Focus on Research: Ebola crisis highlights gap in health care worker safety

Editor’s note: The Focus on Research column highlights different research projects being conducted at Penn State. Each column features the work of a different researcher from across all disciplines.

In September, the U.S. Centers for Disease Control and Prevention confirmed the first case of Ebola diagnosed in the United States. The patient, who traveled to Dallas from Liberia, died nine days later at Texas Presbyterian Hospital.

Two days later, a nurse who treated the patient was diagnosed with Ebola. Five days later, a second nurse who helped treat the patient tested positive for Ebola. After roughly two weeks of treatment, both nurses recovered.

Deirdre McCaughey, an associate professor in the College of Health and Human Development at Penn State, said the issue of health care workers contracting Ebola while treating patients in the United States highlights gaps in health care workplace safety. McCaughey said she believes that few hospitals were prepared to manage the advent of the rare and deadly disease, and many are still unprepared.

“Organizations do not really pay attention to health care provider workplace safety until a major incident occurs, such as an Ebola crisis,” McCaughey said. “If hospitals would recognize the importance and the value of their employees not being hurt or sick in the first place and invest in relevant resources to minimize injury and illness, it would make the health care industry a safer place to work.”

Cases of non-fatal occupational injury and illness among health care workers are among the highest of any industry sector, according to the Centers for Disease Control and Prevention.

“Injury and illness rates in the health care industry are staggeringly high,” McCaughey said. “Care providers are injured at a rate two to three times higher than the national injury rate.”

First-hand health scare

In 2003, Canada experienced a crisis with the outbreak of SARS, or severe acute respiratory syndrome, killing three of roughly 100 infected health care workers, according to the Public Health Agency of Canada. At the time, McCaughey was working in Winnipeg, Manitoba, as a physical therapist in orthopedics at an academic hospital.

In the SARS crisis, health care providers were unsure how to prevent SARS and avoid disease transmission, and whether they possessed the proper equipment to isolate and treat SARS, she said.

“The experience of working in a hospital during a ‘new disease’ crisis is very disturbing for care providers,” McCaughey said. “During the SARS epidemic, almost everyone I worked with was very concerned about SARS from the perspective of being unsure exactly how it transmitted and not knowing if anyone of us may have unknowingly come in contact with a person with SARS, even though it was primarily in Toronto. After the number of reported cases of health care workers with SARS increased and then some died, we were very worried about contracting the disease and taking it home to infect family members. It was very unnerving.”

Making a case for safety training

McCaughey is conducting research on workplace safety for health care workers, and is examining the culture and organizational antecedents that create unsafe environments for both care providers and patients. She said she hopes to determine whether the factors that foster a safe environment for employees and care providers are the same as those that are important for patient care.

“The value of this research would be to link the two safety event outcomes together, so that a very compelling case could be made to hospital leadership that investing resources in promoting a safe workplace not only helps reduce the incident rate of employee injury or illness,” she said.

The research could also help improve patient safety and provide the “return on investment” that health care organizations need as the financial imperative to invest in more workplace safety training and resources, McCaughey said.

Review of hospital programs

Additionally, McCaughey recently conducted a literature review intended to assess the significant factors that contribute to care provider injury. It is scheduled to appear in Health Care Management Review this year. In the review, McCaughey notes that in 2013 the U.S. Department of Labor identified the health care industry as a major source of workplace injuries. Additionally, she notes that direct care workers’ injuries account for roughly 11.5 percent of all worker injury costs in the United States.

McCaughey argues that better training for health care workers would prevent patient-to-care provider disease transmission incidents such as those that accompanied the SARS and Ebola outbreaks.

McCaughey says hospitals, in part, are not actively implementing stronger safety training programs for employees due to the cost, unless an event such as the spread of Ebola arises. She adds that there is often a rush to train employees quickly, but not necessarily thoroughly.

“Reducing care provider injury rates will substantively reduce hospital costs in insurance, employee sick time and labor costs while helping ensure continuous care for patients,” she said. “Ultimately, if your organization seeks to excel in patient outcomes, you need an optimal work environment for optimal care.”

In a recently completed study of hospitals in the United States and Canada, McCaughey examined the effect of safety promotion, integrity and supportiveness among hospital leadership in promoting optimal employee safe workplace practices. The study found that when leaders actively supported safety and safe work practices, employees reported fewer workplace injuries and a more positive workplace climate.