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Justin Morrow, Ph.D. and Jun Wang, Ph.D.
As part of our commitment to promoting safer work environments, UC ERC Outreach has actively engaged in efforts to educate advanced manufacturing (3D printing) users and industries about the potential health risks associated with 3D printing emissions and safer ways to mitigate them. Our initiatives include delivering presentations at industry conferences and collaborating with manufacturers, makerspaces, and small businesses to raise awareness of hazardous airborne pollutants generated during the printing process. Through these efforts, we provide evidence-based guidance on effective exposure control strategies, such as proper ventilation, filtration systems, and material selection to minimize harmful emissions. By bridging the gap between research and practice, we have empowered numerous 3D printing businesses with the knowledge and tools needed to protect themselves and their employees, ensuring a safer and healthier workplace.
CE attendees in the past year represented 35 states and 11 countries including Canada, Egypt, India, Malaysia, Myanmar, Oman, Qatar, Saudi Arabia, Thailand, United Republic of Tanzania, and the United States of America.
IMPACT: Trainees have implemented knowledge and skills at their facilities to help protect workers as they perform their work. A few examples are 1) an attendee indicated their company reviewed their respirator protocol to incorporate new information learned from the course and 2) another attendee indicated they put into place a respirator program in their lab and modified experiments to reduce hazards based on their course.
Dania Abu-Alhaija PhD, Kyle Brittingham, Paida Matibiri, Victoria Simmons, Thomas Huston PhD, Gordon Gillespie, PhD, DNP, RN, Victoria Wulsin MD, Kermit Davis, PhD
A group of trainees worked with the Occupational Medicine Clinic at the University of Cincinnati Medical Center to investigate the impact of COVID-19 on different occupational groups within the hospital during the period of February, 2020 and December, 2022. Over 15,000 employees reporting more than 26,000 cases of COVID-19 were analyzed for trends with respect to demographics (age, gender, BMI, race, and ethnicity), exposure source (patient, co-worker, family member, etc), description of exposure (duration of exposure, social distancing, PPE worn, if COVID-19 positive person coughed or sneezed), types of symptoms (cough, chills, sore throat, fever, shortness of breath, vomiting, nausea, loss of taste or smell), vaccine status, and high-risk conditions (high blood pressure, diabetes, stroke, immunological disorders, and other chronic conditions).
IMPACT: Initial results indicate the real impact of COVID-19 on the hospital staff specifically nurses. The team is working on a summary of the key results and suggest key components that increased the severity of COVID-19. Recommendations should help the medical center to be ready for the next epidemic.
Additional Resources Developed by the UC ERC During the COVID-19 Pandemic
Firefighters (FF) experience significant hazards such as physical demands, temperature stress, exposure to toxic chemicals, and other hazards. Cumulative buildup of fatigue due to the combined effects of shiftwork and overexertion in extreme environments can contribute to increased susceptibility to compromised neuromuscular health. A research team is developing and testing a smart textile-based firefighters cooling jacket which may minimize hyperthermia during intense fires (funding from Ohio Bureau of workers’ compensation innovative grants program). A carbon nanotube layer embedded in a firefighting garment and thermally connected to cold reservoirs. Many NIOSH-sponsored ERC faculty are involved in the development with a complete team including multidisciplinary experts from University of Cincinnati Nanoworld (Drs. Schulz and Shanov), Department of Environmental and Public Health Sciences (Drs Bhattacharya, Davis and Rao) and world-renowned DAAP—College of Design, Architecture, Art, and Planning (Dr. Kubley and Kim). Simulation showed that under heat stress conditions, firefighters skin temperature were considerably reduced by the cooling layer.
IMPACT: The cooling fire jacket has resulted in lower body temperatures, which will allow firefighters to respond to live fires longer and be better acclimated to hot environments, thus reducing the cardiovascular and neuromuscular demands.
