Occupational exposures to hazardous chemicals and agents among healthcare workers in Bhutan

Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan

Background:

Assessment of occupational exposures is an integral component of population-based studies investigating the epidemiology of occupational diseases. However, all the available methods for exposure assessment have been developed, tested and used in high-income countries. Except for a few studies examining pesticide exposures, there is limited research on whether these methods are appropriate for assessing exposure in LMICs. The aim of this study is to compare a task-specific algorithm-based method (OccIDEAS) to a job-specific matrix method (OAsJEM) in the assessment of asthmagen exposures among healthcare workers in a high-income country and a low- and middle- income country (LMIC) to determine an appropriate assessment method for use in LMICs for future research.

Methods:

Data were obtained from a national cross-sectional survey of occupational asthmagens exposure in Australia and a cross-sectional survey of occupational chemical exposure among Bhutanese healthcare workers. Exposure was assessed using OccIDEAS and the OAsJEM. Prevalence of exposure to asthmagens and inter-rater agreement were calculated.

Results:

In Australia, the prevalence was higher for a majority of agents when assessed by OccIDEAS than by the OAsJEM (13 versus 3). OccIDEAS identified exposures to a greater number of agents (16 versus 7). The agreement as indicated by κ (Cohen’s Kappa coefficient) for six of the seven agents assessed was poor to fair (0.02 to 0.37). In Bhutan, the prevalence of exposure assessed by OccIDEAS was higher for four of the seven agents and κ was poor for all the four agents assessed (-0.06 to 0.13). The OAsJEM overestimated exposures to high-level disinfectants by assigning exposures to all participants from 10 (Bhutan) and 12 (Australia) ISCO-88 codes; whereas OccIDEAS assigned exposures to varying proportions of participants from these ISCO-codes.

Conclusion:

There was poor to fair agreement in the assessment of asthmagen exposure in healthcare workers between the two methods. The OAsJEM overestimated the prevalence of certain exposures. As compared to the OAsJEM, OccIDEAS appeared to be more appropriate for evaluating cross-country exposures to asthmagens in healthcare workers due to its inherent quality of assessing task-based determinants and its versatility in being adaptable for use in different countries with different exposure circumstances.

Nurses’ knowledge, perceptions, and behaviors regarding antineoplastic drugs: the mediating role of protective knowledge†

Objective

To explore the relationships between Chinese nurses’ knowledge, perceptions, and attitudes and their behavior and actual implementation of safety measures when handling antineoplastic drugs (ADs) in their daily work.

Methods

This was a multisite study conducted in 8 public hospitals in China. A self-administered questionnaire was sent to participants querying the degree of contact with ADs. The hypothesized relations were explored using structural equation modelling via the bootstrap method. Mediation analysis was applied to explore the mediating role of protective knowledge regarding AD exposure on the associations among protective training, using warning labels, and using protective masks.

Results

A total of 305 nurses were enrolled. The average age of all participants was 30.2 (standard deviation [SD]: 6.2) years. Nurses who had received protective training for AD exposure were more likely to use labels for ADs after age, body mass index (BMI), length of service, marital status, education, and department were controlled as covariates. The bias-corrected bootstrap of 95% confidence interval (CI) indicated that protective knowledge significantly mediated (23.4%) the association between protective training and using labels (indirect effect = 0.202, 95% CI: 0.009, 0.495); the proportion of mediation was 23.4%. Protective knowledge significantly mediated the association between protective training and using protective masks (indirect effect = 0.157, 95% CI: 0.048, 0.325); the proportion of mediation was 27.2%.

Conclusions

The findings of this study have provided baseline information on the current state of Chinese nurses’ perceptions, knowledge, and preventive behaviors toward ADs as the crisis is happening. Training is also recommended to improve nurses’ perceptions of the risks associated with ADs.