Health Care Facilities: Health care facilities include hospitals, clinics, dental offices, out-patient surgery centers, birthing centers and nursing homes. There are numerous health and safety issues associated with health care facilities. They include but are not limited to: bloodborne pathogen and biological hazards, potential chemical and drug exposures, waste anesthetic gas exposures, ergonomic hazards from lifting and repetitive tasks, laser hazards, hazards associated with laboratories, and radioactive material and x-ray hazards. Some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde and paracetic acid used for sterilization; and numerous other chemicals used in health care laboratories.

Nursing Homes: Today nursing homes and personal care facilities employ approximately 1.6 million workers at 21,000 work sites. By the year 2005, industry employment levels will rise to an estimated 2.4 million workers.According to the Bureau of Labor Statistics, in 1994 nursing and personal care facilities reported 221,200 nonfatal occupational injuries and illnesses to their personnel. Among U.S. industries with 100,000 or more nonfatal injury or illness cases, nursing homes have the third highest rate: 16.8 injuries and illnesses per 100 full-time workers. Nursing home workers suffer most injuries (51.2 percent) when handling residents. Fifty-eight percent of their injuries are strains and sprains. While back injuries account for 27 percent of all injuries in the private sector, in nursing homes they account for 42 percent of all injuries. Of the 10 occupations with the largest number of injuries illnesses, nursing aides and orderlies are exceeded only by truck drivers and nonconstruction laborers.

In addition to the medical staff, large health care facilities employ a wide variety of trades that have health and safety hazards associated with them. These include mechanical maintenance, medical equipment maintenance, housekeeping, food service, building and grounds maintenance, laundry, and administrative staff.

NIOSH is concerned with physical, chemical, psychosocial, and biologic hazards facing healthcare workers in a variety of settings. In the area of infectious disease over the past several years, the combination of healthcare-worker immunization, the use of safer needle devices, and the early recognition and control of exposure to infectious patients have contributed to reduced transmission of occupationally related HBV, TB, and HIV. Historical hazards such as back injuries and exposure to a number of infectious diseases continue to pose a substantial risk to the approximately 7.7 million persons who work in more than 6,000 US hospitals and the nearly 1 million workers providing care in a variety of community health settings, including patient homes, where available control measures are more limited than in the hospital setting. Female nursing aides and licensed practical nurses are approximately 2½ times more likely to experience a work-related low-back disorder than all other female workers.

Healthcare workers continue to be at elevated risk of occupational exposure to a number of airborne and bloodborne infectious diseases relative to the general population. For example, urban healthcare workers have a rate of seropositivity on tuberculin skin tests that is approximately eight times that of the US population. Of greater concern is the experience of healthcare workers in hospital-based outbreaks of multidrug-resistant TB, with 17 documented cases among workers. Similarly, in prevaccine surveys, the annual incidence of HBV among physicians and dentists was 5 to 10 times higher than among blood donors. The CDC estimated that, in 1994, there were approximately 1,100 occupationally acquired HBV infections in healthcare workers in the United States, causing 250 to 1,000 cases of clinical acute hepatitis and 50 hospitalizations. In spite of these sobering statistics, HBV vaccination of healthcare workers remains incomplete. Although the incidence of occupational hepatitis C virus infection among healthcare workers is unknown, "occupational exposure" accounts for approximately 2% of all cases of hepatitis C.

Any discussion of the recent history of infection control in the healthcare setting would be incomplete without addressing the occupational risk of HIV infection. As of December 1996, the CDC reported 163 US healthcare workers with documented or possible occupational transmission of HIV as a consequence of the approximately 800,000 needlestick injuries that occur each year.

The first case of occupational transmission of HIV infection to a healthcare worker, documented in 1984, caused an epidemic of fear among healthcare workers and their families and, as a consequence, great advances in occupational health and infection control practices. The final passage of OSHA's Bloodborne Pathogens Standard in 1991 has provided important protection for healthcare workers at risk of HIV, HBV, and other bloodborne infections.

An epidemic of latex allergy is now plaguing healthcare and other exposed workers.

NIOSH is addressing the challenges facing healthcare workers and workers in general through the National Occupational Research Agenda (NORA) developed to guide occupational safety and health research in the next decade. NIOSH, in collaboration with 500 organizations and individuals (including infection control professionals and front-line healthcare workers) who provided input into the agenda, is now in the process of directing and stimulating research in the 21 identified NORA priority areas. A number of these priorities will have a substantial impact on healthcare workers, including infectious diseases, allergic and irritant dermatitis, asthma and chronic obstructive pulmonary disease, low-back disorders, indoor exposures, and organization of work.