Occupational Hazards in Health Care
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Transcript of Occupational Hazards in Health Care
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INTRODUCTION
Apollo Hospitals, Bhubaneswar, the 49th hospital of the major healthcare chain was inaugurated on 5th of
March 2010.This Health Care Institution is a 350-bedded Tertiary Care Hospital with state-of-the-art technology,spread over a campus area of about 7.5 acres with a built-up area of approximately 206,158 sq.ft. TheHospitals Outpatient Department (OPD) has 37 consultation chambers for consultants of all departments.The OPD is supported by Treatment /Minor Procedure Rooms along with outpatient services inOphthalmology, ENT, Dermatology, Dentistry etc.
Medical and Surgical Cardiac Sciences, Oncology, Neurosciences (Neurology and Neurosurgery &Neurophysiology), Urology, Nephrology, Rheumatology, Endocrinology, etc are some of the departmentshaving state-of-art facilities here.
This tertiary care hospital has an excellent amalgamation of medical specialities, laboratory services,Imaging (Radiology) and Rehabilitation services with sophisticated Therapeutic/Diagnostic equipments.This Health Care Institution has 64 ICU beds and is the largest corporate hospital in Odisha offering world
class diagnostic, medical and surgical facilities.
Apollo Hospital, Bhubaneswar has also got a level 3 NICU and is equipped with advance ventilators, andother equipments. Neonatal retrieval system is also available here for the first time in Odisha, wherebabies can be transferred to this Hospital from other units around the state by an ultra modern transportsystem.
Apollo Hospitals, Bhubaneswar, is one of the newest facilities from the Apollo hospitals group. A 350-
bedded tertiary care hospital with state-of-the-art technology, spread over a campus area of about 7.5
acres with a built-up area of approximately 206,158 sq.ft, it was inaugurated on the 5th of March, 2010.
Thesuper speciality hospital offers all major medical and surgical specialities and superspecialities
including
Cardiology CT Surgery,
Orthopedics,
Neurology & Neuro Surgery,
Emergency & Trauma,
Nephrology & Urology, Gastroenterology,
Neonatology,
Oncology (Med. & Surgical),
Pediatrics
Pulmonary/ Chest Medicine
UrologyThe Hospital has 34 consultation chambers for accommodating Consultants of all departments foroutpatients.
HIGHLIGHTS
24 hour Emergency and Trauma care backed by wireless ambulances with life support systems
stationed at different locations in the city available 365 days a year / 24 hours a day.
24 hours Blood Bank and laboratory
24 hours Pharmacy Service
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Restaurant and coffee-shop
Well connected by Air, Rail and Road.
OCCUPATIONAL HAZARDS IN HEALTH CARE
The health care sector is one of the largest, most rapidly expanding areas of employment and is
increasingly in need of qualified staff especially in the area of nursing. The health care sector is complex
and comprises a variety of largely different professions; occupational hazards and exposures differ
accordingly. Rates of absenteeism, reported work-related ill-health, and early retirement or departure from
professions are comparatively high, especially among the nursing staff. While classical health hazards
are addressed by international and national regulations, underlying causes of ill-health and departure
from the profession, such as psychological stress, violence, pressing time schedules, and poor work
organization are less well heeded.
Healthcare workers are exposed to many job hazards. These can include
Infections
Needle injuries
Back injuries
Allergy-causing substances
Violence
Stress
Every year, many lives are lost because of the spread of infections in hospitals. Health care workers can
take steps to prevent the spread of infectious diseases. These steps are part of infection control.
Proper hand washing is the most effective way to prevent the spread of infections in hospitals. If you are
a patient, don't be afraid to remind friends, family and health care providers to wash their hands before
getting close to you.
Other steps health care workers can take include
Covering coughs and sneezes
Staying up-to-date with immunizations
Using gloves, masks and protective clothing
Making tissues and hand cleaners available
Following hospital guidelines when dealing with blood or contaminated items
You can't remove all the safety hazards from your life, but you can reduce them. You can avoid major
hazards and prepare for emergencies by taking the following steps:
Keep emergency phone numbers by your telephones
Make a first aid kit for your home
Make a family emergency plan
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Install and maintain smoke detectors and carbon monoxide detectors
Keepgunsunloaded and locked up. Lock up the ammunition separately.
Follow the directions carefully when using tools or equipment
Hazard Assessment Process
Administrative workers may be exposed to a variety of workplace hazards in the course of
performing their functions. The type and degree of exposure is dependent upon a variety of
individual factors including people-related factors as well as environmental issues.
A key component of a health and safety program is to identify and assess hazards and
determine appropriate controls. A systematic approach to hazard assessment includes the
following steps:
1. List all work-related tasks and activities.
2. Identify potential biological, chemical, physical and psychological hazards associated witheach task.
3. Assess the risk of the hazard by considering the severity of consequences of exposure, the
probability that the exposure willoccur and the frequency the task is done.
4. Identify the controls that will eliminate or reduce the risk. The hierarchy of controls should be
followed. This means that
engineering controls are the most effective, followed by administrative controls (such as training
and rules), and followed by personal protective equipment (PPE).
5. Implement the controls for each hazard.
6. Communicate the hazard assessments and required controls to all workers who perform the
tasks.
7. Evaluate the controls periodically to ensure they are effective.
Potential Hazards and Recommended Controls
The following charts summarize potential hazards for administrative workers in healthcare
facilities and recommended controls to reduce the risk of exposure to the hazards.
