TABLE 1. Occupational Hazards Identified in Case Scenarios 1 to 10 and Suggested Safety Interventions That Can Be Implemented by HHC Managers and Nurses^a.

Occupational Hazards/Contributing Factors to Injuries and Exposures	Agency-Level Interventions: HHC Managers	Work Practice Interventions in the Home: HHC Nurses
Patient characteristics related to Sharps injury hazard Moves suddenly during a sharps procedure Noncooperation/aggression Musculoskeletal strain hazard Limited mobility/overweight Fire hazard Smoking while on oxygen Home environment Clutter/hoarding, pets, distractions during patient care procedures Community/neighborhood Threat of violence Work practice Limited work space, work in isolation without immediate backup, awkward work postures, sharps without safety features	Discharge HHC manager participates in discharge planning and accounts for safety of HHC nurse as well as patient. HHC agency intake: patient evaluation in the home Recommend and initiate home environment modifications for improved safety; develop a care plan considering both the caregiver and patient safety; and educate the patient/family to prepare the home for an HHC visit. Employee training Include OSH training in new employee orientations, continuing education sessions for nurses, and in-service training sessions for home care aides using real-life scenarios. Agency safety policies Develop, implement, and annually review agency policies for BBP exposure control plan, safe patient mobilization/handling practices, violence prevention, pet safety, and oxygen therapy safety. Agency hazard surveillance and injury reporting systems. Establish reporting systems and use positive incentives to encourage employees to report hazards and injuries. Use the systems to identify and solve problems and to identify good practices.	Preparation Set up a safe and clean work area for sharps procedures in accordance with the BBP exposure control plan and clear from distractions. Use standard precautions. During patient care/clinical procedure Be prepared for the patient moving suddenly. When a needle is in the patient, keep your hand on the device in the event the patient flinches. Ensure safe work postures. For infusion therapy or phlebotomy, set the patient in a position you are comfortable with. Recline heavy patients before sharps insertion. Communication Continue patient and family education on safe HHC practices. Report a hazardous situation/incident or injury to the HHC agency management.

Abbreviations: BBP, bloodborne pathogen; HHC, home health care; OSH, occupational safety and health; SHARRP, safe home care and risk reduction for providers.

^aDerived from focus group and interview findings of Project SHARRP and the Safe Home Care Project.16–18,24,26,27,30,31