Home health care registered nurses and the risk of percutaneous injuries: A pilot study Robyn R. M. Gershon, MT, MHS, DrPH, a Monika Pogorzelska, BA, a Kristine A. Qureshi, RN, DNSc, b and Martin Sherman, PhD c New York, New York, Honolulu, Hawaii, and Baltimore, Maryland Background: Home health care is the fastest-growing sector in the health care industry, expected to grow 66% over the next 10 years. Yet data on occupational health hazards, including the potential risk of exposure to blood and body fluids, associated with the home care setting remain very limited. As part of a larger study of bloodborne pathogen risk in non–hospital-based registered nurses (RNs), data from 72 home health care nurses were separately analyzed to identify risk of blood/body fluid exposure. Methods: A 152-item self-administered mailed risk assessment questionnaire was completed by RNs employed in home health care agencies in New York State. Results: Nine (13%) of the home health care nurses experienced 10 needlesticks in the 12-month period before the study. Only 4 of the needlesticks were formally reported to the nurse’s employer. The devices most frequently associated with needlesticks were hollow-bore and phlebotomy needles, and included 3 needles with safety features. Exposure was most commonly attributed to patient actions, followed by disposal-related activities. Conclusions: These data suggest that home health care nurses may be at potential occupational risk for bloodborne pathogen exposure. Risk management strategies tailored to the home health care setting may be most effective in reducing this risk. (Am J Infect Control 2008;36:165-72.) Although risk and risk factors for occupational expo- sure to blood and body fluids is well characterized for health care workers (HCWs) employed in the hospital sector of the health care industry, much less is known about the estimated 5 million health care workers employed in the nonhospital sector, which includes home care. 1-4 The home care setting is of particular inter- est for a number of reasons. First, with approximately 20,000 home health care agencies in the United States, and nearly 1 million health care workers, including more than 110,000 registered nurses (RNs), 5 the sector is large and is the fastest-growing sector in health care. Second, the potential for exposure to blood/body fluids may be rising along with the increasing acuteness of care provided in the home health care setting. In 2003, patients left hospitals after a 4.8-day stay on average, compared with the average length of stay of 6.4 days in 1990; many of these patients are discharged to home health care. 6 In 2000, 48% of recently hospitalized Medi- care patients were discharged to home health care. 7 The scope of care provided in home health now includes a wide range of procedures formerly limited to the hospital or outpatient setting, such as home dialysis, infusion therapy, and tracheostomy and ventilation support. Another reason for the increased interest in home care is that very few blood/body fluid exposure studies on this difficult-to-reach population of RNs have been conducted to date. 8,9 The latest risk assessment study, published 7 years ago by Beltrami et al, 10 found a rate of 2.8 blood contacts and 0.6 percutaneous injuries (PIs) per 1000 home health care procedures and a low rate of compliance with protective barrier use. The authors concluded that home health care workers (HHCWs) were at high risk for blood contact. Impor- tantly, even though extensive guidelines and recom- mendations have been published since the enactment From the Department of Sociomedical Studies, Mailman School of Public Health, Columbia University, New York, NY a ; School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI b ; and Department of Psychology, Loyola College, Baltimore, MD. c Address correspondence to Robyn R. M. Gershon, MT, MHS, DrPH, Mailman School of Public Health, Columbia University, 600 West 168 th Street, 4 th Floor, New York, NY 10032. E-mail: rg405@ columbia.edu. Supported by a grant from the Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health (5UO10H04269-03). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agencies. 0196-6553/$34.00 Copyright ª 2008 by the Association for Professionals in Infection Control and Epidemiology, Inc. doi:10.1016/j.ajic.2007.04.278 165