Healthcare Worker Exposures to Blood Borne Pathogens – Erratic Behavior in Desperate Times?

Background: The reduction of medicals errors (MEs), such as healthcare workers (HCW) blood borne pathogen exposures/needle sticks (etc), is a major concern of the healthcare industry and a priority for government heath policymakers. MEs are diverse, and can be a result of single or multiple factors. It has long been recognized that MEs are more frequent in high stress care settings, such as intensive care units (ICUs), in part due to the effects that stress has on human performance. It is also well recognized that both work place and non-workplace-related stress can impact rates of work place errors – with increases in accidents and more erratic performance during periods when an institution (or nation) is under financial duress, workers are being fired or pay reduced. This has been well established outside the healthcare industry, but little studied in the healthcare setting.

Objective: Explore if MEs, as exemplified by healthcare worker (HCW) exposures to blood borne exposures, might be show some association with workplace and non-workplace-related events that might increases workers sense of insecurity or increased duress.

Methods: Single center retrospective observational study of trends in reported HCW blood borne exposures. These were correlated with ongoing national, regional and institutional events.

Results: From 02/2008 to 09/2008 the number of HCW exposures reported at our institution was a fairly steady, without wide swings in the number of events. From 10/2008 to 10/2009 we observed a new and very erratic pattern, with wide swings in the number of HCW exposures, and an overall alarming upward trend in the number HCW exposures. This new pattern coincides with a number of events contributing to national and institutional duress (Figure).

Conclusions: We observed that the pattern of workplace exposures to blood borne pathogens changed dramatically after the onset of national, regional and institutional financial duress and other stressors. These findings may be coincidental, but suggest that additional studies of global and institutional stress and medical errors may be warranted.