Occupational blood exposure among unlicensed home care workers and home care registered nurses: are they protected?
BACKGROUND
Little is known about the risk of blood exposure among personnel providing care to individual patients residing at home. The objective of this study was to document and compare blood exposure risks among unlicensed home care personal care assistants (PCAs) and home care registered nurses (RNs).


METHODS
PCAs self-completed surveys regarding blood and body fluid (BBF) contact in group settings (n = 980), while RNs completed mailed surveys (n = 794).


RESULTS
PCAs experience BBF contact in the course of providing care for home-based clients at a rate approximately 1/3 the rate experienced by RNs providing home care (8.1 and 26.7 per 100 full time equivalent (FTE), respectively), and the majority of PCA contact episodes did not involve direct sharps handling. However, for PCAs who performed work activities such as handling sharps and changing wound dressings, activities much more frequently performed by RNs, PCAs were at increased risk of injury when compared with RNs (OR = 7.4 vs. 1.4) and (OR = 6.3 vs. 2.5), respectively.


CONCLUSIONS
Both PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that warrant additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts are needed to protect home care workers from blood exposure, namely by assuring coverage and enforcement of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard [Occupational Safety and Health Administration. 1993. Frequently Asked Questions Concerning the Bloodborne Pathogens Standard. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS &p_id=21010#Scope. Accessed May 30, 2008].
Lipscomb
J
J
School of Nursing, University of Maryland, Baltimore, Maryland 21201, USA. lipscomb@son.umaryland.edu
Sokas
R
R
McPhaul
K
K
Scharf
B
B
Barker
P
P
Trinkoff
A
A
Storr
C
C
D000062:Accidents, Occupational / Q000517:prevention & control / Q000706:statistics & numerical data*; D000328:Adult; D001769:Blood; D017848:Blood-Borne Pathogens; D001826:Body Fluids; D003152:Community Health Nursing / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D018576:Home Health Aides / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000453:epidemiology* / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data*; D012307:Risk Factors; D017751:Safety Management; D014481:United States; D014489:United States Occupational Safety and Health Administration; D016526:Workload / Q000706:statistics & numerical data