Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database

An Examination of Washington State Workers’ Compensation Claims for Home-Based Health Care Workers, 2006 to 2016: Part 1. Description of Claims and Claimants

Home-based health care can be physically and emotionally demanding, resulting in injury or illness. Washington State’s workers’ compensation compensable claims between 2006 and 2016 were analyzed to describe the characteristics of injured home-based health care (HBHC) providers and the burden created by these injuries. Comparisons were made with clinical health care (CHC) providers, as well as between all compensable claims and work-related musculoskeletal disorder (WMSD) claims. Over 90% of claimants for both HBHC and CHC were female. The mean age of all compensable HBHC claimants (45.7 years) was significantly older than for CHC, with the majority (54.5%) between the ages of 40 and 59. However, HBHC claimants with WMSDs were younger, overall. Across health care type and claim type, the majority of injured care providers were overweight or obese (BMI ≥ 25). The highest mean age occurred among claimants injured from falls, either on the same level or to a lower level (HBHC: 48.3-48.6 years, CHC: 46.1-48.1 years). This same group also had the highest BMIs. WMSDs accounted for 47.3% of HBHC compensable claims and 50.3% for CHC. Falls on the same level were the second most common injury event among HBHC claims. For both HBHC and CHC, back injuries were the most common body part for both claim types (all compensable claims: 28.8% HBHC and 23.9% CHC, WMSD claims: 60.8% HBHC and 47.5% CHC). Overexertion was the injury event most attributed to WMSDs (HBHC: 82.6%, CHC: 71.6), overexertion during lifting being the most prevalent overexertion type (HBHC: 27.8%, CHC: 19.6%).

Predictors of work-related musculoskeletal symptoms in shoulders among nursing assistants working in nursing homes

Nursing assistants (NAs) working in nursing homes (NHs) are at higher risk for work-related musculoskeletal symptoms (WRMSs) than their counterparts working in other health care settings. Worldwide, NAs have ranked shoulders in the top three body parts at risk of WRMSs. However, factors associated with their shoulder WRMSs are currently unknown. The aim of this study was to identify these associated risk factors among NAs working in NHs. 440 NAs from 47 nursing homes (with 60–90% response rate from each nursing home), recruited by convenience sampling, participated in this cross-sectional study in 2014–2015. A validated and reliable questionnaire was used for data collection. Information on demographic, job content questionnaire (JCQ), perceived physical exertion (PE), workstyle, ergonomic and manual handling knowledge and other work-related factors was collected using a self-administered questionnaire. 53% of the participants reported experiencing with WRMSs in their shoulders. Nine associated factors of shoulder WRMSs were identified using bivariate analysis. With the adjustment of age and gender using multivariable logistic regression, body mass index (OR = .931, 95% CI [.874–.991]), job title of health workers (OR = 2.72, 95% CI [1.18–6.25]) and workstyle-working through pain (OR = 1.06, 95% CI [1.01–1.11]) remained as predictors. Effort should be directed at integrating “workstyle intervention” into lifestyle physical activity training for NAs.

Using workers' compensation claims to investigate occupational injuries among residential day laborers and domestic workers

BACKGROUND

While many states have legal provisions to extend workers' compensation eligibility to day laborers or domestic workers hired directly by homeowners or families, little is known about the nature or frequency of injury claims submitted on behalf of these "residential employees."

METHODS

We examined California workers' compensation claims records for injuries that appear to have occurred in residential settings between 2008 and 2018 and where the employer of record was an individual or family. We examined the demographic, occupational, and injury characteristics of our sample and analyzed factors that contribute to the likelihood of a claim resulting in some sort of payment.

RESULTS

We identified 5,463 workers' compensation claims that were likely submitted on behalf of residential employees. Claims most commonly reflected injuries to workers performing housekeeping tasks, followed by construction/maintenance and caregiving. Workers performing construction/maintenance or gardening/landscaping tasks were more likely to be injured on the same day of hire and were more likely to require hospitalization or emergency treatment for their injuries; however, these workers also had a smaller proportion of claims that resulted in payment. We found that employment tenure had the biggest impact on the likelihood of payment, with the odds increasing sharply after the first day of work.

CONCLUSIONS

Although the claims in our data set likely represent only a small fraction of all injuries to residential day laborers and domestic workers during this period, we suggest that workers' compensation claims can provide valuable clues for better understanding occupational injuries among workers in this largely informal sector.

Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions

BACKGROUND

There is limited evidence on contributing factors and effective interventions for musculoskeletal injuries in aged care workers.

PURPOSE

To systematically review the factors that contribute to musculoskeletal disorder risk amongst workers in the aged care industry, and to undertake a qualitative comparison of the interventions designed and implemented to prevent injury within this workforce.

METHODS

A systematic review of the literature was conducted in Web of Science, Scopus, ProQuest, Medline, and PubMed. Relevant grey literature was also examined. Articles that reported factors that contribute to musculoskeletal injuries, or interventions to prevent and manage musculoskeletal injuries in residential aged care workers were included.

