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Occupational safety and health

CHAPTER ONE

1.0/1.1 INTRODUCTION

General Introduction/background of Clinic Darne Fortis

Clinique Darne is situated in Florealand is one of the leader and prehistoric, yet among one of the modern medical centers inMauritius. Founded in April 1953 byDr Francois Darne, highly respected surgeon, the clinic at the very start had only 12 rooms and one operating theatre.

The clinic now is an impressive building on a site extending over 3 acres. It offers a wide range of high quality medical, surgical and clinical support: cardiology, urology, general surgery,IVF centre, physiotherapy, ophthalmology, neurology. Furthermore the high-tech laboratory allows analysis of a comprehensive number of tests in various fields such as haematology, bacteriology, biochemistry, immunochemistryamong others. As a whole, the only mission of the dedicated personnel is to provide a professional health services in a caring and friendly environment. The clinic operates on a 24 hr basis. Thus providing a better service to the nation.

[Quoted from http://www.cliniquedarne.com/]

1.2: Floreal District

Floreal,a suburb northwest of Curepipe has become synonymous with the high quality knitwear produced by the Floreal Knitwear Company.Floreal offers great shopping opportunities such as textiles,jewelers,home decor articles, ship models,shoes and tailor made clothes.

Floreal is a quiet and peaceful village, offers many villas with flowered gardens in green surroundings. Most of the Ambassador resides in the Vacoas/Floreal area in the central plateau within a few minutes of Curepipe,one of the island's main shopping districts and 30 minutes to the capital Port Louis.

Stratefically situated Fortis Clinique Darne in Floreal is one of the leaders and oldest,yet most modern medical centres in Mauritius,combining traditions of dedicated personal care and modern,hi-tech facilities. Founded in April 1953 by Dr Francois Darne,a highly respected surgeon, the clinic initially had a capacity of 12 rooms and three operating theatre.Today Clinic Darne is playing an important role in the medical tourism sector and is considered as one of the prestigious clinic.

1.3: Geographic location of clinic Darne

1.4: Climate

Nestled in a district called Floreal, Clinic Darne really indicates its freshness and cold atmosphere it prevails on the people over there and around the surroundings. It is situated in a clear and calm atmosphere which is the most important factor a clinic must provide to each of his or her patient. A calm and clean environment also represents a healthy environment for the staffs as well.

The clinic is situated at Guiy street Floreal.It is a renowned clinic where it accommodates more than 50 patients per day. It opened its door on April 1953.It is far away from the hassle and bustles of the busy Floreal region where there are a number of people busy with shopping or with their working transactions as well as roaming around to see the beauty of the district.

CHAPTER TWO

1.5 LITERATURE REVIEW

1.5.1The Occupational Safety and Health Act 2005(Quoted from OSHA 2005)

2.1.2 Duties of employers

2.1.3 Duties of employers regarding Safety and Health Officers

The employer shall provide to every Safety and Health Officer sufficient time and adequate resources to enable him to discharge his duties. [OHSA.2005]

2.1.4 Duties of employees

Every employee shall, while at work -

35.Cleanliness

(1)Every employer shall keep every place of work in a clean state and free from effluvia arising from any drain or sanitary convenience or any other nuisance.

(2)Without prejudice to the generality of subsection (1), the employer shall cause -

(a)accumulation of dirt, refuse or trade waste to be removed daily from the floors and benches of workrooms and from the staircases and passages;

(b)the floor of every workroom to be cleaned at least once every week; and

(c)all inside walls and partitions and all ceilings, and all walls, sides and tops of passages and staircases to be kept clean, and unless they have a smooth impervious surface, to be properly painted or otherwise kept properly decorated.[OHSA.2005]

36. Overcrowding

(1)A place of work shall not, while work is carried on therein, be so overcrowded as to cause risk of injury to the health of the employees.[OHSA.2005]

37.Ventilation and temperature

(1)Effective and suitable provision shall be made for securing and maintaining the adequate ventilation of every workroom by the circulation of fresh or artificially purified air of suitable temperature and relative humidity and for rendering harmless, so far as is practicable, all impurities generated in the course of any process or work carried on in the workroom as may be injurious to health. [OHSA.2005]

39.Sanitary conveniences

  1. In any building where work is carried on, sufficient and suitable sanitary conveniences for the employees shall be provided.
  2. Where persons of both sexes are or are intended to be employed, there shall be provided for each sex -
    1. separate accommodation for the sanitary conveniences;
    2. separate approaches to the sanitary conveniences; and
    3. a notice conspicuously placed indicating the location of the sanitary conveniences.
  3. Every sanitary convenience shall be sufficiently lighted and ventilated and shall not communicate with any workroom, restroom or mess except through an open or through an intervening ventilated space. [OHSA.2005]

40.Supply of drinking water

(1)There shall be provided and maintained at suitable points conveniently accessible to all employees an adequate supply of wholesome drinking water.

