Occupational and Environmental Hazards in Pediatric Home Healthcare: A Cross-Sectional Study

Background: Home healthcare workers (HHCWs) face challenges related to hazard exposure and disease prevention. The Home Healthcare Environmental Assessment Survey (HHEAS) was developed as a mobile-friendly version of the Home Healthcare Observation tool (HHCWO) to assess occupational and environmental hazards among pediatric HHCWs. The study aimed to (a) pilot the use of the HHEAS with HHCWs caring for a pediatric client home visit, and (b) identify environmental and occupational exposures encountered during visits. Methods: The study was conducted in two phases: (1) focus groups to understand pediatric HHCWs’ work environments, and (2) a cross-sectional survey using the HHEAS immediately post-visit. HHCWs were recruited from a Midwestern pediatric home healthcare agency and completed the survey for each home visit immediately post-visit. Findings: 22 pediatric HHCWs identified key hazards in the focus group, including kneeling, incense/marijuana exposure, escort presence, hospice roles, and sharps container placement. Twenty-four HHCWs completed 60 surveys. Participants were 90.9% female, 77.3% Caucasian, and primarily worked in suburban (63.0%) single-family homes (83.0%). Reported respiratory exposures included dust (6.7%), dogs (40.0%), incense/candles (16.7%), and tobacco smoke (3.3%). Slip/trip/fall risks included cords/tubing (20.0%), with pets unsecured in 48.3% of homes. Workers often provided care on the floor (22.0%), frequently kneeling (69.0%). Conclusions: The HHEAS tool helps identify hazards affecting pediatric HHCWs immediately post-visit, thus reducing recall bias. Application to Practice: Use of streamlined tools like the HHEAS can improve real-time hazard recognition, inform training and prevention strategies, and enhance occupational safety for HHCWs delivering pediatric care in home environments.