Does Manual Abdominal Pressure During Colonoscopy Put Endoscopy Staff and Patients at Risk? Experiences of Endoscopy Nurses and Technicians.

Endoscopy staff suffer work-related musculoskeletal disorders at a rate greater than or comparable to nurses and technicians in other subspecialities, which may be attributable to the widespread use of manual pressure and repositioning during colonoscopy. In addition to negatively impacting staff health and job performance, colonoscopy-related musculoskeletal disorder injuries may also signal potential risks to patient safety. To assess the prevalence of staff injury and perceived patient harm relating to the use of manual pressure and repositioning techniques during colonoscopy, 185 attendees of a recent national meeting of the Society of Gastroenterology Nurses and Associates were asked to recall experiencing injuries to themselves or observing injuries to other staff or patients during colonoscopy. A majority of respondents (84.9%, n = 157) reported either experiencing or observing staff injury, whereas 25.9% ( n = 48) reported observing patient complications. Among respondents who perform manual repositioning and apply manual pressure during colonoscopy (57.3%, n = 106), 85.8% ( n = 91) reported experiencing musculoskeletal disorders from performing these tasks; 81.1% ( n = 150) reported no awareness of colonoscopy-specific ergonomics policies at their facility. Results highlight the relationship between the physical job requirements of endoscopy nurses and technicians, staff musculoskeletal disorders, and patient complications, and suggest that implementation of staff safety protocols may benefit patients as well as endoscopy staff.

Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis.

INTRODUCTION: American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. RESULTS: A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. CONCLUSIONS: Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.

Estimates of RelSeq, Mesh1, and SAHMex Hydrolysis of (p)ppGpp and (p)ppApp by Thin Layer Chromatography and NADP/NADH Coupled Assays.

The Mesh1 class of hydrolases found in bacteria, metazoans and humans was discovered as able to cleave an intact pyrophosphate residue esterified on the 3'hydroxyl of (p)ppGpp in a Mn2+ dependent reaction. Here, thin layer chromatography (TLC) qualitative evidence is presented indicating the substrate specificity of Mesh1 from Drosophila melanogaster and human MESH1 also extends to the (p)ppApp purine analogs. More importantly, we developed real time enzymatic assays, coupling ppNpp hydrolysis to NADH oxidation and pppNpp hydrolysis to NADP+ reduction, which facilitate estimation of kinetic constants. Furthermore, by using this assay technique we confirmed TLC observations and also revealed that purified small alarmone hydrolase (SAHMex) from Methylobacterium extorquens displays a strong hydrolase activity toward (p)ppApp but only negligible activity toward (p)ppGpp. In contrast, the substrate specificity of the hydrolase present in catalytically active N-terminal domain of the RSH protein from Streptococcus equisimilis (RelSeq) includes (p)ppGpp but not (p)ppApp. It is noteworthy that the RSH protein from M. extorquens (RSHMex) has been recently shown to synthesize both (p)ppApp and (p)ppGpp.

Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing?

BACKGROUND: People with disabilities continue to experience health disparities resulting from inaccessibility of healthcare practices and medical diagnostic equipment (MDE). OBJECTIVE: The purpose of this study was to evaluate the accessibility of and accommodations for patients with mobility disabilities in clinics of a large healthcare system in the South Atlantic division of the U.S., to determine if accessibility was different based on clinic type, and to identify areas for improvement to increase accessibility. METHODS: This was a cross-sectional study of 214 healthcare professionals conducted between March and June of 2018. Chi square tests and ANOVA were used to compare accessibility between primary care, hospital based, and private diagnostic clinics. RESULTS: A relatively high proportions of respondents reported that their clinic had implemented many accessible features. However, significant differences were found by clinic type with primary care clinics having better access to MDE including height adjustable exam tables, scales with handrails, wheelchair accessible scales, or padded leg supports. However, primary care clinics were less likely to have lifts for transferring patients. The percent of clinics with MDE was higher than that reported in previous studies which may be due to the safe patient handling and mobility program implemented at the healthcare system. Accommodations for patients when a barrier to care is encountered remain an area for improvement. CONCLUSION: While accessibility for people with disabilities was greater in this healthcare system, areas for improvement were identified to help healthcare professional care for their patients with disabilities.

