184 unit 3 | Professional Issues
will need to take the time to learn new devices, and
make certain that the current safety requirements
are enforced with employees. Volunteer to partici-
pate in evaluation committees, or work on teams
testing new devices. Follow these guidelines in your
daily nursing practice (ANA, 1993; Brooke, 2001;
nursingworld.org/dlwa/osh/wp2; Perry, 2001):
■Always use universal precautions.
■Use and dispose of sharps properly.
■Be immunized against hepatitis B.
■Immediately wash all exposed skin with soap
and water.
■Flush affected eyes or mucous membranes with
saline or water.
■Report all exposures according to your facility’s
protocol.
■If possible, know the HIV/hepatitis B virus
status of your patient.
■Comply with postexposure follow-up.
■Support others who are exposed.
■Become active in the safety committee—be a
change agent.
■Educate others.
Although health-care providers are aware of the
need to use gloves as a protection against blood-
borne pathogens, only one evidence-based summary
has been reported regarding blood-borne pathogens
and glove safety. The summary explored double
gloving versus single gloving in reducing the number
of infections. This includes postoperative wound
infections or blood-borne infections in surgical
patients and blood-borne infections in the surgical
team and to determine if double gloving reduces the
incidence of glove perforations compared with single
gloving. A total of 18 randomized controlled trials
met the inclusion criteria and were included in the
review. There is clear evidence from this review that
double gloving reduces the number of perforations
to the innermost glove. There does not appear to be
an increase in the number of perforations to the out-
ermost glove when two pairs of gloves are worn.
Korniewicz et al. (2004) participated in the first
clinical trial to test the barrier integrity of nonlatex
sterile surgical gloves after use in the operating room.
During the 14-month study, more than 21,000
gloves were collected from more than 4000 surgical
procedures. Based on results, Korniewicz et al. con-
cluded that nonlatex or intact latex gloves provide
adequate barrier protection but that nonlatex gloves
may tear more frequently than latex during use.
Ergonomic Injuries
Occupational-related back injuries affect more
than 75% of nurses over the lifetime of their
career. Poor ergonomics is a safety factor for both
nurses and patients, whose safe nursing care is
already in jeopardy by the escalating nursing short-
age (Durr, 2004).Back Injuries
Back injuries are the most critical of ergonomic
injuries. Annually, 12% of nurses leave the profes-
sion as a result of back injuries, and more than
52% complain of chronic back pain. Nursing aides,
orderlies, and attendants ranked second and regis-
tered nurses sixth in a list of at-risk occupations for
strains and sprains (DOL, 2002). The problem
with lifting a patient is not just one of overcoming
heavy weight. Size, shape, and deformities of the
patient as well as balance and coordination, com-
bativeness, uncooperativeness, and contractures
must be considered. Any unpredictable movement
or resistance from the patient can throw the nurse
off balance quickly and result in a back injury.
Environmental considerations such as space, equip-
ment interference, and unadjustable beds, chairs,
and commodes also contribute to back injury risk
(Edlich, Woodard, & Haines, 2001).
This issue of back injuries and other ergonomic-
related injuries has become so severe that in July
2001 the OSHA began to develop a comprehensive
approach to ergonomics. Public forums, meetings
with stakeholder groups and individuals, and writ-
ten comments were analyzed. Out of this work, a
four-pronged comprehensive approach to ergonom-
ics was developed to include (osha.gov/ergonomics/
ergofact02):
1.Task- or industry-specific written guidelines
2.Enforcement
3.Outreach/assistance
4.Research
The OSHA issued an ergonomics guideline for the
nursing home industry on March 13, 2003. The
back injury guide for health-care workers
(dir.ca.gov/dosh/dosh_publications/backinj.pdf )
and the OSHA guidelines for nursing homes
(osha.gov/ergonomics/guidelines/nursinghome/in-
dex) are comprehensive resources. Although guide-
lines are less than legislated standards, the OSHA
uses the General Duty Clause to cite employers for