(2)Where the supply of drinking water is not a supply of running water, it shall be contained in suitable vessels and shall be renewed at least daily, and all practicable steps shall be taken to preserve the water and vessels from contamination at any time.

(3)All containers or vessels containing harmful liquids which may be confused with drinking water or other beverages shall be clearly marked to indicate their contents or marked with a warning sign. [OHSA.2005]

45.Provisions for first-aid

(1)Every employer shall provide such equipment and facilities as are adequate and appropriate in the circumstances for enabling first-aid to be rendered to his employees if they are injured or become ill at work.

(2)Every employer shall provide such number of suitable persons as is adequate and appropriate in the circumstances for rendering first-aid to his employees if they are injured or become ill at work. [OHSA.2005]

73.Electrical installations

All electrical apparatuses and conductors, including machines, equipment and fittings, shall be sufficient in size and power for the work for which they are used, and shall be so constructed, installed, protected, worked and maintained as to prevent danger. [OHSA.2005]

74.Prevention of fire

(1)In every building there shall be provided and maintained, so as to be readily accessible, means of extinguishing fire, which shall be adequate and suitable having regard to the circumstances of the premises and the process, as required by the Fire Services. [OHSA.2005]

1.5.2 Occupational Hazards

Clinic as well as Hospital presents numerous hazards in common with other complex employment settings and industries as well as having some unique hazards. A great variety of jobs are performed in health care facilities including: direct patient care, laboratory and research work,laundry,food preparation,trades,security work, waste disposal ,driving, office and library work, housekeeping and maintenance and pharmacy.

The myriad of occupational hazards to which hospital workers may be exposed can be classified into five broad categories:

1. Biological Hazards

Biological hazards are contagious agents such as bacteria,viruses,fungi or parasites which may be transmitted via contact with infected patients or contaminated objects, body secretions, tissue, or fluids. Health care workers, mostly those in hospital settings, are regularly exposed to biological or infectious agents.

In the workplace both Hepatitis (HBV) and Human Immunodeficiency Virus(HIV),can be spread by infected blood and body fluids when they are in direct contact with the inside of the mouth, the eye or with broken,scraped,chapped or inflamed skin. The exposure of greatest apprehension, however is when the skin is broken by a contaminated object such as a needle or a scalpel.

"Universal Precautions" should be established in any care setting where the exposure to blood and body fluids is possible. Their objective is to eliminate or reduce the risk of transmission of blood-borne pathogens. Because patients infected with HBV or HIV cannot always be reliably identified, blood and body fluid precautions should be used with all patients.

Table 1 provides a list of some other infectious agents or diseases to which health care workers may be exposed. Most institutions have infection control policies. Although usually developed to prevent the spread of infection to patients, these policies should also cover health care personnel. Such policies could include directives for worker training,immunization,cleanliness,disinfecting and sterilizing equipment, treatment of infective waste, housekeeping and processing laundry. Hand washing remains the single most important procedure for preventing the spread of infectious disease in health care settings.

Table 1:Pathogens and other

Mode of transmission

Infectious Agent/Disease

Blood and body fluids

Hepatitis B,Hepatitis C,Acquired Immunodeficiency Syndrome (AIDS)

Faeces

Hepatitis A,Salmonella

Virus shedding in urine and stool

Rubella

Contact with infected skin lesions

Scabies

Respiratory secretions

Rubella,measles,Mumps,influenza,Respiratory syncytial virus(RSV)

2. Chemical Hazards

Several chemicals found in Clinic may be toxic or irritating to body systems. They may be present as dusts,vapours or gases or liquids and they may be medications and other substances used for therapeutic purposes. Chemicals can enter the body through contaminated food or cigarettes, absorption through the skin, inhalation or by accidental needle stick. The major routes of entry are by inhalation or skin absorption.