FINDINGS

Of the 864 articles and 35 grey literature publications found, 63 and 29 were included in the review respectively. Results indicate that physical factors such as manual handling of people, use of assistive devices, and physical work environment are most commonly associated with musculoskeletal disorders in this population. Limited evidence of organisational and psychosocial factors considered staffing issues, work schedules, and violence. The heavy emphasis on physical factors is echoed in the grey literature in relevant guidance material and codes of practice focused on assessment and control of risks. There was limited evidence for interventions specific to aged care; existing evidence focused on equipment, training and education, policy and procedure. Interventions incorporating a combination of approaches, such as equipment and training, showed promise while preliminary evidence of the effectiveness of participatory approaches are positive.

DISCUSSION

Interventions which address multiple types of contributing factors are needed to adequately prevent musculoskeletal injuries in aged care workers. Tweetable abstract: Review of contributing factors, interventions, and application of knowledge for work-related musculoskeletal injuries in aged care.

Bathing frail seniors at home: Home care providers' approaches

BACKGROUND

Home care providers assisting with seniors' personal care often experience high rates of musculoskeletal disorders, particularly affecting the lower back. Assisting with bathing is consistently identified as one of their most physically demanding activities.

OBJECTIVE

To identify and describe care providers' procedures for assisting a frail senior to bathe that are likely to contribute most to the development of back injuries.

METHODS

Eight community-based personal support workers (home care aides) assisted a frail senior (actor) to bathe in a simulated home bathroom. Video recordings of the activity were coded according to providers' postures and to characterize techniques for providing care.

RESULTS

Exposure to severe trunk flexion and high posture-induced back loads was greatest during transfers in and out of the bathtub. In particular, lifting the legs over the rim of the tub, assisting the client to shift across the bath transfer bench, and providing care to the legs and feet involved the care provider spending substantial time in highly flexed postures. No observed techniques for these activities showed substantially lower exposures.

CONCLUSIONS

Further tools and/or techniques must be identified or developed to improve caregiver safety during these strenuous activities.

Quality of home healthcare among Arab countries

Objective:

To examine the quality of home healthcare services provided and to systematically review publications concerning the quality of home healthcare in Arab countries.

Methods:

In 2017, we conducted an online literature search to identify relevant published studies using the following electronic databases: Embase, CINAHL, PubMed, and the Cochrane library. First, we screened the publications according to titles. Second, we evaluated the titles and abstracts of the included publications. Third, we independently reviewed and assessed the full texts of the included publications.

After the final selection, we extracted the following information from the full-text articles that met the inclusion criteria: author, year of publication, country, study design, number of participants, participant type, and the main findings.

Results:

In total, 6 of 214 studies met the inclusion criteria. These 6 studies were published from 3 countries. The country with the most number of studies was Saudi Arabia (4 articles), followed by Jordan (one article) and Iraq (one article). We found that all studies were assessed according to 3 indicators, namely, safety, efficiency, and effectiveness, out of the 6 indicators of quality by the Institute of Medicine.

Conclusion:

This review shows a clear gap in the literature regarding the quality of home healthcare in Arab countries, emphasizing the need for more studies, particularly quality studies on timely, equitable, and patient-centered care in home healthcare settings.

Mapping the Scientific Research on Healthcare Workers' Occupational Health: A Bibliometric and Social Network Analysis

In the last few years, the occupational health (OH) of healthcare workers (HCWs) has been shown increasing concern by both health departments and researchers. This study aims to provide academics with quantitative and qualitative analysis of healthcare workers’ occupational health (HCWs+OH) field in a joint way. Based on 402 papers published from 1992 to 2019, we adopted the approaches of bibliometric and social network analysis (SNA) to map and quantify publication years, research area distribution, international collaboration, keyword co-occurrence frequency, hierarchical clustering, highly cited articles and cluster timeline visualization. In view of the results, several hotspot clusters were identified, namely: physical injuries, workplace, mental health; occupational hazards and diseases, infectious factors; community health workers and occupational exposure. As for citations, we employed document co-citation analysis to detect trends and identify seven clusters, namely tuberculosis (TB), strength training, influenza, healthcare worker (HCW), occupational exposure, epidemiology and psychological. With the visualization of cluster timeline, we detected that the earliest research cluster was occupational exposure, then followed by epidemiology and psychological; however, TB, strength training and influenza appeared to gain more attention in recent years. These findings are presumed to offer researchers, public health practitioners a comprehensive understanding of HCWs+OH research.

Comparison of BRFSS Data Between Home-Based Care Providers and Health Care Support Workers in Clinical Environments in Washington State

Background: The demand for home-based health care support providers (HB providers) is growing as the locus of care shifts to private homes. However, industry representative data of these workers are limited. Methods: Washington Behavioral Risk Factor Surveillance System (WA BRFSS) data from 2011 to 2016 were analyzed to compare HB providers (n = 385) with health care support occupations not based in the home, non-HB providers (n = 229), and all other occupations (n = 32,011). Findings: More HB providers were overweight (4.2%, 95% confidence interval [CI] = [3.3%, 5.2%]) than non-HB providers and all other occupations. Significantly more HB providers had arthritis (33.2%, 95% CI = [27.0%, 39.4%]) and diabetes (9.4%, 95% CI = [5.7%, 13.2%]) than non-HB providers. Nearly twice as many HB providers currently smoked (31.3%, 95% CI = [24.2%, 38.4%]) than non-HB providers. Significantly more HB providers reported serious mental illness (6.8%, 95% CI = [2.8%, 10.7%]) than all other occupations (2.2%). Conclusion/Application to Practice: It is imperative to maintain good health in this home-based health care population as these workers are aging and their professional time becomes limited.

