Nurses confront potential exposure to infectious diseases, toxic substances, back injuries, and radiation. They also are subject to hazards such as stress, shift work, and violence in the w workplace. These typically fall under the broad categories of chemical, biological, physical, and psychosocial hazards.

INFECTIOUS DISEASES

The risk of infections is present not only in hospitals but in other settings where nurses are employed such as nursing homes, institutions for the retarded, prisons, and outpatient facilities, i.e.: dialysis centers, workplace health centers, or community health clinics. In hospitals high risk areas include pediatric areas, infectious disease wards, emergency rooms, and ambulatory care facilities.

Hepatitis B (HBV) is the most prevalent work-related infectious disease in the United States. Although blood is the major source of the virus, it may also be present in saliva, semen, and feces. Transmission may occur from a percutaneous stick from a contaminated needle or other sharp instrument (the risk of contracting HBV after a stick with a known contaminated needle is 6–30 percent) (Udasin and Gochfeld, 1994), after contaminated blood enters a break in the skin or splatters onto mucous membranes, or upon ingestion. The OSHA Bloodborne Pathogens Standard has provisions for preventing Hepatitis B in healthcare workers including Hepatitis B vaccine, education, procedures for sterilization and disinfection, and use of personal protective clothing. In addition, the CDC has recommendations for work practices during invasive procedures.

Hepatitis A poses a risk for workers in settings such as institutions for the retarded where personal hygiene may be poor (Levy and Wegman, 1995). The use of good handwashing techniques is most effective preventive measure for this virus.

Delta hepatitis occurs only in patients who are infected with Hepatitis B (Levy and Wegman, 1995). This occurs mainly in IV drug abusers, and hemophiliacs and may be transmitted to patients who undergo hemodialysis. The preventive measures utilized to minimize the spread of Hepatitis B should be instituted to limit the transmission of Delta hepatitis.

The majority of cases of Hepatitis C are associated with IV drug use or are idiopathic in origin. The disease has rarely been transmitted to health care personnel via percutaneous exposure. Additional research is needed to determine the extent of this disease as an occupational hazard.

The United States experienced a resurgence of tuberculosis in the 1990s. This is attributed to the HIV epidemic, an increase in immigration



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