Exposure does not always produce adverse health effects. Chemicals for which there is little or conflicting information about potential toxic effects should be treated as toxic. Toxic chemicals are best dealt with by preventing worker exposure. This can be done by identifying the chemicals, considering their toxic properties and potential health effects and implementing control measures.

Table 2 lists a number of toxic chemicals commonly used in clinic and the types of staff most likely to be exposed to them.

Table 2:Chemical Agents commonly found in the Clinic Environment

Employees potentially exposed

Selected chemical agents

Central supply workers

Cleaning and sterilizing agents

Dietary & Housekeeping staff

Insecticides,detergents,solvents

Laboratory technicians

Tissue fixatives and reagents

Maintenance & facilities workers

Solvents, insecticides

Nurses

Solvents, Medications

Operating room staff

Anesthetic agents

Pharmacists

Medications and anticancer agents

3. Ergonomic and Safety Hazards

Ergonomic and safety hazards cause or worsen accidents,injuries,strain or discomfort. Ergonomic is the application of scientific knowledge to the design of the environments,tools,workstations and the content of work to suit the mental and physical limitations and capabilitites.Work environments and procedures that incorporate ergonomic principles can anticipate accidents and avert injury and error. Health care safety hazards include: slippery floors, cluttered hallways or blocked exits, explosive gases used in laboratories and operating rooms, various power tools and other maintenance equipment, sharp utensils and instruments and materials handling.

One of the most common and severe hospital injuries is musculoskeletal injury, particularly of the lower back. The most frequent time loss injury was to the back resulting from overexertion while moving objects or handling patients. Approaches to reducing back injury and disability must be comprehensive and involve ergonomic strategies,education,early and aggressive injury treatment and appropriate rehabilitation programs.

Violence against health care workers is an emerging occupational hazard. Preventing injury from aggressive acts starts when the employer acknowledges that the potential for violence exists. There must be strong management commitment to violence prevention programs. Strategies should encompass workplace design; patient care approaches to reduce anger, frustration and agitation; staff training on recognition and interventions for potentially violent situations; and support systems for workers who do experience a violent event.

4. Physical Hazards

Ionizing and non ionizing radiation,electricity,noise and heat are examples of physical hazards found in hospitals.Ionising radiation is used in diagnostic procedures such as x-ray,fluoroscopy and angiography, and in treatment using radioactive implantations or injections.Cummulative and long- term health effects include genetic damage and adverse reproductive outcomes. The risks of long term low level exposure to ionizing radiation are not fully known. Measures to minimize exposure include maximizing distance between the radiation source and the worker, using appropriate shielding and minimizing exposure time. Special attention should be given to the maintenance of portable fluoroscopy and x-ray equipment which may scatter radiation during procedures.

Excessive noise and heat are commonly found in kitchens, laundries and boiler rooms.Cold,heat and sunlight are hazards for grounds and building maintenance personnel. Permanent hearing loss can result from long term exposure to noise in excess of 80 decibels. At lower levels, noise from equipment,alarms,conversation and other sources can impede communication and interfere with concentration.

5. Psycho-social Hazards

Many factors in the hospital environment can affect the psychological and social well-being of workers. Examples of work organization which can have adverse impact on workers include: little decision making latitude, excessive job demands, role ambiguity, poor management ability, inadequate resources and shiftwork.Rotating shifts and night work can have a negative impact on general well being and performance because of the constant disruption of an individual's biological clock. Shift work can also negatively affect workers' social roles. Combative patients, terminally ill patients, and co-workers or managers are also stressors. The current economic climate in clinic can create excessive workload demands and a sense of insecurity at work.

6. Fire Hazards

For a fire to start, three things are needed:

If any one of these is missing, a fire cannot start. Taking steps to avoid the three coming together will therefore reduce the chances of a fire occurring.

Possible sources of heat(ignition) in a clinic are:

Possible sources of fuel(anything that burns) at the clinic are:

[Quoted from MFL Occupational Health Centre, Inc, February 1995]

1.5.3: Chronobiology-Night work and shift work

Chronobiology is that branch of the life sciences which tries to objectively quantify and explore the mechanisms of biological time including the important rhythms of life.Chronobiology is time related biological related activities.Chronobiology is most commonly practiced in Clinic. Shift work is a reality for about 30% of the Mauritian working population. Nurses such as health care providers are obliged to work during the day and during the night to cater for the needs of sick people thus having a negative impact on the individual's health ability to function thus affecting the services provided.