Firefighters (FF) experience significant hazards such as physical demands, temperature stress, exposure to toxic chemicals, and other hazards. Cumulative buildup of fatigue due to the combined effects of shiftwork and overexertion in extreme environments can contribute to increased susceptibility to compromised neuromuscular health influencing their ability to sustain safe dynamic postural stability while firefighting. The economic burden of firefighter injury is estimated to range between $1.6 billion and $5.9 billion annually. A cooling coat liner is being developed and evaluated to determine whether it can minimize thermal burden and cumulative buildup of associated fatigue resulting in reduced injuries, overexertion, slips/trips, and falls. The project will focus on measuring the effectiveness and commercial viability of the coat liner to be integrated into Firefighter Turnout Gear. Our innovative solution has the potential to prevent on the job injuries and improve workforce safety and comfort for Ohio Firefighters in the near- and long-term future. Currently, firefighters are undergoing laboratory studies as well as live burn simulations to measure the heat stress and core body temperature, as well as the neuromuscular and biomechanical responses necessary to complete their jobs. Once the first phase of developing a conceptual product (coat liner) is complete, a prototype will be developed for mass production and usability studies.
IMPACT: Cooling coat liners will reduce injuries and potentially save lives by providing personalized individual climate control to minimize heat stress, reduce injuries by preventing skin exposure to carcinogens, and improve cognitive health. Our goal is to evaluate the potential of our intervention to reduce injuries for Firefighters in the state of Ohio.
Ada Jesuthasan, Swade Barned, Jiajian Ding, Xinyi Niu, & Tyler Nickle
Xinyi Niu Ph.D., (trainee), Peyton Hall, Steven Lange, Jun Wang, Ph.D.
A collaboration between the University of Cincinnati Leather Research Laboratory and UC ERC IH program explores the potential release of harmful air pollutants during the laser cutting of tanned and finished leather, a process widely used in small businesses, artisanal workshops, and the fashion industry. Tanned leather contains various chemical treatments, dyes, and finishes that, when exposed to high-intensity lasers, can generate hazardous airborne emissions, including the carcinogenic chemical hexavalent chromium (Cr6+), along with fine particulate matter and volatile organic compounds (VOCs). Through our research, we have characterized these emissions, assessed their potential health risks to workers, and identified proper strategies to mitigate these concerns. Our findings, published in two peer-reviewed studies, provide critical insights into the indoor air quality impacts of laser cutting and highlight the need for effective engineering controls, such as improved ventilation, local exhaust systems, and air filtration technologies. By disseminating these research findings and offering practical recommendations, our study has helped small businesses across the United States implement safer practices, reduce occupational health risks, and foster a healthier work environment for craftsmanship.
Alexei Krainev MD, Wali Jahangiri MD, Hannah Phipps, Sofia Villaveces, Kermit Davis PhD, Gordan Gillespie, PhD, DPT, Victoria Wulsin MD, DPH, Ericka Purtee, RN
Occupational sharps and needlestick injuries (SNSIs) place significant direct and indirect costs on the healthcare employer. Annually, there are approximately 385,000 SNSIs among the US healthcare workforce, with nurses and physicians carrying the greatest burden of injury. A SNSI is any occupational percutaneous or skin penetrating injury from a blood-contaminated device or instrument. An anonymous 35-item paper survey was used to evaluate the prevalence of SNSIs, SNSI non-reporting and contributing factors among nurses and resident physicians at a major academic medical center. Nurses and resident physicians made up 33% and 54% of all reported SNSIs at UCMC, respectively. Among nurses, hypodermic needles accounted for 50% of all the SNSIs followed by sutures needles and IV stylets. Residents were most likely to be injured by a suture needle or hypodermic needle during work. Based on the survey, 21% of physicians respondents who had a previous SNSI indicated that they did not report their injury. resident physicians carry a larger burden of SNSIs compared to their nursing counterparts. Residents had a three-fold higher rate of SNSI compared to nurses.
Andrew Freeman, Kermit Davis, David Lang, Jeffrey Huth
Opioid use in the treatment of musculoskeletal injuries is a complex decision where benefits must be balanced with risk. Previous research has shown an association between higher opioid doses and adverse health effects. The study’s objective was to investigate whether opioid prescriptions are associated with increased costs and deaths through an injury mechanism or as a direct result of the opioid prescription. Data on 144,553 de-identified Ohio Bureau of Workers’ Compensation claims with shoulder, knee, and low back injuries were obtained from 2010-2014 and followed through 2016. The outcome variables were medical and indemnity costs, lost days, MaxMED (maximum claim prescribed daily morphine equivalent dose), and death status. The strength of association between the maximum opioid dose and deaths was determined by logistic regression analysis. Several outcome variables, including claim medical and indemnity costs, and the likelihood of claimant death, showed significant associations with the MaxMED. In the analysis of claim deaths, these associations held for all claim types (except complex), even after adjusting for age, gender, surgery, and lost time.
