UMass Lowell School of Health and Environment
Background on Project SHARRP—Safe Homecare and Risk Reduction for Providers

The ultimate objective of Project SHARRP is to protect the rapidly growing population of home healthcare practitioners in Massachusetts from risks associated with needlestick injuries and blood exposures. The 4-year $2M grant received from National Institute for Occupational Safety and Health will allow UMass Lowell School of Health and Environment to research the number of injuries, identify risk factors, and develop tracking and analyzing systems--all to develop prevention methods to improve the way home healthcare is delivered and attract practitioners to the field.

Significant Job Growth Predicted in Home Healthcare Industry
The home healthcare industry is one of the fastest growing industries in the U.S. Due to the increasing aging population, 68% growth in the home healthcare workforce is anticipated over the next ten years. In 2000 in Massachusetts, there were 20,655 home healthcare practitioners employed in 342 home healthcare establishments. It is projected that home healthcare agencies will double in size, generating 18,800 new jobs in Massachusetts by 2008.

Injuries in Healthcare
For all healthcare settings, the Centers for Disease Control estimates that 600,000 to 800,000 injuries occur annually nationwide from needles and other sharp devices (often referred to as “sharps” in the healthcare industry). Hospital injuries account for only half, or about 385,000. The Massachusetts Department of Public Health has an injury reporting system for hospitals yet there is no comparable system for home healthcare. Therefore, one of the goals of Project SHARRP is to identify the frequency and nature of the injuries unique to the home environment.

Potential Risks
Healthcare providers are at risk of infection from blood exposures, primarily as a result of injuries from needlesticks and other sharp devices, such as lancets and scalpels. Occupational exposures can result in debilitating or fatal diseases like hepatitis A, B, C or HIV. Even the post-exposure treatment can have serious health, emotional and economic consequences for caregivers and their families.

Failing to Report Exposures
Tracking and analyzing sharps injuries and blood exposures in healthcare settings is limited because healthcare providers often fail to report exposures to their employers. Estimated underreporting rates for sharps injuries among U.S. hospital workers range from 39% to 56%. Healthcare providers may fail to report sharps injuries because of denial or fear of the diseases they have been exposed to, concerns about job security or the extra paperwork and time involved in follow-up.
Home Healthcare Providers in Massachusetts will be Reached by Partners
Project SHARRP research will be conducted by a multi-disciplinary team from the Department of Work Environment and the Department of Nursing at the University of Massachusetts Lowell and the Occupational Health Surveillance Program in the Massachusetts Department of Public Health. Industry partners include three large home health care agencies--VNA Care Network, UMass Memorial Home Health and Hospice, and Winchester Home Care--and two labor unions--Massachusetts Nurses Association and Service Employee International Union, Local 2020--with nurses, aides, and other home health care workers as members. The partner agencies and unions represent a large portion of home healthcare practitioners in eastern Massachusetts. The VNA Care Network, for instance, is the second largest visiting nurse association in the U.S. and serves more than 200 communities in eastern and central Massachusetts.

Project SHARRP Goals
The research design will use both quantitative and qualitative methods to accomplish the following goals:

1. Establish a reporting system for sharps injuries and other blood exposures by adapting the Massachusetts Sharps Injury Surveillance System for use in the three large home healthcare agencies, and gather sharps injury and blood exposure data for two years.
2. Conduct surveys of home health care workers in the agencies and unions to understand the risk factors for blood exposures, the magnitude of and reasons for reporting and underreporting of these exposures, and the barriers and incentives for the use of medical safety devices. Using survey data, identify factors that affect reporting behavior, exposure/injury, and the availability and use of medical safety devices.
3. Work with the home health care agencies and unions to identify the institutional barriers and incentives for safety programs, exposure/injury reporting, and medical safety device availability and use.
4. Analyze data from the reporting system, quantify blood exposure and sharps injury rates in the home health care setting, and compare them to Massachusetts hospitals.
5. Disseminate the findings to the study participants and agency/union partners and more widely in the home healthcare industry and the scientific community. Develop educational materials to facilitate the selection and use of products and practices to reduce injuries, risks and exposures in the home healthcare setting.