In this section the biological hazards most commonly encountered by administrative workersand methods to control them are presented. Employers should carefully evaluate the potential
for exposure to biohazardous materials in all tasks and ensure that they have an effective
hazard control plan in place. This information will be useful for inclusion into hazard
assessments. Please note, this is not designed to be an exhaustive treatment of the subject, but
is rather an overview summarizing the biological hazards most frequently encountered by
administrative workers.
http://www.nlm.nih.gov/medlineplus/gunsafety.htmlhttp://www.nlm.nih.gov/medlineplus/gunsafety.htmlhttp://www.nlm.nih.gov/medlineplus/gunsafety.htmlhttp://www.nlm.nih.gov/medlineplus/gunsafety.html -
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Exposure to biological hazards may occur for administrative workers in contact with clients or
co-workers, their blood, body fluids, or contaminated items. Controls include any mechanisms to
reduce the potential for exposure to infectious agents and the immunization of administrative
personnel against infectious diseases to which they may be exposed.
Engineering Controls
In the hierarchy of controls, the highest level of control is directed at the source. From an
occupational health perspective, the highest level of control may be immunization of workers
who may come in direct contact with infected clients. Good engineering controls such as proper
design and maintenance of facilities also contribute to minimizing the transmission of infectious
agents.
Engineering controls, once designed and implemented, are not under the control of the worker,
but are directed at the source of the hazard.
Decontamination of facilities and materials
Decontamination is a term used to describe procedures that remove contamination by killing
microorganisms, rendering the items safe for disposal or use. Sterilization refers to the complete
destruction or removal of all microorganisms by chemical or physicalmeans, usually to provide
sterile items for use. All contaminated materials must be decontaminated before disposal or
cleaning for reuse. The choice of method is determined by the nature of the material to be
treated. Disinfection refers to the destruction of specific types of organisms but not all spores,
usually by chemical means. Disinfection is a means of decontamination. Surfaces must be
decontaminated after any spill of potentially infectious materials and at the end of the working
day. Work areas, client rooms, and pieces of equipment may also require decontamination.
General ventilation
General ventilation systems serving buildings must be maintained regularly and inspected for
conditions that could adversely affect air quality provided to work spaces. Accumulations of
water that could stagnate in humidification systems or drip trays may becomesources of
potential biological contamination of air handling systems that need regular monitoring and
inspection.
Biohazardous organisms may be carried through general ventilation systems, potentially
distributing them to other workspaces in a facility. Ultraviolet germicidal irradiation units, and or
HEPA filtration media incorporated into air handling systems may be warranted for special
circumstances.
Mould growth in the indoor environment can be affected by relative humidity levels, which is a
function of some general ventilation systems. High relative humidity levels may contribute to an
increase in the growth of some moulds and lead to condensation developing on surfaces.
Control of indoor relative humidity levels is an important factor in preventing mould growth.
Isolation
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In some cases, it may be prudent to separate infectious patients from other patients. This
commonly occurs in doctors offices and community clinics where infectious patients are asked
to identify themselves and may be relocated in a separate waiting room or treatment room.
Administrative Controls
The next level of controls includes administrative controls. Because it is not always possible to
eliminate or control the hazard at the source, administrative controls are frequently used for
biological hazards in healthcare. Administrative controls focus on ensuring that the appropriate
prevention steps are taken, that all proper work procedures are documented, that administrative
personnel are trained to use the proper procedures, and that their use is enforced.
Administrative controls include policies and procedures that establish expectations of
performance, codes of practice, staff placement, required orientation and training, work
schedules, and occupational health programs in which immunizations are provided. For
administrative workers, a risk for exposure to biological hazards may also occur through contact
with clients blood or body fluids through violent or abusive behaviour. This type o f exposure is
considered in more detail in the physical hazards section of this document.
A comprehensive management system considers the continuum of infection prevention and
control efforts across all sites and operations. It includes attention to client, visitor, contractor,
volunteer and health care worker (HCW) safety. A comprehensive system should include the
following components:
tasks and appropriate controls are identified
responsibilities
and policies including Routine Practices, Additional Precautions, hand hygiene policies and
facilities, client risk assessments, communication protocols, decontamination of clothing and
dedicated clothing Outbreak prevention and management
waste handling procedures and policies
Routine practices and additional precautions
Procedural controls may include procedures that relate to detection and follow-up of infectious
diseases, the use of Routine Practices and Additional Precautions as directed, baseline health
assessments and periodic screening of workers, hazard identification and control processes,
and outbreak management procedures. Awareness of the infectious disease status of clients is
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another good control, though this is not always possible for administrative staff. All work
procedures should include the consideration and control of the risk of exposure to workers.
Routine Practices and Additional Precautions (where required) greatly assist in reducing the
transmission of infectious agents from both known and unknown client sources by treating all
contacts as potential risks.
Infection Prevention and Control Definitions:
form the foundation of
limiting the transmission of microorganisms in all health care settings and is generally accepted
care for all clients. Elements of Routine Practices are: hand hygiene: risk assessment related to
client symptoms, care and service delivery, including screening for infectious diseases; risk
reduction strategies through the use of PPE, cleaning environment, laundry, disinfection and
sterilization of equipment , waste management, safe sharps handling, client placement and
healthy workplace practices; and education of healthcare providers, clients and families, and
visitors.
spread by direct or indirect contact with the client or clients environment that are necessary in
addition to Routine Practices for certain pathogens or clinical presentations. These precautions
include Contact Precautions, Droplet Precautions, and Airborne Precautions that are based on
the method of transmission
Routine Practices include being attentive to all routes of transmission. Awareness of routes of
transmission has led to the development of a variety of transmission-route specific strategies.
Most of these are well documented in infection prevention and control plans. In particular, hand
hygiene is identified as the single most important administrative strategy in infection prevention
and control.
Surfaces must be decontaminated after any spill of potentially infectious materials. Specific
written protocols must be developed and followed for each decontamination process.
Chemical Disinfectants
Chemical disinfectants are used to decontaminate surfaces, reservoirs of infectious material,
and to clean up spills of infectious material. The choice of chemical disinfectant must be made
carefully based on:
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of disinfectant
In many cases, the choice of disinfectant for specific uses may be standardized in the
organization and made after evaluation by IPC and OHS professionals.
