Occupational Hazards in Health Care

Project Report On Occupational Hazards In Health Care
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. The Hospitals 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 in Ophthalmology, ENT, Dermatology, Dentistry etc. Medical and Surgical Cardiac Sciences, Oncology, Neurosciences (Neurology and Neurosurgery & Neurophysiology), Urology, Nephrology, Rheumatology, Endocrinology, etc are some of the departments having 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, and other equipments. Neonatal retrieval system is also available here for the first time in Odisha, where babies can be transferred to this Hospital from other units around the state by an ultra modern transport system. Apollo Hospitals, Bhubaneswar, is one of the newest facilities from the Apollo hospitals group. A 350bedded 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 Urology The Hospital has 34 consultation chambers for accommodating Consultants of all departments for outpatients. 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
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
Install and maintain smoke detectors and carbon monoxide detectors Keep guns unloaded 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 with each 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 workers and 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.
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
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 of 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
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:
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
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 is designed 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, orsecondhand 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 allinclusive. 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 educating workers in the practices is vital. Safe work procedures should be designed to:
route of exposure to the worker
harmful substances
Worker education is critical for safely handling harmful substances. In this section the most common chemical exposure hazards encountered by administrative personnel 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.
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 to specific 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 reduce contamination, 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
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), and poor 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 to reduce 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.
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 engineering controls 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
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
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 and falls. 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.
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 allinclusive, 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 is discussed, 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 how to 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
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.
-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 of technology 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
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.
tive working days to a maximum of 5-7 days.
consider limiting consecutive shifts to 2-3 days. sive shifts.
full sleep. . The Danger Zone Over 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 control professionals 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 of concern 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 and Answers
Controlling occupational injuries and illnesses and related expenditures is a top priority in most companies. Selecting a qualified health care professional to participate in the workplace safety and health activities can be a vital step in this process. The following questions and answers are to 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 an appropriate 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 the worksite; 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, employee involvement, worksite analysis, hazard prevention and control, occupational health care management (including screening and surveillance for disease and injury), and training and education. Qualified occupational health care professionals can assist the employer in achieving a safe and healthful work environment. Along with other safety and health professionals, health care professionals work collaboratively with labor and management to:

