HOSPITAL ENVIRONMENT AND SAFETY INTRODUCTION :

The hospital environment presents particular and, in some cases, unique safety problems when compared with other industrial settings. These problems affect the patient, staff, and visitor.

The causes of such hazards fall into two broad categories:

a) Failure of a device to correctly perform the desired function. - b) Failure of hospital personnel to correctly use medical equipment.

every hospital needs a safety program and a safety committee to oversee these aspects of the hospital's daily function.

THE SAFETY PROGRAM: A safety program has three major components. These are: A) The identification of hazards and risk. b) The prevention of hazards and risk. c) Documentation

The identification component requires constant vigilance with respect to in- hospital activities and information from outside sources on the hazards and risks associated with procedures or equipment. It is particularly important that the identification phase be an ongoing one that can respond to new information. One particularly important part of identification is incident analysis.

protection to personnel and patients Elimination or direct control of the hazard and Supervision and education of the worker. Inspection and preventive maintenance, The replacement or change in types of equipment, changes in procedures, the addition of safety and protective devices, and improved worker qualifications.

Documentation serves as a record of the program provide visual and concrete documentation to accrediting or licensing bodies such as the Joint Commission for Accreditation of Hospital Organization (JCAHO), which requires a documented program review the prevention efforts and the "causes of incidents and also serve as a permanent record of what was done and why

HOSPITAL EMPLOYEE HEALTH AND SAFETY Hospital environmental exposures are categorized in the same way as in other workplaces; there are chemical, physical, biological, and psychological conditions. The hospital has many of the same exposures in these categories, as do other workplaces; electrical equipment deficiencies, toxic gases, weights to lift or move, job motivation and responsibility, and poor housekeeping.

NIOSH The National Institute for Occupational Safety and Health completed a survey of 3687 hospitals to identify the types and frequencies of injuries and illnesses among hospital employees. This study found that among all the exposures typified, the most common types of injury were strains and sprains. These injuries are usually caused by improperly lifting objects, including patients, and slipping and falling on slippery floors, stairs, or ladders.

Hospital Occupational Health and Safety 1. Pre-placement medical examinations should be given to all new employees. These examinations should include a medical history, a thorough physical examination, laboratory tests (blood, urine, chest X-ray, etc.), and special consultations as indicated by the history, physical findings, or special job requirements.

2. Periodic health maintenance procedures should be instituted that include a general examination, as in item 1 above, an assessment of continued job compatibility, and special appraisals necessitated by extensive illness or job changes

3. Health and safety education programs should be developed to include job orientation safe working habits, relevant health information and the use of the hospital occupational health unit for reporting injury or illness.

4. Employee immunizations should be given that include smallpox, diphtheria, tetanus, polio, and other diseases as indicated by epidemics or unusual laboratory conditions. Updating should also be a part of this program. 5. Provisions for care of illness and injury at work should include arrangements for medical, surgical, psychological, and rehabilitative services; specific location availability of competent medical personnel, and a formalized procedure should be maintained. Treatment and reports of occupational injuries and illnesses should conform to state compensation laws and OSHA requirements.

7. Environmental control and surveillance services should be provided to detect, avoid, or limit harmful occupational exposures. Special attention should be given to hazardous occupational exposures for women of childbearing age, to employees exposed to ionizing or non-ionizing radiation, and to operating room personnel exposed to anaesthetic gases. 8. Employee health and safety records should be maintained in the health unit. These must include examinations, injury or illness reports, radiation records, and other environmental exposure reports or records.

9. Coordinated planning is recommended between the health unit and other hospital departments and services including the safety committee, infection control committee, labour union, and similar groups.

Hospital Acquired Infection Nosocomial infection Infection occurring during hospitalization is considered the major problem. ‘cross infection’

Agents: staph aureus, hemolytic strep, ecoli, klebsiella, pseudomones and viruses. Sources: patients: staff working in the hospital and environment

Routes of spread: Direct contact: from hands of a doctor or nurse Droplet Air borne

Recipients All patient are potential recipients of infection from sources within hospital some patients are more susceptible or more liable for cross infection than others especially the severely ill and the and those in whom the ability to resist infection is reduced

Prevention and control Isolation Disinfection: is an agents which destroy all micro-organism but not usually the spore forming… E,g: phenol lysol Sterilization:

sterilization Is the only process that reliably kills all forms of microbial life (bacteria, spores, fungi, and viruses). Several types of sterilization have been used in hospitals (e.g.; dry heat, chemical bath, or irradiation) but two methods are most commonly used: steam and gas sterilization. Steam sterilization is the oldest method (dating from the 1800s) and the least expensive. However, some items cannot be steam sterilized because of heat sensitivity.

Ethylene oxide (ETO) sterilization is an important method owing to the quantity of medical devices that cannot be steam sterilized. In this method, ETO gas is introduced into the sterilizer chamber and the sterilization cycle lasts from I to 4 hrs

Types of disinfection Concurrent disinfection terminal disinfection Prophylactic disinfection

SAMPLING METHODS SAMPLING METHODS Air sampling: Water Sampling: Surface sampling