CDC Updates on Zika Virus

The CDC released several updates on Zika virus disease last week. We have summarized the main points. Follow the links to read the full guidelines.

Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016

  • Occupational transmission of Zika is “theoretically possible”
    • Zika virus has been found in several body fluids, including blood, semen, urine, and amniotic fluid
    • Transmission is primarily through mosquito bites, but sexual transmission has also been documented
    • Occupational transmission has not been documented
  • CDC recommends standard precautions in all healthcare settings
  • Notes that for labor and delivery settings, standard precautions will require more than just gloves/gown due to high risk of exposure to body fluids

Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016

These are guidelines for healthcare providers to counsel women of reproductive age with possible Zika virus exposure on conception.

  • Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception
  • Men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception
  • Women and men with possible exposure to Zika but no clinical illness should wait 8 weeks after exposure to attempt conception
  • Recommendations on providing preconception counseling and counseling on how to avoid pregnancy for people who reside in areas with endemic Zika
  • Testing for Zika virus is only recommended for people attempting conception with at least one symptom within 2 weeks of exposure—
    • Testing is not recommended for people with exposure but no symptoms because of unknown test performance in people without symptoms
  • New guidance for testing pregnant women residing in area with endemic Zika
    • Testing for pregnant women upon initiation of prenatal care if no symptoms, including a second test for Zika mid-second trimester if 1st was negative
  • See link for full guidelines.

Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016

  • Men who have traveled to or reside in an area with local Zika transmission should use condoms or abstain from sex with pregnant sex partners for the duration of the pregnancy
  • Men and non-pregnant sex partners should use condoms or abstain from sex to reduce the risk for sexual transmission
    • If the man is symptomatic, they should use condoms/abstain for 6 months after onset of illness
    • If the man just has exposure but no symptoms, then they should use condoms/abstain for 8 weeks after departure from area with local Zika transmission
    • If the man resides in an area with local Zika transmission but has no symptoms, they should consider using condoms/abstaining while active transmission persists

Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak — Puerto Rico, 2016

  • Local Zika transmission has been increasing quickly in Puerto Rico in recent months
  • This study estimates that 2/3 of the pregnancies in Puerto Rico are unintended and seeks to understand the scope of barriers to contraceptives use
  • Found that access to contraceptives is very limited, due to high cost, limited availability, incomplete insurance coverage, and lack of trained providers
  • The study estimated the number of long-lasting contraceptives needed to prevent unintended pregnancies
    • Estimates were based on studies done in the US on the uptake of long-lasting contraceptives (e.g., IUD, contraceptive implants, depot medroxyprogesterone acetate) with counseling from providers and availability and affordability of contraceptives

NNU Statement on the ANA endorsement of Hillary Clinton

America’s nurses, including the actual largest organization of U.S. nurses, National Nurses United, overwhelmingly support Bernie Sanders for President.

That’s due to Sanders’ stellar record of consistent support for nurses, patients, and working families, exemplified in his campaign for guaranteed healthcare for all, through an improved and expanded Medicare for all, free college tuition and eradicating student debt which is also critical for nurses, and his challenge to Wall Street, which includes many health care corporations.

And Bernie Sanders is the only candidate who supports national legislation, sponsored by NNU, to establish mandatory limits on the number of patients assigned to each RN, Senate S. 864, which he co-sponsors, and the HR 1602.

By contrast, the American Nurses Association, which is supporting Hillary Clinton, is primarily a lobbying arm for the nurse administrators and academics who govern it and functions largely as an adjunct to the health care industry.

ANA’s Foundation, for example, features a corporate advisory board that includes pharmaceutical giants, such as Merck, Pfizer, and McKesson, and health industry technology companies, with major funding also from the health insurance industry, including the nation’s largest UnitedHealth, and hospital corporations.

Three of its advisory board corporate members, Avantos, Lippincott Solutions, and Kronos, actually promote healthcare restructuring techniques that would be harmful to nurses and patients, including cutting nursing hours and the nurse workforce and limiting the role of RN professional judgment. Another corporate board member is Epic, creator of the health IT/clinical decision software systems despised by so many direct care RNs.

Over the past two decades ANA has been hemorrhaging members – its ludicrous claim of 3.4 million members, the total number of U.S. nurses, is not actual ANA membership which is just a miniscule fraction of that number.

