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Occupational Safety in Healthcare: Guidelines vs Implementation

While healthcare workers dedicate their entire professional lives to safeguarding the health of patients, the hospitals in which they work — and they themselves — often neglect potential dangers at the workplace which can affect their health. Any place where ill people congregate for treatment is bound to be a gold mine for infections, and all those who work there are perpetually susceptible to contracting the diseases themselves.

While systems to prevent this are nominally in place, they exist more often on paper than in practice. Hospitals often bank on what they think is the low rate of occupational health accidents, without having any data to prove that such incidents are rare. In her latest column, Dr R Sukanya, MBBS, MD, PGDID, CIC, Consultant – Clinical Microbiology, Infection Control and Prevention, Infectious Diseases, Quality Accreditation & Training, writes about the gaps in the system, the impact on healthcare, what actually happens on-ground, and how hospitals need to gear up to protect employee health.

According to the Bureau of Labour Statistics, the likelihood of injury or illness resulting in days away from work is higher in hospitals than in construction and manufacturing two industries that are traditionally thought to be relatively hazardous.”

Dr R Sukanya

What is occupational health?

Occupational health is essentially preventive medicine. It is defined as the highest degree of physical, mental and social well-being of workers in all occupations, and deals with all aspects of health and safety at the workplace with a strong emphasis on the prevention of hazards at a primary level.

There are presently 16 laws related to working hours, conditions at work and employment, of which two Acts contain the main provisions for legal measures towards protection of health and safety of workers in India. They are the Factories Act (1948) and the Mines Act (1952). The most important global bodies — regarded as icons in occupational safety — are OSHA (Occupational Safety and Health Administration (OSHA) and NIOSH (National Institute for Occupational Safety and Health).

What are the occupational health risks for healthcare workers?

The delivery of healthcare services is inclusive of a wide range of health care workers (HCW), such as physicians, nurses, technicians, clinical laboratory workers, first responders, building maintenance, security and administrative personnel, social workers, food service, housekeeping, and mortuary personnel, who face a number of serious safety and health hazards. They include blood-borne pathogens and biological hazards, potential chemical and drug exposures, waste anaesthetic gas exposures, respiratory hazards, ergonomic hazards from lifting and repetitive tasks, laser hazards, workplace violence, hazards associated with laboratories, and radioactive material and X-ray hazards.

Some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and peracetic acid used for sterilization; and numerous other chemicals used in healthcare laboratories.

HCWs are also occupationally exposed to a variety of infectious diseases during the performance of their duties. Hospitals have serious hazards — lifting and moving patients, needlesticks, slips, trips, and falls, and the potential for agitated or combative patients or visitors — along with a dynamic, unpredictable environment and a unique culture. According to the Bureau of Labour Statistics, the likelihood of injury or illness resulting in days away from work is higher in hospitals than in construction and manufacturing — two industries that are traditionally thought to be relatively hazardous.

The Impact of Occupational Hazards

High cost:

  • Workers’ compensation for lost wages and medical costs
  • Temporary staffing, backfilling, and overtime when injured employees miss work
  • Turnover costs when an injured employee quits
  • Decreased productivity and morale as employees become physically and emotionally fatigued.

On Patient care:

Manual lifting can injure caregivers and also put patients at risk of falls, fractures, bruises, and skin tears. Caregiver fatigue, injury, and stress are tied to a higher risk of medication errors and patient infections. Though we do have several well defined guidelines, policies and laws for ensuring the safety and health of employees in any occupation, why are there still so many lacunae in the implementation of safety practices, and provision of critical care and guidance to employees, especially in healthcare? Is it a false sense of security and a mindset that healthcare workers are immune to dangers and harm in their workplace and are required to be selfless in their profession as it is a “Noble profession”?

The present status of occupational health in healthcare

There are several studies and data pointing to the overwhelming number of stigmatised and traumatised healthcare workers living with HIV, Hepatitis B and C infections which were acquired occupationally, and many more who died combating serious and novel deadly infections like Nipah, Ebola and MERS, while rendering patient care. We thus need to assess why and what went wrong in every case of occupational exposure.

Presently, the healthcare system focuses on safety training, drills, post-exposure prophylaxis and follow-ups and vaccination drives for HCWs. However, where is the data on evaluation of such training and drills conducted and who actually reviews these critical training events? In many healthcare institutions, safety practices are restricted and confined to SOPs and policies. This is due to several reasons.

What is lacking?

The lack of transparency and commitment of the management in addressing occupational grievances, scarcity of resources (financial, manpower) leading to decreased prioritisation of critical safety measures and most importantly, poor knowledge and awareness regarding the rights to safety and behavioural issues among the HCWs are some of the grave and fundamental issues and causes of failure in implementing a safe and healthy environment. In order to achieve a solution to this issue, the critical step is to analyse and review every occupational injury or exposure or harm.

Analysis and response

It is important to recognize conditions that lead to injury, such as a wet floor leading to slips and falls. But even more important is understanding behavior. Why did the employee not get help before moving the patient with obesity? Were there time pressures in the OR to proceed with no help? In the present technological era, there is no dearth of information or difficulty in accessing anybody or anything. Several tools for analysis of specific occupational injuries are available on the Net. The Job Safety Behavioural Observation process for healthcare uses tools and methodologies common in industry, yet is never applied to health care.

Another tool adopted from industry is the Job Safety Analysis. This tool facilitates a meticulous analysis of a risky process by requiring identification of hazards for each process step and a way to eliminate them. Analysis of blood-borne virus exposures is facilitated through EPINet software, which gives key information regarding every exposure, enabling appropriate prevention and management. Thus, actual improvement and progress can be achieved by combining selected tools and techniques used in manufacturing and continuous improvement to develop a process to identify, prioritize, and mitigate hazards in the healthcare environment.

These tools should be implemented by cross-functional teams consisting of people who do the work, their supervisors, and employee health and safety professionals. In many incidents of occupational hazards, the slack and careless attitude, behavioural issues and lack of accountability of the employees pose an insurmountable challenge to Safety officers and Quality departments. There is an urgent need to constantly evaluate, innovate, and improve equipment, processes, and training. The crucial key to healthcare worker safety is creating a “culture of safety” through rules, norms, rewards and training. Thus, real and lasting progress in improving workplace safety can only be achieved by changing the safety culture to one in which employees believe that all accidents are preventable, need to be reported for appropriate management and benefits and that everyone plays a role and is accountable for safety and good health at the workplace.

Where is the data on evaluation of training and drills conducted and who actually reviews these critical training events? In many healthcare institutions, safety practices are restricted and confined to SOPs and policies.”

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