Spill response procedures
The efficient and effective control of a biological spill requires that all staff members are trained
in and have practiced the established spill response techniques. The materials and supplies that
are necessary for spill clean-up and decontamination must be readily available to ensure timely
spill response. Written spill response procedures should outline spill response actions and roles.
The actual procedure used will vary with the size of the spill and the location of spill (including
materials, equipment or environmental surfaces affected). All spill responses should be
documented as incidents.
Training
Training in biological hazards and controls should be provided to all health care workers
(HCWs), including those working in administrative positions. Each HCW must understand the
facilitys IPC and OHS programs as they relate to their job duties. For newly hired HCWs all
relevant IPC and OHS policies and procedures must be provided before they start work. To
ensure that HCWs understand and apply this information to their jobs, specific training should
also be provided to address job-specific biological hazards. Periodic refresher training to
reinforce policies and procedures and introduce any new practices will benefit all HCWs.
Competency assessments should be provided for all training, and training records should be
maintained.
HCW immunization and health surveillance
An immunization policy and program is a proactive mechanism to reduce risk of communicable
diseases for HCWs. Each healthcare organization should have an immunization and health
surveillance program in place that is appropriate to the size and type of workplace.
Immunization and health surveillance programs should include:
-preventable diseases
exposure
nizations (or referral for immunizations, as appropriate)
-up of any baseline health assessments, communicable disease
status and immunizations Ideally, the immunization and surveillance programs should provide
easy, authorized access to HCW immune status records for follow up of exposure incidents and
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outbreaks. In some cases, immunizations or baseline testing may be required prior to
commencement of work.
Post-exposure follow-up management
Post-exposure management includes management of HCWs exposed to, colonized by, or
infected with microorganisms; an outbreak management process for exposures and/or HCWs
who are symptomatic or colonized with infectious disease; and access by Occupational Health
professionals to utilize medical assessment and diagnostic services for timely follow-up for
HCW exposures.
Personal Protective Equipment (PPE)
Personal protective equipment such as gloves, respiratory protection and eye protection should
be used based on the risk assessment. PPE is often used in conjunction with other controls
(engineering and administrative) to provide additional protection to workers. The primary types
of PPE are designed to protect the worker from infectious disease by breaking the chain of
infection at the portal of entry or exit of the microorganisms. This means that all PPE isdesigned to reduce exposure via specific routes of transmission. Gloves, gowns and other
protective clothing reduce exposure through the dermal (skin) contact route and help contain the
microorganisms to the work environment. Gloves are the most common type of PPE used to
reduce exposure to biological hazards. In addition, PPE is required when there is the potential
for exposure of the face to splashes or sprays of infectious material.
In cases where a patient presents with a respiratory infection that may be communicable,
patients may be asked to don procedure masks to reduce the spread of droplet contaminants.
Chemical Hazards and Controls
Most administrative workers do not work with many chemical products. However, they may be
exposed to chemical disinfectants as well as client-specific chemical hazards such as
fragrances and scents they may be sensitized to, toner and other office supplies, orsecond-
hand tobacco smoke. This section will provide a brief overview of selected chemicals that
administrative personnel may come into contact with. Note that this list is not extensive or all-
inclusive. In the control column, E, A and P are used to designate Engineering, Administrative
and PPE controls. These controls are briefly summarized and the reader should link to the
references provided for additional information. The proper choice of control measures must be
based on a risk assessment for the specific tasks being performed. Safe work practices are
administrative controls necessary for working with all harmful substances and educatingworkers in the practices is vital. Safe work procedures should be designed to:
route of exposure to the worker
harmful substances
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Worker education is critical for safely handling harmful substances.
In this section the most common chemical exposure hazards encountered by administrativepersonnel and methods to control them are presented. Employers should carefully evaluate the
potential for exposure to chemical hazards in all administrative activities and ensure that they
have an effective hazard control plan in place. This information will be useful for inclusion into
hazard assessments.
Please note, this is not designed to be an exhaustive treatment of the subject, but is rather an
overview summarizing the chemical hazards most frequently encountered by administrative
personnel.
Engineering Controls
Many engineering controls are available for controlling the hazard at the source and along the
path of transmission. For chemical hazards, common engineering controls include:
-toxic chemicals)
-ventilated areas; location of
printers/copies away from occupants)
For administrative personnel, chemical exposures may be limited by ensuring the facilities are
well designed and have effective ventilation.
Elimination
Elimination of a hazardous chemical from the healthcare workplace is always desirable but not
always possible. For example, disinfectants are required when biological hazards are present,
and cleaning solutions are necessary to maintain hygienic conditions.
In some cases, exposures can be eliminated by transferring specific processes or activities to
another facility, or areas within a facility where better controls are available.
Substitution
Some chemicals used in the health care environment are chosen based on tradition or cost. In
recent years, efforts have been made to find less hazardous alternatives to some of the
chemicals commonly used. When substituting a chemical for one that is currently in use, it is
critical to ensure that the new chemical does not have properties that may make it more toxic or
more flammable, etc.
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Administrative Controls
Policies and procedures, training
As administrative controls, policies and procedures should be in place to ensure that there are
safe work procedures in place for any situation where chemicals are used. Workplace
Hazardous Materials Information System (WHMIS) training should be provided to all
administrative personnel who may come into contact with chemicals. In addition, emergency call
lines that provide expertise and eadvice regarding toxic chemicals should be made available.
Scent-free policies are in place in many administrative areas as well as
doctors offices and clinics. Signage reminding patients and visitors that many people are
sensitive to fragrances and scents are often used to request that these products are not used.
Medical follow-up of the exposed worker
A worker who has had a chemical exposure may require medical follow-up. Guidelines are
available to provide information on the treatment and monitoring of workers with exposure tospecific chemicals.