Psychometric Evaluation of the Workstyle Short Form among Nursing Assistants with Work-Related Musculoskeletal Symptoms

The Workstyle Short Form (24 items) (WSF-24) has been tested for its psychometric properties on work-related upper-extremity musculoskeletal symptoms (WRUEMSs) among office workers. However, the impact of workstyle should not only be limited to WRUEMSs and the sedentary workforce. The purpose of this study was to test the psychometric properties of the modified 24-item Chinese WSF (C-WSF-24) to identify work-related musculoskeletal symptoms (WRMSs) in various body parts among nursing assistants (NAs) working in nursing homes. Four hundred and thirty-nine NAs participated in the study. The results of the factor analysis were that a four-factor solution (working through pain, social reactivity at work, demands at work and breaks) accounted for 56.45% of the total variance. Furthermore, validation against known groups showed that the total score and subscale scores of the C-WSF-24 had the ability to discriminate between NAs with and without WRMSs in various body parts (such as low back and lower extremities). Additionally, C-WSF-24 had a statistically significant association with the contributing factors to WRMSs. This is the first study to examine the psychometric properties of the C-WSF-24 in the non-sedentary workforce, with a focus on various body parts of WRMSs. The results demonstrated that C-WSF-24 is reliable and valid for assessing WRMSs in various body parts among NAs.

Prevalence of and Factors Associated with Work-Related Musculoskeletal Symptoms in Nursing Assistants Working in Nursing Homes

The prevalence of work-related musculoskeletal symptoms (WRMSs) in different body parts for nursing assistants (NAs) working in nursing homes is currently unknown. The aim of this study was to determine the extent of WRMSs in nursing assistants and the factors associated with them. Four hundred and forty NAs from 52 nursing homes, recruited by convenience sampling, participated in this cross-sectional study in 2014-2015. A valid and reliable study questionnaire was used to collect data. The results of our study found that 88.4% of NAs reported at least one body part with WRMSs. These NAs reported more symptoms in the shoulders than lower back. Adverse workstyle (OR = 1.04, 95% CI = 1.01-1.08) was the only factor associated with WRMSs after adjustment for potential confounders using multivariable logistic regression. This adverse workstyle could be developed because of physical and psychological work demands. Efforts should be directed at integrating "workstyle intervention" into lifestyle physical activity training to this group of healthcare workers.

Exploring Relationships Among Occupational Safety, Job Turnover, and Age Among Home Care Aides in Maine

As the U.S. population ages, the number of people needing personal assistance in the home care setting is increasing dramatically. Personal care aides and home health workers are currently adding more jobs to the economy than any other single occupation. Home health workers face physically and emotionally challenging, and at times unsafe, work conditions, with turnover rates ranging from 44 percent to 65 percent annually. As part of a mixed-method, longitudinal study in Maine examining turnover, interviews with 252 home care aides were analyzed thematically. Responses to interview questions regarding the job's impact on health and safety, the adequacy of training, and the level of agency responsiveness were examined. Emergent themes, indicating some contradictory perspectives on workplace safety, quality of training, and agency support, were compared across three variables: job termination, occupational injury, and age. Implications for increasing occupational safety and job retention are discussed.

Safety of union home care aides in Washington State

INTRODUCTION

A rate-based understanding of home care aides' adverse occupational outcomes related to their work location and care tasks is lacking.

METHODS

Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides' demographic and work characteristics. Injury narratives and focus groups provided contextual detail.

RESULTS

Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern.

CONCLUSIONS

Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides' improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce.

Exploring the Synergic Effects of Nursing Home Work on Work-Related Musculoskeletal Disorders Among Nursing Assistants

Little is known about how nursing assistants (NAs) perceive the nature of their work and how their work contributes to work-related musculoskeletal disorders (WMSDs). This qualitative study addressed these gaps. Twenty-four NAs with WMSDs working in four nursing homes participated in semistructured focus group interviews. Their WMSDs were not limited to the lower back but involved several body parts. The risk factors for WMSDs included physical, psychosocial, organizational, and personal factors as well as coworkers and clients. However, it is the synergistic effects of long work hours without sufficient rest, work even with musculoskeletal pain because of staff shortages, ineffective management with insufficient prework training and inadequate equipment maintenance, and an aging workforce with strong commitment to resident care that play a crucial role in WMSDs among NAs working in nursing homes. The study found that multidimensional intervention strategies using engineering, administrative, and personal controls should be developed to reduce WMSDs among NAs working in nursing homes.

