Older adults discharged from the hospital to skilled home health care (SHHC) are at high risk for experiencing suboptimal transitions. Using the human factors approach of shadowing and contextual inquiry, we studied the workflow for transitioning older adults from the hospital to SHHC. We created a representative diagram of the hospital to SHHC transition workflow, we examined potential workflow variations, we categorized workflow challenges, and we identified artifacts developed to manage variations and challenges. We identified three overarching challenges to optimal care transitions-information access, coordination, and communication/teamwork. Future investigations could test whether redesigning the transition from hospital to SHHC, based on our findings, improves workflow and care quality.
The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.
Slips, trips, and falls from mobile mining equipment have been documented for decades. However, little research has been conducted to determine the events precipitating these incidents during ingress or egress. This study examined slips, trips, and falls sustained during ingress or egress from front-end loaders to determine the frequencies of factors that may contribute to injuries. Non-fatal injuries, when getting on or off of front-end wheel loaders specifically, were identified, coded, and analyzed from the Mine Safety and Health Administration's accidents, injuries, and illnesses database. Overall trends, events that precipitated the injury, injuries sustained, contributing factors, location of the individual, and equipment characteristics were analyzed. More incidents occurred during egress (63%); and egress is believed to be more hazardous than ingress. Foot slips were the most common event that precipitated the incident and the leading cause of these was contaminants on the equipment. Misstep, loss of footing, and step on/in related incidents were more common during egress and are likely due to the operator's reduced visibility when descending a ladder facing the equipment, limiting their ability to detect hazards. Egress also makes an operator less capable of avoiding unsafe ground conditions as indicated by the significant number of step on/in injuries occurring on the ground during egress. Most of the front-end loaders associated with the incidents were found to have bottom rungs with flexible rails, which may also increase fall risk during egress due to inconsistent rung heights and lengthy transition areas from the ground, through the flexible-railed rungs, to the rungs with rigid rails. Recommendations are provided to reduce the risk for slips, trips, and falls from mobile mining equipment.
Footwear plays an important role in worker safety. Work boots with safety toes are often utilized at mine sites to protect workers from hazards. Increasingly, mining operations require metatarsal guards in addition to safety toe protection in boots. While these guards provide additional protection, the impact of metatarsal guards on gait are unknown. This study aimed to measure the effects of 4 safety work boots, steel toe, and steel toe with metatarsal protection in wader- and hiker-style boots, on level and inclined walking gait characteristics, during ascent and descent. A total of 10 participants completed this study. A motion capture system measured kinematics that allowed for the calculation of key gait parameters. Results indicated that gait parameters changed due to incline, similar to previous literature. Wader-style work boots reduced ankle range of motion when ascending an incline. Hip, knee, and ankle ranges of motion were also reduced during descent for this style of boot. Wader-style boots with metatarsal guards led to the smallest ankle range of motion when descending an inclined walkway. From these results, it is likely that boot style affects gait parameters and may impact a miner’s risk for slips, trips, or falls.
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