Health Surveillance and Medical Monitoring in the Workplace
The pre-placement assessment considers the workers personal health status as it relates to
potential workplace exposures. It is useful to identify if workers have any allergies or sensitivities
to products that they may come into contact with.
Chemical Waste Handling and Disposal
Chemical wastes must be addressed with a good chemical waste management system.
Municipal and or Provincial codes address appropriate disposal requirements and aim to reducecontamination, possible injuries, illness or reactions related to chemical exposures.
Additional considerations for reducing risk of exposure
It is prudent to be aware of the need for modification of the work environment, conditions or
required PPE for workers who may be medically vulnerable to the effects of some substances.
Higher risk workers may include pregnant workers, workers with allergies or those who are
sensitized to certain chemicals. Some common approaches to accommodate these workers
include temporary reassignment to areas or tasks where the exposure potential is eliminated;
work scheduling to reduce the amount of exposure, and changes to the PPE to accommodate
limitations.
Personal Protective Equipment
Personal protective equipment (PPE) is considered the lowest level of protection in the
hierarchy of controls. This reflects the reliance on proper selection, fit, use and maintenance of
the equipment by the organization and individual HCWs. PPE is often used in conjunction with
other controls (engineering and administrative) to provide additional protection to workers. PPE
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is designed to protect the worker from exposure to chemicals by blocking access to the route of
entry into the body. Gloves, aprons and other protective clothing reduce exposure through the
dermal (skin) contact route. Eye and face protection reduce exposure through skin and mucous
membrane contact.
Physical Hazards and Controls
There are many potential physical hazards to which administrative personnel may be exposed.
The nature of the work may pose
ergonomic hazards, the potential for slips, trips and falls, exposure to environmental conditions,
cuts, and electrical hazards.In this section the physical hazards most commonly encountered by
administrative personnel and methods to control them are presented. Employers should
carefully evaluate the potential for exposure to hazards for all administrative activities and
ensure that they have an effective hazard control plan in place. This information will be useful
for inclusion into hazard assessments.
Engineering Controls
Ergonomic hazards Computer WorkstationsOne of the most commonly encountered physical
hazards for administrative workers is associated with computer ergonomics. The use of
computers is ubiquitous in a variety of HCW positions and healthcare settings, including almost
all administrative workers. The key biomechanical risk factors for computer use are awkward
postures, excessive force, repetition and compression and impact forces. In addition to
biomechanical risk factors, there may be other risk factors related to the work environment (e.g.
lighting, noise), workstation design and personal factors. Examples of personal risk factors
include state of health, fitness level, casual addictions
(e.g. caffeine and smoking), poor posture, poor typing technique (e.g. pounding the keys), andpoor typing posture (e.g. bent wrists).
In addition to musculoskeletal injuries (MSIs), it should be noted that the signs and symptoms
related to poor computer workstation ergonomics may include eye fatigue and discomfort, and
in some cases headaches.
A self assessment is a useful tool to assist workers to evaluate biomechanical risk factors
related to their computer workstations and to provide recommendations for control measures.
Ideally, healthcare organizations should provide workers with self assessment tools and, if
concerns persist, an ergonomics assessment should be performed by someone with specialized
training. The goal of the hazard assessment is to identify hazards and control strategies toreduce the risk of injury.
Engineering controls related to computer ergonomics include
The goal is to purchase and
provide equipment and furniture that will support ergonomically correct work postures and
behaviours.
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biomechanical risk factors.
For example, frequently accessed equipment and materials should be located in easy reach
(and located to minimize awkward postures).
Trips, Slips and falls
In order to prevent slips, trips and falls, adequate lighting should be available. Cords and other
tripping hazards should not be in the
path of traffic. Non-slip flooring should be provided. The following are common engineering
controls used to reduce the risk of slips, trips and falls:
ipment layout to minimize cords and to accommodate
equipment without creating tripping hazards.
-slippery surfaces on the whole steps or at least on the leading edges.
surfaces on the stairs, handrails or banisters (e.g. nails or splinters).
ast to improve depth perception.
Cuts
The most effective controls to reduce cuts are engineering controls. Common engineeringcontrols include
Electrical Hazards
Insulation protects workers from contact with electricity. All equipment, wiring and cords must be
maintained and used in a manner that keeps electrical insulation intact. Electric appliances and
equipment are protected from overloading by means of electric overloading devices such as
fuses or circuit breakers. Although these devices will stop the flow of current when too much
current flows through them, they are intended to protect equipment but not workers. All
overloading devices must be of sufficient ratings.
Replacing fuses or circuit breakers with overloading devices that trip at a higher current than
specified is a dangerous practice as is replacing overloading devices with a conductor. Ground
fault circuit interrupters (GFCIs) are safety devices that will interrupt the flow of current by
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monitoring the flow of current to and from the device. GFCIs are important engineering controls
that should be used in wet environments and to power tools and equipment outdoors.
Administrative Controls
Ergonomic hazards
Controls that focus on how work is performed and organized are administrative controls.
Administrative controls include policies, procedures, work practices, rules, training, and work
scheduling, including:
equipment, including computer
workstations.
symptoms and safe work practices(including proper lifting methods and proper use of lifting
devices).
e biomechanical hazards.
Trips, Slips and Falls
Administrative controls to prevent slips, trips and falls include:
footwear
-up of any spills
Cuts
Administrative controls widely used to reduce the potential for cuts include
cedures
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Electrical Hazards
A major component of an electrical safety program is worker training. Extension cords are used
in many applications for temporarily supplying power. Considerations to follow when using
extension cords include:
Never keep an extension cord plugged in when it is not in use.
gs (one blade wider than the other).
These plugs are designed to prevent electric shock by properly aligning circuit conductors.
Never file or cut the plug blades or grounding pin of an extension cord.
ingle cord of sufficient length.
Hazard assessments should guide the development of work procedures to assess and control
electrical hazards.