Occupational hazards for home care nurses across the rural-to-urban gradient in Ontario, Canada

The purpose of this paper was to describe occupational hazards for nurses working in home care (HC) and explore how they differ across the rural-to-urban gradient. Responses (n = 823) from a cross-sectional survey conducted in 2012 of HC nurses registered to practise nursing in the Province of Ontario, Canada were used. Using chi-square analysis and posthoc pairwise tests with a Bonferroni correction, 14 occupational hazards were individually tested for differences between four geographical settings (rural, town, suburban or urban areas). Our study reports that in addition to common occupational hazards that all HC nurses experience, the frequency of experiencing some hazards varies based on geographic setting. These specific hazards include exposure to: aggressive pets, environmental tobacco smoke, oxygen equipment, unsafe neighbourhoods and pests. Findings from this study suggest that a relationship exists between where a patient's home is located and the types of occupational hazards that may be experienced by HC staff. This research is useful for HC organisations in developing staff training programmes to recognise and manage occupational hazards that workers are likely to encounter. Home healthcare and policy leaders may use these findings to develop and implement educational and other strategies to reduce risk and manage exposures across the rural-to-urban gradient.

Assisting Frail Seniors With Toileting in a Home Bathroom: Approaches Used by Home Care Providers

Home care providers experience high occupational injury rates. Improving safety is becoming increasingly urgent as this sector expands to support the aging population. Caregivers identify assisting with toileting as a particularly frequent and difficult activity. This mixed-methods observational study identified and analyzed the toileting subactivities that place care providers at the greatest risk of musculoskeletal injury. Eight personal support workers (home care aides) assisted a frail older adult (actor) in a simulated home bathroom. Overall technique and body postures were analyzed. Exposure to musculoskeletal injury risk factors (low back loads and time in extreme trunk postures) was greatest when removing/replacing clothing and providing posterior perineal care; high loads were also possible during transfers. Exposures can be reduced by lowering the pants only to knee level or squatting to raise them. A bidet seat or attachment can perform perineal cleaning, which accounted for 32% of time in severe trunk flexion.

Frequency and Risk of Occupational Health and Safety Hazards for Home Healthcare Workers

Given the increased prevalence of chronic disease and health care costs, more individuals are treated in the home, which has augmented the demand for more Home Healthcare Workers (HHCWs) in the field. HHCWs face multiple hazards with injury rates being more than double the national average; however, current studies on HHCWs have provided limited understanding of their occupational safety & health experiences and exposures. The aim of this study was to assess the frequency and risk of exposures through perceptions of HHCWs. The results of this study provide an initial picture of the different risks that HHCWs face daily. These findings show that studies involving HHCWs occupational safety need to be job-specific, and the proposed interventions will also likely need to be tailored by HHCWs type.

Occupational Exposures of Home Healthcare Workers

Population demographics in the United States are rapidly changing with increased dependence on home healthcare (HHC) by an aging population, patients suffering from chronic diseases, and inability to perform activities of daily living. Despite the occupational injury rates for HHC workers (HHCW) being higher than the national average, an understanding of the occupational safety and health experiences and exposures of HHCW is limited. The purpose of this study was to understand the health and safety risk factors for HHCW. One-on-one interviews were conducted with HHCW to elicit frequency of daily occupational exposures to hazards and risk factors during visits to patients' homes. Approximately 67% of the study population was over 40 years old and mostly obese, potentially increasing risk for injury. HHCW routinely perform physical tasks with increased risk for occupational musculoskeletal injuries. Exposures to drug residue from dispensing oral medications and anticancer medications and exposure to potentially infectious agents and cleaning chemicals used for infection prevention were reported. The majority of HHCW were also exposed to secondhand smoke and occasionally experienced violence. Developing and implementing intervention strategies that address engineering controls, establish employee safety-related policies, provide training and retraining, promote a healthy lifestyle among HHCW, and providing suitable personal protective equipment may help to decrease occupational injury rates.

Complexity of occupational exposures for home health-care workers: nurses vs. home health aides

AIM

To identify occupational exposures for home health-care nurses and aides.

BACKGROUND

Home health-care workers' occupational injury rates in the USA are higher than the national average, yet research on causative exposures and hazards is limited.

METHODS

Participants were interviewed about annual frequency of occupational exposures and hazards. Exposure and hazard means were compared between home health-care nurses and aides using a Wilcoxon two-sample test.

RESULTS

A majority of the sample was over 40 years old and obese, potentially increasing injury risks. Home health-care nurses performed more clinical tasks, increasing exposure to blood-borne pathogens. Home health-care aides performed more physical tasks with risk for occupational musculoskeletal injuries. They also dispensed oral medications and anti-cancer medications, and were exposed to drug residue at a frequency comparable to home health-care nurses. Both groups were exposed to occupational second-hand smoke.

CONCLUSIONS

Establishing employee safety-related policies, promoting healthy lifestyle among staff, and making engineered tools readily available to staff can assist in decreasing exposures and hazards.

IMPLICATIONS FOR NURSING MANAGEMENT

Implications for nursing management include implementation of health-promotion programmes, strategies to reduce exposure to second-hand smoke, ensuring access to and education on assistive and safety devices, and education for all staff on protection against drug residue.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review

OBJECTIVE

The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides.

BACKGROUND

Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry.

METHOD

A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review.

RESULTS

Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies).

CONCLUSION

MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities.

