Rouen, dans le
cadre d'un projet financé par la Caisse Nationale de retraites des agents des Collectivités Locales.
Les résultats proposées sont issues de la surveillance mensuelle d'une sélection de périodiques, de
sites Internet d'organismes spécialisés et des bases de données CISMeF, PubMed et BDSP.
Pour obtenir un document, vous pouvez vous adresser à la BIUM (http://www.bium.univ-paris5.fr/) ou
à l'INIST-CNRS (http://www.inist.fr/) .
Juin 2005
1. Risques biologiques ................................................................................................................. 2
1.1 Accident d'exposition au sang .............................................................................................. 2
1.2 Vaccination............................................................................................................................ 5
1.3 Transmission aérienne.......................................................................................................... 7
1.4 Transmission de contact ....................................................................................................... 9
1.5 Contamination soignant-soigné
2. Hygiène et gestion des risques ............................................................................................... 10
3. Infections nosocomiales .......................................................................................................... 12
4. Risques physiques ................................................................................................................. 13
4.1 Troubles musculo-squelettiques ........................................................................................ 13
4.2 rayonnements ionisants ...................................................................................................... 15
5. Risques chimiques .................................................................................................................. 16
6. Allergies ................................................................................................................................... 16
7. Conditions de travail et santé psychologique .......................................................................... 18
8. Violence ................................................................................................................................... 24
9. Autres ...................................................................................................................................... 25
10. Bonnes pratiques
1
1. Risques biologiques
1.1 Accident d'exposition au sang
Documents en français :
In : Bulletin Epidémiologique Hebdomadaire (BEH), n°23, p.115-116, 7 juin 2005
Contaminations professionnelles par le VIH et le VHC chez le personnel de santé, France,
situation au 31 décembre 2004
Florence Lot (Institut de veille sanitaire), Brigitte Miguéres (Groupe d’étude sur le risque d’exposition
des soignants aux agents infectieux), Dominique Abiteboul (Groupe d’étude sur le risque d’exposition
des soignants aux agents infectieux, Hôpital Bichat, Paris)
Accès au texte intégral : http://www.invs.sante.fr/beh/2005/23/beh_23_2005.pdf
REVUE DU CADRE SOIGNANT, Vol. 14, p. 22-26, 2004/11
Évaluation du coût de la prise en charge des accidents exposant au sang.
NIDEGGER (D.), CASTEL (O.), PELTIER (M.P.)
L'étude présentée ici a pour objectif d'apprécier les dépenses réellement occasionnées par les
examens sérologiques, les consultations et les traitements antirétroviraux, dans le cadre du bilan initial
et du suivi des accidents exposant au sang pour l'année 2000 au centre hospitalier universitaire
(CHU) de Poitiers.
Etude, Risque professionnel, Statistique, Coût, CHU, Evaluation, Exposition sang
Mémoire pour l'obtention du diplôme de cadre de santé. Paris : AP-HP, 2004/12, 113p., ann., réf. 2p.
Prévenir les accidents d'exposition au sang : un travail d'équipe.
MULMANN (Odile), MACE (Brigitte) / dir.
Assistance Publique-Hôpitaux de Paris. (A.P.H.P.). Institut de Formation des Cadres de Santé.
(I.F.C.S.). Paris. FRA / com.
Pourquoi les infirmières ne respectent-elles pas toujours les mesures de prévention vis-à-vis du risque
d'exposition au sang ? Est-ce par méconnaissance du risque ou cette attitude cache-t-elle alors des
mécanismes de défense ? Afin de répondre à cette question, nous avons mené une enquête auprès
des équipes de quatre services différents. Cette enquête a pu être menée grâce à l'utilisation de
différents outils d'analyse : questionnaire et entretiens notamment. Tous sont conscients des risques
induits par leur métier. Les médecins reconnaissent que les paramédicaux ont adopté bien avant eux
les mesures de prévention mais que depuis quelques années, ils se sont, eux aussi, "mis aux gants".
Néanmoins, les résultats de notre enquête montrent que toutes les infirmières n'appliquent pas les
mesures élémentaires de prévention préconisées. Le cadre est garant de la mise en oeuvre effective
de ces mesures. (R.A.).
Prévention, Réglementation, Pratique soins, Travail équipe, Accident travail, Risque professionnel,
Epidémiologie, Exposition sang
Documents en anglais :
Haut
Scand J Infect Dis. 2005;37(4):295-300.
Accidental exposure to biological material in healthcare workers at a university hospital:
Evaluation and follow-up of 404 cases.
Gutierrez EB, Lopes MH, Yasuda MA.
Division of Infectious Diseases of the Hospital das Clinicas School of Medicine, University of Sao
Paulo, Brazil. [email protected]
The care and follow-up provided to healthcare workers (HCWs) from a large teaching hospital who
were exposed to biological material between 1 August 1998 and 31 January 2002 is described here.
2
After exposure, the HCW is evaluated by a nurse and doctor in an emergency consultation and
receives follow-up counselling. The collection of 10 ml of blood sample from each HCW and its source
patient, when known, is made for immunoenzymatic testing for HIV, HBV and HCV. Evaluation and
follow-up of 404 cases revealed that the exposures were concentrated in only a few areas of the
hospital; 83% of the HCWs exposed were seen by a doctor responsible for the prophylaxis up to 3 h
after exposure. Blood was involved in 76.7% (309) of the exposures. The patient source of the
biological material was known in 80.7% (326) of the exposed individuals studied; 80 (24.5%) sources
had serological evidence of infection with 1 or more agents: 16.2% were anti-HCV positive, 3.8% were
HAgBs positive and 10.9% were anti-HIV positive. 67% (273) of the study population completed the
proposed follow-up. No confirmed seroconversion occurred. In conclusion, the observed adherence to
the follow-up was quite low, and measures to improve it must be taken. Surprisingly, no difference in
adherence to the follow-up was observed among those exposed HCW at risk, i.e. those with an
infected or unknown source patient. Analysis of post-exposure management revealed excess
prescription of antiretroviral drugs, vaccine and immunoglobulin. Infection by HCV is the most
important risk of concern, in our hospital, in accidents with biological material.
MeSH Terms: Adult - Anti-HIV Agents/therapeutic use - Antiviral Agents/therapeutic use - Blood-Borne
Pathogens - Brazil - Disease Transmission, Patient-to-Professional - Female - Follow-Up Studies - HIV
Infections/prevention & control* - Hepatitis B/prevention & control* - Hepatitis B Vaccines - Hepatitis
C/prevention & control* - Humans - Immunoglobulins/therapeutic use - Male - Middle Aged Occupational Exposure* - Personnel, Hospital*
Substances: Anti-HIV Agents - Antiviral Agents - Hepatitis B Vaccines - Immunoglobulins
RN. 2005 Apr;68(4):17.
Advice on avoiding a needlestick.
[No authors listed]
Publication Types: Comment - Letter
MeSH Terms: Humans - Needlestick Injuries/prevention & control* - Nursing/methods
MLO Med Lab Obs. 2005 Apr;37(4):20-1.
Assess your sharps injury prevention program.
Silverman R.
ECRI, Plymouth Meeting, PA, USA.
MeSH Terms: - Humans - Needlestick Injuries/prevention & control* - Occupational Health* - Program
Development - Program Evaluation - United States
Infect Control Hosp Epidemiol. 2005 Apr;26(4):410-4.
Evaluation of policies regarding physicians infected with blood-borne pathogens.
Ng C, Swartzberg J.
School of Public Health, University of California, Berkeley, California,
[email protected]
OBJECTIVE: Formulating an effective approach to preventing surgeon-to-patient transmission of
blood-borne pathogens has been controversial. The objective of our study was to evaluate current
community hospital policies, if any, regarding restrictions on surgeons (general surgeons and
obstetricians and gynecologists) infected with blood-borne pathogens operating on patients. DESIGN:
A survey on hospital policies regarding surgeons infected with blood-borne pathogens was sent to
infection control officers at Northern California community hospitals (n= 113). RESULTS: Forty-five
hospitals responded to the survey. Of these, only 6 (13.3%) had a policy. Of the 39 (86.7%) that did
not have a policy, only 3 hospitals were planning on implementing one. CONCLUSIONS: Many
community hospitals are uninterested in instituting a policy regarding the practice of surgeons infected
with blood-borne pathogens. Possible reasons include the lack of concern on the individual level,
difficulty in defining exposure-prone procedures, and the nature of the relationship between medical
staff and community hospitals.
Publication Types: Evaluation Studies - Multicenter Study
MeSH Terms: Blood-Borne Pathogens* - California - Disease Transmission, Professional-to-
3
Patient/prevention & control* - Health Policy* - Hospitals, Community – Humans -Infection
Control/statistics & numerical data* Questionnaires – Risk - Surgery*
Infect Control Hosp Epidemiol. 2005 Apr;26(4):336.
Fine needle aspiration cytology without needle manipulation to reduce the risk of occupational
infection in healthcare personnel.
Galed-Placed I, Pertega-Diaz S, Pita-Fernandez S, Vazquez-Martul E.
Publication Types : Letter
MeSH Terms: - Allied Health Personnel - Communicable Diseases/transmission* - Disease
Transmission, Patient-to-Professional/prevention & control* - Humans - Needlestick Injuries/diagnosis
- Needlestick Injuries/prevention & control* - Predictive Value of Tests
J Bone Joint Surg Br. 2005 Apr;87(4):556-9.
Glove perforation and contamination in primary total hip arthroplasty
Al-Maiyah M, Bajwa A, Mackenney P, Port A, Gregg PJ, Hill D, Finn P
Department of Orthopaedics, School of Health, University of Teeside, Middlesbrough TS1 3BA, UK.
[email protected]
We conducted a randomised, controlled trial to determine whether changing gloves at specified
intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A
total of 50 patients were included in the study. In the study group (25 patients), gloves were changed
at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed
prior to cementation. In addition, gloves were changed in both groups whenever there was a visible
puncture. Only outer gloves were investigated.Contamination was tested by impression of gloved
fingers on blood agar and culture plates were subsequently incubated at 37 degrees C for 48 hours.
The number of colonies and types of organisms were recorded. Glove perforation was assessed using
the water test. The incidence of perforation and contamination was significantly lower in the study
group compared with the control group. Changing gloves at regular intervals is an effective way to
decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty.
Publication Types: Clinical Trial - Randomized Controlled Trial
MeSH Terms: Arthroplasty, Replacement, Hip* - Bacteria/isolation & purification - Disease
Transmission, Patient-to-Professional/prevention & control* - Equipment Contamination/prevention &
control - Equipment Failure - Gloves, Surgical*/microbiology - Humans - Medical Staff, Hospital Needlestick Injuries/etiology - Needlestick Injuries/prevention & control* - Operating Room Nursing Research Support, Non-U.S. Gov't
J Hosp Infect. 2005 Jun 1
Medical students' knowledge of sharps injuries.
Elliott SK, Keeton A, Holt A.
Clinical Microbiology, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital,
Edgbaston, Birmingham B15 2TH, UK.
Healthcare workers (HCWs) including medical students are at risk of occupational exposure to bloodborne viruses following sharps incidents including needlestick injuries. The recent Department of
Health guidelines recommend that all HCWs entering a career involving exposure-prone procedures
should be tested for hepatitis C, making preventative strategies even more relevant. A survey of
current medical students' knowledge regarding prevention of sharps injuries in Birmingham, UK was
carried out to determine their awareness of these risks and to compare the findings with an earlier
cohort of students. Two hundred and fifty-six medical students were enrolled into the study. Their
knowledge of needlestick injury, prevention and management had significantly improved compared
with the previous study. This demonstrates that intensive teaching and self-learning programmes can
improve the knowledge of HCWs and reduce the number of needlestick injuries.