Personal Protective Equipment Controls
Ergonomic hazards
The most important personal protective equipment to control ergonomic hazards is appropriate
footwear with gripping soles and good support.
Trips, Slips and falls
The use of appropriate footwear by administrative workers is essential to prevent trips, slips andfalls. Workers should be required to wear flat or low-heeled shoes with non-slip soles that offer
good support.
Cuts
Eye protection is important if there is any possibility that fragments of glass or other sharps may
enter the eyes, and footwear must protect the wearer from accidental exposure to sharps.
Gloves are usually required as PPE to protect workers from cuts.
Psychological Hazards and Controls
Each administrative area should systematically conduct hazard assessments for tasks
performed by administrative personnel and identify if and where the potential exists for
psychological hazards. In this section, examples are provided of psychological hazards that may
be encountered by any healthcare worker, and possible control measures will be suggested.
This information will be useful for inclusion into hazard assessments. Please note, this is not
designed to be an exhaustive treatment of the subject, but is rather an overview summarizing
the some of the reported psychological hazards in healthcare settings.
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Potential psychological hazards and controls vary greatly in jobs, locations and organizations
and are only briefly discussed here.
Personal factors impact how stressors are viewed and addressed. A comprehensive discussion
of causes and impacts of psychological stressors on workers and on the organization can be
found in Best Practices for the Assessments and Control of
Psychological Hazards. Included in the discussion are the topics of environmental factors
such as noise and indoor air quality and their impacts on personal health, as well as outcomes
of workplace stress that may impact personal health such as substance abuse, depression,
anxiety, sleep disorders and other mental illness, and age-related factors.
Program elements for preventing or controlling violence and abuse towards workers in the
workplace Because the scope of abuse of workers is broad, with a wide range of potential
internal and external perpetrators and a myriad of individual considerations, prevention of abuse
of workers is multi-faceted. This list of prevention procedures and control techniques is not all-
inclusive, but rather a sample of the complexities that should be considered in a program for
administrative personnel:
form of violence, harassment, or abuse including bullying. Awareness sessions for all workers
on abuse and violence in the workplace, reporting procedures and controls.
this includes a requirement of all
workers to wear identification badges. It is suggested that information that is not necessary not
be shown on the front to the badge to reduce risk to workers.
this may include
the preparation and dissemination of client information guidelines, in which client behaviour isdiscussed, the commitment to no tolerance for abuse against workers and the encouragement
of mutual respect are covered.
nications protocols. Working alone guidelines are
required by Alberta occupational health and safety legislation (OHS Code, Part 28), and must
include a written hazard assessment as well as communication protocols for workers who must
work alone.
ystems and emergency communication devices (panic buttons, etc.). Identification of
workers or locations that should be provided with alarm systems and panic buttons should
occur. Once any alarm systems are installed or provided, all workers should be trained on howto use them and how to respond to alarms.
Identification and correction of high risk facility issues (e.g., isolated areas, parking lots, low
lighting, no escape routes, etc.).
There are many risk factors posed by the design of the facility. The administrative area should
identify risk factors and work to
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reduce the risk in the areas. A checklist would be useful to help identify issues contributing to
worker risk.
-violent crisis intervention and assault management
techniques.
Work-Life balance, including reduction of excessive workloads
An employer should strive to develop policies and programs that support work-life balance. The
following is a list of general work-life balance policies and programs to consider:
voluntary reduced hours / part-time work and phased in retirement
offices
educational and sabbatical leaves
e and referral services29 | P a g e
A work-life conflict issue recognized in healthcare is often brought on by workload and work
demands. Some strategies to reduce the impact of increased workloads and work demands
include the following:
to reduce worker workloads. According to research, special attention is
required for managers and professionals.
increased turnover, employee assistance program use, increased absenteeism).
-related travel.
(e.g. cell phones, PDA, laptops, email)
outside of work time.
(childcare and eldercare) and personal problems.
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-life practices (e.g. job sharing, compressed work week, etc.) and
reward sections of the organization with high usage. Investigate sections where usage is low.
s should increase the extent to
which managers are effective at planning the work to be done, make themselves available to
answer worker questions, set clear expectations, listen to worker concerns and give recognition
for a job well done.
Technostress (stress resulting from the introduction of new technologies)
The primary controls an organization employs to reduce the potential of technostress are
administrative controls. While major engineering control opportunities exist in the design and
development oftechnology to make it easier to use, an employers choice of technology is an
administrative control.
Administrative controls an organization can use to reduce the risk of technostress include:
e user
feedback as to its use
technology
Provision of problem-solving resources and support to workers
-up plans in the event of technology failure
-wide technology change
-tasking
h time new technology is introduced.
Personal controls for reducing the risk of technostress include:
-education concerning new technologies
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e including good nutrition, exercise and getting enough sleep
-task
-outs (avoiding being plugged in continually)
-vacations)
Shiftwork
The following guidelines will assist in reducing the psychological impacts of shift work.
Good Practice Guideline for Shift Work Schedule Design2
variety of tasks to be completed during the shift to allow workers some
choice about the order they need to be done in. Avoid scheduling demanding, dangerous,
safety-critical or monotonous tasks during the night shift, particularly during the early morning
hours when alertness is at its lowest.
-rotating schedule for rotating shifts, when possible.
transport for workers on particular shifts.
t shifts to a maximum of 12 hours (including overtime) and consider the needs of
vulnerable workers.
monotonous.
courage and promote the benefit of regular breaks away from the workstation.
workers from saving up break time for
the end of the workday.
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tive working days to a maximum of 5-7 days.
consider limiting consecutive shifts to 2-3 days.
sive shifts.
full sleep.
.
The Danger ZoneOver the past decade, the rates of occupational injury to healthcare workers (HCWs) have
continued to rise. From occupational hazards like communicable diseases, sharps injuries,
infectious-fluid splashes, latex allergies, back injuries to violence and stresshealthcare staff
members are constantly at risk.
