OSH MANAGEMENT - Hazards in Health Care Industry

Health care workers represent many different occupations that expose them to a wide range of hazards.  Women represent nearly 80% of the healthcare work force. Although it is possible to prevent or reduce healthcare worker exposure to these hazards, healthcare workers continue to experience injuries and illnesses in the workplace. on the job. The rates of occupational injury to health care workers (HCW’s) have continued to rise.

Health care occupational hazards can be divided into 4 groups :

1.  Physical hazards
2.  Ergonomic hazards
3.  Psychological hazards
4.  Hazardous agents


Physical Hazards

Physical hazards include toxic, reactive, corrosive or flammable compressed gases and chemicals; extreme temperatures that may cause burns or heat stress; mechanical hazards that may cause lacerations, punctures or abrasions; electrical hazards; radiation; noise; violence; and slips and falls.

After overexertion, falls on the same level is the leading cause of injury or illness for health services (15 percent of all cases), followed by contact with objects (11 percent of all cases).

Precautions for this hazard category include :

●  Wearing the right shoes.
●  Properly cleaning and maintaining floors.
●  Reporting leaks and spills.
●  Storing cylinders upright.
●  Storing flammables in approved, closed containers.
●  Wearing proper personal protective equipment, including hearing protection 

    where necessary.
●  Maintaining electrical equipment according to manufacturer and company 

    standards.
●  Regularly inspecting tools, cords, grounds and accessories.
●  Locking and tagging out power sources and switches when servicing or 

    repairing mechanical equipment.
●  Learning to recognize and treat the signs of heat stress and drinking plenty 

    of water.
●  Not entering restricted radiation areas, unless trained and authorized.
●  Treating and interviewing aggressive patients in relatively open areas.
●  Reporting all assaults or threats to a supervisor or manager.

  

Ergonomic Hazards

Ergonomic hazards caused by badly designed machinery, mechanical devices and tools used, improper seating and workstation design, or poorly designed work practices, includes posture, body movement and load bearing.

Ergonomic hazards also include lifting, repetitive motion, standing for long periods of time and eye strain due to poor lighting. Overexertion (including lifting) is the number one cause of injury and illness for health care services.

After the motor vehicles/equipment and meat products industries, hospitals, specifically, have the highest number of non-fatal illness cases of disorders associated with repeated trauma.

Health care employers may wish to address their own ergonomics hazards by examining possible ergonomic risk factors of health care jobs. These have been identified as noted in Table 1.

Table 1 : Ergonomic Risk Factors of Health Care Jobs

Risk Factors	Examples
Repetition	Transferring patients, hand cranking beds, slicing meat, using a computer keyboard, etc.
Force	Transferring patients, lifting laundry bags, pushing carts or patients in wheelchairs or gurneys, grasping a syringe or forceps, gripping or scooping ingredients from large blood bags, etc.
Awkward Postures	Lifting, transferring or turning patients, reaching manual bed cranks, bathing and dressing patients, loading and unloading linen carts, assisting in surgery with neck and back bent, walking on wet floors, reaching for food supplies, using a computer keyboard, etc.
Contact Stress	Wearing tight latex gloves, sitting on a chair where the seat pan cut the blood supply to the legs,, sitting on a chair with armrests that are too close to the body, etc.
Vibration	Using an electric drill, chipping hammer, jig saw, grinder or sander (maintenance  in health care industry).

In order to control these risks, healthcare employers may want to :

●  Provide assist devices for lifting.
●  Provide convenient storage of lifting devices.
●  Lower items to alleviate reaching.
●  Provide handles on carts.
●  Encourage team lifts or start a no-lift program.
●  Provide redesigned surgical instruments, containers and computer 

    workstations.
●  Perform regular maintenance on lifting devices and equipment wheels, 

    cranks and controls.
●  Encourage exercise.

Psychological Hazards

Psychological hazards are related to extreme temperature, technological changes, malfunctioning equipment, excessive job demands, overwork, paperwork, increased facility size and bureaucracy, demanding or difficult patients, and patient deaths.

All of these factors contribute to stress, fatigue, anger, frustration and the feeling of being isolated and powerless. Failure to recognize and treat the sources of stress results in workers who suffer "burnout" (i.e., those who remain on the job but cease to function effectively). Workers are most likely to encounter severe stress in intensive care units, burn units, emergency rooms and operating rooms.