There are three shift work which are:

The nurse's health study found that women who worked night shifts at least three times per month for 15 years or more had a35% greater risk for intestinal cancer, including 41% greater risk of right colon cancer, 22% greater risk of left colon cancer, and 51% greater risk of rectal cancer than women never worked rotating night shifts. (Brigham and women's hospital, 2003)

Some of the health problem associated with the clinic Darne nurses staffs are:

  1. Disturbance of sleeping habits
  2. Disturbance of eating habits
  3. Gastro-intestinal disorders
  4. Neuro-psychic functions
  5. Cardiovascular problems

Occupational sicknesses among night workers are:

  1. Weariness
  2. Mental irritability
  3. Moods of depression
  4. Loss of vitality and disinclination to work
  5. Unhealthy eating habits
  6. Psycho somatic disorders(loss of appetite, disturbance of sleep, and digestive troubles)

1.5.4 Psychological stress work

Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources or needs of the worker. Job stress can lead to poor health and injury (US NIOSH)

Nurses must live and work in a setting that is filled with stressors. Each one of these stressors threatens the nurse's sense of control. When control is threatened, or even lost, the nurse and stress management must become constant companions. Consider some of the stressors a nurse faces.

1.5.6 Biomedical waste

Clinic generates large amount of wastes that require disposal. These wastes are of different types. There are domestic wastes as well as clinical wastes. The domestic wastes comes mainly from the kitchen, waste foods and other wastes left by patients, and those wastes coming from the cleaning and maintaining of the clinic yard. Domestic wastes are mostly non-infectious. Clinical wastes exist both as infectious and non infectious and these wastes are generally very hazardous.

From the waste regulation 1988, clinical waste can be defined as:

The World Health Organization (WHO) has classified medical waste into different categories.Theseare:
Infectious: material-containing pathogens in sufficient concentrations or quantities that, if exposed, can cause diseases. This includes waste from surgery and autopsies onpatientswithinfectiousdiseases;
Sharps: disposable needles, syringes, saws, blades, broken glasses, nails or any other itemthatcouldcauseacut;
Pathological: tissues, organs, body parts, human flesh, fetuses, blood and body fluids;
Pharmaceuticals: drugs and chemicals that are returned from wards, spilled, outdated,contaminated,orarenolongerrequired;
Radioactive: solids, liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter; and
Others: waste from the offices, kitchens, rooms, including bed linen, utensils, paper, etc.

Of these wastes, the infectious clinical wastes are those which are contaminated with pathogenic microorganisms and which can transmit diseases to people.Wastes are burnt in the incinerator by the use of electricity formerly done by the clinics servants which mostly have not received any on the job training. These people place the wastes in the incinerator and put on the flame. They use long wooden rods and also iron rods to overturn the wastes while burning. There are none of the protective personal equipments used such as boots or gloves or masks and moreover the incinerator is not equipped with fire extinguishers.

If clinic waste is not managed properly it proves to be harmful to the environment. It not only poses a threat to the employees working in the clinic, but also to the people surrounding that area. Under moist conditions likewise Floreal where it is raining everyday, mosquitoes transmit many times of infections, like malaria and yellow fever. Similarly dogs, cats and rats also transmit a variety of diseases, including plague and flea born fever, as they mostly live in around the refuse.

1.5.7 Manual Handling

Manual handling means any activity requiring the use of force exerted by a person to lift, lower, push, pull, carry or otherwise move, hold or restrain a person, animal or thing. Manual handling injuries are not limited to those sustained by lifting or carrying heavy loads. A person can be injured when handling objects in a variety of ways including pulling, pushing, holding or restraining. The object can be anything from an animal to a piece of equipment.


The Health Industry Classification Project (1997) reported the following as majorcontributors to nurse injuries:

Sprains and strains were the main types of manual handling injury. Of injuries to registered nurses, 40 per cent involved the back, 12 per cent the upper limbs, and 9per cent the lower limbs. Of injuries to enrolled nurses, 30 per cent were to the back and 17 per cent to the upper limbs. The bed was involved in nearly all patient-handling activities where injuries occurred, e.g. repositioning and transferring patients. The number of injuries was unrelated to the number of people participating in the patient lift. As many injuries occurred during team lifting as when the patient was lifted by one person. Very few injuries involved the use of mechanical lifting aids. The risk of manual handling injuries is exacerbated by a number of unpredictable variables. These include the fluctuating nature of physical illnesses, patient resistance to assistance, and, at times, a patient's medical condition, which may result in aggression towards staff. Although the statistics focus on the activities being carried out at the time of injury, it's important to understand that musculoskeletal disorders can be cumulative in nature and are often the result of multiple stresses and strains over time.