In order to prevent or reduce exposure to these day-to-day dangers, infection controlprofessionals must interface with healthcare personnel to identify potential risks, increase
awareness of safety challenges, implement protective policies and procedures, and evaluate
measures after they are taken. In addition, groups like the Association of Occupational Health
Professionals in Healthcare (AOHP), the Occupational Safety and Health Administration
(OSHA) and the National Institute for Occupational Safety and Health (NIOSH) are in place to
promote and advance the health and safety of workers in healthcare.
But in order for infection control personnel and occupational health advocacy groups to develop
better policies and practices that prevent work-related injuries, they must first understand what
todays occupational healthcare workers are facingby looking at what ranks among the top
safety concerns.
To achieve this goal, AOHP designed a survey to illuminate the top public policy issues ofconcern to its members. The survey can be conducted to, examine the most common safety
challenges faced by occupational HCWsincluding bloodborne pathogen exposure, violence in
the workplace, safe patient handling, ergonomics, bioterrorism/emergency preparedness, health
promotion/wellness, respiratory protection and pandemic influenzaand ask respondents to
rank the issues as very important, important, somewhat important or unimportant.
Top-three most pressing concerns for todays occupational healthcare workers are safe patient
handling, bloodborne pathogen exposure and respiratory protection. Safe patient handling and
bloodborne pathogen exposure were both ranked as very important by 76.7 percent and 73.5
percent of voters, respectively, while respiratory protection was considered important by 52.1
percent of respondents.
Some Questionarries
The Occupational Health Professionals Services and Qualifications: Questions andAnswers
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Controlling occupational injuries and illnesses and related expenditures is a top priority in mostcompanies. Selecting a qualified health care professional to participate in the workplace safetyand health activities can be a vital step in this process. The following questions and answers areto provide guidance and serve as a resource for those considering such a selection.
What Issues Should be Considered in Selecting a Health Care Professional?
A variety of health care professionals are available to employers. Selecting anappropriate provider for the worksite depends on a number of factors, including:
The Occupational Safety and Health Administrations (OSHA) screening and
surveillance requirements for specific substances or hazards associated with theworksite; The number, diversity, size, and seriousness of the hazards involved at the worksite(s);
and The level of resources committed to an occupational health care service as part of a
comprehensive safety and health program; and Distance to the closest trauma center or health care facility.
At a minimum, workplace safety and health involves management support, employeeinvolvement, worksite analysis, hazard prevention and control, occupational health caremanagement (including screening and surveillance for disease and injury), and training andeducation.
Qualified occupational health care professionals can assist the employer in achieving a safe andhealthful work environment. Along with other safety and health professionals, health careprofessionals work collaboratively with labor and management to:
Identify potential hazards and to find ways to prevent, eliminate, minimize, or reducehazards;
Develop and manage training programs to promote workplace health and safety; and Enhance the accuracy of OSHA recordkeeping.
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What UniqueContributions Can an Occupational Health Care Professional Make toWorkplace Safety and Health?
Health care professionals are uniquely qualified to assess and treat illnesses andinjuries. Health care professionals must have the appropriate licensure,
registration, or certification. Additionally, they should have occupational healthexperience and expertise in management and be available on a full- or part-timebasis, depending on the nature and size of worksite(s). They may be a permanentemployee or hired on a contractual basis.
In addition to working collaboratively with other safety and health professionals, a qualifiedhealth care professional may be selected to:
Provide screening related to specific chemicals or exposures, including preplacement(post-offer) physical examinations, job placement assessments, periodic examinations,and maintenance of confidential employee health records, including individual screeningresults.
Manage and/or treat work-related illnesses and injuries, with emphasis on earlyrecognition and intervention; make recommendations about work restrictions or removal;and follow up and monitor workers as they return to work.
Develop and implement health promotion programs. Provide guidance for case management of employees who have prolonged or complex
illnesses and injuries.
For small employers, or those with limited resources, one of several models for deliveringoccupational health care at the workplace can be considered. This might involve sharing theservices of health care professionals within a business or industrial park, or contracting with alarger firm whose occupational health service includes an occupational health care professionalas part of its total safety and health program. (See References: B. Burgel Innovation at the
Worksite.)
Health care providers such as licensed practical nurses (LPNs) and emergency medicaltechnicians/paramedics (EMTs) can augment the services of the physicians or registered nurse.Physician assistants (PAs) also contribute valuable services. Whatever health care professionalis chosen, the employer should ensure that the provider has expertise or experience inoccupational health and safety as well as an understanding of occupational illnesses andinjuries.
Who Are Qualified Occupational Health Care Professionals?
Health care professionals qualified to design, manage, supervise, and deliver
health care in occupational settings include a variety of practitioners. It isimperative, however, that the legal scope of practice unique to each state beconsidered prior to hiring or contracting for services. The scope of practicerefers to the credentials, responsibilities, and legally authorized practice of healthcare professionals.
Physicians, physician assistants, and registered nurses, including nurse practitioners, receivestandardized educations with core curricula (individualized to their profession) necessary topass national or state boards and to be licensed in a particular state. Physicians and registered
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nurses are then eligible to become certified in a specialty practice, such as occupationalmedicine (physicians and physician assistants) or occupational health nursing (registerednurses and nurse practitioners), through a combination of additional specific education andexperience. The additional educational training in occupational health typically includes coursework in epidemiology, toxicology, industrial hygiene, recognition and management ofoccupational illnesses and injuries, research, and general management of a comprehensive
occupational health program.
Physicians
Medical Doctors(MDs) have completed study at the college level and training at an accreditedschool. Licensed MDs have passed the National Medical Board Exam or equivalentexaminations and have a license to practice within a given state(s).
Doctors of Osteopathy(DOs) graduate from college and an osteopathic school approved bythe American Osteopathic Association. They must pass a state board examination to qualify fora license to practice within a given state(s).