Reliability and validity of the Home Care STAT (Safety Task Assessment Tool)

Home care workers are a priority population for ergonomic assessment and intervention, but research on caregivers' exposures to hazards is limited. The current project evaluated the reliability and validity of an ergonomic self-assessment tool called Home Care STAT (Safety Task Assessment Tool). Participants (N = 23) completed a background survey followed by 10-14 days of self-monitoring with the STAT. Results showed that the most frequent task was house cleaning, and that participants regularly performed dangerous manual client moving and transferring tasks. Researcher in-home observations of 14 workers (duration ≤ 2 h) demonstrated that workers' self-assessments were moderately reliable. Correlational and multi-level analyses of daily self-assessment data revealed that several task exposures were significantly related to daily fatigue and/or pain. Other associations have implications for Total Worker Health™; for example, daily stress was positively associated with both pain and consumption of high calorie snacks. Findings support the STAT as a reliable and potentially valid tool for measuring home care workers' exposures to physically demanding tasks.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

The role of ergonomic and psychosocial workplace factors in the reporting of back injuries among U.S. home health aides

BACKGROUND

Due to the aging population and a shift to patient home care, home health aides (HHAs) are a fast-growing occupation. Since little is known about workplace risk factors for back injuries among HHAs, we examined the role of ergonomic and psychosocial factors in injury reporting among HHAs.

METHODS

We used the 2007 U.S. National Home Health Aide Survey data (weighted n = 160,720) to predict the risk of back injuries by use of/need for ergonomic equipment and supervisor support with logistic regression, adjusted for socio-demographic variables.

RESULTS

The annual prevalence of back injuries for U.S. HHAs was 5.2%. Injury risk was increased in HHAs reporting the need of additional ergonomic equipment in patient homes, and marginally associated with low reported supervisor support.

CONCLUSIONS

Improvement of workplace ergonomic and psychosocial factors could be targeted as a strategy to decrease work-related injuries in HHAs.

Work Organization, Area Labor-market Characteristics, and Depression among U.S. Nursing Home Workers: A Cross-classified Multilevel Analysis

Associations between forms of work organization that follow globalization and depression were examined in U.S. nursing home assistants. A cross-sectional study of 539 nurse assistants in 49 nursing homes in three states in 2000 assessed nursing home ownership type, managerial style, wage policy, nurse assistants' emotional stresses, and area labor-market characteristics (county income inequality, median household income, and social capital) in relation to the prevalence of depression among the nurse assistants. A cross-classified multilevel analysis was used. For-profit ownership, emotional strain, managerial pressure, and lack of seniority pay increases were associated with depression. Labor-market characteristics were not associated with depression once work organization was taken into account. The deregulation of the nursing home industry that accompanies globalization is likely to adversely affect the mental health of nursing home assistants.

Personal service assistance: musculoskeletal disorders and injuries in consumer-directed home care

BACKGROUND

Like other types of care for disabled or elderly adults, consumer-directed personal assistance services may present multi-factorial risks for work-related musculoskeletal disorders (WRMSDs).

METHODS

Using survey data, we compared providers experiencing WRMSDs in the previous year to those who did not, seeking to identify functional, temporal, physical, and relationship risk factors for transient and chronic conditions.

RESULTS

Longer work experience with the recipient and more frequent bending increased the risk of being in the most chronic group (≥12 painful episodes), whereas predictable work hours with rest breaks and greater social support from the recipient appeared protective. For transient conditions (one to two episodes), longer work experience with the recipient and predictable hours with rest breaks appeared protective.

CONCLUSIONS

We offer recommendations to improve hazard assessment as well as training and information distribution related to home care programs. With the population aging, home care jobs require increasing oversight to prevent WRMSDs.

The Role of Transformational Leadership Styles in the Home Health Care Industry

The concept of transformational leadership styles has been popular in medical communities in recent years but very limited information is available in the literature on the role of transformational leadership in relation to workplace performance among home health aides. A secondary data analysis was conducted using the 2007 National Home Health Aides Survey ( n = 1,828). A multivariate regression analysis was performed to estimate the association of transformational leadership styles with workplace performance among home health aides. Transformational leadership styles were positively linked to performance in reducing injury, increasing career satisfaction, and choosing their career again if they had to choose. Our finding suggests that introducing transformational leadership practices may benefit home health aides in improving their workplace performance.

A biomechanical assessment of floor and overhead lifts using one or two caregivers for patient transfers

This study investigated the differences in peak external hand forces and external moments generated at the L5/S1 joint of the low back due to maneuvering loaded floor-based and overhead-mounted patient lifting devices using one and two caregivers. Hand forces and external moments at the L5/S1 joint were estimated from ground reaction forces and motion capture data. Caregivers gave ratings of perceived exertion as well as their opinions regarding overhead vs. floor lifts. Use of overhead lifts resulted in significantly lower back loads than floor lifts. Two caregivers working together with a floor lift did not reduce loads on the primary caregiver compared to the single-caregiver case. In contrast, two-caregiver operation of an overhead lift did result in reduced loads compared to the single-caregiver case. Therefore, overhead lifts should be used whenever possible to reduce the risk of back injury to caregivers. The use of two caregivers does not compensate for the poorer performance of floor lifts.

