The Etiology and Consequences of Injuries to Certified Veterinary Technicians (CVTs) Leslie Nordgren, MPH Susan Gerberich, PhD Bruce Alexander, PhD Andrew Ryan, MS Timothy Church, PhD Jeff Bender, DVM, MS

Background Greatest number of injuries to veterinarians due to: - Animal bites and other animal-induced trauma - Needle sticks - Ergonomic injuries 2004 study of 147 Veterinary Technicians: Bites and scratches Needle sticks Chronic neck and back pain This is the first population based study surveying CVTs from a given state.

Methods – Phase 1 Phase 1 - Determined: - Frequency - Rates - Consequences - Potential risk factors Identified injury events in past 12 months Collected exposure data on the 4 most severe injuries in past 12 months Up to 3 follow-up surveys Bullet 1 - For injuries in all CVTs certified in Minnesota.

Methods – Phase 2 Case-control study to determine risk and protective factors for bite injuries Cases - exposures during the month prior to the incident. Controls - exposures during the month prior to a randomly selected month from the study period.

Phase 1 Data Analyses Determined injury rates by various characteristics using Poisson models Multivariate regression – to determine potential risk factors

Injury definition An acute traumatic event Occurring as a result of veterinary practice - In the Clinic - On the client’s or employer’s premises - During work-related driving activities to or from the client’s location

Injury definition Restriction of normal activities for any length of time Loss of consciousness, loss of awareness or amnesia for any length of time The use of medical assistance Bruising and/or break in the skin from a bite injury

Phase I Response rate 1427 - Surveys mailed to valid addresses 1052 - Responded 73.7% - Response rate 873 - Eligible Those not eligible did not work in the 12 months prior to the survey

Population 97% - Female 73% - 25 to 44 Years of age 53% - Worked from 3 to 11 years as a CVT

Facility characteristics 58% - small animal private clinical practice 66% - clinics with 3 or more doctors 72% - clinics with 3 or more CVTs 42% - clinics with less than 11 total staff < 11 employees – not regulated by OSHA standards 4 separate questions about where they worked

Primary animals handled 96% - Dogs 91% - Cats 74% - Pocket pets (rabbits, rodents, chinchillas, etc.) 48% - Ferrets 46% - Birds 28% - Exotics (snakes, turtles, lizards, etc.)

Injury experience 51% - Injuries in past 12 months 36% - 3 or more injuries 1,827 - Total injuries 236.8 - Injuries per 100 full-time CVTs per year Bullet 3 – among 873 CVTs

Injury experience 12.7 - Lost time injuries per 100 full-time CVTs per year 600 - Total bites in past 12 months 77.8 - Bite rate per 100 full-time CVTs per year Bullet 1 – 98 lost time injuries for 75 CVTs Rate for loosing 1 or more days = 5.3 per 100 full-time CVTs per year (41 lost time > 1 day for 28 CVTs Bullet 3 – This is the basis for the case-control phase.

For the 4 reported most severe injuries (N = 777): Body location: 85% - Hands and arms Most Frequent Sources: 47% - Cats 35% - Dogs 3.5% - Pocket Pets 3.5% - Needle/scalpel Type: 52% - Bite injuries We collected descriptive information about the 4 most severe injuries during the past 12 months, and for these injuries, 85%........ Bullet 2 – 5 – in order of frequency

Treatment of the most severe injuries 77% of injuries - received treatment Sources of treatment: 47% - Treated themselves 19% - Physician 10% - Urgent care 5% - Chiropractor

Consequences of the most severe injuries

Higher injury rates per 100 full-time CVTs

Higher injury rates per 100 full-time CVTs Worked less than 4 years as CVT – rate = 396.4 (C.I. = 70.5 to 424.1) Worked in a mixed, mostly small, animal clinic - Rate = 593.8 (C.I. = 40.5 to 652.4) Believed work-related injuries a problem - Rate = 312.2 (C.I. = 95.3 to 330.0)

Factors associated with CVT injuries- Multivariate analyses Bullet 1 – includes type of facility Bullet 2 – includes age

Factors associated with CVT injuries- Multivariate analyses Bullet 1 – includes type of facility Bullet 2 – includes age

Phase 2 - Case-Control Study Identify risk factors associated with animal bites, based on relevant exposures

Phase 2 - Response rate Questionnaires mailed to all CVT’s who returned Phase 1 questionnaires 534 - Responded – 61.9% 489 - Eligible

Phase II – Bite Cases and Controls Cases – bite injury - 176 Controls – no bite injury - 313

Risks for bite injury - Multivariate analyses Bullet 1 – includes type of facility Bullet 2 – includes age

Risks for bite injury - Multivariate analyses Bullet 1 – includes type of facility Bullet 2 – includes age

Risks for bite injury - Multivariate analyses Bullet 1 – includes type of facility Bullet 2 – includes age

Risk of bite injury associated with using muzzles Compared with those reporting no use of muzzles during the selected month: Over 4 times the risk of bite injury with use of muzzles Only 6 of the 176 cases who reported that they used muzzles during the indicated month made any mention of using a muzzle during the injury event description. We may need to ask the exposure questions within a time-frame closer to the event. This would involve a change to study design to better study the effects of bite prevention methods.

Conclusions Opportunities for future research on injury exposures: Clinical and animal handling experience Handling multiple types of animals Exposures in emergency and small animal clinics Working long hours Effects of owners presence during procedures Perception of injury risk Clinic staffing levels Protective equipment and best work practices for injury risk reduction

Acknowledgments Support for this effort was provided, in part, by the: National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services, National Occupational Research Agenda Program and the Occupational Injury Prevention Research Training Program Midwest Center for Occupational Health and Safety (T42 OH008434); and the Regional Injury Prevention Research Center, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, U.S.A. The contents of this effort are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention or other associated entities.