OCCUPATIONAL HAZARDS ON HEALTH CARE WORKERS
Author: Shreyash Singhal, III year of B.A.,LL.B. from Kirit P. Mehta School of Law, Mumbai
Introduction
While providing health services, (preventive, curative, rehabilitative), health care workers (HCW) face hazards. Developments in medical science provide some safety, still modern technology has made health care very complex with many hazards. Biological (viruses, bacteria, and parasites) and chemical (disinfectants, drugs, and diagnostics) therapeutic modalities in health delivery are leading to many disorders in HCW. Needle prick injuries, radiation exposure, violence, psychiatric disorders, stalking by patients, and suicides are common. HCW are at high risk for musculoskeletal disorders, due to patient handling, compounded by increasing number of obese patients.
With increase in workload because of human immunodeficiency virus, hardships have increased. Health care industry around the world employ over43 million health workers in 2015, including 9.8 millionphysicians and 20.7 million nurses/midwives. [1]Health care workers define to be all peopleengaged in actions whose primary intent is to enhancehealth. They make important contributions and are criticalto the functioning of most health systems.Health care workers face a wide range of hazards on thejob; including needle stick injuries, back injuries, latexallergy, violence, and stress. Health-care workers (HCWs)need protection from these workplace hazards just asmuch as do mining or construction workers. Yet, becausetheir job is to care for the sick and injured, HCWs areoften viewed as“immune” to injury or illness. Theirpatients come first. They are often expected to sacrificetheir own well-being for the sake of their patients. Indeed,health protecting health-care workers has the addedbenefit to contribute to quality patient care and healthsystem strengthening.
The public health issue of occupational illness is a potential risk to the health of individuals exposed to an unhealthy environment. The Act for Occupational Health and Safety describes occupational hazard or illness as a condition arising from exposure to physical, chemical or biological agent in a workplace affecting normal physiological mechanisms and impairing health of the worker. Occupational hazard is any material, processes, activities or situations that can result in accidents or diseases at the workplace. Occupational illness develops after long exposure to ergonomic hazards, disease-causing bacteria and viruses, chemicals or dust over a period of time because of unhygienic and unhealthy conditions at workplace. Occupational health of musculoskeletal problems, blood borne diseases, tuberculosis, latex allergy, violence and work-related stress is neglected and considered a public health issue among healthcare workers in developing countries.Health problems among healthcare workers in hospitals can arise due to contact with chemicals and body fluids, accidents and absence of personal protective equipment. Occupational hazards among healthcare workers can largely be blamed on several issues within the healthcare system
Chances of hazards in health facilities are highly variable depending on type of health facility. Women represent 80% of the health workforce, so they are major sufferers, with effect on their reproductive health also. Nonfatal injuries and illnesses among the HCP are the highest of any industry. Even, agriculture and construction industries have become safer than health facilities. Prevention of infections, injuries, and violence all needs to be in place at health facilities. HCP are also the segment of society who are in need of guidance for prevention of substance use and therapy of substance abuse.
A National Institute for Occupational Safety and Health (NIOSH)report indicated that an estimated 600,000 to 800,000percutaneous injuries occur annually to HCWs. TheAssociation of Peri Operative Registered Nurses (AORN) says inits position statement on workplace safety, “Nurses practicing inthe perioperative environment are at distinct risk forpercutaneous injury due to prolonged exposure to open surgicalsites, frequent handling of sharp instruments, and the presenceof large quantities of blood and other potentially infectious bodyfluids.”Occupational hazards in the workplace have beenidentified as a major contributor to nurses leaving the profession,contributing to the growing nursing shortage.
Statement of purpose
The purpose of this study is to highlight some points regarding the occupational hazards on health care workers which is a neglected part of our society.
The research was based on a survey done on the local level by myself.
There is an interesting thing I came to know while surveying that not only healthcare workers are at risk of getting disease while curing the patient but also the attendant which came with the patient are at risk.
Review of literature
Keep health workers safe to keep patients safe by WHO
This article talks about the 5 steps to improve health worker safety and patient safety which are:
Establish synergies between health worker safety and patient safety policies and strategies
Develop and implement national programmes for occupational health and safety of health workers
Protect health workers from violence in the workplace
Improve mental health and psychological well-being
Protect health workers from physical and biological hazards
In addition to the Health Worker Safety Charter, WHO has also outlined specific World Patient Safety Day 2020 Goals for health care leaders to invest in, measure, and improve health worker safety over the next year. The goals are intended for health care facilities to address five areas: preventing sharps injuries; reducing work-related stress and burnout; improving the use of personal protective equipment; promoting zero tolerance to violence against health workers, and reporting and analysing serious safety related incidents.
