1. Health Care Workers Occupational Diseases Dr. Alireza Safaeian Occupational Medicine Specialist

2. What is healthcare?  Healthcare is involved, directly or indirectly, with the provision of health services to individuals.  These services can occur in a variety of work settings, including hospitals, clinics, dental offices, out-patient surgery centers, birthing centers, emergency medical care, home healthcare, and nursing homes.

3. Other than doctors and nurses, what workers are exposed?  physicians, nurses, technicians, clinical laboratory workers, first responders, building maintenance, security and administrative personnel, social workers, food service, housekeeping, and mortuary personnel

5. What types of hazards do workers face?  bloodborne pathogens and biological hazards  potential chemical and drug exposures (formaldehyde, ethylene oxide, glutaraldehyde )  waste anesthetic gas exposures  respiratory hazards  ergonomic hazards from lifting and repetitive tasks  laser hazards  workplace violence  hazards associated with laboratories  radioactive material and x-ray hazards.

10. Hazards in hospital

11. HCWs: Clinical areas Bloodborne pathogens Airborne pathogens Ergonomic Slips, trips, falls Sharps

12. Surgical Suite Anesthetic gases Bloodborne pathogens Compressed gases Lasers Ergonomic Latex

13. HCWs: Lab Workers Infectious diseases Chemical agents(formaldehyde, toluene, xylene) Ergonomic Slips, trips, falls Sharps

14. HCWs: Radiology Radiation Ergonomics Airborne pathogens Bloodborne pathogens Slips, trips, falls

15. HCWs: Physical Therapy Ergonomics Trips, falls Equipment hazards Bloodborne pathogens

16. HCWs: Pharmacy Drug absorption Ergonomic Slips, trips, falls Latex

17. HCWs: Central Supply Compressed gases Anesthetic gases Chemical agents (sterilizers, cleaners) Ergonomic Burns, cuts

18. HCWs: Laundry Workers Contaminated laundry Noise Heat Lifting Sharps Slips, trips, falls Fire hazard

19. HCWs: Housekeepers Chemical agents Contaminated objects (infectious agents) Latex Sharps Lifting hazard Slips, trips, falls

20. HCWs: Dietary Foodborne diseases Heat Moving machinery Fire hazards Slips, trips, falls Electrical equipment

21. Stress Life threatening illnesses and injuries Understaffing Malfunctioning equipment Patient death Hierachy of authority Demanding patients Excessive paperwork Health Effects: loss of appetite, ulcers, mental disorder, migraines, difficulty in sleeping emotional instability, disruption of social and family life, and the increased use of cigarettes, alcohol, and drugs. Stress can also affect worker attitudes and behavior.

22. Reduce Stress Define aggravating factors Establish discussion/support groups Change work design Involve Employee Assistance personnel

23. How to Prevent Musculoskeletal Disorders (NIOSH)

24. Prevent Ergonomic Injuries Use proper lifting techniques Have more than one HCW assist on lifts Use lifting assist devices Change positioning

25. Lifting guidelines for health care workers  Never transfer patients/residents when off balance.  Lift loads close to the body.  Never lift alone, particularly fallen patients/residents, use team lifts or use mechanical assistance.  Limit the number of allowed lifts per worker per day.  Avoid heavy lifting especially with spine rotated.  Training in when and how to use mechanical assistance.

26. Patient handling tasks pose increased ergonomic risk if they are:  repetitive  done in awkward postures  done using a great deal of force  lifting heavy objects  combining these factors.

