Healthcare workers: protecting those who protect our health.

The nation’s healthcare system is in a transition of potentially historic proportions, driven by the need for cost-effectiveness under pressures of cost containment and competition, but also made possible by scientific and technological breakthroughs.1 This transition presents new challenges and opportunities for protecting the health and safety of our nation’s healthcare workers. Toward the goal of maximizing future opportunities for the primary prevention of illnesses and injuries among healthcare workers, a brief review of history in relationship to this work force should assist us in identifying successful models for future action. In the United States, the practice of occupational health dates back to the late 1800s. National professional societies in occupational medicine and nursing were established in 1916 and 1942, respectively. The hospital and healthcare environments did not become a focus of study and prevention strategies until much later. In fact, as recently as the 1950s, there still was no consensus regarding the occupational risk of tuberculosis (TB) exposure. It has been suggested that a number of factors drove this lack of consensus, including the fear that young women would avoid nursing if they knew the risks involved and that liability might surface. It was not until TB declined significantly in the general public but remained elevated in the medical profession that TB was recognized fully as an occupational hazard.2 Professional associations and the federal government began to address healthcare-worker health and safety in subsequent years. In 1958, the American Medical Association (AMA) and American Hospital Association (AHA) issued a joint statement in support of worker health programs in hospitals; the Centers for Disease Control and Prevention (CDC)’s National Institute for Occupational Safety and Health (NIOSH) published criteria for effective hospital occupational health programs in 1977; and, in 1982, the CDC published the “Guideline for Infection Control in Hospital Personnel.” This last document focused on infections transmitted between patient-care personnel and patients, not exclusively on healthcare workers’ risk of infectious diseases. The CDC guidelines for blood and body fluid precautions (1982) and universal precautions (1987) were published to provide guidance to healthcare workers. In 1987, the Departments of Labor and Health and Human Services issued a Joint Advisory Notice entitled “Protection Against Occupational Exposure to HBV and HIV.” In 1988, NIOSH published comprehensive guidelines for protecting the safety and health of healthcare workers. In late 1991, the Occupational Safety and Health Administration (OSHA) promulgated the Bloodborne Pathogens Standard, which required the observance of Universal Precautions, the offering by the employer of hepatitis B (HBV) vaccine, and the implementation of engineering controls to protect workers from the health hazards related to bloodborne pathogens. OSHA is scheduled to publish a proposed TB standard in the Federal Register in mid-1997. Editorial