Controlling Health Hazards to Hospital Workers
This report summarizes the control methods to eliminate or reduce healthhazards in hospitals. More than 300 papers were reviewed and more than 150control methods with an emphasis on engineering or substitution were identified.We compiled a summary of studies that were performed to evaluate the efficacyof these controls. The summaries were done to make the information easily accessible to health and safety professionals, hospital administrators, and employeesand union representatives working in healthcare settings. The information inthis report can be used as a way to select and implement solutions to more than30 health hazards that are common in hospitals and other healthcare settings.
Occupational Safety and Health Administration
The article deals with 4 questions regarding the occupational hazards.
What is healthcare?
What types of hazards do workers face?
Other than doctors and nurses, what workers are exposed?
Objectives
To analyse what problems faced by healthcare workers?
To analyse the consequences of occupational hazards for Healthcare Worker.
To suggest some preventive solutions for overcoming the Hazards.
Research Questions
What are the types of occupational hazards?
What are the types of interactions occurring at work place?
Budget allocation on healthcare sector?
Types of diseases due to biological Hazards?
Prevention from these hazards?
Hypothesis
The main drug in medicine is the doctor himself but no one is there for oneself.
Analysis
Healthcare sector requires highly skilled human resources from doctors to other medical support stafflike nurses, lab technicians, pharmacists, etc. The physician’s ratio in India stands at 0.7 per 1000population while this ratio for countries like China and OECD is at 1.9 and 3.2, respectively. Moreover,majority of the healthcare professionals happen to be concentrated in urban areas where consumershave higher paying power, leaving rural areas underserved.The Government of India approved continuation of 'National Health Mission' with a budget of Rs. 37,130 crore (US$ 5.10 billion) under the Union Budget 2021-22.
The year2014 marked a remarkable moment in the Indian Public Healthcare system with the World HealthOrganization (WHO) declaring India a polio-free nation. India was only the fourth such region in theworld after the Americas (1994), the Western Pacific Region (2000) and the European Region (2002).
Occupational hazards are risks of illnesses or accidents in the workplace. In other words, hazards that workers experience in their place of work. An occupational hazard is something unpleasant that a person experiences or suffers as a result of doing their job. Some dictionaries say that the term also includes hazards that people experience as a result of working on their hobbies.
There are many types of occupational hazards, some of them are listed below:
Physical Hazards
Biological
Chemical
Psychosocial
PHYSICAL HAZARDS
Physical hazards may be factors, agents, or circumstances that can cause harm without or with contact. We classify them as either environmental or occupational hazards.
Radiation, heat and cold stress, vibrations, and noise, for example, are types of physical hazards. Physical hazards cause injuries and illnesses in several industries. In some industries, such as mining and construction, they are unavoidable.However, over time, we have developed safety procedures and methods to minimize the risks of physical danger in people’s place of work.
BIOLOGICAL HAZARDS
Biological hazards or biohazards refer to biological substances that threaten the health of human beings and other living organisms.This type of hazard may include samples of a toxin of a biological source, a virus, or a microorganism. Specifically, samples that harm human health.
CHEMICAL HAZARDS
Chemical hazards are occupational hazards that exposure to chemicals in the workplace may cause. Victims can suffer acute or long-term negative health effects.There are hundreds of hazardous chemicals, including immune agents, dermatologic agents, carcinogens, neurotoxins, and reproductive toxins. Asthmagens, sensitizers, and systemic toxins are also hazardous chemicals.
“Long-term exposure to chemicals such as silica dust, engine exhausts, tobacco smoke, and lead (among others) have been shown to increase risk of heart disease, stroke, and high blood pressure.”
PSYCHOLOGICAL HAZARDS
Psychosocial hazards are occupational hazards that affect employees’ psychological health. These hazards affect their ability to take part in a work environment with other colleagues.
Psychosocial hazards are associated with how the work was designed, organized, and managed. They are also related to the social and economic contexts of the work. Patients suffer psychological or psychiatric injury or illness. Some also suffer physical injury or illness.Workplace violence and occupational stress, for example, are psychosocial hazards.