Factors associated with lift equipment use during patient lifts and transfers by hospital nurses and nursing care assistants: A prospective observational cohort study.

BACKGROUND: Despite wide availability of patient lift equipment in hospitals to promote worker and patient safety, nursing staff do not consistently use equipment. OBJECTIVE: To determine the influence of factors on the use or non-use of lift equipment during patient lifts/transfers. DESIGN: Prospective observational cohort study. SETTING: One university teaching hospital and two community hospitals in a large health system in southeastern United States. PARTICIPANTS: 77 nurses and nursing care assistants with patient handling duties in critical care, step-down and intermediate care units. METHODS: Participants recorded information about all patient lifts/transfers during their shifts during a 1 week period per month for three months: type of lift/transfer, equipment use, type of equipment, and presence of 20 factors at the time of the lift/transfer. With the patient lift/transfer as the unit of analysis, the association (risk ratios (RR) and 95% confidence intervals (CI)) between factors and equipment use was examined using multivariate Poisson regression with generalized estimating equations. RESULTS: Seventy-seven participants (465 person-shifts) reported 3246 patient lifts/transfers. Frequent lifts/transfers included bed-to-toilet (21%), toilet-to-bed (18%), bed-to-chair (13%), chair-to-bed (13%), chair-to-toilet (6%), and toilet-to-chair (6%). Equipment was used for 21% of lifts/transfers including powered floor based dependent lift (41%), powered sit-to-stand lift (29%), non-powered sit-to-stand lift (17%), air-assisted lateral transfer device (6%), ceiling lift (3%), and air-assist patient lift (3%). Factors associated with equipment use included: availability of equipment supplies (RR = 9.61 [95%CI: 6.32, 14.63]), staff availability to help with equipment (6.64 [4.36, 10.12]), staff preference to use equipment (3.46 [2.48, 4.83]), equipment required for patient condition (2.38 [1.74, 3.25]), patient inability to help with lift/transfer (2.38 [1.71, 3.31]), equipment located in/by patient room (1.82 [1.08, 3.06]), sling already under patient (1.79 [1.27, 2.51]), and patient size/weight (1.38 [0.98, 1.95]). Lower patient mobility score (3.39 [2.19, 5.26]) and presence of physical or mental impairments (2.00 [1.40, 2.86]) were also associated with lift equipment use. Factors associated with non-use of equipment included: patient/family preference (0.31 [0.12, 0.80]), staff assisting with lift did not want to use equipment 0.34 ([0.17, 0.68]), patient condition (0.48 [0.20, 1.20]), and patient almost fell (0.66 [0.45, 0.97]). CONCLUSIONS: Patient, worker, equipment, and situational factors influence whether nursing staff used equipment to lift/transfer a patient. Quantifying and understanding these factors associated with lift equipment use and non-use provides specific information for hospitals and safety professionals to enhance effectiveness of future organizational and ergonomic intervention efforts to prevent work-related patient-handling injuries.

Use of Assistive Devices to Lift, Transfer, and Reposition Hospital Patients.

BACKGROUND: Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized. OBJECTIVE: The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used. METHODS: Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics. RESULTS: Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was "always/almost always" provided from coworkers (83.3%) and often perceived as "very helpful" (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% "always/almost always") yet perceived as "very helpful" by 66.3%. One fifth always used friction-reducing devices. DISCUSSION: Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.

The E. coli Global Regulator DksA Reduces Transcription during T4 Infection.