Identify potential hazards and to find ways to prevent, eliminate, minimize, or reduce hazards; Develop and manage training programs to promote workplace health and safety; and Enhance the accuracy of OSHA recordkeeping.
What Unique Contributions Can an Occupational Health Care Professional Make to Workplace Safety and Health? Health care professionals are uniquely qualified to assess and treat illnesses and injuries. Health care professionals must have the appropriate licensure, registration, or certification. Additionally, they should have occupational health experience and expertise in management and be available on a full- or part-time basis, depending on the nature and size of worksite(s). They may be a permanent employee or hired on a contractual basis. In addition to working collaboratively with other safety and health professionals, a qualified health 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 screening results. Manage and/or treat work-related illnesses and injuries, with emphasis on early recognition 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 delivering occupational health care at the workplace can be considered. This might involve sharing the services of health care professionals within a business or industrial park, or contracting with a larger firm whose occupational health service includes an occupational health care professional as 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 medical technicians/paramedics (EMTs) can augment the services of the physicians or registered nurse. Physician assistants (PAs) also contribute valuable services. Whatever health care professional is chosen, the employer should ensure that the provider has expertise or experience in occupational health and safety as well as an understanding of occupational illnesses and injuries. 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 is imperative, however, that the legal scope of practice unique to each state be considered prior to hiring or contracting for services. The scope of practice refers to the credentials, responsibilities, and legally authorized practice of health care professionals. Physicians, physician assistants, and registered nurses, including nurse practitioners, receive standardized educations with core curricula (individualized to their profession) necessary to pass national or state boards and to be licensed in a particular state. Physicians and registered
nurses are then eligible to become certified in a specialty practice, such as occupational medicine (physicians and physician assistants) or occupational health nursing (registered nurses and nurse practitioners), through a combination of additional specific education and experience. The additional educational training in occupational health typically includes course work in epidemiology, toxicology, industrial hygiene, recognition and management of occupational 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 accredited school. Licensed MDs have passed the National Medical Board Exam or equivalent examinations and have a license to practice within a given state(s). Doctors of Osteopathy (DOs) graduate from college and an osteopathic school approved by the American Osteopathic Association. They must pass a state board examination to qualify for a license to practice within a given state(s). Occupational Medicine Physicians are medical doctors or doctors of osteopathy who have completed additional occupational medicine training or acquired on-site experience. Completion of additional residency training and further practice in occupational medicine enables physicians to pursue certification in occupational medicine after meeting rigorous qualifying standards and successfully completing an examination in occupational medicine given by the American Board of Preventive Medicine (ABPM). Registered Nurses Registered Nurses (RNs) receive training and education at the college level and graduate from a state-approved school of nursing. They pass a state board examination and are granted a license to practice within a given state(s). Nurse Practitioners (NPs) are registered nurses who are licensed in their state and have completed formal advanced education, usually at the masters level. NPs practice under their state Nurse Practice Act. Some NPs are certified in occupational health as a specialty area. NPs independently perform many health evaluation and care activitiesincluding physical exams, common diagnostic and laboratory testsand diagnose and treat employees who are ill or injured. They also can prescribe medications in most states. Additionally, NPs work collaboratively with physicians. Occupational Health Nurses (OHNs) are registered nurses and nurse practitioners with experience 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 successfully passing an occupational health nursing examination. Physician Assistants Physician Assistants (PAs) provide services with the supervision of a doctor of medicine or osteopathy. PAs may perform physical examinations, diagnose and treat illnesses, order and interpret tests, prescribe medications in most states, and plan and implement therapeutic interventions. PAs must graduate from an accredited physician assistants program, pass a
national certification exam, and be licensed by the state. Some PAs specialize in occupational medicine. 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 institution where they received the training. Sometimes the state licenses or certifies these providers and usually 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, or implement orders given by, licensed health care professionals such as MDs, DOs, RNs, PAs, and NPs, except when delivering first aid. Licensed Practical/Vocational Nurses (LPN/LVNs) graduate from a program of practical nursing and must pass the state board examination. They are licensed by the state to perform certain specific health care activities, under the direct supervision of a physician or registered nurse. Emergency Medical Technicians/Paramedics (EMTs) are prehospital providers trained to provide specific and limited emergency care. Some EMTs receive advanced training to become paramedics, which allows them to perform more advanced emergency procedures. EMTs are authorized to perform their duties by standing orders or protocols from physicians. They respond primarily to injuries and acute illnesses on a temporary basis and are not independently licensed to provide other medical care. How Can an Employer Verify the Scope of Practice for Health Care Professionals in the Licensing 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 of practice for the occupational setting, the individual states licensing or certification board should be contacted, as follows: Medical Doctor State boards of medical examiners and professional licensure can provide information about an occupational physicians educational training and type of practice. The American Board of Medical Specialties (ABMS) publishes an annual list of certified occupational medicine specialists. The employer may refer to the ABMS listings in the reference department of most public 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 of Medical Examiners, Licensing Examiners, Board of Osteopathic Examiners, Board of Medical Practice, or Medical Licensing Board of (name of particular state). The American Board of Medical Specialties (ABMS) publishes an annual list of certified occupational medicine specialists (see MD listing above). Registered Nurse and Nurse Practitioner
