Applying a Risk-Risk Tradeoff Economics Approach to the Occupational Health of Nurses: Economic and Microbial Risk Analysis

Abstract

Public health challenges are increasingly complex, and interventions reducing the risk of one health outcome may increase the risk of another. We focus on the increased risk of occupational asthma (OA) for nurses and the decreased risk of occupational infections from contaminated surfaces from intensifying cleaning and disinfection protocols (i.e., during the COVID-19 pandemic). A risk-risk trade-off approach allows for the calculation of tolerable risks. We then determine, through a quantitative microbial risk assessment, critical concentrations of SARS-CoV-2 hygiene standards for surfaces that would achieve those tolerance levels. We find that, on average, in three out of our four scenarios, nurses prefer contracting a respiratory viral illness over OA around 80% of the time. Knowing another person who has contracted a respiratory viral infection (RVI) is negatively related to increasing respiratory viral infection risk. Critical concentrations were <0.01 viral particles/cm², implying frequent monitoring of viral concentrations on surfaces is needed to ensure risk targets are achieved. When applied to occupational health trade-offs for nurses engaging in cleaning and disinfection, we show that high environmental hygiene standards are needed.

Keywords: behavioral economics; occupational health; risk–risk trade‐off.

FIGURE 1

Example of scenario setup in survey (Scenario 1 (baseline risk: OA = I&R, equal risk increase, OA, and I&R)).

FIGURE 2

Distribution of the healthcare environment choices, by scenario and chosen risk increase (%).I&R, infection and recovery; OA, occupational asthma.

FIGURE 3

Probability of choosing an increase in respiratory infection risk (instead of an increase in occupational asthma), by scenario. Probabilities calculated based on specification (1) of Table 5. I&R, infection and recovery; OA, occupational asthma.