Occupational Medicine Physic iansare medical doctors or doctors of osteopathy who havecompleted additional occupational medicine training or acquired on-site experience. Completionof additional residency training and further practice in occupational medicine enables physiciansto pursue certification in occupational medicine after meeting rigorous qualifying standards andsuccessfully completing an examination in occupational medicine given by the American Boardof Preventive Medicine (ABPM).
Registered Nurses
Registered Nurses(RNs) receive training and education at the college level and graduate froma state-approved school of nursing. They pass a state board examination and are granted alicense to practice within a given state(s).
Nurse Practi t ioners(NPs) are registered nurses who are licensed in their state and havecompleted formal advanced education, usually at the masters level. NPs practice under theirstate Nurse Practice Act. Some NPs are certified in occupational health as a specialty area.NPs independently perform many health evaluation and care activitiesincluding physicalexams, common diagnostic and laboratory testsand diagnose and treat employees who are illor injured. They also can prescribe medications in most states. Additionally, NPs workcollaboratively with physicians.
Occupational Health Nurses(OHNs) are registered nurses and nurse practitioners withexperience and additional education in occupational health. Certified occupational health nurses(COHN or COHN-S) obtain certification from the American Board for Occupational Health
Nurses after meeting rigorous qualifying educational and experience standards and successfullypassing an occupational health nursing examination.
Physician Assistants
Physic ian Assistants(PAs) provide services with the supervision of a doctor of medicine orosteopathy. PAs may perform physical examinations, diagnose and treat illnesses, order andinterpret tests, prescribe medications in most states, and plan and implement therapeuticinterventions. PAs must graduate from an accredited physician assistants program, pass a
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national certification exam, and be licensed by the state. Some PAs specialize in occupationalmedicine.
Other Health Care Providers
Other health care providers include licensed practical or vocational nurses and emergency
medical technicians. Traditionally, these individuals are not licensed to practice independently.They have specific training and are usually certified or licensed by the educational institutionwhere they received the training. Sometimes the state licenses or certifies these providers andusually the states scope of practice outlines the specific work restrictions for these individuals.For example, usually these providers are required to work under the supervision of, orimplement orders given by, licensed health care professionals such as MDs, DOs, RNs, PAs,and NPs, except when delivering first aid.
Licensed Practical/Vocational Nur ses(LPN/LVNs) graduate from a program of practicalnursing and must pass the state board examination. They are licensed by the state to performcertain specific health care activities, under the direct supervision of a physician or registerednurse.
Emergency Medical Technic ians/Paramedics(EMTs) are prehospital providers trained toprovide specific and limited emergency care. Some EMTs receive advanced training to becomeparamedics, which allows them to perform more advanced emergency procedures. EMTs areauthorized to perform their duties by standing orders or protocols from physicians. Theyrespond primarily to injuries and acute illnesses on a temporary basis and are not independentlylicensed to provide other medical care.
How Can an Employer Verify the Scope of Practice for Health Care Professionals in theLicensing State?
Each state has a unique legal description of the scope of practice for health care
professionals. When it is necessary to verify a health care professionals scope ofpractice for the occupational setting, the individual states licensing or certificationboard should be contacted, as follows:
Medical Doctor
State boards of medical examiners and professional licensure can provide information about anoccupational physicians educational training and type ofpractice. The American Board ofMedical Specialties (ABMS) publishes an annual list of certified occupational medicinespecialists. The employer may refer to the ABMS listings in the reference department of mostpublic libraries or call the Office of ABMS at (800) 776-2378.
Doctor of Osteopathy
Doctors of osteopathy are licensed by a board in each state. Listings may include Board ofMedical Examiners, Licensing Examiners, Board of Osteopathic Examiners, Board of MedicalPractice, or Medical Licensing Board of (name of particular state). The American Board ofMedical Specialties (ABMS) publishes an annual list of certified occupational medicinespecialists (see MD listing above).
Registered Nurse and Nurse Practitioner
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The National Council of State Boards of Nursing [(312) 787-6555] has information on theregulation of nursing in each state. Generally, the American Nurses Association (ANA) [(202)651-7000] certifies NPs. The American Board for Occupational Health Nurses (ABOHN) [(630)789-5799] certifies RNs in the specialty of occupational health.
Physician Assistant
All states except Mississippi license physician assistants. PAs are licensed by the state medicalboard or by a separate licensing board. PAs are certified by the National Commission onCertification of Physician Assistants (NCCPA) [(770) 734-4500].
Emergency Medical Technician
The scope of practice for emergency medical technicians (EMTs) also varies from state to state.There are several practice levels of EMTs each determined by the number of hours of trainingand the range of procedures authorized. Each state has a director of EMTs listed in thetelephone directory under State Government. The appropriate office may be contacted under
the telephone directory subheading listed as either the Department of Health, Department ofPublic Health, or Department of Emergency Medical Services.
Licensed Vocational/Practical Nurse
The state board of nursing in each state is listed in the telephone directory and defines thescope of practice issues for licensed vocational or practical nurses LVNs/LPNs.
What Qualifications Should an Employer Look for in an Occupational Health CareProfessional?
An occupational health care professional evaluates the interactions between
employees work and health in the workplace. To do this effectively, theoccupational health care professional should possess the following skills andcompetencies:
General knowledge of the work environment, including worksite operations; familiaritywith the toxic properties of materials used by employees as well as the potential hazardsand stressors of work processes and jobs or tasks.
Ability to determine an employees physical and emotional fitness for work. Ability to recognize, evaluate, treat, and/or refer occupational illnesses and injuries. Knowledge of workers compensation laws; local, state, and federal regulatory
requirements; and systems for maintaining health records. Ability to organize and manage the delivery of health care services. Knowledge of legal and ethical issues related to occupational health care practice.