4
Ann Ig. 2005 Jan-Feb;17(1):67-74.
Retrospective survey on epidemiologic monitoring of accidents due to professional exposure
to biological agents in A.O.U. "G. Martino" of Messina, Italy
[Article in Italian]
Sindoni L, Calisto ML, Alfino D, Cannavo G, Grillo CO, Squeri L, Spagnolo EV.
Dipartimento di Igiene, Medicina Preventiva e Sanita Pubblica "R. De Blasi", Universita degli Studi di
Messina. [email protected]
The management of healthcare professionals exposed to biological material which may potentially be
contaminated with HIV HBVand HCV viruses, is of vital importance in acquiring precise
epidemiological data regarding the type and means of exposure, and the efficacy or failure to apply
recommended preventive measures. This will make it possible to assess over time which measures
need to be implemented or improved. For these reasons we decided to analyze cases of occupational
exposure to biological risk occurring in the University Hospital in Messina between 1998 and 2002.
Our study highlighted in particular that the most frequently affected category was that of professional
nurses (46.74%) and that only 31.72% of the healthcare workers who tested negative for HBsAb were
administered vaccine prophylaxis also after the accident. Moreover, it emerged that there is the need
to increase the amount and quality of information made available, by changing report forms, with the
aim of identifying problems and risky behavior and procedures, and thus make ways to ensure the
continued improvement of the accident prevention and management programmes. In fact, in the
accident reporting procedure used, it was not possible to specify the precise way in which the
accidents happened.
MeSH Terms: Biological Products*/adverse effects - English Abstract - Health Surveys - Humans Italy/epidemiology - Needlestick Injuries - Nursing Staff, Hospital/statistics & numerical data* Occupational Exposure/statistics & numerical data* - Retrospective Studies - Risk Factors Substances: Biological Products
Mater Manag Health Care. 2005 Mar;14(3):33-4.
Sticking to OSHA guidelines.
Stoker R.
International Sharps Injury Prevention Society. [email protected]
MeSH Terms: Guideline Adherence* - Hospitals – Humans - Needlestick Injuries/prevention & control*
- Safety Management/methods* - United States - United States Occupational Safety and Health Administration*
1.2 Vaccination
Vaccine. 2005 Jun 10;23(30):3876-86. Epub 2005 Apr 7.
Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune
manifestations after viral vaccines.
Schattner A.
Department of Medicine, University of Cambridge, School of Clinical Medicine, Level 5, Addenbrooke's
Hospital, Hills Road, Cambridge CB2 2QQ, UK.
BACKGROUND:: Viruses and virus-induced lymphokines may have an important role in the
pathogenesis of autoimmunity (Schattner A. Clin Immunol Immunopathol; 1994). The occurrence and
significance of autoimmune manifestations after the administration of viral vaccines remain
controversial. METHODS:: Medline search of all relevant publications from 1966 through June 2004
with special emphasis on search of each individual autoimmune manifestation and vaccination, as well
as specifically searching each viral vaccine for all potential autoimmune syndromes reported. All
relevant publications were retrieved and critically analyzed. RESULTS:: The most frequently reported
autoimmune manifestations for the various vaccinations, were: hepatitis A virus (HAV) - none; hepatitis
B virus (HBV) - rheumatoid arthritis, reactive arthritis, vasculitis, encephalitis, neuropathy,
thrombocytopenia; measles, mumps and rubella vaccine (MMR) - acute arthritis or arthralgia, chronic
arthritis, thrombocytopenia; influenza - Guillain-Barre syndrome (GBS), vasculitis; polio - GBS;
varicella - mainly neurological syndromes. Even these 'frequent' associations relate to a relatively
small number of patients. Whenever controlled studies of autoimmunity following viral vaccines were
undertaken, no evidence of an association was found. CONCLUSIONS:: Very few patients may
5
develop some autoimmune diseases following viral vaccination (in particular - arthropathy, vasculitis,
neurological dysfunction and thrombocytopenia). For the overwhelming majority of people, vaccines
are safe and no evidence linking viral vaccines with type 1 diabetes, multiple sclerosis (MS) or
inflammatory bowel disease can be found.
J Emerg Nurs. 2005 Apr;31(2):173-7.
Designing a rabies postexposure prophylaxis program with emphasis on staff and patient
education.
Repasky TM, Soskis E.
Emergency Center, Tallahassee Nenorial HealthCare, 1300 Miccosukee Road, Tallahassee, FL
32308, USA. [email protected]
MeSH Terms: Animals - Critical Pathways/organization & administration* - Disease Notification - Drug
Administration Schedule - Education, Nursing, Continuing/organization & administration - Emergency
Nursing*/education - Emergency Nursing*/organization & administration - Florida - Health Services
Needs and Demand - Humans - Immunization Programs/organization & administration* - Inservice
Training/organization & administration - Nurse's Role - Nursing Staff, Hospital*/education - Nursing
Staff, Hospital*/organization & administration - Patient Education/organization & administration* Professional Autonomy - Program Development - Quarantine - Rabies/etiology - Rabies/prevention &
control* - Rabies Vaccines/therapeutic use
Substances: Rabies Vaccines
Occup Med (Lond). 2005 May 27; [Epub ahead of print]
Factors affecting influenza vaccine uptake among health care workers.
O'reilly FW, Cran GW, Stevens AB.
Rolls Royce plc, Derby, UK.
Background In 2000, the UK Departments of Health recommended influenza immunization to
employees directly involved in patient care. Uptake of this immunization had tended to be variable and
usually low. Aims To assess personal and organizational factors associated with influenza
immunization uptake among Health Care Workers (HCWs). Methods A cross-sectional survey of all
HCWs within the Health and Social Care Trusts in Northern Ireland and a parallel-group study of
nursing staff within Elderly Care using self-administered questionnaires. Results Of 203 nurses
working in elderly care units 76(37%) were immunized and 127(63%) declined. Almost 70% of those
not immunized perceived themselves to be 'healthy' and gave this reason for declining immunization.
Nurses were more likely to be immunized by a factor of four if they believed there was benefit for
healthy HCWs, three if they felt at-risk of contracting influenza and nine on a recommendation from the
occupational health (OH) unit. Fifteen OH units participated in a survey of HCWs at the time of
immunization. Five thousand two hundred and thirty (9.7%) HCWs were immunized. Increased uptake
was correlated with immunization in area of work (r=0.74, P=0.02) and when provided out of hours
(r=0.83; P<0.001) and by a factor of two with individual targeting of availability (P<0.001) and when
individuals had been previously immunized (P<0.001). Conclusion Uptake of influenza immunization is
low. Attitudes to one's health and to the value of influenza immunization affect the uptake as does the
delivery of the immunization programme.
Indian J Gastroenterol. 2005 Mar-Apr;24(2):82-3
Hepatitis B vaccination status in health-care workers.
Saffar MJ, Jooyan AR, Mahdavi MR, Khalilian AR.
Department of Pediatrics, Mazandaran University of Medical Sciences, Bouali -Cina Hospital, Sari,
Iran. [email protected].
J Coll Physicians Surg Pak. 2005 May;15(5):257-60.
Hepatitis B vaccination status and identification of risk factors for hepatitis B in health care
workers.
Ali NS, Jamal K, Qureshi R.
6
Department of Family Medicine, The Aga Khan University Hospital, Karachi.
Objective: To assess the vaccination status of health care workers and to identify the risk factors for
hepatitis B at a tertiary care hospital. Design: A descriptive study. Place and Duration of Study: The
Aga Khan University Hospital, Karachi from March 2003 to May 2003. patients and Methods: Three
hundred and ninety-three health care workers were interviewed after taking verbal consent using a
self-administered questionnaire by convenience sampling. A sample size of 385 was calculated, using
5% level of significance, margin of error as 5% and an expected prevalence of 50%. Descriptive
statistics like percentages, mean and range were obtained. Results: A total of 393 respondents, (age
range 19-59 years) were interviewed. Amongst them 86% were completely vaccinated, 12% had
incomplete vaccination and 2% didn't have even a single dose. Needle stick injuries were highest
amongst those health care workers who had complete vaccination. Conclusion: Despite the availability
of free vaccination, a target of 100% coverage has not yet been achieved. All health care workers
should be motivated and ensured for vaccination. Regular educational campaigns for health care
workers are needed to increase vaccination compliance.
J Emerg Med. 2005 Feb;28(2):139-45.
To be vaccinated or not? A survey of Turkish emergency physicians regarding smallpox.
Yanturali S, Suner S, Aksay E, Cevik AA, Sonmez Y.
Department of Emergency Medicine, Dokuz Eylul University Hospital, Izmir, Turkey.
We investigated Turkish emergency physicians' opinions about the threat of smallpox, smallpox
vaccination, and the treatment of patients with suspected smallpox, and sought to identify factors that
affect willingness to receive smallpox vaccination. Anonymous surveys were sent by mail to universityaffiliated Emergency Departments in Turkey. Ten of the 21 university-based Emergency Medicine
programs participated in the study, and 125 physicians (48% of all emergency physicians in Turkey)
completed the survey. The probability of a bioterror attack using smallpox within Turkish borders was
viewed as none or minimal by 43.2% of participants. Only 22.4% of the participants stated that they
would agree to be vaccinated. The only factor that affected the rate of participants' willingness to
receive smallpox vaccination was the occurrence of a smallpox case within Turkish borders. Decisions
about the treatment of patients with suspected smallpox are strongly influenced by whether or not the
physician has been vaccinated against smallpox. At the time of the survey, even during the weeks
leading up to and during the war in Iraq, Turkish emergency physicians' perceived risk of a bioterror
attack using the smallpox virus was low. A significant number of Turkish emergency physicians were
unwilling to participate in a hypothetical vaccination program. This study shows that the occurrence of
a smallpox case within Turkish borders would significantly increase the willingness of emergency
physicians to receive the smallpox vaccine. Decisions about treatment of patients with suspected
smallpox are strongly influenced by whether or not the physician has been vaccinated against
smallpox.
MeSH Terms: Adult - Attitude of Health Personnel* - Bioterrorism/prevention & control Bioterrorism/statistics & numerical data - Emergency Medicine/statistics & numerical data* - Female Health Care Surveys - Health Knowledge, Attitudes, Practice* - Humans - Male - Patient
Participation/statistics & numerical data - Refusal to Treat/statistics & numerical data Smallpox/prevention & control* - Smallpox Vaccine/therapeutic use* - Turkey
Substances: Smallpox Vaccine
1.3 Transmission aérienne
Ann Acad Med Singapore. 2005 Jan;34(1):105-10.
Infectious respiratory illnesses and their impact on healthcare workers: a review.
Low JG, Wilder-Smith A.
