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Concerns About Stress, Potential Hepatitis B Risk at Adult Developmental Center Prompt NIOSH Help

NIOSH Update:

Contact: Fred Blosser (202) 401-3749
August 25, 2003

Many states or counties operate centers that provide direct care to individuals with severe mental and developmental disabilities. Employee duties may include helping to feed, clean, or otherwise assist some of those individuals with personal care and personal hygiene needs. In those duties, employees have risks of exposure to saliva and other body materials. Some individuals may have challenging behaviors such as biting, scratching, or becoming verbally aggressive.

At one center in Ohio, such challenging behaviors prompted concerns from employees last year about work-related stress and potential exposures to infectious disease agents. At the request of employees, the National Institute for Occupational Safety and Health (NIOSH) conducted an assessment. From that evaluation, NIOSH made recommendations for practical measures to reduce potential risks without compromising services to individuals at the center.

The findings and recommendations from the NIOSH health hazard evaluation, conducted last year, are reported as a case study in a recent issue of Applied Occupational and Environmental Hygiene.

“Job-related injuries and illnesses are preventable, whatever the work setting,” said NIOSH Director John Howard, M.D. “As this case study shows, occupational safety and health can be combined successfully with compassionate care in facilities that serve people with developmental disabilities.”

In its evaluation, NIOSH 1) interviewed employees and management at the center, 2) reviewed existing research to understand how job conditions and individual personality and coping styles relate to job stress, and how those factors might pertain to staff working with individuals with developmental disabilities, and 3) reviewed county procedures for preventing job-related communicable diseases. From that assessment, NIOSH:

  • Emphasized the importance of taking organizational steps to reduce work stress, and not dismissing stress as a “necessary evil” in a challenging job. NIOSH recommended that management engage a consultant to evaluate the extent of work stress among the employees, and pursue strategies for eliminating sources of stress and training staff in active, problem-solving coping methods.
  • Recommended that the center follow Occupational Safety and Health Administration regulations and U.S. Centers for Disease Control and Prevention guidelines for managing occupational exposures to bloodborne pathogens. Standard precautions should be followed to prevent occupational infections. Any employee potentially exposed to a bloodborne pathogen should be referred immediately to his or her occupational health clinic, where counseling, treatment, and post-exposure prophylaxis should be offered as appropriate.
  • Addressed concerns that tearing occurred frequently in the disposable gloves provided to employees, compromising the gloves’ ability to prevent exposures to body materials. NIOSH recommended that 1) management provide different sizes of protective gloves to decrease the possibility that the glove might tear because it is too small, 2) assess the circumstances associated with tearing, to identify circumstances in which any disposable glove might tear occasionally, and 3) in those situations, provide employees with the option of wearing double gloves or thicker gloves.

The case study, “Job Stress and Infectious Disease Risks in an Adult Developmental Center,” was published in the Applied Occupational and Environmental Hygiene, 18:561-565, 2003. The hazard evaluation report is available at

NIOSH has also conducted research and made recommendations for preventing work-related injuries and illnesses among employees with developmental disabilities, based on assessments of workplace factors at sheltered workshops. Those recommendations are available at Further information about the health hazard evaluation program is available at