In addition to administering the health care program and supervising health care personnel, theoccupational health care professional should communicate with workers and managers at alllevels. Most importantly, the health care professional must maintain confidentia l i tybetween
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the health care professional and the employee as required by OSHA, professional ethicscodes, and indiv idu al state privacy acts. Management should only be provided thenecessary information to make an informed and competent decision on occupational health andsafety issues.
Is There a Good Way to Evaluate the Qualifications of an Occupational Health Care
Professional?
During the interview process, the following kinds of questions and issues areappropriate to evaluate prospective occupational health care professionals:
What type of education/training does the candidate have?
Note graduation date and all degrees and type of specialty certification; Titles of continuing education courses taken in the last 2 years; Where and when licensed, registered, or certified (ask for documentation); and Years of experience in occupational health.
In what type of industries has the candidate had experience? What kind of management experience(s) has the candidate had? For how long? What does the candidate know about OSHA recordkeeping requirements? Has the candidate ever prepared for and/or participated in an OSHA inspection? Does the candidate know about workers compensation laws in your state? Is the candidate familiar with the Americans with Disabilities Act?What kind of
information does the candidate want to know about your business? How can the candidate develop or improve your safety and health program?
You should expect the candidate to ask you about the following: Facilities (type, location) Number of employees Work processes Known or potential hazards Application of standards and/or regulations Current method of providing occupational health care services Other health care providers involved in providing services Existence and specifics of a safety and health program Medical surveillance programs Collective bargaining contracts Previous OSHA citations
References from current/previous employers or educational institutions should berequested.
What Is the Difference Between Occupational Health Care Professionals and OtherOccupational Safety and Health Professionals?
All occupational health and safety professionals are educated to have aproactive, preventive orientation, with the health and well-being of the
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employee as their primary focus. As mandated by each individual state, however, only healthcare professionals, within the scope of their practice, can assess and treat illness and injurybeyond first aid. Additionally, health care professionals, based upon their education and training,can provide high-quality preventive health care information and programs.
The following descriptions highlight the overall skills and areas of competency of other
occupational safety and health professionals who might be part of an effective safety and healthprogram at your work site.
Industrial Hygienists
Industrial hygiene focuses on the identification and control of occupational health hazardsarising as a result of or during work. The industrial hygienist focuses on the recognition,evaluation, and control of chemical, biological, or physical factors or stressors arising from theworkplace, that may cause sickness, impaired health and well-being, or significant discomfortand inefficiency among workers or in the community. Professional industrial hygienists possesseither a baccalaureate or masters degree in engineering, chemistry, biology, physics, orindustrial hygiene.
The industrial hygienist monitors and uses analytical methods to detect the extent ofoccupational chemical, biological, or physical exposure and implements engineering controlsand work practices to correct, reduce, or eliminate workplace hazards. Industrial hygienists cangive expert opinion as to the magnitude of chemical, biological, or physical exposure, and thedegree of associated risk. Certified industrial hygienists have passed a rigorous qualifyingexamination.
Industrial Engineers
Industrial engineering is the design, installation, and improvement of integrated systems ofpeople, material, information, equipment, and energy. Industrial engineering draws upon
specialized knowledge and skills in the mathematical, physical, and social sciences, togetherwith principles and methods of engineering analysis and design to specify, predict, and evaluatethe results obtained from such systems.
The Institute of Industrial Engineers has a special division devoted to ergonomics, and manyindustrial engineers elect to receive advanced training in this increasingly complex and growingspecialty.
Safety Professionals
Safety professionals focus on developing procedures, standards, or systems to achieve thecontrol or reduction of hazards and exposures that would be detrimental to people, property,
and/or the environment. Certified safety professionals (CSPs) graduate from accredited collegeor university programs with a baccalaureate degree in safety and must have at least 4 years ofprofessional safety experience prior to taking the Safety Fundamentals exam.
What OSHA Standards for General Industry Require Screening and Surveillance orOccupational Health Services?
The following OSHA General Industry Standards regulating toxic and hazardoussubstances have specific medical surveillance requirements in Title 29 Code of
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Federal Regulations, Part 1910.
Copies of OSHA regulations are available at cost from the Superintendent of Documents, U.S.Government Printing Office, Washington, DC 20402.
Please be advised that this list is subject to revision and expansion.
It is the employers responsibility to know the general and specificOSHA standards that apply to the industry and workplace.
General Industry Standards
2-AcetylaminofluoreneAcrylonitrilealpha-Naphthylamine4-Aminodiphenyl
Arsenic, InorganicAsbestosBenzeneBenzidinebeta-Naphthylaminebeta-Propiolactonebis-Chloromethyl EtherBloodborne Pathogens1,3 ButadieneCadmiumCoke OvensCotton Dust1,2-dibromo-3-chloropropane3,3' Dichlorobenzidiene (and its salts)4-Dimethylaminoazobenzene
Ethylene OxideEthyleneimineFormaldehydeHazard CommunicationHazardous Waste and Emergency ResponseLeadMethylene ChlorideMethyl Chloromethyl EtherMethylenedianiline4-NitrobiphenylN-NitrosodimethylamineOccupational Exposure to Hazardous Chemicals in Laboratories
RespiratorsVinyl Chloride
1910.10141910.10451910.10041910.10111910.10181910.10011910.10281910.10101910.10091910.10131910.10081910.10301910.10511910.10271910.10291910.10431910.10441910.10071910.1015
1910.10471910.10121910.10481910.12001910.1201910.10251910.10521910.10061910.10501910.10031910.10161910.1456
1910.1341910.1017
Some OSHA Standards that Require Occupational Health Services
Access to Employee Exposure and Medical RecordsConfined SpaceFire ProtectionLabor Camps
1910.10201910.1461910.1561910.142
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Medical Services/First AidNoisePulpwood LoggingTelecommunicationsTextilesWelding
1910.1511910.951910.2661910.2681910.2621910.152