27. Safe Patient Handling  Equipment, which can range from ceiling-mounted lifts to simple slide sheets that facilitate lateral transfer  Minimal-lift policies and patient assessment tools  Training for all caregivers or for dedicated lifting teams on proper use of the equipment

28. Mechanical Lift Equipment - Patient Transfer Systems Sling-Type Full Lift

37. A Safety and Health Management System also known as an injury and illness prevention program is a proactive, collaborative process to find and fix workplace hazards before employees are injured or become ill. Almost all successful systems include six core elements:  Management leadership  Employee participation  Hazard identification and assessment  Hazard prevention and control  Education and training  Program evaluation and improvement

38. Workplace violence  The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.“  Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting

39. The risk factors  The increasing number of acute and chronic mentally ill patients  The availability of drugs or money at hospitals, clinics and pharmacies  Unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly;  The increasing presence of drug or alcohol abusers, trauma patients or distraught family members;  Low staffing levels during times of increased activity such as mealtimes, visiting times and when staff are transporting patients;  Isolated work with clients during examinations or treatment;  Solo work, often in remote locations with no backup or way to get assistance, such as communication devices or alarm systems (this is particularly true in high- crime settings);  Lack of staff training in recognizing and managing escalating hostile and assaultive behavior;  Poorly lit parking areas.

40. Hazardous Drugs  Preparation, administration, manufacturing, and disposal of hazardous medications  Healthcare facilities and the pharmaceutical industry,  Antineoplastic cytotoxic medications, anesthetic agents, anti-viral agents, and others  These hazardous medications are capable of causing serious effects including cancer, organ toxicity, fertility problems, genetic damage, and birth defects.

41. Hazards control and prevention  engineering and work practice controls  administrative controls  ensure the use of personal protective clothing and equipment  provide training  medical surveillance  hepatitis B vaccinations  signs and labels Engineering controls are the primary means of eliminating or minimizing employee exposure and include the use of safer medical devices, such as needleless devices, shielded needle devices, and plastic capillary tubes.

42. Personal Protective Equipment Healthcare Workers

43. Why You Need to Wear Assigned PPE  You could face a variety of workplace hazards  Safety controls don’t always eliminate hazards  When hazards can’t be eliminated, PPE serves as a barrier between you and the hazards

44. Common Healthcare Hazards Requiring PPE  Skin penetration by sharps  Chemicals  Antineoplastic and other potentially harmful drugs  Blood and other potentially infected materials  TB or other airborne bacteria

45. Common Healthcare Hazards Requiring PPE (cont.)  Mechanical hazards  Heat  X rays  Light radiation (e.g., lasers or UV)  Any other identified hazard

46. PPE Is Your Personal Defense Against Hazards  Eyes and face  Skin  Respiratory system  Feet  Hearing  Head

47. Eye and Face Protection  Shatterproof safety glasses  Goggles  Filtered lenses  Face shields  Eye protection with prescription glasses

48. Skin Protection  Gloves  Disposable  Cotton  Leather  Rubber, neoprene, or vinyl  Heat resistant  Protective clothing

49. Respiratory Protection  Respirators  Respirator fit testing and training

50. Foot Protection  Sensible, sturdy shoes with nonslip soles  Safety shoes  Boots  Shoe covers

51. Hearing Protection  Earmuffs  Earplugs  Canal caps  Homemade hearing protection IS NOT effective and should NOT be used

52. Head Protection  Hard hats protect your head in two ways:  Hard outer shell resists blows and penetration  Shock-absorbing suspensions act as a barrier between the outer shell and your head to absorb impact

53. Inspect PPE Before Use  Inspect before each use  Look for holes, tears, cracks, wear, or other problems  Don’t use defective, worn, or damaged PPE. Turn it in and get an effective replacement.

54. Get a Good Fit  PPE fits well when it:  Provides you with the protection you need  Is comfortable enough to allow you to move and perform your job well  Remember to check fit before each use

55. Remove and Dispose of PPE Correctly  Remove PPE when it’s contaminated  Remove PPE from the top down, wearing gloves to protect your skin  Grasp contaminated gloves on the inside and peel down without touching the outside  Place contaminated PPE in assigned containers  Wash thoroughly after removing PPE

56. Maintain PPE Properly  Clean PPE before you put it away  Store PPE in a safe place where it won’t be damaged or lost

57. Thanks for your attention Any questions ?