Show me the Evidence

Fall 2012
Volume 1, Issue 3

[ Table of Contents ]

Guest Editorial on Workplace Health and Safety

Are Guidelines Enough? A Successful Example of Evidence-Based Guidelines Protecting the Health of Health Workers

Dr. Nancy Edwards, Scientific Director, CIHR Institute of Population and Public Health

Evidence-based guidelines, such as workplace guidelines, are commonly used knowledge translation tools. Yet questions about guidelines abound. Why is it that evidence-informed guidelines can be so difficult to get into policy or practice? Are guidelines produced in one country pertinent to another? What kinds of monitoring systems are needed to support guideline implementation and use? Are there ways to enhance the likelihood of guideline scale-up?

These are the kinds of questions Dr. Annalee Yassi is tackling to reduce occupational transmission of infectious diseases among health workers, thereby creating healthier and safer workplaces. Three key features of her work are especially pertinent and help to explain her success. First, she has taken a systems approach to collaboration, involving international institutions such as the World Health Organization, the International Labour Organization and UNAIDS, as well as local partners such as the Ministry of Health in countries of focus. This has created multiple levels of partner engagement and system support for these efforts, and provided leverage points for expanding the scale-up and reach of this work. Second, the research findings have been translated into and adapted for local use. They take into account contextual nuances of the settings where Dr. Yassi is working – such as Quito and the Amazon in Ecuador, Bloemfontein, Free State in South Africa, and British Columbia in Canada. These adaptations are critical yet difficult to make without a deep understanding of context and its interface with interventions. This understanding has been gained through interactive training programs that were developed collaboratively, building on local capacities. Third, her approach has addressed sustainability right from the get-go. Guidelines have been embedded within work settings by building a surveillance system that not only identifies problematic hot spots using a sentinel system, but also provides regular reminders to employees on protective behaviours. Her work highlights the complexity of knowledge translation strategies and the layers of interventions that are needed to succeed.

Dr. Yassi's work is also important for another reason. Despite many calls for strengthening health care systems, the health care workforce has been an oft-neglected occupational group in the research literature. Even in Canada, large-scale Canadian studies documenting the risks of occupational exposure among health care workers are quite recent. It was only in the 1980s that the first Canadian studies were undertaken to examine the prevalence of back injuries among nurses (Abenhaim, Suissa, & Rossignol, 1988); studies documenting health workers' exposure to violence in the workplace are even more recent (Lemelin, Bonin, & Duquette, 2009). Contentious points of debate such as whether or not health workers should be required to get annual flu vaccinations reflect knowledge gaps in this field. Rigorous research to test generalizable knowledge translation strategies, particularly those leading to sustained improvements in health and scaled-up action on evidence-informed occupational health standards, is a priority.

There is much to be learned from resource-poor settings where novel, cost-effective strategies for occupational health improvements may originate. The work of Dr. Yassi and others who are tackling occupational health issues among health workers in other settings profiles these innovative approaches and provides a call to action. A strong health care system requires a healthy workforce, where no health worker is left behind.

Abenhaim, L., Suissa, S., Rossignol, M. (1988). Risk of recurrence of occupational back pain over three year follow up. Br J Ind Med;45:829–833.

Lemelin, L., Bonin, J-P., Duquette, A. (2009). Workplace Violence Reported by Canadian Nurses. CJNR;41(3):152–167.

Yassi, A., Bryce, E.A., Breilh, J., Lavoie, M-C., Ndelu, L., Lockhart, K., Spiegel, J. (2011). Collaboration between infection control and occupational health in three continents: a success story with international impact. BMC International Health and Human Rights;11(Suppl 2):S8.

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