PREVENTION FROM THESE HAZARDS
Measures for health protection of workers are enlisted below:
Nutrition
Communicable disease control
Environmental sanitation
Water supply
Handwash after every act
Food
Toilet
Proper garbage & waste disposal
General plant cleanliness
Sufficient space
Lighting
Ventilation
Mental health
Measures for women and children
Family planning services
Health education
Reduce the number of injections by providing oral medication
Single-use needles designed to retract or cover the sharp end immediately after use (Safety Needles)
Use puncture-resistant waste boxes for discarding sharp items and needles
Limit number of staff members caring for a patient with certain illnesses like Tuberculosis or MRSA
Strict adherence to Standard Precautions/Routine Practices
Gloves should be:
Discard and change between patients
Use only once or disinfect 2-3 times maximum
Gowns should be:
Use if spills/splashes are possible
Change between patients
Eye goggles or face shields should be worn if spills are possible
Masks and respirators
N95/FFP respirators with a tight face seal used if a risk of exposure to airborne pathogens
When not available, use surgical masks
Repeat the examination periodically of HCW’s
Provide vaccinations for all non-immune HCWs against the following diseases
Hepatitis B, Influenza, Mumps/Measles/Rubella/Varicella/Pertussis, Poliovirus, Tetanus, Diphtheria (as a routine adult vaccination)
The 2017 policy aims to project an incremental assurance-basedapproach that expounds on the need for a new health policy to account for changing priorities inIndia’s abysmal healthcare delivery system.This involves building a more ‘robust health care industry’,reducing ‘catastrophic expenditure’ in the form of out-of-pocket healthcare costs and enhancing ‘fiscalcapacity’ to meet a widening healthcare financing deficit. Some of the specific goalsand objectives as laid out by the policy are:
Increase Life Expectancy at birth from 67.5 to 70 by 2025.
Reduce infant mortality rate to 28 by 2019.
Increase utilization of public health facilities by 50% from current levels by 2025.
Meet need of family planning above 90% at national and sub national level by 2025.
Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
Increase health expenditure by Government as a percentage of GDP from the existing 1.15 percent to 2.5 percent by 2025.
Increase State sector health spending to > 8% of their budget by 2020.
Establish primary and secondary care facility as per norms in high priority districts (population as well as time to reach norms) by 2025.
Ensure district-level electronic database of information on health system components by 2020.
Strengthen the health surveillance system and establish registries for diseases of public health importance by 2020.
Establish federated integrated health information architecture, Health Information Exchanges and National Health Information Network by 2025.
Conclusion
This study highlights that half of respondents had experienced an occupational health hazard, mostly sharp relatedinjuries and stress. The likely predictors for both biologicaland nonbiological hazards were not wearing all the necessarypersonal protective equipment, were working overtime, and were job related pressures. In addition, nonbiological hazardswere predicted by working in multiple health facilities. The mitigation measures to control the hazards were mainly availing waste disposal facilities for the medical waste and provision of safety tools and equipment.
Long working hours results inprolonged exposures to hazards and limited recovery timewhich translates into physiologic depletion thatcontinues to the next workday. Other studies have shownthat working long hours is also associated with adverse health effects and unhealthy behaviours. This modeof work has also raised concern about patient safety.
The industry faces major challenges owing to the changing demographics of the country, the poor state of the public infrastructure, lack of financial resources, paucity of human capital and poor governance. The staggeringly low contribution of the public sector in the healthcare industry sits at the centre of all these problems. While the National Health Policy tries to address the majority of these challenges, it lacks significantly in terms of the feasibility of implementation and also inadequate finances.While the initiatives of the government sound extremely ambitious, it seems more like a “repackaged” version of the social security scheme of 2016. The major reasons why most of the healthcare policycommitments of the Indian Government have failed to translate into results have been inadequatebudgetary allocation as well as lack of coordination between the centre and the states in the planningprocess, leading to inefficient spending. The budgetary allocation of Rs 52,800 Crores for healthcarein 2018-19 was only 5 percent higher than the revised estimate of Rs 50,079.6 Crores in 2017-18. Thisfalls way short of a year-on-year increase of 20 percent needed to meet the target of governmenthealth spend at 2.5 percent of the GDP by the year 2025.
All said and done, it may not be very accurate to directly compare the Indian situation with any of theother countries in the world given its huge population, unique demographics and democraticgovernance. We need our own solutions to our own problems which are best suited to our populationand our systems.
[1]WHO (2014) Global strategy on human resources for health: Workforce 2030, WHO Library Cataloguing-in-Publication Data 1-64. https://www.who.int/home/cms-decommissioning