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore. [email protected]
Respiratory illnesses are increasingly recognised as a growing concern for healthcare workers
(HCWs) and patients. The recent hospital-based outbreak of Severe Acute Respiratory Syndrome
(SARS) has once again highlighted the vulnerability of HCWs. The new epidemic of the 21st century
resulted in tremendous economic and psychological impact with its high rates of mortality and
nosocomial transmission. Even as the epidemic was brought under control within months, many
details about the SARS coronavirus remained a mystery. The threat of another potential global
7
outbreak continues to lurk in the background. Many valuable lessons have been learned through the
SARS epidemic. It is, therefore, timely for us to review some of the respiratory pathogens that are wellknown to cause nosocomial outbreaks. We need to be better armed to deal with future potential
outbreaks and biohazardous situations. The importance of safeguarding the health of our medical staff
and the community cannot be over-emphasised. In this paper, we review the incidence, transmission
and various preventive strategies of respiratory illnesses in HCWs, in particular, new diagnostic tools,
infection control management strategies, personal protective equipments, vaccination programmes
and post-exposure prophylaxis.
Publication Types: Review - Review, Tutorial
MeSH Terms: Cross Infection/epidemiology - Cross Infection/transmission - Disease Outbreaks Disease Transmission, Patient-to-Professional* - Health Personnel* - Humans - Respiratory Tract
Infections/epidemiology - Respiratory Tract Infections/transmission*
JAMA. 2005 Jun 8;293(22):2746-55
Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a
whole-blood interferon gamma assay with tuberculin skin testing.
Pai M, Gokhale K, Joshi R, Dogra S, Kalantri S, Mendiratta DK, Narang P, Daley CL, Granich RM,
Mazurek GH, Reingold AL, Riley LW, Colford JM Jr.
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India.
[email protected]
CONTEXT: Mycobacterium tuberculosis infection in health care workers has not been adequately
studied in developing countries using newer diagnostic tests. OBJECTIVES: To estimate latent
tuberculosis infection prevalence in health care workers using the tuberculin skin test (TST) and a
whole-blood interferon gamma (IFN-gamma) assay; to determine agreement between the tests; and to
compare their correlation with risk factors. DESIGN, SETTING, AND PARTICIPANTS: A crosssectional comparison study of 726 health care workers aged 18 to 61 years (median age, 22 years)
with no history of active tuberculosis conducted from January to May 2004, at a rural medical school in
India. A total of 493 (68%) of the health care workers had direct contact with patients with tuberculosis
and 514 (71%) had BCG vaccine scars. INTERVENTIONS: Tuberculin skin testing was performed
using 1-TU dose of purified protein derivative RT23, and the IFN-gamma assay was performed by
measuring IFN-gamma response to early secreted antigenic target 6, culture filtrate protein 10, and a
portion of tuberculosis antigen TB7.7. MAIN OUTCOME MEASURES: Agreement between TST and
the IFN-gamma assay, and comparison of the tests with respect to their association with risk factors.
RESULTS: A large proportion of the health care workers were latently infected; 360 (50%) were
positive by either TST or IFN-gamma assay, and 226 (31%) were positive by both tests. The
prevalence estimates of TST and IFN-gamma assay positivity were comparable (41%; 95%
confidence interval [CI], 38%-45% and 40%; 95% CI, 37%-43%, respectively). Agreement between the
tests was high (81.4%; kappa = 0.61; 95% CI, 0.56-0.67). Increasing age and years in the health
profession were significant risk factors for both IFN-gamma assay and TST positivity. BCG vaccination
had little impact on TST and IFN-gamma assay results. CONCLUSIONS: Our study showed high
latent tuberculosis infection prevalence in Indian health care workers, high agreement between TST
and IFN-gamma assay, and similar association between positive test results and risk factors. Although
TST and IFN-gamma assay appear comparable in this population, they have different performance
and operational characteristics; therefore, the decision to select one test over the other will depend on
the population, purpose of testing, and resource availability.
J Hosp Infect. 2005 Apr;59(4):365-8.
Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of
multiple surgical masks.
Derrick JL, Gomersall CD.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of
Wales Hospital, Shatin, Hong Kong, China. [email protected]
Guidelines issued by the Centers for Disease Control and Prevention and the World Health
Organisation state that healthcare workers should wear N95 masks or higher-level protection during all
contact with suspected severe acute respiratory syndrome (SARS). In areas where N95 masks are not
available, multiple layers of surgical masks have been tried to prevent transmission of SARS. The in
vivo filtration capacity of a single surgical mask is known to be poor. However, the filtration capacity of
8
a combination of masks is unknown. This was a crossover trial of one, two, three and five surgical
masks in six volunteers to determine the in vivo filtration efficiency of wearing more than one surgical
mask. We used a Portacount to measure the difference in ambient particle counts inside and outside
the masks. The best combination of five surgical masks scored a fit factor of 13.7, which is well below
the minimum level of 100 required for a half face respirator. Multiple surgical masks filter ambient
particles poorly. They should not be used as a substitute for N95 masks unless there is no alternative.
Publication Types: Evaluation Studies
MeSH Terms: Cross-Over Studies - Disease Transmission, Patient-to-Professional/prevention &
control* - Equipment Design - Filtration/instrumentation* - Humans - Infection Control/standards Masks/standards* - Particle Size - Prospective Studies - Respiratory Protective Devices/standards* Severe Acute Respiratory Syndrome/prevention & control* - Severe Acute Respiratory
Syndrome/transmission
Southeast Asian J Trop Med Public Health. 2004 Dec;35(4):1005-11.
Risk assessment towards tuberculosis among hospital personnel: administrative control, risk
exposure, use of protective barriers and microbial air quality.
Luksamijarulkul P, Supapvanit C, Loosereewanich P, Aiumlaor P.
Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
[email protected]
A recent increase in the rate of tuberculosis among hospital personnel has led to a greater concern
about the risk of Mycobacterium tuberculosis transmission in the hospital. A cross-sectional study was
conducted to assess the risk of tuberculosis infection among hospital personnel of a governmental
hospital in Bangkok by applying hospital tuberculosis control strategies, including administrative
control, risk exposure, use of protective barriers when in contact with TB patients, and microbial air
quality in the studied wards. Fourteen members of the infection control committee (ICC) and 118
hospital personnel were interviewed regarding the infection control policy and its implementation. The
history of TB exposure at work and the use of protective barriers when in contact with TB patients
were recorded for the studied hospital personnel. Air samples in the studied wards were collected to
investigate bacterial and fungal counts. The results reveal that all the studied ICC members and more
than 85% of studied hospital personnel knew the infection control policy and attempted to implement
it. However, 35.71, 37.50, 80.90,93.93, and 88.46% of personnel working in ER, OPD, ICU, female
medical ward, and male medical ward, respectively, implemented the TB isolation policy. More than
80% of studied personnel had histories of exposure to TB patients, but only 52.73% (31.57% in OPD
to 80.00% in ICU) used the appropriate barriers (N95) when in contact with TB patients. Air samples
collected from the studied wards, except ICU, had high bacterial and fungal counts (> 500 cfu/m3).
These findings show that hospital personnel working in the studied wards, except ICU, were at risk for
tuberculosis infection. The hospital ICC should advertise the use of TB standard precautions to
hospital personnel and provide a ventilation system for reducing the microbial counts in the air of the
studied wards.
MeSH Terms: Adult - Air Microbiology* - Cross-Sectional Studies - Disease Transmission, Patient-toProfessional/statistics & numerical data* - Female - Humans - Infection Control/methods* - Infection
Control/organization & administration - Male - Middle Aged - Personnel, Hospital* - Risk Assessment Thailand - Tuberculosis/transmission*
Southeast Asian J Trop Med Public Health. 2005 Mar;36(2):481-8.
Risk of respiratory infections in health care workers: lessons on infection control emerge from
the SARS outbreak.
Wilder-Smith A, Low JG.
Travellers' Health and Vaccination Centre, Department of Infectious Diseases, Tan Tock Seng
Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. [email protected]
Close proximity of persons together with handling of human secretions (eg respiratory secretions)
make health care workers (HCW) particularly vulnerable to transmission of droplet-transmitted
respiratory infections. This was tragically highlighted during the international outbreak of severe acute
respiratory syndrome (SARS) in 2003 with attack rates of more than 50% in HCW. The purpose of this
article is to review common airborne and droplet-transmitted bacterial and viral respiratory tract
infections with regard to their impact on health care workers. Lessons need to be learned from the
9
SARS epidemic. The three main strategies to prevent or control occupationally acquired infections are
relatively simple and cost-effective-droplet and contact precautions and for some pathogens also
vaccination. Enforced implementation of stringent droplet precautions during the SARS crisis should
be maintained; and this will most likely have a major additional impact on other nosocomial infections.
Employee health services should proactively and creatively devise delivery systems that enhance
compliance with vaccination programs for all health care workers. Hospital surveillance should be
expanded to all respiratory diseases to facilitate early detection of nosocomial outbreaks, and this
should also include surveillance of all HCW. Integrated syndromic and virological surveillance systems
set up during the SARS epidemic will also further our understanding of other respiratory infections in
the hospital setting. Even if pursuing early diagnosis for unspecific respiratory illnesses is expensive,
identification of the causative organism may reduce unnecessary isolation, contact tracing and anxiety,
in particular during an outbreak situation. We have a duty to protect our health care workers.
1.4 Transmission de contact
Am J Forensic Med Pathol. 2005 Mar;26(1):18-23.
Prevalence of Demodex in health personnel working in the autopsy room.
Ozdemir MH, Aksoy U, Sonmez E, Aksu C, Yorulmaz C, Hilal A.
Department of Forensic Medicine, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey.
[email protected]
The health personnel working in the autopsy rooms and laboratories are considered among the
professional groups carrying a high risk of contamination with infection. In this study, we have
investigated the prevalence of Demodex, which provides a convenient environment for bacteria and
acts as a vector for certain microorganisms, in the health personnel working in autopsy rooms. The
study, which was cross-sectional, was conducted on 58 health personnel working in autopsy rooms. A
questionnaire was administered to the individuals. Specimens were obtained from 4 different regions
of the face using the standard skin-surface biopsy technique. The data obtained were then evaluated
statistically. This study group consisted of 76% males and 24% females. The prevalence of Demodex
was 26%. Demodex was found to occur more frequently in women. The most frequent occurrence of
Demodex was seen among people with darker complexion and in cheek localizations. We believe that
Demodex, which has a role in the pathogenesis of dermatologic diseases, provides a convenient
environment for bacteria, and acts as a vector for some pathogenic microorganisms, poses a risk as
far as individuals working in the autopsy room are concerned.
