Home Health and Community Care Workers’ Occupational Exposure to Secondhand Smoke: A Rapid Literature Review

Abstract

IntroductionAlthough many workers are protected from exposure to secondhand tobacco smoke (SHS), home health and community care workers enter domestic settings where SHS is commonly present. Little is known about the extent of SHS exposure among this occupational group.MethodsA rapid review to examine the literature on home health and community care workers’ exposure to SHS at work and identify research gaps. Systematic searches combining terms for SHS exposure (eg, “tobacco smoke pollution”) with terms for home health and care workers, patients and settings (eg, “home health nursing”) were run in CINAHL and Medline (with no date or language limitations). Web site and backward-forward citation searches identified further papers for narrative review.ResultsTwenty relevant publications covering seventeen studies considered home health or community care workers’ exposure to SHS either solely or as part of an assessment of other workplace hazards. Eight studies provided data on either the proportion of home care workers exposed to SHS or the frequency of exposure to SHS. No studies provided quantification of SHS concentrations experienced by this group of workers.ConclusionsExposure to SHS is likely to be common for workers who enter private homes to provide care. There is a need for research to understand the number of workers exposed to SHS, and the frequency, duration, and intensity of the exposure. Guidance should be developed to balance the rights and responsibilities of those requiring care alongside the need to prevent the harmful effects of SHS to workers providing care in domestic settings.ImplicationsVery little is known about home health and community care workers’ exposure to SHS. There is a need for research to quantify how many workers are exposed, how often and for how long exposure occurs, and the concentrations of SHS experienced. In many countries, home health care workers may be one of the largest working groups that experience exposure to SHS as part of their employment. The public health community needs to engage in a debate about how home health care workers can be best protected from SHS.

Assessing progress in protecting non-smokers from secondhand smoke

“…The situation is likely to be similar in many countries where smoke-free measures are well developed and while much of this exposure takes place in home settings there is still considerable evidence that non-smokers are exposed in the workplace, cars and peripheral settings such as building entrances and outdoor areas of bars [21]. Recent work has shown that those employed in the prison sector continue to be occupationally exposed to SHS [23] as are health and community care workers who enter smokers’ homes to provide care [24]. The ‘SHS issue’ is not yet ‘solved’: the public health community needs to continue their efforts and consider further measures to protect non-smokers from SHS.…”

Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides

“…The home-work environment presents OSH risks rarely found in facilities, including spaces too small or cluttered to perform care work safely, aggressive unrestrained pets, bedbugs and other pests, loaded firearms, needles used by the client or other household members and discarded around the home, tobacco smoking, clients smoking while on oxygen, slippery or unsafe surfaces indoors and outdoors, and transportation accidents during work travel [ 47 , 50 , 51 , 55 ••, 56 , 57 ••].…”

Second-hand Smoke Exposure Among Home Care Workers (HCWs) in Scotland

“…Current guidance and policy measures used by Health Boards and Social Care providers to assess and manage the risks to health from SHS are fragmented and often poorly understood. Evidence suggests that SHS exposure is a real concern for many domiciliary workers ( Angus and Semple, 2019 ) who feel left behind in terms of exposure to SHS when almost all other workers are protected through legislation.…”