Bacteriophage T4 relies on host RNA polymerase to transcribe three promoter classes: early (Pe, requires no viral factors), middle (Pm, requires early proteins MotA and AsiA), and late (Pl, requires middle proteins gp55, gp33, and gp45). Using primer extension, RNA-seq, RT-qPCR, single bursts, and a semi-automated method to document plaque size, we investigated how deletion of DksA or ppGpp, two E. coli global transcription regulators, affects T4 infection. Both ppGpp° and ΔdksA increase T4 wild type (wt) plaque size. However, ppGpp° does not significantly alter burst size or latent period, and only modestly affects T4 transcript abundance, while ΔdksA increases burst size (2-fold) without affecting latent period and increases the levels of several Pe transcripts at 5 min post-infection. In a T4motAam infection, ΔdksA increases plaque size and shortens latent period, and the levels of specific middle RNAs increase due to more transcription from Pe’s that extend into these middle genes. We conclude that DksA lowers T4 early gene expression. Consequently, ΔdksA results in a more productive wt infection and ameliorates the poor expression of middle genes in a T4motAam infection. As DksA does not inhibit Pe transcription in vitro, regulation may be indirect or perhaps requires additional factors.

Visualizing the phage T4 activated transcription complex of DNA and E. coli RNA polymerase.

The ability of RNA polymerase (RNAP) to select the right promoter sequence at the right time is fundamental to the control of gene expression in all organisms. However, there is only one crystallized structure of a complete activator/RNAP/DNA complex. In a process called σ appropriation, bacteriophage T4 activates a class of phage promoters using an activator (MotA) and a co-activator (AsiA), which function through interactions with the σ(70) subunit of RNAP. We have developed a holistic, structure-based model for σ appropriation using multiple experimentally determined 3D structures (Escherichia coli RNAP, the Thermus aquaticus RNAP/DNA complex, AsiA /σ(70) Region 4, the N-terminal domain of MotA [MotA(NTD)], and the C-terminal domain of MotA [MotA(CTD)]), molecular modeling, and extensive biochemical observations indicating the position of the proteins relative to each other and to the DNA. Our results visualize how AsiA/MotA redirects σ, and therefore RNAP activity, to T4 promoter DNA, and demonstrate at a molecular level how the tactful interaction of transcriptional factors with even small segments of RNAP can alter promoter specificity. Furthermore, our model provides a rational basis for understanding how a mutation within the ß subunit of RNAP (G1249D), which is far removed from AsiA or MotA, impairs σ appropriation.

Determining the Architecture of a Protein-DNA Complex by Combining FeBABE Cleavage Analyses, 3-D Printed Structures, and the ICM Molsoft Program.

Determining the structure of a protein-DNA complex can be difficult, particularly if the protein does not bind tightly to the DNA, if there are no homologous proteins from which the DNA binding can be inferred, and/or if only portions of the protein can be crystallized. If the protein comprises just a part of a large multi-subunit complex, other complications can arise such as the complex being too large for NMR studies, or it is not possible to obtain the amounts of protein and nucleic acids needed for crystallographic analyses. Here, we describe a technique we used to map the position of an activator protein relative to the DNA within a large transcription complex. We determined the position of the activator on the DNA from data generated using activator proteins that had been conjugated at specific residues with the chemical cleaving reagent, iron bromoacetamidobenzyl-EDTA (FeBABE). These analyses were combined with 3-D models of the available structures of portions of the activator protein and B-form DNA to obtain a 3-D picture of the protein relative to the DNA. Finally, the Molsoft program was used to refine the position, revealing the architecture of the protein-DNA within the transcription complex.

Adjustable task lighting: Field study assesses the benefits in an office environment.

BACKGROUND: Lighting is a part of every work task in the office environment, yet it is often overlooked. Research links direct and indirect glare to increased risk of visual discomfort among office workers with symptoms ranging from dry eyes to blurry vision or headaches. Researchers have been primarily concerned with those characteristics of task lighting that cause glare including luminance level, position (line of sight), and control. It is unknown what the benefits of adjustable task lights are and whether or not their use has an effect on musculoskeletal comfort or posture. No comprehensive field evaluations of this type were found among peer-reviewed, indexed journals. OBJECTIVE: The purpose of this study was to assess the ergonomic and calculated utility power consumption benefits of adjustable LED task lighting in an office environment using a control/intervention experiment design. METHODS: One hundred participants were originally recruited and randomly assigned to intervention and control groups. Self-reported data was collected on level of eye fatigue, perception of job content, intervention usability, and musculoskeletal discomfort. Data was also collected on workspace level of illumination and posture during standardized tasks (assessed using RULA). RESULTS: Comparing baseline data to follow-up data for the intervention group, the use of the adjustable, LED task lights provided statistically significant, positive impacts on users' rating of discomfort, eye fatigue, perception of job content, and posture between baseline and the short-term follow up. CONCLUSIONS: Significant benefits to musculoskeletal comfort, posture, and visual comfort were documented when participants used the adjustable task lights. Participants' assessments of the light's usability, usefulness and desirability were positive. There were no negative results found with adjustable task light use.