MeSH Terms: - Adult - Autopsy - Cross-Sectional Studies - Face/parasitology* - Female - Health
Personnel/statistics & numerical data - Humans - Male - Middle Aged - Mite Infestations/epidemiology*
- Mite Infestations/etiology - Mite Infestations/parasitology - Occupational Diseases/epidemiology* Occupational Diseases/etiology - Occupational Diseases/parasitology - Prevalence - Questionnaires Turkey/epidemiology
2. Hygiène et gestion des risques
Bonnes pratiques d'hygiène en hémodialyse
[site éditeur SFHH Société Française d'Hygiène Hospitalière] Indication du niveau de preuve, risque
infectieux en hémodialyse, surveillance épidémiologique et signalement des infections en
hémodialyse, les accidents d'exposition au sang : données épidémiologiques et prévention, hygiène
lors des soins aux patients, conception des locaux, désinfection et maintenance des générateurs
d'hémodialyse ; 81 pages ; Hygiènes Volume XIII - N°2 - Avril 2005 [langue : français ; format : html,
pdf ; accès : gratuit et libre ; site non parrainé ; daté du 01/12/2004 ; visité le 08/06/2005]. -Fr
Mots clés : *agents pathogènes transportés sang ; bactériémie ; cathétérisme veineux central /effets
indésirables ; désinfectants ; *désinfection ; *dialyse rénale ; *dialyse rénale /effets indésirables ;
équipement et appareillage hospitaliers ; étude évaluation ; exposition professionnelle /prévention et
contrôle ; hépatite B /transmission ; hépatite C /transmission ; hépatite D /transmission ; *hygiène ;
incidence ; *infection croisée ; *infection croisée /prévention et contrôle ; *infection d'une plaie
chirurgicale ; infections à VIH /transmission ; *infections bactériennes ; infections bactériennes
10
/épidémiologie ; législation ; *lutte contre infection ; notification maladie ; pratique professionnelle ;
signalement obligatoire ; *transmission horizontale maladie /prévention et contrôle ; transmission
maladie malade-personnel médical /prévention et contrôle ; *unité hémodialyse hôpital
Type de publication: *recommandation professionnelle
Accès au texte intégral : http://www.sfhh.net/telechargement/recommandations_hemodialyse.pdf
Disponible aussi dans "Hygiènes" , volume XIII, n°2, 2005
Qualité de l'air au bloc opératoire (La)
[site éditeur SFHH Société Française d'Hygiène Hospitalière] Indication du niveau de preuve,
contexte, objectifs, méthodologie, recommandations : air et risques infectieux, outils de traitement de
l'air, bonnes pratiques pour la qualité de l'air au bloc opératoire ; sûreté de fonctionnement, glossaire,
bibliographie ; 69 pages [langue : français ; format : pdf ; accès : gratuit et libre ; site non parrainé ;
daté du 01/10/2004 ; visité le 08/06/2005]. -Fr
Mots clés : *bloc opératoire ; cheveu ; coût et analyse coût ; désinfectants ; désinfection ;
environnement contrôlé ; équipement et appareillage hospitaliers ; évaluation méthodes santé ;
formation continue ; hygiène ; hygiène /enseignement et éducation ; hygiène professionnelle ;
*infection croisée /prévention et contrôle ; *infection d'une plaie chirurgicale /microbiologie ; *infection
d'une plaie chirurgicale /prévention et contrôle ; intervention chirurgicale ; *microbiologie air ;
*polluants atmosphériques origine professionnelle /prévention et contrôle ; salle réveil ; sécurité ;
température ; textiles ; ventilation ; ventilatio artificielle
Type de publication : bibliographie ; *recommandation professionnelle
Accès au texte intégral : http://www.sfhh.net/telechargement/recommandations_grair.pdf
In : Risques & Qualité en milieu de soins, Volume II, n°2 - Juin 2005
Qualité et sécurité au quotidien au bloc opératoire
M. Sfez, G. Bazin
Résumé : Faire entrer la qualité et la sécurité dans le quotidien des blocs opératoires nécessite une
évolution des mentalités et des pratiques. Les procédures d’accréditation ont certainement agi sur les
mentalités en valorisant la procédure écrite. Celle-ci n’empêche pas les migrations de pratiques
hâtées par l’augmentation de la productivité et la nécessaire continuité du service dans un univers en
perpétuelle mutation. Construire une culture pérenne de la qualité et de la sécurité effectives
nécessite de combiner plusieurs approches. La coercition et l’encadrement réglementaire ont
sûrement amélioré la sécurité au bloc opératoire avec des disparités entre les disciplines. Elle
n’empêche pas les comportements de contournement, au mieux limités par un partage des
représentations de la qualité et de la sécurité des soins. Cela nécessite du temps et un effort soutenu
de formation transdisciplinaire, rare en formation initiale comme en formation continue. La perspective
de l’articulation de ces approches avec les démarches d’évaluation des pratiques professionnelles et
de l’accréditation des médecins laisse espérer de nouveaux gains de sécurité si l’écueil du formalisme
est évité.
Mots-clés : Bloc Opératoire – Obstétrique – Hôpital – Qualité Soins – Sécurité – Gestion Risques –
Formation Professionnelle
Recommandations en matière de traitement du linge des institutions de soins
par Conseil Supérieur d'Hygiène de Belgique [site éditeur Université Catholique de Louvain (UCL),
Faculté de médecine ] institutions et linge concernés, traitement du linge, objectifs et critères de
qualité, guide de bonnes pratiques relative au traitement du linge, contrôles, annexes ; 23 pages
[langue : français ; format : pdf ; accès : gratuit et libre ; site non parrainé ; daté du 01/05/2005 ; visité
le 31/05/2005]. -Fr
Mots clés : Belgique ; hôpital ; hygiène ; *lingerie hôpital /normes \recommandation professionnelle ; lit
; *literie et linge /normes \recommandation professionnelle ; textiles ; vêtements
Type de publication : *recommandation professionnelle
Accès au texte intégral : http://www.md.ucl.ac.be/didac/hosp/cours/linge2005.pdf
11
In : Objectif Prévention, vol. 28, no 2, 2005
Vitrine des nouveautés - Des produits antiseptiques faciles d’application
Se laver les mains demeure la meilleure façon de prévenir la propagation des infections
Accès au texte intégral : http://www.asstsas.qc.ca/documentation/op/op282003.pdf
AAOHN J. 2005 Mar;53(3):111-6
Impact of converting to powder-free gloves. Decreasing the symptoms of latex exposure in
operating room personnel.
Korniewicz DM, Chookaew N, Brown J, Bookhamer N, Mudd K, Bollinger ME.
University of Miami, School of Nursing & Medicine, Coral Gables, FL, USA.
This study examined health care worker satisfaction with the use of non-powdered natural rubber latex
(NRL) surgical gloves to determine the impact of non-powdered NRL gloves on the NRL sensitization
of operating room personnel. The study used a 1-year longitudinal design to obtain recall information
from employees about their NRL exposure. Additionally, a survey was completed by participants
related to their satisfaction with non-powdered NRL gloves. Informed consent was obtained from 103
employees. After conversion to an operating room using non-powdered NRL, there was a significant
decrease in reported symptoms with NRL exposure (42% pre- and 29% post-conversion, Fisher's
exact, two-tailed, p = .0001). This study demonstrated that the conversion to non-powdered lowprotein NRL gloves resulted in decreased symptoms because of NRL exposure.
MeSH Terms: Academic Medical Centers - Adult - Attitude of Health Personnel* Baltimore/epidemiology - Female - Gloves, Surgical*/adverse effects - Gloves, Surgical*/utilization Humans - Latex Hypersensitivity/epidemiology - Latex Hypersensitivity/etiology - Latex
Hypersensitivity/prevention & control* - Longitudinal Studies - Male - Middle Aged - Nursing
Methodology Research - Occupational Diseases/epidemiology - Occupational Diseases/etiology Occupational Diseases/prevention & control* - Occupational Exposure/adverse effects - Occupational
Exposure/prevention & control - Occupational Health - Operating Rooms* - Personnel,
Hospital/psychology* - Powders/adverse effects - Questionnaires - Research Support, Non-U.S.
Gov't Substances: - Powders
3. Infections nosocomiales
Infect Control Hosp Epidemiol. 2005 Feb;26(2):213-5.
An outbreak of methicillin-resistant Staphylococcus aureus surgical-site infections initiated by
a healthcare worker with chronic sinusitis.
Faibis F, Laporte C, Fiacre A, Delisse C, Lina G, Demachy MC, Botterel F.
Center Hospitalier de Meaux, Laboratoire de Microbiologie, Meaux, France. [email protected]
An investigation was performed following two methicillin-resistant Staphylococcus aureus surgical-site
infections in a 946-bed French general hospital. The investigation revealed that the outbreak involved
7 patients in 2 surgical wards and that infections were probably contracted in the operating theater
from a healthcare worker suffering from chronic sinusitis.
MeSH Terms: - Adult - Aged - Carrier State* - Chronic Disease - Cross Infection/transmission* Disease Outbreaks* - Electrophoresis, Gel, Pulsed-Field - Female - France - Humans - Male Methicillin Resistance* - Middle Aged - Sinusitis/microbiology* - Staphylococcal
Infections/transmission* - Staphylococcus aureus/isolation & purification* - Surgical Wound
Infection/etiology*
Infect Control Hosp Epidemiol. 2005 Apr;26(4):357-61.
How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022
outbreaks.
Gastmeier P, Stamm-Balderjahn S, Hansen S, Nitzschke-Tiemann F, Zuschneid I,
Groneberg K, Ruden H.
12
Institute of Medical Microbiology and Hospital Epidemiology, Medical School
Hannover, Hannover, Germany. [email protected]
OBJECTIVE: To describe the epidemiology of nosocomial outbreaks published in the scientific
literature. DESIGN: Descriptive information was obtained from a sample of 1,022 published
nosocomial outbreaks from 1966 to 2002. METHODS: Published nosocomial outbreaks of the most
important nosocomial pathogens were included in the database. A structured questionnaire was
devised to extract information in a systematic manner on nosocomial outbreaks published in the
literature. The following items were used: the reference, type of study (case reports or studies applying
epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel
involved, type of infection, source of infection, mode of transmission, risk factors identified, and
preventive measures applied. RESULTS: Bloodstream infection was the most frequently identified
type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In
37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources
were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%),
and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks.
Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%.
The percentage of outbreaks investigated by case-control studies or cohort studies over the years was
small (21% and 9%, respectively, for the whole time period). CONCLUSION: Outbreak reports in the
literature are a valuable resource and should be used for educational purposes as well as for
preparing outbreak investigations.
Publication Types: Review
MeSH Terms : Adolescent - Adult - Algorithms - Child - Cross Infection*/epidemiology - Cross
Infection*/mortality - Cross Infection*/prevention & control - Databases, Factual - Disease
Outbreaks/statistics & numerical data* - Humans - Methicillin Resistance - Middle Aged - Periodicals Research Support, Non-U.S. Gov't - Staphylococcus aureus/drug effects - Staphylococcus
aureus/pathogenicity
Cent Eur J Public Health. 2005 Mar;13(1):29-31.
Outbreaks of epidemic kerato-conjunctivitis in two hospital wards.
Stefkovicova M, Sokolik J, Vicianova V, Madar R.
State Health Institute in Trencin, Nemocnicna 4, 911 01 Trencin, Slovak Republic.
[email protected]
The authors analyzed two hospital outbreaks of epidemic keratoconjunctivitis (EKC), one at the
Department of Ophthalmology (30 cases) and another one at the Department of Premature Newborns
(22 cases). In both outbreaks, EKC was diagnosed in inpatients (16 and 6 respectively), outpatients (5
and 3 respectively), healthcare workers (HCWs) (3 and 5 respectively), and relatives of EKC patients
(6 and 8 respectively). Implemented infection control measures included isolation precautions,
improved disinfection and hand-washing of both hospital and outpatient department personnel. Shortly
after Meimplementation of control measures the rate of infection transmission started to decrease
significantly.
MeSH Terms: - Adenoviridae Infections/epidemiology* - Adenoviridae Infections/virology - Cross
Infection/epidemiology* - Disease Outbreaks* - Hospital Units* - Humans Keratoconjunctivitis/epidemiology* - Keratoconjunctivitis/virology - Slovakia/epidemiology
4. Risques physiques
4.1 Troubles musculo-squelettiques
Ajustement du poste de travail à écran
Marie-Andrée Beaupré (ASSTSAS)
Travailler devant un petit écran vous occasionne des douleurs au cou, au poignet, au coude à l’épaule
? Décidément, il faut examiner votre poste de travail au plus vite !
13
Bien s’asseoir ? Tout un sport !