The association between increasing opioid doses and deaths for low-severity diagnoses was disturbing, given the lack of demonstrated efficacy of opioids for the treatment of minor injuries. A focus on provider education, increased utilization of non-opioids, and early intervention for minor, soft-tissue injuries could reduce claims costs, disability, and future deaths.
IMPACT: Workers' injuries have shown high levels of opioid-based prescriptions, which have been shown to have an association with elevated deaths. One of the more puzzling results was how simple injuries still had relatively high levels of opioid-based prescriptions.
Elizabeth Keller, RN, BSN, Beverly Hittle RN, PhD, Samantha Boch, RN, PhD, Kermit Davis, PhD, Gordon Gillespie, PhD, DNP, RN
Correctional nurses experience unique stressors while caring for patients in jails and prisons. However, the impact of working in these environments on nurse health and wellbeing needs to be better understood. A study was completed with the goal to determine the relationship between job stress and organizational characteristics (including job demands, job control, workplace relationships, peer support, manager support) with wellbeing in a sample of U.S. correctional nurses. The Job Demands-Resources Theory guided this study, informing the creation of a conceptual model to be tested. A cross-sectional descriptive design was used, and a sample of 270 practicing correctional nurses completed the online REDCap survey. Survey questions were from the Perceived Stress Scale, the Health & Safety Executive Management Standards Indicator Tool, and the Wellbeing Index. Multiple linear regression and structural equation modeling were used for analysis. Results revealed a significant model fit, R2=0.724, and the significant impact of job stress, job demands, job control, and workplace relationships on nurse wellbeing. Job stress significantly mediates the relationship between job control and job demands with wellbeing. Findings suggest that better organizational characteristics and reduced job stress could improve correctional nurse wellbeing.
IMPACT: Correctional facilities may leverage these findings and increase job control of nurses by implementing mentorship programs, reduce job demands by ensuring adequate staff are hired and retained, foster positive workplace relationships between colleagues through peer support groups, and mitigate job stress by offering education on personal coping methods. Improving correctional nurse wellbeing may have positive impacts for both the nurses and the organizations, by reducing costs associated with outcomes of poor wellbeing and job stress (i.e., costs for sick days and injuries, retraining new staff due to high turnover).
Thomas Gerding, Jun Wang
Nearly all workers and industry sectors have been affected by the ongoing COVID-19 pandemic. The work-related and pandemic-related stressors experienced in the workplace may vary from industry to industry and may have disproportionately affected vulnerable workers. This study aims to investigate stress levels, stressor events, and other perceptions of stress from vulnerable workers during COVID-19. An in-depth work-related stress survey incorporating many aspects of work, life, work-life balance, and employer-employee relationship was developed with a focus on COVID-19-related stressors. The cross-sectional survey targeting workers whose occupational settings and experiences may have been altered by the pandemic (i.e., those involved in labor, service, healthcare, or education) was completed by 676 workers across these sectors. More than 50% of participants reported an increased workload since the onset of the pandemic, with some industries, such as healthcare, seeing an 80% increase. About 55% of respondents believed they could be exposed to COVID-19 at work, ranging from 51.7% among service workers to 76.5% among healthcare workers. These work- and pandemic-related stressors significantly increased workers' stress levels. While workplaces continue to adapt to the changing health crisis and the corresponding recommended best practices (such as vaccination/facemask policies), there appears to be a perception of increased workplace stress.
IMPACT: The study highlights the importance of providing resources to manage occupational stress to ensure workers remain healthy both physically and mentally.
