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not live past the end of the week.” Nancy was An example of a safety program is the one for
concerned about the care of the patients as well as health-care workers exposed to HIV, instituted at
the apparent lack of information her staff had about the Department of Veterans Affairs Hospital,
prevention of back injuries. She decided to seek San Francisco (Armstrong, Gordon, & Santorella,
assistance from the nurse practitioner in charge of 1995). An HIV exposure can be stressful for health-
Employee Health in order to develop a back injury care workers and their loved ones. This employee
prevention program. assistance program includes up to 10 hour-long indi-
vidual counseling sessions on the meaning and expe-
Assessment of the workplace may require consider- rience of this traumatic event. Additional counseling
able data gathering to document the incidence of sessions for couples are also provided. Information
the problem and consultation with experts before a about HIV and about dealing with acute stress reac-
plan of action is drawn up. Health-care organiza- tions is provided. Counseling helps workers identify
tions often create formal committees, consisting of a plan to obtain assistance from their individual sup-
experts from within the institution and representa- port systems, identify practice methods of dealing
tives from the affected departments, to assess these with blood-borne pathogens, and return to work.
risks. It is important that staff members from vari- A systematic review related to needlestick injury pro-
ous levels of the organization be allowed to offer vides evidence for the use of tissue adhesives.
input into an assessment of safety needs and risks. In the past, the options for wound closure have
The third step is to create a plan to provide opti- been limited largely to sutures (needle and thread),
mal protection for staff members. It is not always a staples, and adhesive tapes.Tissue adhesives (glues)
simple matter to protect staff members without offer the advantages that there are no sutures to
interfering with the provision of patient care. For remove later for the patient and no risk of needle-
example, some devices that can be worn to prevent stick injury to the health-care worker.The adhesive
transmission of tuberculosis interfere with commu- is applied over the surgical wound and holds the
nication with the patient Some attempts have been edges together until healing has occurred.
made to limit visits or withdraw home health-care Adhesives have been compared with alternative
nurses from high-crime areas, but this leaves methods of surgical wound closure in eight ran-
homebound patients without care (Nadwairski, domized clinical trials involving 630 patients.
1992). A threat assessment team that evaluates There was no evidence of a difference in rates of
problems and suggests appropriate actions may wound dehiscence or infection after surgical inci-
reduce the incidence and severity of problems due sion closure with tissue adhesive, sutures, or adhe-
to violent behavior, but it may also increase sive tape. The recommendation from the evidence
employees’ fear of violence if not handled well. was that health-care providers may consider the use
Developing a safety plan includes the following: of tissue adhesives for the closure of incisions in the
operating room, and a protocol was published in
■ Seeking evidence-based practices and recom-
2004 (Coulthard et al., 2004).
mendations related to the problem
■ Consulting federal, state, and local regulations
■ Distinguishing real from imagined risks Violence
■ Seeking administrative support and enforcement
Violence in the workplace is a contemporary social
for the plan
issue. Newspapers and magazines have reported
■ Calculating costs of a program
numerous violent incidents; one of six violent crimes
The fourth and final stage in developing a work- occurs in the workplace, and homicide is the second
place safety program is implementing the program. leading cause of workplace death (Edwards, 1999).
Educating the staff, providing the necessary safety According to the Census of Fatal Occupational
supplies and equipment, and modifying the envi- Injuries, there were 551 workplace homicides and
ronment contribute to an effective program. 5703 workplace injuries in 2004.The rate of assaults
Protecting patient and staff confidentiality and on hospital workers is much higher than the rate of
monitoring adherence to control and safety proce- assaults for all private-sector industries. The Bureau
dures should not be overlooked in the implementa- of Labor Statistics measures the number of assaults
tion stage (Jankowski, 1992). resulting in injury per 10,000 full-time workers.