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INTRODUCTION

Healthcare facilities are among the most complex workplaces.

Unique occupational risks because healthcare workers are routinely exposed to:

Infectious microorganisms.
Hazardous chemicals
Sharps injuries
Physical stressors (Radiation, noise, heat)
Heavy workloads.
Long working hours.
Stressful situations.

If OHS systems fail, the consequences may include:

Occupational diseases.
Workplace injuries.
Healthcare associated infections.
Staff shortages.
Reduced quality of care.
Increased healthcare costs.
Reduced staff moral.

Important OHS should be integrated into every Infection Prevention and Control programme.

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SCOPE

What is Occupational Health and Safety?

Relation between OHS and Infection Prevention and Control.

Why OHS matters?

Principles of OHS.

Common occupational hazards in healthcare.

The Environmental Health Practitioner’s role.

OHS risk assessment.

What is a hazard?

What is a risk?

Hierarcy of controls.

Reporting hazards.

Root cause analysis.

OCCUPATIONAL HEALTH AND SAFETY RISK ASSESSMENT

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SCOPE (Cont….)

Safety Committees.

OHS Committees.

Occupational Health and Safety Management System (OHSMS).

Components of OHSMS.

OHS Policy.

Roles and responsibility of OHS Committee.

Workplace investigation.

OHS audits,

OHS performance indicators

Integrated OHS with Infectious Preventive and Control

Environmental Health perspective.

Environmental Health Leadership

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WHAT IS OCCUPATIONAL HEALTH AND SAFETY?

OHS is the multidisciplinary field concerned with protecting workers from hazards arising in the workplace.

Its objectives are to:

Prevent occupational injuries.
Prevent occupational diseases.
Promote physical and mental well-being.
Maintain safe workplaces.
Improve productivity.
Reduce absenteeism.
Promote a positive safety culture.

In healthcare, Occupational Health and Safety extends beyond protecting employees. Also protects patients, visitors and the surrounding community.

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RELATIONSHIP BETWEEN OHS AND INFECTION PREVENTION AND CONTROL?

OHS and Infection Prevention and Control share many common objectives

OHS

Protects healthcare workers.

Prevents occupational injuries.

Reduces workplace hazards.

Promotes safe work practices.

Supports legal compliance.

Improves staff well-being

INFECTION PREVENTION AND CONTROL

Protects patients, staff and visitors.

Prevents transmission of infectious diseases.

Reduces healthcare associated infections.

Promotes safe clinical practices

Supports quality health care.

Improves patient outcomes.

Both disciplines rely on:

Risk assessment.
Hazard identification.
Safe work practices.
Education and training.
Continuous monitoring.
Leadership commitment.
Quality improvement

Creates a safer healthcare environment

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WHY OCCUPATIONAL HEALTH AND SAFETY MATTERS

An effective OHS program will:

Protect healthcare workers.

Improve patient safety

Reduce healthcare costs.

Improve organizational performance.

PRINCIPLES OF OCCUPATIONAL HEALTH AND SAFETY

An effective OHS program is based on the following principles:

Prevention.

Risk assessment.

Leadership commitment.

Work participation.

Continuous improvement.

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COMMON OCCUPATIONAL HAZARDS IN HEALTHCARE

Five categories, namely:

Biological hazards.

Chemical hazards.

Physical hazards.

Ergonomic hazards.

Psychosocial hazards.

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THE ENVIRONMENTAL HEALTH PRACTITIONER’s ROLE

Environmental Health Practitioners contribute significantly to OHS by:

Conducting workplace inspections.

Performing environmental risk assessments.

Investigating occupational incidents.

Advising management.

Monitoring environmental hazards.

Supporting Infection Prevention and Control Programmes.

Promoting safe work environments.

Delivering staff education.

Participating in multidisciplinary OHS Committee.

Monitoring compliance with OHS policies.

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OCCUPATIONAL HEALTH AND SAFETY RISK ASSESSMENT

Risk assessment is the cornerstone of every OHS program.

Risk assessments not possible if workplace hazards are not understood NO PREVENTIVE MEASURES.

Risk assessments should be conducted:

Before introducing new equipment or procedures.

Changes in workplaces.

Following occupational incidents.

Following outbreaks.

During routine inspections.

Regular planned intervals.

RISK ASSESSMENT IS A CONTINUOUS PROCESS

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WHAT IS A HAZARD?

Hazard = anything with the potential to cause harm.

