NIOSH has identified health care workers (HCW) as a special population at high risk of occupational disease and injury. The Bureau of Labor Statistics estimates that there are over eight million workers employed in US health care industries. Health care workers are involved in very diverse functions and duties that may expose them to many hazards such as toxic chemicals, infectious agents (e.g., blood borne and body substance exposures to bacteria, viruses, fungi, and parasites), latex, ergonomic hazards, workplace violence, work related stress, and physical agents. Relatively little injury and disease surveillance data exists for health care workers. The major objective of this research is to develop a comprehensive system for health, injury, and hazard surveillance of health care workers. This will be accomplished through the combination of population-based and case-based data. A job-exposure matrix will be developed for hazard surveillance and for estimation of individual exposures through linkage with each worker's job history. The surveillance system will use analytical tools for cohort data to study the incidence and causes of work related injuries and health conditions, the identification of high risk populations, and appropriate prevention measures. These data will be supplemented by the use of case-based data, allowing more detailed follow-up of a group of 'sentinel health events' of concern for health care workers. Specific conditions to be addressed by case-based surveillance will include patient lifting and handling injuries, other noninfectious occupational injuries, latex allergy, occupational asthma, and work-related stress. The system will be implemented for 5 years of surveillance of a cohort of over 10,000 health care workers employed by Duke University Health systems (DUHS), which includes Duke University Medical Center, a large teaching hospital, and Durham Regional Hospital, a community based hospital. Other components of DUHS include 20 clinics located in 8 N.C. counties, triangle Hospice, and the Duke Infusion Center. While we will evaluate the utility of the system in this setting, the goal of the project is to define elements and performance characteristics of a model surveillance system which could be used in other health care institutions. Results of the case-based surveillance effort also will have broad application to health care workers.
