Safety at the end of the stream: Occupational injuries among hospital auxiliary workers

While injury from contaminated sharp devices and infection from transmitted bloodborne pathogens have long been recognized hazards for physicians and nurses, less attention has been paid to the risks for “auxiliary” hospital workers (housekeepers and laundry workers). Our Center's sharps injury surveillance data documents the risk for these supposedly “low-risk” workers. Although auxiliary workers do not typically use sharp devices in the course of their work, they nonetheless are at risk of sustaining “downstream” injuries and infections from contaminated sharp devices.

Auxiliary staff comprises the second largest percentage of hospital employees experiencing disposal-related sharp injuries. In a survey of 21 hospitals, an average of 66 sharps per month were discovered hidden in soiled laundry. Reported sharp injuries for auxiliary workers averaged 3 per year. More than 1/3 of hospital laundry workers had experienced a sharps injury, with the number increasing with years of service. Low hepatitis B vaccination rates and use of personal protective devices were also found. Despite OSHA standards, the number of citations for these infractions continues to increase. As hospital laundry service is moved off-site,surveillance of these workers is

lost to the hospital reporting systems. Voluntary reporting in industry creates incentives for workers to remain uncared for or to pursue care at their own expense. Auxiliary workers are the least able to pay for independent post-exposure prophylaxis; therefore their risk of infection is presumably higher. Issues surrounding the sharps injury risk for auxiliary workers will be discussed, and strategies to reduce risk will be outlined.