Les chaises de bureau dites « ergonomiques » offrent plusieurs caractéristiques indispensables :
ajustement du dossier, de l’assise et des appuie-bras, piétement à 5 pattes, etc. Elles ne garantissent
pas pour autant le confort de l’utilisateur
Déplacement des bénéficiaires - Le « lifting-team » une approche qui a fait ses preuves aux
États-Unis !
Jocelyn Villeneuve (ASSTSAS)
La participation à une conférence aux États-Unis sur le transfert sécuritaire des bénéficiaires a été
l’occasion de visiter l’Hôpital général de Tampa et de voir à l’œuvre des équipes spécialisées de
transfert de bénéficiaires.
Déplacement de bénéficiaires - Surfaces glissantes et piqués : mise à jour de l’information
Proteau R.A (ASSTSAS)
Les travailleurs qui mobilisent manuellement des bénéficiaires au lit utilisent une surface glissante
pour réduire leurs efforts.
Douloureux écrasements des pilules !
Angélique Métra (ASSTSAS), Jocelyn Villeneuve (ASSTSAS)
Les travailleurs risquent-ils de se blesser lorsqu’ils écrasent des pilules ? Eh oui ! En effet, de plus en
plus souvent des problèmes musculosquelettiques surviennent à cause de cette activité.
Travail sous hotte à flux laminaire : aïe mes bras !
Julie Bleau (ASSTSAS)
Parmi les tâches des assistants techniques en pharmacie, on retrouve la préparation de médicaments
stériles sous hotte à flux laminaire. Pour assurer l’ asepsie des produits fabriqués, les travailleurs
doivent respecter la règle de base du flux laminaire et une foule d’autres règles pas toujours
synonymes de grand confort postural !
Trop haut, trop bas ? La bonne hauteur d’un plan de travail !
Julie Bleau (ASSTSAS)
Travailler debout à un comptoir dont la hauteur ne convient pas, qu’il soit trop haut au trop bas,
occasionne des inconforts et des douleurs, voire même des troubles musculosquelettiques ( TMS ).
Troubles musculosquelettiques en 2002
Bédard S (ASSTSAS)
De nombreux travailleurs sont affectés chaque année par un trouble musculosquelettique (TMS) de
14
nature professionnelle.
Rheumatology (Oxford). 2005 Apr;44(4):521-8. Epub 2005 Feb 22.
Hand use and patterns of joint involvement in osteoarthritis. A comparison of female dentists
and teachers.
Solovieva S, Vehmas T, Riihimaki H, Luoma K, Leino-Arjas P.
Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki,
Finland. [email protected]
OBJECTIVES: To investigate the effect of mechanical stress on finger osteoarthritis (OA) by
comparing women from two occupations with different hand load but the same socio-economic grade,
and to investigate whether hand load may affect the pattern of joint involvement in OA. METHODS:
Radiographs of both hands of 295 dentists and 248 teachers were examined. Each interphalangeal
(distal, proximal and thumb interphalangeal) and the metacarpophalangeal joints were graded (0 = no
OA, 4 = severe OA) separately by using reference images. The co-involvement of different hand joints
was analysed by logistic regression. RESULTS: The distal interphalangeal joints were the most
frequently involved joints. The non-dominant hand was more frequently affected by OA of grade 2 or
more than the dominant hand. The prevalence of OA of grade 2 or more in any finger joint and also in
any distal interphalangeal joint was higher among the teachers compared with the dentists (59 vs
48%, P = 0.020 and 58 vs 47%, P < 0.010 respectively). Finger OA showed more clustering in the ring
and little fingers and more row clustering and symmetry in the teachers than in the dentists [ageadjusted odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.10-2.23, OR = 1.84, 95% CI 1.28-2.64,
and OR = 1.98, 95% CI 1.38-2.86 respectively]. The OR of more severe OA (grade 3 or more) in the
right-hand thumb and the index and middle fingers was significantly elevated among the dentists
compared with the teachers (OR 2.61, 95% CI 1.03-6.59). CONCLUSION: Our findings indicate that
finger OA in middle-aged women is highly prevalent and often polyarticular. Hand use may have a
protective effect on finger joint OA, whereas continuing joint overload may lead to joint impairment.
MeSH Terms: Comparative Study - Dentists* - Female - Finger Joint/pathology - Finger
Joint/physiopathology* - Finger Joint/radiography - Finland/epidemiology - Hand/physiopathology Hand/radiography - Humans - Middle Aged - Occupational Diseases/epidemiology - Occupational
Diseases/etiology* - Occupational Diseases/pathology - Occupational Diseases/radiography Osteoarthritis/epidemiology - Osteoarthritis/etiology* - Osteoarthritis/pathology Osteoarthritis/radiography - Prevalence - Research Support, Non-U.S. Gov't - Severity of Illness Index
- Stress, Mechanical - Teaching*
Appl Ergon. 2005 Jan;36(1):97-105
Reviewing ambulance design for clinical efficiency and paramedic safety.
Ferreira J, Hignett S.
Hospital Ergonomics and Patient Safety Unit, Dept. of Human Sciences, Loughborough University,
Loughborough, Leics LE11 3TU, UK.
This study aimed to review the layout of the patient compartment in a UK ambulance for paramedic
efficiency and safety using: (1) link analysis; (2) postural analysis. Paramedics were observed over 16
shifts (130 h) carrying out a range of clinical tasks. The most frequently occurring clinical tasks were
checking blood oxygen saturation, oxygen administration, monitoring the heart and checking blood
pressure. Access to the equipment and consumables to support these tasks had been designed for
the attendant seat (head end of the stretcher), however, a link analysis found that paramedics
preferred to sit along side the stretcher which resulted in increased reach distances. The higher
frequency tasks were found to include over 40% of working postures which required corrective
measures. It was concluded that future ambulance design should be based on an ergonomics analysis
(including link analysis and postural analysis) of clinical activities.
MeSH Terms: Adult - Ambulances* - Back Pain/physiopathology - Back Pain/prevention & control* Emergency Medical Technicians* - Equipment Design - Female - Great Britain - Human
Engineering* - Humans - Male - Occupational Diseases/physiopathology - Occupational
Diseases/prevention & control* - Posture/physiology* - Safety
15
4.2 Rayonnement ionisants
Radiol Technol. 2005 Jan-Feb;76(3):185-91.
Occupational radiation exposure: population studies.
Schleipman AR.
Department of Health Physics and Radiopharmacology, Brigham and Women's Hospital, Boston,
Mass., USA.
Occupational exposure to ionizing radiation in the medical setting differs from the acute exposure
received by survivors of atomic bomb blasts. Yet, atomic bomb survivors' disease and mortality
outcomes have been the standard data source on the effects of ionizing radiation on humans.
Therefore, the prevailing estimated risks of ionizing radiation may not apply to radiologic technologists
and other medical radiation workers. Carefully designed epidemiological trials provide evidence that
helps determine the strength of association between exposure and onset of disease in selected
populations. This article reviews radiation effects, explains some basic design concepts of
epidemiologic trials and surveys the epidemiology literature related to radiation exposure to humans,
with special attention to radiology staff.
MeSH Terms : Epidemiologic Studies* - Health Personnel* - Humans - Neoplasms, RadiationInduced/epidemiology* - Nuclear Warfare - Occupational Exposure/statistics & numerical data* Radiation Dosage - Radiation Injuries/epidemiology* - Survivors/statistics & numerical data
Med Phys. 2005 Jan;32(1):149-52.
Reduction of exposure of newborns and caregivers to very high electromagnetic fields
produced by incubators.
Bellieni CV, Bagnoli F, Pinto I, Stacchini N, Buonocore G.
Department of Pediatrics, Obstetrics and Reproduction Medicine, NICU, University of Siena, Viale
Bracci, Siena 53100, Italy. [email protected]
The aims of this paper is to measure whether ferromagnetic panels sufficiently reduce the high
electromagnetic fields (EMF) to which newborns are exposed in incubators and to which caregivers
are exposed when working near the incubators. We measured EMF at mattress level in three neonatal
incubators with and without ferromagnetic panels between the electric motor and the mattress. We
then measured the EMF at the level of the maximum emission point for caregivers, i.e., near the
display panel. The ferromagnetic panels were (a) 5 mm thick iron, (b), (c), (d) respectively, one, two,
and three sheets of 0.3 mm thick mu-metal. The weight of iron sheet was 4 g/cm2, and mu-metal 0.2
g/cm2. The use of the ferromagnetic panels significantly reduced the EMF. No significant difference in
attenuation was recorded using one, two, or, three sheets of mu-metal, or a single sheet of iron. One,
two, and three sheets of mu-metal reduced EMFs by 77%, 82%, and 84.3%, respectively; the
reduction with iron was 80%. EMF values measured in incubators were higher than those to which the
general population is exposed. The use of ferromagnetic panels significantly reduces the level of
EMFs to which neonates and caregivers are exposed.
MeSH Terms: Caregivers - Electromagnetic Fields* - Environmental Exposure - Environmental Health
- Humans - Incubators - Incubators, Infant - Infant, Newborn - Infant, Premature - Magnetics Neonatal Nursing - Occupational Exposure* - Radiation Monitoring - Radiation Protection*
5. Risques chimiques
Document en français :
Risques chimiques - Manipulation d’agresseurs chimiques en pathologie et en cytologie
Brunette D (Laboratoire de cytologie du Centre Hospitalier Régional de Lanaudère)
Au cours des dernières années, les membres du personnel des services de pathologie et de cytologie
ont constaté avec inquiétude que plusieurs de leurs collègues se sont retrouvés avec un diagnostic de
16
cancer.
Document en anglais :
AAOHN J. 2005 Mar;53(3):103-4
Surgical smoke--is there a fire?
Andersen E.
University of California at San Francisco, USA.
Publication Types: - Review - Review, Tutorial MeSH Terms: - Aerosols - Guidelines - Humans - Inhalation Exposure*/adverse effects - Inhalation
Exposure*/prevention & control - National Institute for Occupational Safety and Health - Occupational
Exposure*/adverse effects - Occupational Exposure*/prevention & control - Occupational Health* Operating Rooms* - Personnel, Hospital* - Protective Devices - Smoke*/adverse effects Smoke*/analysis - Smoke*/prevention & control - Smoke Inhalation Injury/etiology - Smoke
Inhalation Injury/prevention & control - United States - United States Occupational Safety and Health
Administration Substances: - Aerosols
6. Allergies
J Allergy Clin Immunol. 2005 Jun;115(6):1197-202
Advances in environmental and occupational diseases 2004.
Frew AJ.
2004 was another good year for publications on environmental and occupational disorders in our
journal. The major focus is clearly on the environment and particularly on environmental risk factors for
sensitization and asthma. There is a growing consensus that exposure to pets is good, provided there
is enough of it. Low levels enhance sensitization, and higher levels protect against the consequences
of that sensitization. Following on from previous work on cockroaches, we now see allergy to feral
mice as an emergent problem-at least we now have the tools to study this properly. Emphasis seems
to be swinging away from the outdoor environment as a cause of allergic disease and toward the
indoor environment, which is, after all, where most of us spend most of our lives. New techniques for
studying isocyanate allergy might kindle a revival of interest in the mechanisms of occupational
asthma caused by low-molecular-weight compounds. But for all types of occupational allergy,
prevention remains key, and it is good to see that comprehensive programs of allergen reduction can
pay off in reduced rates of latex allergy in health care workers. Further work in the area of recombinant
allergens is welcome but needs soon to be translated into new diagnostic and therapeutic strategies.