In a healthcare establishment:

Infectious microorganisms.
Chemicals.
Radiation.
Sharps.
Slippery floors.
Poor ventilation.
Faulty electrical equipment.
Manual handling.
Stress.

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WHAT IS A RISK?

Risk = The probability [Likelihood] that injury or damage will occur.

Steps in a risk assessment:

Step 1 – Identify hazard.

Workplace inspections.
Staff interviews.
Incident reports.
Safety audits.
Maintenance reports.
Infection Prevention and Control surveillance.
Environmental monitoring

Step 2 – Identify who may be harmed

Consider:

Healthcare workers.
Patients.
Visitors.
Students.
Contractors.
Waste handlers.
Laboratory personnel.
Cleaning staff

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WHAT IS A RISK? (Cont….)

Step 3 – Evaluate the risk

Evaluate:

The likelihood of the event occurring.
The potential severity of harm.
Existing control measures.
Whether additional controls are required.

Risk matrix can be used:

CALCULATION: P + C – M = Scoring

Probability	Consequence	Mitigation
Will a risk take place (1-6)	What the outcome will be if risk take place (1-6)	What control methods are in place (1-6)

Scoring
1-3	Low
4-5	Moderate
6-8	High

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WHAT IS A RISK? (Cont….)

Step 4 – Implement control measures

Appropriate controls should be implemented according to the Hierarchy of Controls

Step 5 – Monitor and review

Risk assessments should be reviewed:

After Incidents.
Following outbreaks.
When procedures change.
Following renovations.
During routine inspections.
Annually, or more frequently where required.

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HIERARCHY OF CONTROLS

Control measures should be implemented in the following order:

Elimination. If possible, remove the hazard completely.

Substitution.

Use of safer medical devices.
Replace highly hazardous chemicals with less hazardous chemicals.
Using equipment/machinery minimizing ergonomic problems.

Engineering controls.

Negative-pressure isolation rooms.
Biological safety cabinets.
Sharps disposal containers.
Backflow prevention devices.

Administrative measures.

Standard Operating Procedures.
Education and training of staff.
Rotating staff to reduce exposure.
Cleaning schedules.

Personal protective equipment.

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REPORTING HAZARDS

Healthcare workers should report:

Unsafe work practices.
Damaged equipment.
Sharps injuries.
Chemical spills.
Slippery floors.
Defective PPE.
Poor ventilation.
Near misses.

Prompt reporting addresses the hazards before injury(ies) occur.

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ROOT CAUSE ANALYSIS

When investigating incidents, ask:

What happened?

Why did it happen?

Which system failed?

Were procedures followed?

Were adequate resources available?

How can recurrence be prevented?

The aim is to improve systems AND NOT TO BLAME INDIVIDUALS.

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SAFETY COMMITTEES

Healthcare facilities should establish OHS Committee to:

Review incidents.

Monitor workplace hazards.

Review audit findings.

Recommend improvements.

Promote worker participation.

Monitor corrective actions.

EHP’s are important members of these committees.

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OCCUPATIONAL HEALTH AND SAFETY COMMITTEES

Committee members may include:

EHP.
Occupational Health Practitioner.
Infection Prevention and Control Practitioner.
Nursing representatives
Medical Practitioners
Engineering representatives.
Human Resources.
Employee representatives.
Quality Assurance personnel.
Facility Management

Committee should meet regularly to review OHS performance and monitor improvement plans.

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PRACTICAL: ENVIRONMENTAL HEALTH PERSPECTIVE IMPLEMENTING A RISK ASSESSMENT

EHP observes that housekeeping staff experiencing repeated slips in the hospital’s sluice rooms.

Investigation. Smooth floor surfaces. Inadequate draining. Delayed cleaning of spills.

Risk assessment. Using risk matrix to determine risk category = HIGH

Control measures.

Elimination. Repair leaking plumbing.

Substitution. Replace slippery floor coating with a slip-resistant surface.

Engineering controls. Improve drainage and install floor gradients.

Administrative measures. Warning signs and immediate spill response procedures.

PPE. Slip-resistant footwear.

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OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT SYSTEM

OHS managed through a structured management system rather then through isolated safety activities.

OHSMS systematic framework:

identifying hazards,
controlling risks,
monitoring performance and
continually improving workplace safety.

Effective OHSMS should be integrated with:

Infection Prevention and Control Programmes
Environmental Health Programmes.
Quality Improvement Programmes.
Risk Management Programmes.
Human Resources.
Engineering and Maintenance Programmes.