Challenges for Home Health Care Providers: A Needs Assessment

Home health care provides substantial benefits over traditional, hospital-based health care, such as supporting older adults' independence and quality of life, as well as being more cost effective. This aspect of the health care industry could be enhanced through increased technological supports. When providing health care in a home setting, caregivers are faced with many challenges that impede their ability to perform their jobs. Technological interventions have the potential to alleviate many of these challenges. However, to achieve this potential, new technologies must be created to meet the needs of home health care providers. To date, these providers' specific and most critical needs are not thoroughly understood. This understanding can be gained by conducting a detailed needs assessment that captures the common challenges and difficulties that home health care providers encounter. We conducted a needs assessment comprising three phases: 1) an extensive literature review; 2) subject matter expert interviews; and 3) structured interviews with home health care providers. We identified several significant sources of frustration and difficulty faced by providers including: medical device usage; patient education; family involvement; provider isolation; and barriers to communication. This analysis provides an understanding of the challenges confronting home health care providers that can provide guidance for interventions. Future home health care technology can be developed to specifically target these workers' most urgent needs and allow them to perform their jobs with greater ease.

Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes

BACKGROUND

We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity.

METHODS

Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design.

RESULTS

Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65-0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12-0.26), and 0.55 for Hispanic NAs (95% CI: 0.37-0.82).

CONCLUSIONS

Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living.

Physically demanding workloads and the risks of musculoskeletal disorders in homecare workers in the USA

Although musculoskeletal disorders (MSDs) are prevalent among homecare workers, little is known about the MSD risk factors. This study investigated whether physically demanding workloads among homecare workers are related to MSDs, especially in neck, shoulder and back pain. Data were taken from two waves of a random sample (June to December 2003 and December 2003 to February 2004). The sample included 1643 homecare workers at Wave 1 and 1198 homecare workers at Wave 2, respectively. A basic telephone interview and 30 minutes computer-assisted interview were performed for homecare workers in Wave 1 and Wave 2. The prevalence of neck, shoulder and back MSDs was assessed at Wave 1 and Wave 2 using the Nordic questionnaire of musculoskeletal symptoms. The incidence of MSDs at 6 months was estimated at Wave 2 using only those who were in the asymptomatic reference group at Wave 1 as the denominator. At Wave 1, back MSDs were the most prevalent (10.2%), followed by neck (9.6%) and shoulder (7.1%) MSDs. After 6 months, the incidence of neck MSDs was the highest (7.0%), followed by back (6.4%) and shoulder (4.8%) MSDs. Physical demands of work were assessed using items developed from focus groups of workers. When compared with asymptomatic workers, those with MSDs showed a dose-response effect for physical job demands. After controlling for age, psychosocial demands and social support on-the-job, physical demands among homecare workers were significantly associated with an excessive odds of neck, shoulder and back MSDs incident at 6 months (odds ratios of 1.14-1.17 for each unit increase on a physical demand scale). Our study shows that the physical demands of work are a significant risk factor for MSDs among homecare workers. Considering the high physical demands among homecare workers, the finding in this study clearly indicates that practical intervention strategies should be implemented to protect homecare workers from exposure to MSD risk factors.

Work and its role in shaping the social gradient in health

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or "precarious" employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

Sharps injuries and other blood and body fluid exposures among home health care nurses and aides

OBJECTIVES

We quantified risks of sharp medical device (sharps) injuries and other blood and body fluid exposures among home health care nurses and aides, identified risk factors, assessed the use of sharps with safety features, and evaluated underreporting in workplace-based surveillance.

METHODS

We conducted a questionnaire survey and workplace-based surveillance, collaborating with 9 home health care agencies and 2 labor unions from 2006 to 2007.

RESULTS

Approximately 35% of nurses and 6.4% of aides had experienced at least 1 sharps injury during their home health care career; corresponding figures for other blood and body fluid exposures were 15.1% and 6.7%, respectively. Annual sharps injuries incidence rates were 5.1 per 100 full-time equivalent (FTE) nurses and 1.0 per 100 FTE aides. Medical procedures contributing to sharps injuries were injecting medications, administering fingersticks and heelsticks, and drawing blood. Other contributing factors were sharps disposal, contact with waste, and patient handling. Sharps with safety features frequently were not used. Underreporting of sharps injuries to the workplace-based surveillance system was estimated to be about 50%.

CONCLUSIONS

Sharps injuries and other blood and body fluid exposures are serious hazards for home health care nurses and aides. Improvements in hazard intervention are needed.

A national view of workplace injuries in nursing homes

OBJECTIVES

Data from a large sample of nursing homes were used to examine the cross-sectional association between workplace injuries and organizational factors, caregiver staffing levels, and quality.

METHODS

Three sources of data were used, the Occupational Safety and Health Administration data initiative for 2004, the Online Survey Certification and Recording system representing 2004, and the 2004 Area Resource File.

RESULTS

For the organizational characteristics of interest, the results show that for-profit facilities were less likely to report high injury rates and that facilities with a higher average occupancy and belonging to a chain were more likely to report high injury rates. For the staffing characteristics of interest, facilities with high staffing levels of registered nurses were more likely to report high injury rates, whereas those with high staffing levels of nurse aides were less likely to report high injury rates. For the quality characteristic of interest, facilities of low quality (as measured by quality-of-care deficiency citations) were more likely to report high injury rates.

CONCLUSIONS

Workplace injuries are associated with organizational, caregiver, and quality characteristics of nursing homes. This may present an opportunity to reduce high injury rates.