Architecture of the bacteriophage T4 activator MotA/promoter DNA interaction during sigma appropriation.

Gene expression can be regulated through factors that direct RNA polymerase to the correct promoter sequence at the correct time. Bacteriophage T4 controls its development in this way using phage proteins that interact with host RNA polymerase. Using a process called σ appropriation, the T4 co-activator AsiA structurally remodels the σ(70) subunit of host RNA polymerase, while a T4 activator, MotA, engages the C terminus of σ(70) and binds to a DNA promoter element, the MotA box. Structures for the N-terminal (NTD) and C-terminal (CTD) domains of MotA are available, but no structure exists for MotA with or without DNA. We report the first molecular map of the MotA/DNA interaction within the σ-appropriated complex, which we obtained by using the cleaving reagent, iron bromoacetamidobenzyl-EDTA (FeBABE). We conjugated surface-exposed, single cysteines in MotA with FeBABE and performed cleavage reactions in the context of stable transcription complexes. The DNA cleavage sites were analyzed using ICM Molsoft software and three-dimensional physical models of MotA(NTD), MotA(CTD), and the DNA to investigate shape complementarity between the protein and the DNA and to position MotA on the DNA. We found that the unusual "double wing" motif present within MotA(CTD) resides in the major groove of the MotA box. In addition, we have used surface plasmon resonance to show that MotA alone is in a very dynamic equilibrium with the MotA element. Our results demonstrate the utility of fine resolution FeBABE mapping to determine the architecture of protein-DNA complexes that have been recalcitrant to traditional structure analyses.

The Bordetella pertussis model of exquisite gene control by the global transcription factor BvgA.

Bordetella pertussis causes whooping cough, an infectious disease that is reemerging despite widespread vaccination. A more complete understanding of B. pertussis pathogenic mechanisms will involve unravelling the regulation of its impressive arsenal of virulence factors. Here we review the action of the B. pertussis response regulator BvgA in the context of what is known about bacterial RNA polymerase and various modes of transcription activation. At most virulence gene promoters, multiple dimers of phosphorylated BvgA (BvgA~P) bind upstream of the core promoter sequence, using a combination of high- and low-affinity sites that fill through cooperativity. Activation by BvgA~P is typically mediated by a novel form of class I/II mechanisms, but two virulence genes, fim2 and fim3, which encode serologically distinct fimbrial subunits, are regulated using a previously unrecognized RNA polymerase/activator architecture. In addition, the fim genes undergo phase variation because of an extended cytosine (C) tract within the promoter sequences that is subject to slipped-strand mispairing during replication. These sophisticated systems of regulation demonstrate one aspect whereby B. pertussis, which is highly clonal and lacks the extensive genetic diversity observed in many other bacterial pathogens, has been highly successful as an obligate human pathogen.

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting.

BACKGROUND: Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. METHODS: Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. RESULTS: Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. CONCLUSION: Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption.

A lift assist team in an acute care hospital-prevention of injury or transfer of risk during patient-handling tasks?

A Lift Assist Team (LAT) was created on three units at a medical center where nursing staff were at high risk for patient-handling injuries. LAT members were drawn from the hospital's pool of patient transporters. Using qualitative and quantitative data, this case study summarizes the development, implementation, and experiences of the LAT. Nursing staff valued the LAT, reporting increased staff safety and improved patient care. LAT members reported greater job satisfaction and a newfound sense of assimilation into the nursing group compared to when their role was patient transport only. However, over time, their job responsibilities expanded beyond those officially designated for LAT members. Active, ongoing surveillance of the LAT's exposures and outcomes is warranted to understand whether patient-handling injury risk is shifting from nursing personnel to LAT members.

A mutation within the ß subunit of Escherichia coli RNA polymerase impairs transcription from bacteriophage T4 middle promoters.