Working nurses know the difference. They’re joining NNU – which represents nurses who work at the bedside advocating for improved care and health and safety for nurses and patients – not their employers’ representative, the ANA. 

– Jean Ross, RN, NNU Co-President


OSHA’s New Severe Injury Reporting Requirement: One Year In

Last week, OSHA published a report on severe injuries reported in 2015. A new recordkeeping requirement went into effect January 1, 2015, requiring employers to report all work-related amputations and injuries requiring hospitalization to federal OSHA within 24 hours. This was in addition to the long-standing requirement to report all work-related fatalities to OSHA within 8 hours.

The report sings the praises of many employers who, after reporting a severe injury and being contacted and coached by OSHA staff, conducted their own incident investigations and “went above and beyond” what OSHA required to fix the unsafe situation. OSHA inspected workplaces based on some of the reports: about a third of all injury reports and 58% of amputation reports. For most of the reports, however, OSHA opted for a more cooperative approach, which was:

…guided by the principle that when employers engage with OSHA after a worker suffers a severe injury—whether or not a workplace inspection is launched—they are more likely to take action to prevent future injuries.

We have encountered this principle before—we call it “labor-management partnership.” This new recordkeeping program, while giving OSHA access to important information regarding injury/illness rates, is another step in management-friendly programs, which seriously compromise workers obtaining safer workplaces.

Much of the evidence supplied to support the report’s claims is anecdotal—stories about a severe injury and the rapid and effective abatement in a wastewater treatment plant in Illinois or a tuna cannery in Hawaii. Seven such “success” stories are supplied as compared to two “failure” stories where employers were “continuing practices that put workers at risk” upon investigation (which begs the question whether “failure” stories can be identified through the engagement program at all, or whether they require an inspection to uncover). OSHA claims that,

Most employers who experienced a severe injury to a worker were eager to cooperate with OSHA inspectors to prevent anything similar or worse from happening again.

But how many is “most”—51%? 99%? Perhaps when you give an employer the opportunity to self-report on severe injuries, the conditions that led to those injuries, and the steps taken to prevent future injuries, they will all be “eager” to “cooperate.” But our work experience has shown that self-reporting by employers is often not reliable evidence. If OSHA had released more information about their conversations with employers, we could better understand the process. Workers and their representatives have the right to accompany OSHA during an inspection. So why is there no clear involvement of workers in this engagement program?

OSHA claims in this report that they:

…have found this process to be extremely effective in abating hazards while also using far fewer OSHA resources than are required for on-site inspections. In this way, we are able to use agency resources more efficiently and, ultimately, better protect the safety and health of workers.

OSHA inspections are often detailed, laborious processes (if done well) that require a lot of staff time and attention. It is true; this engagement program does use fewer resources than inspections. And, yes, the new rule provides OSHA with very important data on severe injuries that enables the agency to better protect workers’ health and safety than they were able to before. But we have seen that using fewer resources usually results in weaker protections for workers. So we ask: does this engagement program protect workers’ health and safety better than the traditional program of inspections and citations? The report does not answer this question.

General Medical and Surgical Hospitals ranked 6th for number of severe injuries reported in 2015. Note that this is data only from states covered by federal OSHA, not from states with their own state plans, which had to adopt a similar or more protective reporting requirement. It also does not take into account the total number of workers involved in each industry, which is how OSHA usually reports injuries and illnesses. OSHA estimates that many severe injuries are not being reported, possibly more than 50%.

Here’s the top 10 breakdown:

Top 10 Industry Groups Reporting Severe Injuries (4 digit NAICS)

NAICS Title NAICS Severe Injury Reports
Foundation Structure and Building Exterior Contractors 2381 391
Building Equipment Contractors 2382 343
Support Activities for Mining* 2131 323
Nonresidential Building Construction 2362 271
Postal Service 4911 229
General Medical and Surgical Hospitals 6221 221
Grocery Stores 4451 215
Animal Slaughtering and Processing 3116 213
Utility System Construction 2371 201
Plastics Product Manufacturing 3261 196

Links:

Year One of OSHA’s Severe Injury Reporting Program

OSHA Factsheet Updates to OSHA’s Recordkeeping Rule: Reporting Fatalities and Severe Injuries

State Plan Adoption of OSHA’s Revised Reporting Requirements (29 CFR 1904.39) As of March 8, 2016