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Employee Safety (Occupational Health and Safety)

Hospitals are in fact small communities and have all the problems related to this type of environment, including automobile accidents, home accidents, etc. In addition, there are hazards related to the use of: various types of equipment; gases which are toxic, explosive, or carcinogenic, and may cause fires; a variety of chemicals found in various parts of the institution; and various procedures used in patient diagnosis and treatment. Excessive heat may be found in laundries, kitchens, boiler rooms, and furnace rooms. Poor lighting which may lead to accidents may be found in innumerable areas throughout the institution. High levels of noise may be created by a variety of situations. Radioactive material is used in various treatment and diagnostic situations. Research areas may become hazardous from animal contamination and other safety considerations such as slippery floors and specific problems related to disease being studied by research staff. Fires are a constant threat due to potential breaks in procedure in housekeeping as well as the use of electrical appliances throughout the institution, flammable liquids, heating units, explosive materials, paint storage areas, compressed gases, etc.

Employee safety in the healthcare setting is complicated by a wide range of hazards including sharps injuries, back injuries, latex allergies, violence, and stress. Sharps expose healthcare workers to blood-borne pathogens. Reproductive risks may be associated with cleaning and decontaminating materials, laboratories, x-ray rooms, pharmacy, various chemotherapies, and specialized antibiotics.

Musculoskeletal injuries occur in patients and healthcare workers because of the job demands, workload, physical factors, and health conditions of the individuals. Back injuries occur primarily because of improper lifting of patients who may be too heavy, lifted improperly, combative, agitated, totally unable to lift himself/herself because of a lack of upper body strength, and have a physical condition which needs special types of lifting. Slips, trips, and falls which are the second most common cause of employee injuries in hospitals may occur throughout the institution. Problems exist on the exterior grounds, parking lots, walkways, and staircases and may be created either by poor maintenance of surfaces or by weather-related elements such as rain, ice, or snow. Within the facility there are numerous places where floors may become a safety hazard because of water, body fluids, spilled liquids, food, or grease. There are special risk factors in the emergency room, operating rooms, laundry facility, and food facilities because of the concentration of employees working in a limited space with considerable potential unknown hazards. There are a large number of sinks in the facility which are frequently used and therefore are more prone to contribute, because of poor use or overflow, to liquid and cleaning materials ending up on the floors.

There is a serious concern about occupational exposure to infectious diseases because of blood- borne pathogens that are either transmitted to the worker by a sharps injury (needles, scalpels, broken glass or plastic, or other sharp objects) or contaminated blood or body fluids entering a mucus membrane or exposed damaged skin of the worker. Large numbers of healthcare workers experience these problems annually. Sharps may transmit hepatitis B virus, hepatitis C virus, HIV, and many other potential diseases. Under-reporting of these incidents is considerable because of fear of being disciplined, lack of time to report the information, or lack of concern about the risk of disease transmission. The healthcare worker who has been contaminated in this manner now may become a hazard to new patients. The worker is also affected because the exposure may trigger physical problems or emotional problems giving rise to fear and anxiety in the individual and his/her family.

Healthcare workers are exposed to hazardous drugs, chemicals, and other substances. Many treatments and diagnostic techniques used in healthcare areas unfortunately have unintended consequences of employee exposure to hazardous substances. The employees may be subjected to antineoplastic agents and cytotoxic drugs which are used in cancer chemotherapy. Pharmacists who prepare these drugs and nurses who administer them have the highest potential exposure and the greatest opportunity to suffer unwanted consequences. There is also potential exposure by physicians, operating room personnel, custodial workers, laundry workers, and those who handle waste. Chronic effects can include liver and kidney damage, damage to the bone marrow, lungs and heart, infertility, and hazards to a developing fetus in a pregnant woman. Environmental contamination and worker exposure may occur. Exposure may occur through inhalation, skin contact and absorption, ingestion, and needle stick or sharps injury. (See endnote 44.)

Healthcare workers are also exposed to antiviral drugs, hormones, bioengineered drugs, and radiographic diagnostic materials. Cleaning products, disinfectants, sterilants, and anesthesia gases have been previously mentioned.

Radiation of various types is used in the diagnosis and treatment of patients. Healthcare workers are at risk because of unintended exposure to the radioactive material. In the past these workers had a higher than normal risk of leukemia, skin cancer, and breast cancer. The use of lead aprons has reduced this risk substantially. However, there are new technologies that require that the healthcare worker be very close to the patient and therefore close to the source of radiation.

Workforce staffing schedules may create extreme fatigue and result in health and safety problems for the employees as well as for the patients. Employee performance errors increase with shift work, rotating shifts, periodic night shifts, extended work hours and excessive workloads, and inadequate or non-existent work breaks and lunch hours. These create problems of chronic fatigue, sleep deprivation, nervous reactions, effects on the cardiovascular, metabolic and immune systems, burnout, and exhaustion. Mentally and emotionally these people are drained because of the work schedules and in addition all of the health problems and potential deaths that they deal with daily. Work schedules can also affect the reproductive system.

Violence in the healthcare setting is affecting workers’ emotional as well as general health and safety. People are being intimidated by threatening language, sexual harassment, bullying (especially through the use of electronic devices), disruptive behavior, and assaults. Hospitals have a large number of parking lots, entrances, and exits to the facility and a substantial number of people of all types who are either delivering vital supplies or are visitors or patients and staff. Many of these individuals are traumatized, may be disoriented or experiencing the side effects of medications, are sleep deprived, or are just plain angry at the current situation and are having difficulty coping with it. Patients may assault healthcare workers or other patients. Waiting rooms, emergency rooms, and mental health units are potentially high areas of conflict. People being treated may be under the influence of alcohol or drugs. Factors that contribute to the potential for violence include professionals working alone; understaffing of vital areas in an attempt to save money; unrealistic productivity demands; cost-containment or reduction demands; transportation of patients; long waiting times to be seen by a healthcare professional; overcrowded, uncomfortable, poorly designed, and poorly administered waiting rooms; badly lit areas throughout the institution and the parking lots; improper training or lack of training of staff and how to deal with a serious situation; and an inadequate security systems and extremely poor response time to emergencies.

Older workers have higher rates of injury than younger workers especially among the direct care staff. They may have preexisting conditions as well as decreased strength and therefore are more susceptible to injury from a variety of factors.

 
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