1.7 CHAPTER FOUR

OBSERVATIONS

1.7.1 Some of the protective devices worn by nursing staffs are:

[M.Mayntz, http://safety.lovetoknow.com/Medical_Protective_Clothing)

1.7.2 SAFETY CHECKLIST

1. Management role

Active participation and support from the Management and the Ministry of Health. A health and safety committee should be formed comprising of heads of department, a worker from each department of the hospital and a safety officer.

2. Identification of hazards:

3. Evaluation of hazards

Clinic hygiene monitoring can be done by the use of specific equipment as noisimeter for noise, flux meter for lighting. Infections can be monitored by the use of swabs from different sites from the clinic set up. These swabs are sent for a microscopic culture.

4. Development of a Health and safety policy which will include:

5. Health education and training

6. Program review

Previous results of periodic safety inspections, hygiene monitoring and medical surveillance to find patterns of hazards should be reviewed to measure success of health and safety program and to determine the effectiveness of controls.

These measures should be changed as new procedures and equipments are being introduced in the clinic environment, or by the identification of new hazards hence a new program should be set.

7. Reporting and record Keeping

Clinic staffs should be motivated to report all accidents and near misses in their working environment. These reports would help a lot in the monitoring of the working environment.

There should be a proper method of record keeping. Records should be also maintained for all results of surveys and clinic hygiene monitoring. Unfortunately it was prohibited to check any of the statistics at the clinic.

CHAPTER FIVE

1.8 RECOMMENDATIONS

Physical Hazards

1. Radiation Exposure

Some of the appropriate measures are:

2. Back injury

Hospital staff and particularly nurses are prone to back injury from the need to lift and roll immobilized or disabled patients for toilet, washing, dressing and pressure care. Hospitals are now required to give training on back care to all new staff.

3. Laser Burns

Lasers are now frequently used in Operating Theatres and appropriate protective equipment must be used, especially eye protection to prevent retinal burns.The use of this equipment is covered by sets of protocols.

Chemical Hazards

The hierarchies of principles for controlling chemical hazards are well documented and utilized within clinics:

Biological Hazards

If acute exposure to a biological hazard does occur, staff members need to be aware of relevant policies and procedures for appropriate management of the exposure. This will include:

Psychological Hazards

Clinics are stressful places for sick and injured patients and their families. However they can also be stressful for staff due to factors as:

Clinics are part of high demand, high expectation service industry and are heavily reliant on staff for the friendly, safe,effective and efficient delivery of services. To optimize productivity and attitude of staff, senior management must be committed to ensuring a conductive organizational climate with high staff morale.Clear priorities and direction, realistic performance goals and workloads, commitment to continuing education and quality assurance, reception to staff feedback and support with the counseling services for stressed staff are all important components.

Evacuation Plans for internal Emergencies

Well documented and rehearsed evacuation plans are required to ensure the safe evacuation of disabled, immobilized or otherwise helpless patients. In critical care areas this will include manual back up for life support systems.

CHAPTER SIX

1.9 CONCLUSION

After having analyzed the working environment of the different working areas in the previous chapters, I have reached to a conclusion that the health and safety aspects of work has moderately been taken into consideration at the Clinic Darne since most of the information was very confidential and I could not get an accurate evaluation of the working environment. Most of the working staffs are not fully aware of the potential hazards present in their working environment and the effects that these hazards may have on their health and safety.

While these are obvious differences between health care services and other industries, one must not forget that in all working environments, potential health hazards and risks are always present and that appropriate measures must be taken to reduce if not eradicate the effects of these hazards on the health of the workers. The most important barrier for such actions to be taken in a clinic is that clinic has been mistakenly assumed to be safe and healthy places of work.

There is need for the development of Health and Safety programs at the clinic to be able to identify and control occupational hazards. Personnel trained in occupational health and safety needs to be appointed for the designation, implementation and managements of such programs.

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