Gender, precarious work, and chronic diseases in South Korea

OBJECTIVE

In view of the growing number of nonstandard workers in South Korea, this study examined whether nonstandard workers reported poorer health compared to standard workers and assessed whether there were gender differences in the association between employment status and chronic health outcomes.

METHOD

Data were taken from a representative-weighted sample of 1,563 men and 1,045 women aged 20-64, from the 2001 National Health and Nutrition Examination Survey. Nonstandard employment included part-time work, temporary work, and day labor. Self-rated health and self-reported chronic disease conditions were used as health measures.

MAIN RESULTS

Nonstandard employment was significantly associated with higher risk of self-rated health and chronic conditions after adjusting for socioeconomic position (education, occupational class, and income) and health behaviors (cigarette smoking, alcohol consumption, regular exercise, and health examinations). However, the pattern in the relation between nonstandard work and specific health problems greatly differed by gender. Among men, nonstandard work arrangements were significantly associated with musculoskeletal disorders (OR 1.97, 95% CI 1.24-3.19) and liver disease (OR 2.83, 95% CI 1.27-6.32). Among women, nonstandard employment was related to mental disorders (OR 3.25, 95% CI 1.40-7.56).

CONCLUSION

The findings clearly indicate the need for further study of the observed associations, particularly prospective and analytical studies.

Under Pressure, Out of Control, or Home Alone? Reviewing Research and Policy Debates on the Occupational Health and Safety Effects of Outsourcing and Home-Based Work

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.

Determinants of Escalating Costs in Low Risk Workers’ Compensation Claims

OBJECTIVE

To identify and quantify attributes that lead to unanticipated cost escalation in workers' compensation claims.

METHODS

We constructed four claim categories: low initial reserve/low cost, migrated catastrophic (low initial reserve/high cost), high initial reserve/low cost, and catastrophic (high initial reserve/high cost). To assess the attributes associated with the increased cost of migrated catastrophic claims, we analyzed 36,329 Louisiana workers' compensation claims in the four categories over a 5-year period.

RESULTS

In the 729 claims initially thought to be low-cost claims (migrated catastrophic), the most significant predictors for cost escalation were attorney involvement and claim duration, followed by low back disorder, married/single/divorced status, male gender, small company size, high premium, reporting delays, and older age. These injuries accounted for 2% of all claims but 32.3% of the costs. Accelerated escalation of costs occurred late in the claim cycle (2 years).

CONCLUSION

Certain attributes, particularly attorney involvement and claim duration, are associated with unanticipated cost escalation in a small number of claims that drastically affect overall losses. The results of this study suggest that these cases may be identified and addressed before rapid escalation occurs.

Barriers to documenting occupational injuries among personal assistance services workers

BACKGROUND

Personal Assistance Services (PAS) workers provide essential support to disabled and elderly individuals living at home rather than institutions. Occupational injury risks are known, but limitations in occupational injury surveillance prevent assessing injury prevalence. Changing employment arrangements adopted by publicly funded programs may complicate the classification of PAS workers.

METHODS

We surveyed state workers' compensation agencies and Financial Management Services organizations used by state Medicaid programs.

RESULTS

Changing employment arrangements pose further barriers to classifying and documenting injury, and accessing workers' compensation coverage. Workers' Compensation coverage varies according to employment arrangements of the PAS workers. Financial Management Services organizations vary in their roles for reporting injury. Most frequent activities were providing written information about injury reporting, and reporting injuries to appropriate agencies or insurance companies.

CONCLUSIONS

Current limitations undercount the prevalence and consequences of PAS-related occupational injuries among agency workers and largely ignore independent providers. Policy and research recommendations are presented.

Work-related injury among direct care occupations in British Columbia, Canada

OBJECTIVES

To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada.

METHODS

Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care).

RESULTS

CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%).

CONCLUSIONS

Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

There's no place like home: a qualitative study of the working conditions of home health care providers

OBJECTIVE

Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures.

METHODS

The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts.

RESULTS

HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands.

CONCLUSIONS

The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

Injury Rates, Predictors of Workplace Injuries, and Results of an Intervention Program Among Community Health Workers

BACKGROUND

Few incidence studies of workplace injuries among community health workers exist, and evidence regarding the effectiveness of interventions in this population is lacking.

OBJECTIVES

To determine the incidence of workplace injury among community health workers in British Columbia; to identify predictors of injury; and to assess the effectiveness of a multicomponent intervention program in this population.

METHODS

Data were collected from an intervention study of 648 community health workers from six agencies to calculate injury rates. Interventions included an education and training module, a risk assessment tool and resource guide, and a lift equipment registry.

RESULTS

The majority of injuries were attributed to overexertion and falls. Annual incidence rates were 20.7% for reported injuries, and 8.1% for time-loss injuries. A history of previous injuries and working full time were predictors of time to first injury report. Participants who received an intervention were significantly more likely to report workplace injuries than participants in the comparison group, but were less likely to incur a time-loss injury.

CONCLUSIONS

The interventions used in this study led to increased awareness and an increase in reported injuries but resulted in fewer time-loss injuries. The mechanisms that led to these findings need to be explored further.