The National Council of State Boards of Nursing [(312) 787-6555] has information on the regulation 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 medical board or by a separate licensing board. PAs are certified by the National Commission on Certification 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 training and the range of procedures authorized. Each state has a director of EMTs listed in the telephone directory under State Government. The appropriate office may be contacted under the telephone directory subheading listed as either the Department of Health, Department of Public 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 the scope of practice issues for licensed vocational or practical nurses LVNs/LPNs. What Qualifications Should an Employer Look for in an Occupational Health Care Professional? An occupational health care professional evaluates the interactions between employees work and health in the workplace. To do this effectively, the occupational health care professional should possess the following skills and competencies:
General knowledge of the work environment, including worksite operations; familiarity with the toxic properties of materials used by employees as well as the potential hazards and 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, the occupational health care professional should communicate with workers and managers at all levels. Most importantly, the health care professional must maintain confidentiality between
the health care professional and the employee as required by OSHA, professional ethics codes, and individual state privacy acts. Management should only be provided the necessary information to make an informed and competent decision on occupational health and safety 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 are appropriate 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 be requested.
What Is the Difference Between Occupational Health Care Professionals and Other Occupational Safety and Health Professionals? All occupational health and safety professionals are educated to have a proactive, preventive orientation, with the health and well-being of the
employee as their primary focus. As mandated by each individual state, however, only health care professionals, within the scope of their practice, can assess and treat illness and injury beyond 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 health program at your work site. Industrial Hygienists Industrial hygiene focuses on the identification and control of occupational health hazards arising 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 the workplace, that may cause sickness, impaired health and well-being, or significant discomfort and inefficiency among workers or in the community. Professional industrial hygienists possess either a baccalaureate or masters degree in engineering, chemistry, biology, physics, or industrial hygiene. The industrial hygienist monitors and uses analytical methods to detect the extent of occupational chemical, biological, or physical exposure and implements engineering controls and work practices to correct, reduce, or eliminate workplace hazards. Industrial hygienists can give expert opinion as to the magnitude of chemical, biological, or physical exposure, and the degree of associated risk. Certified industrial hygienists have passed a rigorous qualifying examination. Industrial Engineers Industrial engineering is the design, installation, and improvement of integrated systems of people, material, information, equipment, and energy. Industrial engineering draws upon specialized knowledge and skills in the mathematical, physical, and social sciences, together with principles and methods of engineering analysis and design to specify, predict, and evaluate the results obtained from such systems. The Institute of Industrial Engineers has a special division devoted to ergonomics, and many industrial engineers elect to receive advanced training in this increasingly complex and growing specialty. Safety Professionals Safety professionals focus on developing procedures, standards, or systems to achieve the control or reduction of hazards and exposures that would be detrimental to people, property, and/or the environment. Certified safety professionals (CSPs) graduate from accredited college or university programs with a baccalaureate degree in safety and must have at least 4 years of professional safety experience prior to taking the Safety Fundamentals exam. What OSHA Standards for General Industry Require Screening and Surveillance or Occupational Health Services? The following OSHA General Industry Standards regulating toxic and hazardous substances have specific medical surveillance requirements in Title 29 Code of
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 specific OSHA standards that apply to the industry and workplace. General Industry Standards 2-Acetylaminofluorene Acrylonitrile alpha-Naphthylamine 4-Aminodiphenyl Arsenic, Inorganic Asbestos Benzene Benzidine beta-Naphthylamine beta-Propiolactone bis-Chloromethyl Ether Bloodborne Pathogens 1,3 Butadiene Cadmium Coke Ovens Cotton Dust 1,2-dibromo-3-chloropropane 3,3' Dichlorobenzidiene (and its salts) 4-Dimethylaminoazobenzene Ethylene Oxide Ethyleneimine Formaldehyde Hazard Communication Hazardous Waste and Emergency Response Lead Methylene Chloride Methyl Chloromethyl Ether Methylenedianiline 4-Nitrobiphenyl N-Nitrosodimethylamine Occupational Exposure to Hazardous Chemicals in Laboratories Respirators Vinyl Chloride Some OSHA Standards that Require Occupational Health Services Access to Employee Exposure and Medical Records Confined Space Fire Protection Labor Camps 1910.1020 1910.146 1910.156 1910.142 1910.1014 1910.1045 1910.1004 1910.1011 1910.1018 1910.1001 1910.1028 1910.1010 1910.1009 1910.1013 1910.1008 1910.1030 1910.1051 1910.1027 1910.1029 1910.1043 1910.1044 1910.1007 1910.1015 1910.1047 1910.1012 1910.1048 1910.1200 1910.120 1910.1025 1910.1052 1910.1006 1910.1050 1910.1003 1910.1016 1910.1456 1910.134 1910.1017
Medical Services/First Aid Noise Pulpwood Logging Telecommunications Textiles Welding
1910.151 1910.95 1910.266 1910.268 1910.262 1910.152

Occupational Hazards in Health Care

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Project Report On Occupational Hazards In Health Care

Project Report On Occupational Hazards In Health Care

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