This sector of allergy research remains vibrant, and the editors will continue to welcome outstanding
contributions in this area.
Allergy. 2004 Jul;59(7):790-1.
Elastic encasing material for mattresses may be a hidden source of occupational latex
exposure in health care facilities.
Koch P, Raulf-Heimsoth M.
Department of Dermatology University of the Saarland 66421 Homburg/Saar Germany.
[email protected]
Publication Types: Case Reports
MeSH Terms: - Beds/adverse effects* - Enzyme-Linked Immunosorbent Assay/methods - Female Health Facilities* - Humans - Immunoglobulin E/immunology - In Vitro - Latex/adverse effects* Latex/immunology - Latex Hypersensitivity/immunology* - Middle Aged - Occupational Exposure*
Substances: Latex - Immunoglobulin E
J Am Dent Assoc. 2005 Apr;136(4):500-10.
Occupation-related allergies in dentistry.
17
Hamann CP, DePaola LG, Rodgers PA.
SmartHealth, Phoenix, USA.
BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That
changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This
case and others prompted regulatory and manufacturing changes in rubber products and increased
awareness throughout the profession. However, other common dental chemicals cause allergic
reactions and irritation and often are handled with insufficient precautions. Although recognition of
NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is
limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be
decreasing. In contrast, occupation-related dermatoses associated with other dental products may be
more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can
cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions
may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific
information about the recognition and management of allergic and irritant reactions is needed.
CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis
may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating
personnel about proper skin care are essential to reversing this trend.
Publication Types: Review - Review, Tutorial
MeSH Terms: Dental Materials/adverse effects - Dentists* - Dermatitis, Allergic Contact/prevention &
control - Dermatitis, Irritant/prevention & control - Dermatitis, Occupational/prevention & control* Humans - Latex Hypersensitivity/prevention & control - Occupational Exposure - Risk Assessment
Substances: Dental Materials
18
7. Conditions de travail et santé psychologique
Haut
RAPPORT, CERMES, 2004/07, 242 p., tabl., réf.bibl.
Configurations et reconfigurations du travail infirmier à l'hôpital.
ACKER (F.)
Centre de Recherche Médecine Sciences Santé et Société. (C.E.R.M.E.S.). Paris. FRA
Cette recherche a été menée dans le cadre de l'appel d'offre sur les dynamiques professionnelles
dans le champ de la santé lancé par la Mission Recherche de la Direction de la recherche, des
études, de l'évaluation et des statistiques du Ministère chargé de la santé. Elle porte sur les
reconfigurations actuelles du travail infirmier à l'hôpital liées aux modifications récentes apportées à la
définition et au pilotage de l'offre de soins au niveau national et régional d'une part, au développement
de l'activité médicale, à la gestion de l'emploi et des prestations hospitalières au niveau local de
l'autre.
Infirmier, Condition travail, Hôpital, Exercice salarié, Pratique médicale, Maîtrise dépense, Pratique
infirmière, Restructuration, Politique hospitalière, Crise, Accréditation, Convention collective, Equipe
soins, Fermeture, Séjour, Consultation, Exercice libéral, Organisation hospitalière, Organisation
travail, Relation soignant soigné, Prise charge médicosociale, Soins infirmiers, Accompagnement
malade, Suivi malade, Substitution, Relation professionnelle, Médecin, Charge travail, Planification
hospitalière, Décentralisation, Transfert compétence, Evolution, Méthodologie, Analyse problème,
Sociologie santé, France, Gestion ressources humaines, Chimiothérapie
Départs en retraite et « travaux pénibles » l'usage des connaissances scientifiques sur le travail et
ses risques à long terme pour la santé par Pr Lasfargues Gérard (CHU de Tours - Centre Hospitalier
Universitaire de Tours), Mme Molinié Anne Françoise, M. Volkoff Serge [site éditeur Centre d'études
de l'emploi ] pénibilité, travail de nuit, horaires alternants, travail à la chaîne, travail posté, cadences
imposées, exposition aux produits toxiques, 39 pages [langue : français ; format : pdf ; accès : gratuit
et libre ; site non parrainé ; daté du 01/04/2005 ; visité le 09/06/2005]. -Fr
Mots clés : adulte ; bruit professionnel ; *cancérogènes /effets indésirables \figure ; causes décès ;
distribution selon âge ; distribution selon sexe ; espérance vie \figure ; *exposition professionnelle
/effets indésirables ; facteur risque ; France ; incidence \figure ; indemnité travailleurs ; lombalgie
/épidémiologie \figure ; maladies cardiovasculaires ; *maladies de l'appareil locomoteur \figure ;
maladies professionnelles /épidémiologie \figure ; maladies professionnelles /mortalité \figure ;
membre inférieur ; morbidité ; prévalence ; probabilité ; profession ; *retraite ; rythme circadien ; stress
psychologique ; sujet âgé ; tolérance horaire travail ; *travail ; travail /statistiques et données
numériques ; vieillissement
Type de publication : *rapport technique
Accès au texte intégral : http://www.cee-recherche.fr/fr/rapports/retraite_travail_sante_lasfargues.pdf
In : Pistes, Perspectives Interdisciplinaires sur le Travail et la Santé, Volume 7, n°2; mai 2005
Effets du statut d’emploi sur la santé et la sécurité au travail : le cas des auxiliaires familiales
et sociales et des infirmières de soins à domicile au Québec
Esther Cloutier, Madeleine Bourdouxhe, Élise Ledoux, Hélène David, Isabelle Gagnon, François
Ouellet et Catherine Teiger
Les données de cette recherche corroborent les principaux résultats de nombreuses études sur les
liens entre la précarité d’emploi et les risques accrus à la santé et à la sécurité du travail (SST).
Constituée de quatre études de cas de services de soutien à domicile (SAD) de Centres locaux de
services communautaires (CLSC), cette recherche montre comment l’organisation du travail peut
soutenir les stratégies protectrices auxquelles ont recours les auxiliaires sociales et familiales (AFS) et
les infirmières de services de SAD ou leur nuire. Il s’avère que les pratiques organisationnelles
positives auraient les mêmes effets sur les salariées régulières que sur celles qui ont un statut
précaire, cependant ces dernières bénéficient rarement de ce soutien. Quant aux dysfonctionnements
organisationnels, les personnels précaires disposent de moins de marges de manœuvre pour les
pallier. Ils sont donc doublement à risque au regard de leur santé et de leur sécurité au travail.
19
Mots clés : statut d’emploi, risques, santé et sécurité au travail, stratégies protectrices, facteurs
organisation
Accès au texte intégral : http://www.pistes.uqam.ca/v7n2/articles/v7n2a2.htm
Exposition contrôlée à la lumière et à l’obscurité ajuste le rythme du cortisol salivaire chez les
travailleurs de nuit
Diane B. Boivin, Francine O. James, Anny Casademont
Dans cette étude réalisée sur le terrain et en laboratoire, nous avons testé l’efficacité d’une
intervention consistant à contrôler l’exposition à la lumière/obscurité de façon à favoriser l’adaptation
circadienne au travail de nuit. Six travailleurs permanents de nuit (moyenne d’âge 37,1 ± σ: 8,1 ans)
avaient comme consigne de s’exposer de façon intermittente à une lumière blanche vive plein spectre
(~2 000 lux) au cours des 6 premières heures de leur quart de travail de 8 heures. Il leur était
demandé de se protéger de la lumière solaire du matin avec des verres teintés (densité gris neutre,
transmission visuelle de la lumière 15 %) et de maintenir des épisodes réguliers de sommeil/obscurité
dans une pièce très sombre. Ces épisodes devaient commencer 2 heures après la fin de chaque
quart de travail de nuit. Cinq travailleurs du groupe contrôle (41,1 ± σ: 9,9 ans) ont été étudiés alors
qu’ils devaient uniquement maintenir un horaire régulier de sommeil/obscurité. Des procédures de
routine constante, réalisées avant et après une série d’environ 12 quarts de travail de nuit
s’échelonnant sur 3 semaines, ont montré chez les travailleurs du groupe traitement une variation
significative dans l’heure d’apparition du pic de cortisol ainsi qu’un ajustement de ce rythme à un
horaire de travail de nuit. Un plus petit changement de phase a été observé dans le groupe contrôle,
ce qui suggère une adaptation partielle à l’horaire de travail de nuit. Nos résultats démontrent
l’efficacité d’une exposition judicieuse à la lumière et à l’obscurité pour favoriser l’adaptation des
rythmes physiologiques au travail de nuit
Mots clés : Travail de nuit, rythmes circadiens, cortisol salivaire, photothérapie, changement de phase
Intervention en centres d’hébergement et de soins de longue durée visant à réduire les
problèmes de santé mentale liés au travail
Renée Bourbonnais, Nathalie Gauthier, Michel Vézina, Chantal Viens, Pierre J. Durand, Chantal
Brisson, Marie Alderson, Pauline Bégin et Jean-Paul Ouellet
Une intervention visant la diminution des contraintes de l’environnement psychosocial du travail et de
leurs effets sur la santé mentale a été mise en place à l’hiver 2002. Cette intervention se résume en
cinq étapes : l’engagement du milieu et la constitution d’une équipe d’intervention, l’identification des
contraintes, l’élaboration des plans d’action, l’actualisation des plans d’action et l’évaluation de
l’intervention. La recherche se déroule dans douze centres d’hébergement et de soins de longue
durée (CHSLD) et inclut l’ensemble du personnel soignant en contact direct avec la clientèle (N =
493). Un devis quasi-expérimental avec quatre groupes expérimentaux, huit groupes témoins et des
mesures avant et après l’intervention a été utilisé.
La description des phases de développement et d’implantation de la démarche d’intervention est
présentée ainsi que l’évaluation à 12 mois des effets de l’intervention sur la prévalence des
contraintes psychosociales au travail et des problèmes de santé mentale.
Mots clés : Environnement psychosocial du travail, santé mentale, intervention participative,
évaluation, soins de longue durée
In : Risques & Qualité en milieu de soins, Volume II, n°2 - Juin 2005
Mobiliser les acteurs jusqu’où ? Le syndrome d’épuisement professionnel au bloc opératoire
C. Dualé, H. Tahéri, P. Schoeffler
Résumé : Le syndrome d’épuisement professionnel ou « burnout syndrom » est une entité
comportementale pour laquelle l’intérêt est récent dans le monde médical. Elle recouvre des réalités
différentes sous-tendues par des déterminants d’organisation générale de l’établissement et de
l’équipe soignante associés à des facteurs individuels, dont il est difficile de dire s’ils préexistent ou
20
sont induits par les conditions de travail. La capacité individuelle d’adaptation au stress est la
composante la plus apparente. Les modalités d’expression du syndrome varient suivant chacun de
ces éléments et selon les réponses que les individus et le groupe auquel il appartient peuvent
apporter. Les stratégies de réponse peuvent être complémentaires mais combinent presque toujours
des axes individuels et des axes institutionnels. Un effort de communication avec les professionnels
vulnérables est un axe prioritaire. La connaissance de ce syndrome permet d’en anticiper la survenue
et d’en atténuer les conséquences, tant pour les individus qui y sont exposés que pour la sécurité des
patients.
Mots-clés : Surmenage Professionnel – Département Anesthésie Hôpital – Bloc Opératoire – Stress –
Facteur Risque – Personnalité.
