Interdisciplinary public health career leads to novel study of risky behaviors

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As interdisciplinary as public health is by nature, Christine McGuire-Wolfe, adjunct faculty in the Department of Global Health, may be adding a new twist that has led to a novel study.

McGuire-Wolfe became a volunteer firefighter while she was studying for her MPH. She became a paid career firefighter with Pasco County Fire-Rescue in 2003. Working part-time while finishing her public health PhD, she graduated in 2013 and remains at PCFR in the department’s special projects sector, where she soon will return to full-time status.

Christine McGuire-Wolfe. PhD, MPH

Christine McGuire-Wolfe, PhD, MPH

“I do infection control for the whole department,” she explained, “so for example, if someone out on a call gets stuck with a needle from a patient, there’s a whole set of follow-up and testing, screening, and moving forward with immunizations.”

Applying public health’s prevention mindset was only natural for McGuire-Wolfe, and that meant some research was in order. How much were risky behaviors with sharp objects – or “sharps” in fire-rescue vernacular – contributing to responder injuries?

“Part of the issue is that there’s a huge under-reporting,” she said, noting that estimates put unreported needle-sticks at 50-60 percent. “The fire department’s not military, but it’s para-military. There are disciplinary referrals, so there can be a fear of consequences if they report, or there’s the paperwork hassle.

“One of the other challenges is their immunizations. When we had H1-N1, how are you going to respond to that? If you’re the emergency responder, who’s looking out for you and your well-being? Is it getting an appropriate response and priority?

“Sometimes, departments are very good about that, especially the bigger ones. Some of the medium and smaller departments don’t have the same access to resources. They don’t always have delineated infection control or exposure response plans.”

PCFR is a medium-sized department, she said. Additionally, county governments in the state of Florida are exempt from federal OSHA regulations. Since there is no similar agency on the state level, each county is left to draft and enforce its own safety policies and regulations, only underscoring the need for investigating sharps injury causes and prevalence.

The resultant study of risky behaviors was unfunded, McGuire-Wolfe said, but a former colleague came to the rescue.

“The only reason I was able to do this study self-funded was I had a fire department colleague who had retired and opened up a hazardous waste disposal company, and he transported all the hazardous waste for me for fuel cost.”

Hazardous waste disposal at regular cost, she said, would have run thousands of dollars.

“Syringes had to be picked up and driven here. You have to have a hazardous waste transport certificate. If I had had to pay for that out of pocket, it would have been astronomical. But in the brotherhood spirit, he donated that or I never would have been able to do it.”

An interdisciplinary USF course about patient safety helped inspire the study, she said. Much of the course was devoted to “work-arounds” that by-pass safety in the process, and that issue pertained to much of what she observed in Pasco County.

“When you start an IV, when you take the sharp piece of metal out, there’s a little safety device that goes over the sharp end of it,” she said. “What I was seeing out in the field was that they were removing that or pushing it back so they could get an extra drop of blood to test the patient’s blood sugar. So they were manipulating the thing that was there to protect them.”

“The study just snow-balled from there. We were going to look at just that, but then we decided that, if we were looking at that work-around, why not look at all the riskier behaviors?”

Still, needle-stick injuries are the most prevalent source of HIV transmission from patients to health care workers, McGuire-Wolfe said, adding that the study also suggested that the risky behaviors causing them increase with the urgency of the call.

“They may not occur that frequently, but the consequences when it does happen are pretty significant,” she said.

The risky behaviors study was accepted for poster presentations at Association for Professionals in Infection Control conferences in Anaheim, Cal., and Fort Lauderdale, Fla. It is one of nine poster or oral presentations co-authored by McGuire-Wolfe and her mentor, Dr. Donna Haiduven, associate professor in the Department of Global Health.

Pending funding, McGuire-Wolfe said, her hope is to expand that initial research, the positive implications for public health being fairly obvious.

“We did this pilot study. We know what risky behaviors are happening with needles in Pasco County, and we know what they told us in focus groups about why those things are happening, but what’s going on in other departments? Are the same risky behaviors happening? If so, are the factors and the reasons similar?

“So the next step,” she said, “is to take it to a bigger audience and a bigger study population. We’ve presented the results at two national conferences. We were contacted by Portland, Ore., Fire-Rescue, who used some of our training materials. The hope is to raise awareness and disseminate the information we have, but also to include more departments and more settings in the knowledge base.”

Story by David Brothers and photo by Natalie D. Preston, College of Public Health.