Ryan Bellacov, Taylor Buckley, Sean Dobson, Afton Erbe, Efosa Obariase, Thomas Huston PhD, Gordon Gillespie, PhD, DNP, RN, Victoria Wulsin MD, Kermit Davis, PhD
While workplace violence (WPV) in the home healthcare industry has been a growing area of research interest, there remains a paucity of studies regarding the role of policy in WPV mitigation. This study aimed to elucidate the relationship between written policy and its effect on rates of WPV experienced and reported.This cross-sectional study was conducted in two phases. Phase I was comprised of a blinded review and scoring of written policies from home healthcare agencies in Ohio, Oregon and Texas. Scoring was completed using a tool created by the study investigators which included five areas of criteria. In Phase II, self-reported surveys were completed by home healthcare workers who were employed by the agencies in Phase I. Seven agencies participated in Phase I of the study regarding policy review. Of these agencies, only one met over 50% of policy criterion. A major area of deficiency for most agencies was the absence of methods to prevent WPV; including formal training in WPV prevention for employees and use of protective strategies when conducting home visits. For Phase II, a total of sixteen home healthcare workers completed the self-reported survey. All participants were found to have knowledge of a protocol to report WPV; however only 37% felt comfortable speaking with management. Another major finding was that while all participants had experienced one form of WPV while working at their current agency, none of them reported the violence to management.: This study suggested that the home healthcare industry still has much room for growth regarding the mitigation of WPV. Even in the presence of existing policy on reporting, there continues to be barriers to reporting of WPV to management. This discrepancy has the potential to not only harm the individual worker, but the industry as a whole. Future research should focus on the continued elucidation of these barriers and their subsequent resolution.
IMPACT: The research team provided suggestions to the home healthcare agencies to improve the workplace violence policies. Broader dissemination should impact the home healthcare sector by providing a list of best practice criteria for workplace violence policies.
Amour Dondi, Erin Clark, Danya Kiydal, Holly Meyer, Kyle Seifert, Ryan Bellacov, Dania Abu-Alhaija PhD, Thomas Huston PhD, Gordon Gillespie, PhD, DNP, RN, Victoria Wulsin MD, Kermit Davis, PhD
There is an increasing demand for quality health care workers who work with older adult patients. It is important to ensure that these health care workers work in safe environments. One of the most common occupational hazards among home health care and long-term care workers is workplace violence. Our research team investigated the prevalence of workplace violence in home health care and long-term care facilities and resulting impact on health care worker well-being. A cross-sectional study was conducted where health care workers were asked to complete surveys that included six validated instruments: 1) satisfaction of work and life; 2) work-related rumination; 3) work/family conflict, 4) burnout, 5) turnover intention, and 6) workplace violence. Seventeen participants completed the survey. Verbal abuse by patients was the most frequent experienced type of workplace violence, followed by threats of violence from patients. Employees who reported experiencing workplace violence had higher burnout and lower satisfaction with work and life.
IMPACT: Verbal workplace violence occurs regularly in long term and home health care, resulting in adverse response in care givers. Given the tremendous demands for nurses and nursing aides, the adverse situations that result from workplace violence may continue to impact long-term employment numbers.
Gordon Gillespie, Ph.D.
Workplace violence against emergency nurses perpetrated by patients and visitors has been a known issue for more than 40 years. Gordon Gillespie, Occupational Health Nursing faculty and ERC TRT deputy director at the University of Cincinnati ERC, is internationally recognized for his research on workplace violence against healthcare workers. Dr. Gillespie conducted multiple studies documenting the health and safety consequences of workplace violence on healthcare workers in all various settings including emergency care. Furthermore, his work helped establish how workplace violence negatively impacts worker productivity and, as a result, patient care. Gillespie recently served as guest editor for a special edition of Journal of Emergency Nursing focused on Workplace Violence. His editorial includes a call to action for the adoption of Universal Violence Prevention – a multi-level approach that recommends education, prevention, mitigation, and recovery strategies for healthcare organizations.
Ohio Gov. Mike DeWine signs House Bill 452, a hospital violence prevention bill, into law on Wednesday, Jan. 8, 2025 (Dayton Daily News, 2025)
IMPACT: Research conducted by Gillespie and other ERC faculty and students have contributed significantly to the body of knowledge on workplace violence in the healthcare sector. Our evidence combined with other studies helped support the creation and passage of Ohio House Bill 452 in 2024 which addresses workplace violence among healthcare workers. On January 8, 2025, the Governor of Ohio signed the Healthcare Workplace Safety Act into law. This law, which takes effect in April 2025, requires the implementation of safeguards and protections regarding hospital violence in healthcare organizations and promotes a safer workplace for nurses and other healthcare providers.
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