Occupational Hazards in Health Care

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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. 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.


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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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.


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.


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

Occupational Hazards in Health Care

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