Quand organisation du travail rime avec santé psychologique
Legault Lucie (ASSTSAS)
Il est révolu le temps où les problèmes de santé psychologique au travail s’expliquaient uniquement
par les dispositions personnelles des individus
An Pediatr (Barc). 2005 Mar;62(3):248-51.
Burnout syndrome among health workers in pediatrics
[Article in Spanish]
Lopez Franco M, Rodriguez Nunez A, Fernandez Sanmartin M, Marcos Alonso S, Martinon Torres F,
Martinon Sanchez JM.
Departamento de Pediatria, Hospital Clinico Universitario, Santiago de Compostela, La Coruna, Spain.
[email protected]
BACKGROUND: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious
problems in occupational behavior. OBJECTIVE: In the present study we assessed the prevalence of
burnout syndrome in pediatric healthcare workers. DESIGN: Cross-sectional, descriptive study.
MATERIAL AND METHODS: In November 2002, the Maslach Burnout Inventory was given to 127
staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The
questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b)
depersonalization, and c) personal achievement. RESULTS: The questionnaire was completed by 93
staff members (73.2 % of the whole sample; 83 % women and 17 % men). The mean age was 38.6
+/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine
percent were pediatricians, 50.5 % were nurses and 20.5 % were nurse assistants. A total of 20.8 %
had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales
were applied, the results showed that 67.7 % of respondents presented a low level of personal
achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the
depersonalization scale. CONCLUSIONS: BS is present in a significant percentage of hospital workers
attending pediatric patients. In our sample, the most notable component of BS was the lack of
personal achievement. This finding alerted us to the eventual presence of negative attitudes toward
self and professional activity, as well as to the loss of interest in pediatric care, low productivity and
diminished self-esteem. We believe that specific strategies should be implemented to attenuate the
factors influencing the development of BS in pediatric health staff.
MeSH Terms: - Adult - Burnout, Professional/epidemiology* - Cross-Sectional Studies - English
Abstract - Female - Humans - Male - Middle Aged - Pediatric Nursing/statistics & numerical data* Pediatrics/statistics & numerical data* - Prevalence - Risk Factors - Spain/epidemiology
J Psychiatr Ment Health Nurs. 2005 Apr;12(2):154-62.
Emotional labour and stress within mental health nursing.
Mann S, Cowburn J.
Occupational Psychology, University of Central Lancashire, Preston, Lancashire, UK.
[email protected]
21
For many within the nursing profession, the work role involves a great deal of emotional work or
'emotional labour'. Such emotional work can be performed through 'surface acting' in which the
individual simply feigns an appropriate emotion, or through 'deep acting' in which they actually try to
feel the required emotion. The current study aims to aid understanding of the complex relationship
between components of emotional labour and stress within the mental health nursing sector. Thirtyfive mental health nurses completed questionnaires relating to a total of 122 nurse-patient interactions.
Data were collected in relation to: (1) the duration and intensity of the interaction; (2) the variety of
emotions expressed; (3) the degree of surface or deep acting the nurse performed; and (4) the
perceived level of stress the interaction involved. Nurses also completed Daily Stress Indicators.
Results suggest that: (1) emotional labour is positively correlated with both 'interaction stress' and
daily stress levels; (2) the deeper the intensity of interactions and the more variety of emotions
experienced, the more emotional labour was reported; and (3) surface acting was a more important
predictor of emotional labour than deep acting. Implications for mental health nurses are outlined.
MeSH Terms: Adaptation, Psychological - Analysis of Variance - Attitude of Health Personnel* Burnout, Professional/diagnosis - Burnout, Professional/prevention & control - Burnout,
Professional/psychology* - Chronic Disease - Emotions* - England - Humans - Interprofessional
Relations - Job Satisfaction - Mental Health* - Models, Psychological - Nurse's Role - Nurses'
Aides/organization & administration - Nurses' Aides/psychology - Nursing Methodology Research Nursing Staff, Hospital/organization & administration - Nursing Staff, Hospital/psychology* Occupational Health - Psychiatric Nursing/organization & administration* - Questionnaires Regression Analysis - Risk Factors - Role Playing - Self Care - Severity of Illness Index - Time Factors
- Workload*
JONAS Healthc Law Ethics Regul. 2005 Jan-Mar;7(1):4-7; discussion 7-9.
Moral distress at 3 am.
Bosek MS.
Department of Adult Health Nursing and Program in Ethics, Rush University, Chicago, Ill, USA.
MeSH Terms:
Burnout, Professional/prevention & control - Burnout, Professional/psychology - Ethics
Consultation/organization & administration* - Ethics, Institutional - Humans - Morals - Night
Care/ethics* - Nurse's Role - Nursing Staff, Hospital/ethics* - Nursing Staff, Hospital/psychology Nursing, Supervisory/ethics - Nursing, Supervisory/organization & administration - Pain,
Postoperative/nursing - Pain, Postoperative/prevention & control - Patient Advocacy/ethics* Postoperative Care/ethics* - Power (Psychology) - Professional Role
Soc Psychiatry Psychiatr Epidemiol. 2005 Mar;40(3):223-32.
Morale and job perception of community mental health professionals in Berlin and London.
Priebe S, Fakhoury WK, Hoffmann K, Powell RA.
Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK.
[email protected]
INTRODUCTION: Morale and job perception of staff in community mental health care may influence
feasibility and quality of care, and some research has suggested particularly high burnout of staff in
the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction
and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental
health care in Berlin and London; b) compare findings between the groups and test whether personal
characteristics, place of working and professional group predict morale; and c) explore what tasks,
obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs.
METHODS: In all, 189 mental health professionals (a minimum of 30 in each of the six groups)
responded to a postal survey and reported activities per week using pre-formed categories. Perception
of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job
Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were
used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did
and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were
subjected to content analysis using a posteriori formed categories. RESULTS: Weekly activities and
morale varied between sites and professional groups. Some mean scores for groups in London
exceeded the threshold for a burnout syndrome, and are particularly less favourable for social
workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity.
22
Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with
higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team
identity. However, professional group and site interacted in predicting burnout and job satisfaction.
Psychiatrists in London had much more favourable scores than the other two groups, whilst this did
not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct
patient contact and disliking bureaucracy, but also various views that were specific to a site or
professional group or both. CONCLUSIONS: Burnout remains a problem for some, but not all,
professional groups in community mental health care, and social workers in London appear to be a
group with particularly low morale. Differences between professional groups depend on the location,
and it remains unclear to what extent job-related and general factors impact on the morale of mental
health professionals. Answers to open questions reveal general as well as specific aspects of the job
perception of the professional groups, some of which may be relevant for service development,
training and supervision. More conceptual and methodological work and more extensive studies are
required to develop a better understanding of how community mental health professionals perceive
their job and how morale may be improved.
MeSH Terms: - Adult - Burnout, Professional* - Catchment Area (Health) - Community Mental Health
Services/manpower* - Employment/psychology* - Female - Germany - Great Britain - Health
Personnel/psychology* - Humans - Job Satisfaction* - Male - Middle Aged - Morale*
AAOHN J. 2005 May;53(5):213-7.
Nurses' inclination to report work-related injuries: organizational, work-group, and individual
factors associated with reporting.
Brown JG, Trinkoff A, Rempher K, McPhaul K, Brady B, Lipscomb J, Muntaner C.
Department of Behavioral and Community Health, University of Maryland School of Nursing,
Baltimore, MD, USA.
Work-related injuries such as back strain are common among health care workers. Work-related injury
data are a primary data source with which managers can assess workplace safety, yet many workrelated injuries go unreported. This study examined organizational, work-group, and individual factors,
and nurses' inclination to report a work-related injury. Using a cross-sectional mailed survey, a
probability sample of currently employed nurses (N = 1,163) indicated their inclination to report a
workplace injury. Inclination to report injuries was higher in organizations with onsite health programs
and when health and safety committees included non-management nurses and occupational health
representatives. Reporting was reduced when nurses felt a lack of concern for staff welfare from
supervisors and a climate of blame for worker injuries were present. Nurses were also less inclined to
report work-related injuries when working in jobs with non-standard work arrangements. Improvements
in the reporting climate may influence the completeness and, thus, the value of injury data for
identifying hazards in the workplace. These data could provide valuable information for targeting
preventive initiatives.
Swiss Med Wkly. 2005 Feb 19;135(7-8):101-8.
Psychosocial and professional characteristics of burnout in Swiss primary care practitioners: a
cross-sectional survey.
Goehring C, Bouvier Gallacchi M, Kunzi B, Bovier P. [email protected]
OBJECTIVE: To measure the prevalence of burnout and explore its professional and psychosocial
predictors among Swiss primary care practitioners. METHODS: A cross-sectional postal survey was
conducted to measure burnout, work-related stressors, professional and psychosocial characteristics
among a representative sample of primary care practitioners. Answers to the Maslach burnout
inventory were used to categorize respondents into moderate and high degree of burnout. RESULTS:
1784 physicians responded to the survey (65% response rate) and 1755 questionnaires could be
analysed. 19% of respondents had a high score for emotional exhaustion, 22% had a high score for
depersonalisation/cynicism and 16% had a low score for professional accomplishment; 32% had a
high score on either the emotional exhaustion or the depersonalisation/cynicism scale (moderate
degree of burnout) and 4% had scores in the range of burnout in all three scales (high degree of
burnout). Predictors of moderate burnout were male sex, age 45-55 years and excessive perceived
stress due to global workload, health-insurance-related work, difficulties to balance professional and
private life, changes in the health care system and medical care uncertainty. A high degree of burnout
was associated with male sex, practicing in a rural area, and excessive perceived stress due to global
workload, patient's expectations, difficulties to balance professional and private life, economic
23
constraints in relation to the practice, medical care uncertainty and difficult relations with non-medical
staff at the practice. CONCLUSION: About one third of Swiss primary care practitioners presented a
moderate or a high degree of burnout, which was mainly associated with extrinsic work-related
stressors. Medical doctors and politicians in charge of redesigning the health care system should
address this phenomenon to maintain an efficient Swiss primary care physician workforce in the
future.
MeSH Terms: - Age Factors - Burnout, Professional/epidemiology - Burnout, Professional/psychology*
- Cross-Sectional Studies - Female - Humans - Male - Middle Aged - Physicians/psychology* Practice Management, Medical - Primary Health Care* - Professional Practice Location Questionnaires - Sex Factors - Switzerland/epidemiology - Workload
J Am Coll Surg. 2005 Apr;200(4):635-6.
Should I lie about my work hours this week?
Grogan EL.
Publication Types: Letter
MeSH Terms: Attitude of Health Personnel - Humans - Personnel Staffing and Scheduling* Physicians/psychology* - Trauma Centers/manpower* - Workload*
BMC Health Serv Res. 2005 Jun 10;5(1):45 [Epub ahead of print]
The factors associated to psychosocial stress among general practitioners in Lithuania. Crosssectional study.
Vanagas G, Bihari-Axelsson S.
BACKGROUND: There are number of studies showing that general practice is one of the most
stressful workplace among health care workers. Since Baltic States regained independence in 1990,
the reform of the health care system took place in which new role and more responsibilities were
allocated to general practitioners in Lithuania. This study aimed to explore the psychosocial stress
level among Lithuanian general practitioners and examine the relationship between psychosocial
stress and work characteristics. METHODS: The cross-sectional study of 300 Lithuanian General
practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale.
Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics;
interrelationship analysis between characteristics and multivariate logistic regression to estimate odds
ratios for each of the independent variables in the model. RESULTS: Response rate 66% (N=197).