According to the National Institute for Occupational Safety and Health, some of the methods that have successfully reduced hospital worker stress and dissatisfaction include :

●  Regular staff meetings to share feelings and innovative ideas.
●  Stress management programs.
●  Readily available counseling.
●  Alternative job arrangements.
●  Adequate staffing.
●  Reasonable shift schedules.
●  Group therapy for staff dealing with chronically ill or deceased patients.
●  Organized and efficient work functions and environment.
●  Recognition of and action on legitimate complaints.
●  Relaxation exercises.
●  Opportunities to improve skills.
●  More flexibility and worker participation in scheduling.
●  Scheduled rotation of unit assignments.

         

Hazardous Agents

Hazardous agents include :
●  biological agents
●  chemical agents
●  disinfectants and sterilants
●  antibiotics
●  hormones
●  antineoplastics (cancer chemotherapy drugs, cytotoxic drugs)
●  waste anesthetic gases
●  latex gloves
●  aerosolized medications (e.g. ribavirin)
●  hazardous waste.

Healthcare employees will find these hazardous agents almost everywhere they turn - the operating room, maintenance, the laundry, food services, the laboratory, radiology, even office areas.

Not surprisingly, the Bloodborne Pathogens Standard and the Hazard Communication Standard were the top two regulations cited against health services by the Occupational Safety and Health Administration and Health Authorities.

It is important, then, for healthcare employers to develop both an exposure control plan and a hazard communication program, if applicable, as well as to encourage employees to follow safe work practices. Although safe work practices will be facility- and agent-specific, generally employees should :

●  Keep hazardous agents labeled properly
●  Avoid eating around hazardous agents
●  Wear proper personal protective equipment, including respirators where 

    necessary
●  Request non-latex gloves if allergic to latex
●  Use tools to apply or handle hazardous agents
●  Avoid recapping needles and use safe and effective alternatives where 

    available
●  Learn where emergency eyewash stations are located
●  Dispose of hazardous agents in proper containers
●  Report leaks and spills promptly
●  Recognize the signs and symptoms of illness relating to hazardous agents
●  Report exposure incidents promptly

Most Common Risk of Exposure
Exposure to Antineoplastic Agents (cancer chemotherapy drugs, cytotoxic drugs).
Exposure to Carcenogenic, Mutagenic and Teratogenic substances.
Exposure to Bloodborne Infections – Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Tuberculosis (TB), etc.
Exposure to Biological Agents - bacteria, viruses, infectious waste and humans.
Exposure to Needle and Sharps.
Exposure Latex Allergy (respiratory disease and skin irritation).
Exposure to Musculoskeletal Disorders
Exposure to Ergonomic Disorders
Exposure to Chemicals (liquids, vapours, smoke and gases).
Exposure to Stress
 

Source of Hazards

1.  Atmospheric pollutants

      ●  Liquids, vapours, smoke and gases (e.g. solvents, acids, alkalis,

         detergent etc.) 

     ●  Smoke from Laser/Electric Surgical Procedures.

         During surgical procedures using a laser or electrosurgical unit, the

         thermal destruction of tissue creates a smoke byproduct. Research

         studies have confirmed that this smoke plume can contain toxic gases

         and vapors such as benzene, hydrogen cyanide, and formaldehyde,

         bioaerosols, dead and live cellular material (including blood fragments),

         and viruses. At high concentrations the smoke causes ocular and upper

         respiratory tract irritation in health care personnel, and creates visual

         problems for the surgeon. The smoke has unpleasant odors and has

         been shown to have mutagenic potential.

     ●  Anesthetic Gases

     ●  Acetone, Ethanol, Methylene Chloride (laboratory)

     ●  Bacteria and viruses from air conditioning system (e.g. legionella)

2.  Equipments

     ●  Syringes containing potentially infected blood.

     ●  Specimen containers carrying potentially infected materials.

     ●  Physical contact with contaminated items and surfaces (e.g., door

         knobs, patient-care instruments or equipment, bed rails, examination

         table).

3.  People

      ●  Handling of patients during emergency response. 

     ●  Skin-to-skin contact.

     ●  Droplets containing infectious agents are generated when an infected

         person coughs, sneezes, or talks, or during certain medical procedures,

         such as suctioning or endotracheal intubation. Transmission occurs

         when droplets generated in this way come into direct contact with the

         mucosal surfaces of the eyes, nose, or mouth of a susceptible

         individual. Two examples of droplet transmissible infectious agents are

         the influenza virus which causes the seasonal flu and Bordetella

         Pertussis which causes pertussis (whooping cough).