During infection of Escherichia coli, bacteriophage T4 usurps the host transcriptional machinery, redirecting it to the expression of early, middle, and late phage genes. Middle genes, whose expression begins about 1 min postinfection, are transcribed both from the extension of early RNA into middle genes and by the activation of T4 middle promoters. Middle-promoter activation requires the T4 transcriptional activator MotA and coactivator AsiA, which are known to interact with σ(70), the specificity subunit of RNA polymerase. T4 motA amber [motA(Am)] or asiA(Am) phage grows poorly in wild-type E. coli. However, previous work has found that T4 motA(Am)does not grow in the E. coli mutant strain TabG. We show here that the RNA polymerase in TabG contains two mutations within its ß-subunit gene: rpoB(E835K) and rpoB(G1249D). We find that the G1249D mutation is responsible for restricting the growth of either T4 motA(Am)or asiA(Am) and for impairing transcription from MotA/AsiA-activated middle promoters in vivo. With one exception, transcription from tested T4 early promoters is either unaffected or, in some cases, even increases, and there is no significant growth phenotype for the rpoB(E835K G1249D) strain in the absence of T4 infection. In reported structures of thermophilic RNA polymerase, the G1249 residue is located immediately adjacent to a hydrophobic pocket, called the switch 3 loop. This loop is thought to aid in the separation of the RNA from the DNA-RNA hybrid as RNA enters the RNA exit channel. Our results suggest that the presence of MotA and AsiA may impair the function of this loop or that this portion of the ß subunit may influence interactions among MotA, AsiA, and RNA polymerase.

Impact of gene patents and licensing practices on access to genetic testing for cystic fibrosis.

Cystic fibrosis is one of the most commonly tested autosomal recessive disorders in the United States. Clinical cystic fibrosis is associated with mutations in the CFTR gene, of which the most common mutation among Caucasians, DeltaF508, was identified in 1989. The University of Michigan, Johns Hopkins University, and the Hospital for Sick Children, where much of the initial research occurred, hold key patents on cystic fibrosis genetic sequences, mutations, and methods for detecting them. Several patents, including the one that covers detection of the DeltaF508 mutation, are jointly held by the University of Michigan and the Hospital for Sick Children in Toronto, with Michigan administering patent licensing in the United States. The University of Michigan broadly licenses the DeltaF508 patent for genetic testing with >60 providers of genetic testing to date. Genetic testing is now used in newborn screening, diagnosis, and for carrier screening. Interviews with key researchers and intellectual property managers, a survey of laboratories' prices for cystic fibrosis genetic testing, a review of literature on cystic fibrosis tests' cost-effectiveness, and a review of the developing market for cystic fibrosis testing provide no evidence that patents have significantly hindered access to genetic tests for cystic fibrosis or prevented financially cost-effective screening. Current licensing practices for cystic fibrosis genetic testing seem to facilitate both academic research and commercial testing. More than 1000 different CFTR mutations have been identified, and research continues to determine their clinical significance. Patents have been nonexclusively licensed for diagnostic use and have been variably licensed for gene transfer and other therapeutic applications. The Cystic Fibrosis Foundation has been engaged in licensing decisions, making cystic fibrosis a model of collaborative and cooperative patenting and licensing practice.

Exploration of work and health disparities among black women employed in poultry processing in the rural south.

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research.

An integrated comprehensive occupational surveillance system for health care workers.

BACKGROUND: Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented. METHODS: Human resources job and work location data were used to define the DUHS population at risk. Outcomes and exposure data from existing occupational health and safety programs, health promotion programs, and employee health insurance claims, were linked with human resources data and de-identified to create the Duke Health and Safety Surveillance System (DHSSS). RESULTS: The surveillance system is described and four examples are presented demonstrating how the system has successfully been used to study consequences of work-related stress, hearing conservation program evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids (BBF). CONCLUSIONS: Utilization of existing data, often collected for other purposes, can be successfully integrated and used for occupational health surveillance monitoring of HCWs. Use of the DHSSS for etiologic studies, benchmarking, and intervention program evaluation are discussed.