Our study highlighted highest prevalence of psychosocial stress among widowed, single and female
general practitioners. Lowest prevalence of psychosocial stress was among males and older age
general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude
is low (chi2 = 18,9; p< 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI
2,102-8,104; p<0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549-22,188;
p<0,01) and young age of GPs (OR 6,874; CI 1,292-36,582; p<0,05) can be assigned as significant
predictors for psychosocial stress. CONCLUSIONS: One half of respondents suffering from work
related psychosocial stress. High psychological workload demands combined with low decision
latitude has the greatest impact to stress caseness among GPs. High job demands, high patient load
and young age of GPs can be assigned as significant predictors of psychosocial stress among GPs.
Psychiatry Clin Neurosci. 2005 Apr;59(2):135-9
Validation of Impact of Events Scale in nurses under threat of contagion by severe acute
respiratory syndrome.
Chen CS, Yang P, Yen CF, Wu HY.
Department of Psychiatry, Kaohsiung Chung-Ho Memorial Hospital, Kaohsiung Medical University,
No. 100 Tzyou 1st Road, Kaohsiung City, Taiwan 807.
The purpose of the present study was to validate the Impact of Events Scale (IES) in a sample of
nurses working under threat of severe acute respiratory syndrome (SARS). The internal consistency,
construct validity and convergent validity of the instrument were examined in a sample of 128 nurses
during the SARS outbreak in Taiwan. Principal component analysis followed by a quartimax rotation
were used to derive a two-factor solution, labeled intrusion (factor 1) and avoidance (factor 2), with
both factors accounting for 50.7% of the explained variance. The total Cronbach's alpha of 0.90
24
reflected the good internal consistency of the instrument. Correlation with the Symptoms Checklist 90R demonstrated the convergent validity of the IES. In conclusion, the IES can be used as a
convenient, reliable and valid instrument for evaluation of the psychological distress of nurses working
with the highly contagious disease.
MeSH Terms: Adult - Factor Analysis, Statistical - Female - Humans - Life Change Events* Mental Processes/physiology - Nurses/psychology* - Occupational Exposure* - Principal Component
Analysis - Psychometrics* - Reproducibility of Results - Severe Acute Respiratory
Syndrome/psychology* - Taiwan
8. Violence
Prévention de la violence - L’ÉPSM Lille-Métropole (France) adopte Oméga
Marie Josée Robitaille (ASSTSAS)
Dernièrement, l’ASSTSAS annonçait une première percée en France de sa formation en prévention
de la violence Oméga.
SOINS. CADRES, Vol. 53, p. 42-46, 2005/02
Urgences face aux violences urbaines (Les).
SVANDRA (Philippe)
Les soignants des services d'urgences, confrontés à une progression de la violence urbaine, peuvent
se sentir personnellement menacés tant psychologiquement que physiquement. Ils tentent alors
d'ajuster leur comportement face à ces situations délicates en faisant preuve de tolérance,
revendiquant notamment la nécessaire prise en charge sociale d'une certaine forme de misère
comme partie intégrante du soin. Deux enquêtes, menées dans deux hôpitaux d'Ile-de-France,
mettent à jour les causes à l'origine de cette violence, et ses répercussions sur les soignants et
l'institution hospitalière. (Extrait du R.A.).
Violence, Urgence hospitalière, Hôpital, Profession santé, Condition travail, Enquête
BMJ. 2005 May 28;330(7502):1227.
Four in five nurses on mental wards face violence.
Cole A.
Publication Types: News
J Adv Nurs. 2005 Feb;49(3):283-96.
Non-somatic effects of patient aggression on nurses: a systematic review.
Needham I, Abderhalden C, Halfens RJ, Fischer JE, Dassen T.
School of Nursing, University of Applied Sciences, Route des Cliniques 15, 1700 Fribourg,
Switzerland. [email protected]
AIM: This paper describes a systematic review of the predominant non-somatic effects of patient
assault on nurses. Background. Patient aggression towards nurses is a longstanding problem in most
nursing domains. Although reports on the consequences of physical aggression are more numerous,
the non-physical effects create much suffering. METHOD: A systematic review of literature from 1983
to May 2003 was conducted using the Medline, CINAHL, PsychINFO and PSYINDEX databases.
Articles from international journals in English or German and reporting at least three non-somatic
responses to patient aggression were included. FINDINGS: The electronic search produced 6616
articles. After application of the inclusion and exclusion criteria, 25 texts from eight countries and four
domains of nursing remained. Twenty-eight main effects were found, and these were categorized
using a system suggested by Lanza and including bio-physiological, emotional, cognitive, and social
25
dimensions. The predominant responses were anger, fear or anxiety, post-traumatic stress disorder
symptoms, guilt, self-blame, and shame. These main effects occurred across most countries and
nursing domains. CONCLUSION: Despite differing countries, cultures, research designs and settings,
nurses' responses to patient aggression are similar. Standardized questionnaires could help improve
estimations of the real prevalence of non-somatic effects. Given the suffering caused by non-somatic
effects, research should be aimed at preventing patient aggression and at developing better ways to
prepare nurses to cope with this problem.
MeSH Terms: Aggression/psychology* - Attitude of Health Personnel - Emotions - Humans - Mental
Disorders/etiology - Nurse-Patient Relations* - Nurses/psychology* - Occupational Diseases/etiology*
RN. 2005 Mar;68(3):12.
Workplace aggression destroyed this nurse's career.
[No authors listed]
Publication Types: Comment - Letter
MeSH Terms: Aggression* - Attitude of Health Personnel - Humans - Interprofessional Relations Nursing Staff/organization & administration* - Occupational Exposure/prevention & control*
9. Autres
Lésions professionnelles en CLSC : la situation en 2003
Sylvie Bédard (ASSTSAS)
L’article présente le portrait des lésions professionnelles indemnisées par la Commission de la santé
et de la sécurité du travail (CSST) en 2003 pour les travailleurs de CLSC. Il donne une idée des
risques reconnus par la CSST, auxquels sont exposés ces travailleurs.
Réduction de facteurs de risque de chronicité et le retour au travail
Michael J.L. Sullivan, Heather Adams, William D. Stanish et André Savard
L’objectif de cette recherche était d'examiner le degré avec lequel la réduction des facteurs de risques
psychosociaux était associée au retour au travail. Cette recherche a été effectuée dans le contexte
d’un programme de réadaptation pour les travailleurs ayant subi une blessure au dos. Les participants
étaient 116 (68 hommes, 48 femmes) clients de la Commission des accidents du travail de la
Nouvelle-Écosse ayant demandé une indemnisation pour accident de travail. Les participants étaient
orientés vers une intervention cognitivo-comportementale, donc le but était de réduire les obstacles
psychologiques au progrès en réadaptation. Les facteurs psychologiques ciblés par le programme
étaient les pensées catastrophiques, la crainte du mouvement, les croyances concernant l’incapacité
et la dépression. Dans cet échantillon, 56 % des participants ont retourné au travail dans les quatre
semaines suivant la fin du traitement. Des analyses de variance à mesures répétées ont révélé des
diminutions significatives dans la douleur, la dépression, les pensées catastrophiques, les croyances
concernant l’incapacité, et la peur du mouvement. Des analyses univariées ont indiqué que la
réduction de tous les facteurs de risque était associée à une plus haute probabilité de retour au
travail. Une analyse de régression logistique a révélé que la durée d’absence du travail et la réduction
des pensées catastrophiques ont contribué uniquement à la prédiction du retour au travail. Les
résultats de cette étude offrent des preuves préliminaires selon lesquelles les interventions qui visent
spécifiquement à réduire les facteurs de risques psychosociaux reliés à la chronicité ont un impact
positif sur la probabilité de retour au travail.
Mots clés : facteurs de risques, chronicité, incapacité, réadaptation, retour au travail
26
Site des accidents du travail et des maladies professionnelles (Le)
[site éditeur AMELI (l'Assurance Maladie En LIgne) Caisse Nationale d'Assurance Maladie des
Travailleurs Salariés] santé et sécurité au travail, prévention des risques professionnels, tarification et
indemnisation des accidents du travail et des maladies professionnelles [langue : français ; format :
html ; accès : gratuit et libre ; site non parrainé ; visité le 25/05/2005]. -Fr
Mots clés : *accident travail ; *accident travail / prévention et contrôle ; *accident travail / statistiques et
données numériques ; *exposition professionnelle / prévention et contrôle ; France ; *indemnité
travailleurs ; *maladies professionnelles ; *maladies professionnelles / prévention et contrôle ;
*prévention accident ; statistique
Type de publication : *guide ressources ; texte
Accès au site : http://www.risquesprofessionnels.ameli.fr
GOHNET (Global Occupational Health Network) newsletter, No. 8, Winter 2005
Health care workers
Summary :
- The effects of Globalization on Health Care Work and the Health Care Worker
- Emerging Infections among Health Care Workers: the Severe Acute Respiratory Syndrome (SARS)
Experience
- Workplace Health Promotion for Auxiliary Nurses
- Use of Respiratory Protection among Health Care Workers and Emerging Infectious Diseases
- Preventing Needle Stick Injuries and Occupational Exposure to Bloodborne Pathogens
- The “Next-study”: Investigating Premature Departure from Nursing in the European Healthcare
System
- Occupational Diseases in Health Care Workers in the Czech Republic
- NIOSH/CDC Resources for Health Care Workers
- Exposure to Nitrous Oxide (N2O) in Hospital Post-operative Units
- New Research shows Workplace Violence Threatens Health Services Worldwide
Accès : http://www.who.int/occupational_health/publications/newsletter/gohnet8eng.pdf
American Journal of Preventive Medicine Volume 29, Issue 1 , July 2005, Pages 61-70
Worksite Health Promotion Programs with Environmental Changes : A Systematic Review
Luuk H. Engbers MSc, Mireille N.M. van Poppel PhD, , Marijke J.M. Chin A Paw PhD and Willem van
Mechelen MD, PhD
Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU
University Medical Center, Amsterdam, The Netherlands
Background : It is now widely believed that health promotion strategies should go beyond education
or communication to achieve significant behavioral changes among the target population.
Environmental modifications are thought to be an important addition to a worksite health promotion
program (WHPP). This review aimed to systematically assess the effectiveness of WHPPs with
environmental modifications, on physical activity, dietary intake, and health risk indicators. Methods :
Online searches were performed for articles published up to January 2004 using the following
inclusion criteria: (1) (randomized) controlled trial (RCT/CT); (2) intervention should include
environmental modifications; (3) main outcome must include physical activity, dietary intake, and
health risk indicators; and (4) healthy working population. Methodologic quality was assessed using a
checklist derived from the methodologic guidelines for systematic reviews (Cochrane Back Review
Group), and conclusions on the effectiveness were based on a rating system of five levels of evidence.
Results : Thirteen relevant, mostly multicenter, trials were included. All studies aimed to stimulate
healthy dietary intake, and three trials focused on physical activity. Follow-up measurements of most
studies took place after an average 1-year period. Methodologic quality of most included trials was
rated as poor. However, strong evidence was found for an effect on dietary intake, inconclusive
evidence for an effect on physical activity, and no evidence for an effect on health risk indicators.
Conclusions : It is difficult to draw general conclusions based on the small number of studies included
in this review. However, evidence exists that WHPPs that include environmental modifications can
influence dietary intake. More controlled studies of high methodologic quality need to be initiated that
investigate the effects of environmental interventions on dietary intake and especially on physical
activity in an occupational setting.
- © CHU de Rouen -
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