OHS is an organizational responsibility and NOT THE RESPONSIBILITY OF ONE DEPARTMENT

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COMPONENTS OF AN OCCUPATIONAL HEALTH AND SAFETY MANAGEMENT SYSTEM

Effective OHSMS should include:

Occupational Health and Safety policy.

Defined roles and responsibilities.

Hazard identification.

Risk assessment.

Safe work procedures.

Incident reporting.

Emergency preparedness.

Occupational health surveillance.

Education and training.

Performance monitoring.

Auditing.

Continuous improvement.

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OCCUPATIONAL HEALTH AND SAFETY POLICY

Every healthcare facility should have a written OHS Policy.

The policy should demonstrate management’s commitment to:

Protecting employees.

Preventing occupational injuries.

Preventing occupational diseases.

Promoting safe work practices.

Complying with legislation.

Continual improvement.

All employees must be educated iro the policy. Policy must be reviewed on a regular basis.

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ROLES AND RESPONSIBILITIES

OHS requires the participation at every level of the organization.

Senior Management

Senior management should:

Demonstrate leadership.
Allocate sufficient resources.
Establish OHS objectives.
Monitor programme performance.
Support a positive safety culture.

Leadership commitment is essential for programme success.

Supervisors and Department Managers

Managers should:

Ensure safe work practices.
Conduct routine inspections.
Support staff training.
Investigate incidents.
Monitor compliance.
Encourage reporting of hazards.

Managers responsible for implementing OHS within their departments

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ROLES AND RESPONSIBILITIES (Cont….)

Healthcare workers

Healthcare workers should:

Work safely.
Follow procedures.
Wear appropriate PPE.
Report hazards.
Report incidents.
Participate in training.
Protect themselves and others.

Environmental Health Practitioners

EHP’s provide specialist expertise by:

Conducting workplace inspections.
Performing environmental risk assessments.
Advising management.
Monitoring environmental hazards.
Supporting Infection Prevention and Control.
Investigating environmental incidents.
Conducting audits.
Promoting continuous improvement.

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WORKPLACE INSPECTIONS

Routine workplace inspections are essential for identifying hazards before injuries occur.

Inspections should access:

Housekeeping.
Ventilation.
Lighting.
Floors.
Emergency exits.
Waste management.
Sharps disposal.
Chemical storage.
PPE availability.
Fire safety.
Ergonomic risks.

Inspection findings should be documented and corrective actions monitored.

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OCCUPATIONAL HEALTH AND SAFETY AUDITS

Audits differ from inspections.

Inspections identify hazards, audits evaluate whether the OHS Management System is functioning effectively.

Audits should review:

Policies.
Procedures.
Training records.
Risk assessments.
Incident reports.
Inspection reports.
Occupational health surveillance.
Corrective actions.

Audits support continual improvement.

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OCCUPATIONAL HEALTH AND SAFETY AUDIT TOOL

Audit item	Yes	No	Comments
OHS Policy available
Risk assessments current
Workplace inspections conducted
Incident investigations completed
Staff training records available
PPE available and appropriate
Emergency procedures displayed
Occupational health surveillance implemented
Corrective actions monitored
Management reviews conducted

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OCCUPATIONAL HEALTH AND SAFETY PERFORMANCE INDICATORS

Performance indicators allow healthcare facilities to measure programme effectiveness.

Performance indicators should be reviewed regularly by management.

Indicators	Example measure
Occupational injuries	Number per month
Lost-time injuries	Number per year
Needle-stick injuries	Number reported.
Staff training	Percentage completed
Workplace inspections	Percentage completed as scheduled
Risk assessments	Percentage reviewed annually
PPE compliance	Audit compliance score
Incident investigations	Percentage completed within required timeframe
Corrective actions	Percentage completed on time
Staff participation	Number of hazards reported

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OCCUPATIONAL HEALTH SURVEILLANCE

Occupational health surveillance monitors workers who may be exposed to specific workplace hazards.

Surveillance programmes may:

Pre-placement medical assessments.
Periodic medical examinations.
Tuberculosis screening.
Hepatitis B vaccination.
Respiratory health monitoring.
Hearing assessments.
Vision screening.
Monitoring following occupational exposure (OREP)

Occupational health surveillance assist with early detection of work-related illnesses.

Performance indicators should be reviewed regularly by management.

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INTEGRATING OCCUPATIONAL HEALTH AND SAFETY WITH