A facilitated early return to work program at a large urban medical center.

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.

Health care workers' experience with postexposure management of bloodborne pathogen exposures: a pilot study.

PURPOSE: This descriptive study of health care workers enrolled in a postexposure bloodborne pathogen management program had 3 goals: (1) to characterize their exposure incidents, (2) to assess health care workers' experience with the program, and (3) to identify strategies to improve the management of exposure incidents. METHODS: A confidential, self-administered, 5-page survey was mailed to 150 hospital employees who were recently evaluated in the employee health clinic for a blood/body fluid exposure. RESULTS: Sixty-five usable surveys were returned to the study office, representing a 43% response rate. Although the majority of the employees enrolled in the postexposure management program were generally satisfied with the overall quality of care they received, many respondents perceived a lack of social support during the lengthy follow-up period. Long-term distress related to the exposure was not uncommon. The respondents' suggestions for improvement focused on the need for department managers to become more personally involved when their staff members have an exposure incident. CONCLUSION: These qualitative data suggest that additional studies are needed to assess both the short-term and long-term impact of exposure incidents on the health and well being of affected health care workers. In addition, because of a paucity of information in this area, studies are needed to assess both the effectiveness of the United States Public Health Service recommendations for postexposure management and the degree to which they have been implemented by health care facilities.

An ergonomics program designed to reduce the incidence of upper extremity work related musculoskeletal disorders.

In 1992, the Johns Hopkins Hospital and University initiated a program aimed at the early diagnosis and treatment of potential upper extremity work related musculoskeletal disorders (UEWMSDs), ergonomic assessment and abatement of work areas where individuals with UEWMSDs are employed, as well as the identification and correction of areas throughout the hospital and university where UEWMSDs could possibly occur. The program resulted in an initial increase in the number and cost for the treatment of UEWMSDs. Subsequently, there was a significant decrease in the number of UEWMSDs reported and virtual elimination of the need to use surgical procedures to correct these conditions. This article suggests that a coordinated program of medical care, ergonomic assessment, and intervention can be efficacious in the primary, secondary, and tertiary prevention of UEWMSD.

The effect of managed care on surgical rates among individuals filing for workers' compensation.

This work evaluates the imposition of managed care techniques on the rate of claims and surgeries utilizing a pre- versus post-program analysis. The purpose was to ascertain whether managed care techniques--specifically, an ergonomic program, medical treatment guide-line, nurse case management, and utilization of a preferred provider organization consisting of academic physicians--would reduce the rate of the claims and surgery in a population of predominantly health care and university workers. The claims frequency rate and surgical frequency rates per 1,000 employees and per 1,000 claims was significantly lower during the managed care period than during the year prior to the initiation of managed care. The distribution of surgical procedures, as well as the duration of disability in the years of injury, after the initiation of managed care (1993-1997) were different from those same parameters in the fiscal years prior to the initiation of managed care (1990-1992). The results suggest that even in the workers' compensation environment, where financial incentives encourage a higher claims and surgical frequency rate than do the fee-for-service or prepaid medical environments, managed care techniques can be successfully utilized. A unique feature of the study was the use of university-based physicians as a specific managed care technique to influence surgical rates.

The effect of dietary vitamin E supplementation on the quality of fresh and frozen lamb meat.

The effect of dietary α-tocopheryl acetate supplementation on the uptake of α-tocopherol in ewe plasma, lamb plasma, milk, organs and muscles was investigated. The oxidative stability and colour in fresh M. longissimus dorsi and frozen M. longissimus dorsi, M. psoas major and M. gluteus medius were also investigated. Ewes (n = 12) were selected and scanned to assess pregnancy. They were divided into two groups (n = 6). The control group was fed a diet containing 20 mg α-tocopheryl acetate/kg feed/day and the supplemented group fed a diet containing 1000 mg α-tocopheryl acetate/kg feed/day, for 9 weeks ante-parturition and 3 weeks post-parturition. The lambs were weaned at 3 weeks and fed supplemented or basal feed for 10 weeks before slaughter. Plasma α-tocopherol increased significantly (p < 0.01) in ewes in the 9 weeks ante-parturition, and lamb plasma taken just before slaughter was significantly (p < 0.01) higher for the supplemented group than the basal group, following 13 weeks of supplementation. Milk α-tocopherol levels were significantly (p < 0.01) higher from ewes fed the supplemented diet at parturition and for the three weeks of supplementation post-parturition (p < 0.05). Supplementation increased the α-tocopherol levels in all tissues sampled. The α-tocopherol concentrations in M. longissimus dorsi and M. psoas major were also determined after frozen storage at -20 °C for 34 weeks. Frozen storage resulted in a significant (p < 0.01) reduction in mean α-tocopherol levels for M. longissimus dorsi but not M. psoas major. Dietary supplementation with α-tocopheryl acetate significantly (p < 0.05) increased the oxidative stability of lamb muscle. Surface colour (Hunter L, a, b) was found to be negatively correlated with metmyoglobin content. Supplementation reduced surface discolouration in refrigerated display under fluorescent light over a 6-7 day storage period. The effect was more pronounced in frozen displayed muscles than in freshly displayed samples.

Occupational chemical exposures in an academic medical center.

Although the risks of certain chemical agents in the hospital environment are well known, problems associated with the entire spectrum of chemicals are not. To address this issue, we analyzed incident reports generated in response to chemical exposures in an academic medical center. We also reviewed workers' compensation clinic logs and the OSHA 200 log to obtain information on medical follow-up and severity. A total of 253 exposures occurred during the 3 years from 1988 to 1990. The overall incidence rate was 8.0 per 1000 person-years. Exposure rates by job title were highest for housekeepers (60.1 per 1000 person-years), followed by maintenance workers (18.6), and laboratory technicians (13.1). The most frequently involved chemical groups were disinfectants (25.9%), solvents (16.8%), and cleaning compounds (12.1%). Exposure by the dermal route was most common (37.9%). Thirteen percent of the exposures resulted in lost time and a similar percentage was reported on the OSHA log. Medical treatment was obtained by 53%. Implications for hazard communication, recordkeeping, and prevention are discussed.