Restructuring of the Québec health network and its effects on the profession of home health aides and their occupational health and safety

The Québec health sector is facing profound macroeconomic and macro-organizational changes. This article addresses the impact of these changes on the work of home health aides (HHAs) and their occupational health and safety (OHS). The study was carried out in the home care services of four local community service centers (CLSCs) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 11 work days, and 35 multidisciplinary or professional meetings observed, as well as administrative documents. HHAs are experiencing an erosion of their job because the relational and emotional components of their work are disappearing. This results in an increase in musculoskeletal and psychological health problems. This study also shows that managers' decisions can reduce or increase the HHAs' work constraints. Stability in the clientele served and the possibility of organizing their routes are good examples of positive impacts.

The prevalence of and risk factors for back pain among home care nursing personnel in Hong Kong

BACKGROUND

There is a large gap in research with regard to back pain (BP) among home care nursing personnel (HCNP); only seven studies have been conducted worldwide. There is a need to identify the magnitude of and risk factors for BP that are unique to Hong Kong (HK) HCNP.

METHODS

A total population sampling technique was employed in this cross-sectional questionnaire-based study. Hierarchical multiple logistic regression analyses were used to control for potentially confounding variables.

RESULTS

The 12-month prevalence of upper and lower BP was 71.2% (n=265). Three predictors were identified: physical risk factors in the office (OR=3.57, 95% CI=1.55-8.24), static postures (OR=1.41, 95% CI=1.04-1.90), and psychological job demands (OR=1.11, 95% CI=1.01-1.22).

CONCLUSION

HCNP in HK have a high prevalence of BP. BP in HK HCNP is independently attributable to physical work factors in the office, static postures, and psychological job demands, and is not primarily associated with patient lifting and transferring which are traditionally identified as risk factors for BP in hospital nursing personnel. Am. J. Ind. Med. 49:14-22, 2006. (c) 2005 Wiley-Liss, Inc.

Staffing and worker injury in nursing homes

OBJECTIVES

We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states.

METHODS

We obtained First Reports of Injury and workers' compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare's Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics.

RESULTS

Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004).

CONCLUSIONS

Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted.

Using state administrative data to study nonfatal worker injuries: challenges and opportunities

PROBLEM

Administrative data from states have the potential to capture broader representation of worker injury, facilitating examination of trends, correlates, and patterns. While many states use their workers' compensation (WC) data to document frequency and type of injury, few conduct in-depth examinations of patterns of injury and other etiologies. Administrative data are generally an untapped resource.

METHOD

Comparisons are made among four state databases used in a study linking worker injuries and patient outcomes in hospitals and nursing homes.

RESULTS

Worker injury data varies in terms of inclusion criteria, variables, and coding schemes used. Linkages to organizational level characteristics can be difficult.

CONCLUSIONS

Despite limitations, data can be used to study injury patterns and etiologies. Users must be knowledgeable and recognize how database characteristics may influence results.

Work-system risk factors for permanent work disability among home-care workers: a case-control study

OBJECTIVE

There is a growing need for home-care services in western societies. As home-care workers show high levels of absence related to poor health it is important that we broaden our knowledge about what factors in the work system contribute to this. The aim of this study was to explore and estimate the impact of the work system on permanent work disability and its relative importance compared with home-life risks among home-care workers.

METHODS

The cases (617 subjects) were all home-care workers in Sweden, whose disability pension was approved in 1997 or 1998. The controls (771 subjects) were home-care workers still working. We used a questionnaire to gain situation-specific information on working life and home life 5 and 15 years before disability pension entitlement.

RESULTS

The most important risk factors in the work system were poor ergonomic/lifting conditions, time pressure and lack of professional caring technique. Fifteen years prior to disability pension entitlement, insufficient management (odds ratio (OR) 95%, CI 2.6[1.6;4.2]) and relational problems at work were also risk factors. Five years before disability pension entitlement, poor organisational support (4.1 [2.5;6.7]), opportunities for co-working and working climate (3.5 [2.4;5.2]) were also strongly related to a persisting work ability. The magnitude of exposure to a number of risk factors had an increased effect (highest 13.8 [5.6-33.8]). The strongest risk factor in home life was little opportunity to rest from work (4.9 [3.0;8.0]). The risk factors in working life were robust to the inclusion of the grouped risk factors of home life.

CONCLUSIONS

The conclusion was that risk factors related to the work system are, alone, strongly related to permanent work disability among home-care workers. Also, exposure to several of the risk factors constitutes a notably strong risk for permanent work disability.

Work-related road accidents in France

A descriptive analysis of all victims of road accidents recorded by the police in 1997 was carried out, distinguishing accidents occurring in the course of work, while commuting and for private reasons. The analysis concerned 105,816 drivers from 14 to 64 years of age; among these, 9.9% were injured during the course of work and 18.6% while commuting. The gender-ratio was maximal for accidents during the course of work (SR = 5.5) and minimal while commuting (2.1). Accidents in the course of work were generally less serious than the two other types aforementioned. Compared with the incidence rates for labourers, those of self-employed trades and services (SETS) and those of employees and executives were higher for accidents incurred during the course of work and lower for those incurred during commuting. Professional drivers had the highest risk during the course of work. Accidents while working were most serious for SETS and professional drivers. Although it was impossible to take into account the mileage travelled, this study points out the real share of work-related road accidents and shows the need to develop and adapt prevention to the groups at risk that we have identified.