handout

1. 1
Overview of Occupational Safety &
Health in the Medical Services
OSH Best Practice For Medical Services Seminar
19th July 2006
NIOSH, Bangi
Dr Mohamad Nizam Jemoin
Department of Community Health
Faculty of Medicine
Universiti Kebangsaan Malaysia

2. 2
Outline of Presentation
 What is Occupational Safety & Health?
 OSH Issues in Medical Services
 OSH Strategies in Managing Risk

3. 3
What is Occupational Health?
Maintenance and promotion of workers’
health and working capacity
Improvement of working environment
and work to become conducive to safety
and health
Development of work organization and
working culture- safe, healthy & enhance
productivity
(ILO-WHO Committee on Occupational Health 1995)

4. 4
Relationship between Work & Health
•Genes
•Diet
•Environment
•Psychosocial
•Habits
•Socioeconomic
•Physical
•Chemical
•Biological
•Psychological
•Ergonomics
•Healthy
•Disease
•Death
PRE-EXISTING
HEALTH STATUS
OCCUPATIONAL
EXPOSURE
HEALTH OUTCOME

5. 5
SAFETY AND HEALTH IN
MEDICAL SERVICES
•Health care workers – large part of the workforce – in
government and private health care facilities
•Health care workers are covered under Occupational Safety
and Health Act 1994
•Health care workers are exposed to a variety of hazards
•Role of employers, employees, designers and suppliers in
ensuring safety and health under OSHA 1994

6. 6
Hazard Classification
 Physical
 Noise, Heat, Vibration, Ionizing radiation,
Electricity
 Chemical
 Solid/liquid/semisolid/gas
 Heavy metal, solvent etc
 Biological
 Bacteria, Virus, Parasite
 Psychological
 Stress
 Ergonomic problem
 Lifting heavy object, poor posture, repeated
movements

7. 7
Biological Hazards
•Hepatitis B
•HIV/AIDS
•Tuberculosis
•SARS

8. 8
INCIDENCE RATE OF NEEDLESTICK INJURIES 2002
CATEGORY NO OF
CASES
NO. AT
RISK
INCIDENCE
RATE/1,000
DENTAL
OFFICER
17 687 24.7
ATTENDANT 31 2,512 12.3
DOCTOR 165 6,836 24.1
MEDICAL
ASSIST.
45 4,535 9.9
JM/MIDWIFE 50 6,823 7.3
NURSE 181 21,104 8.5
MLT 9 2,153 4.1

9. 9
Hepatitis B and Health Care
Workers
 Prevalence among blood donors : 1.55% HBsAg positive (45124
screened in 1993)
 Liver cancer - 70% of cases are due to HBV
 Prevalence among HCW are 3-5 times higher than the general
population
 Risk associated with :
 Higher frequency of exposure to blood, body fluid and
contaminated sharps
 Longer duration of work- in contact with high risk groups
 High prevalence of Hepatitis B among patient

10. 10
Severe Acute Respiratory Syndrome
 Issues arise:
Case management- specific protocols
Appropriate personal protective equipments:
mask, respirators, gowns, gloves
Efficient ventilation system

11. detergents pesticides
formaldehide
pharmaceuticals
toxic
wastes
HAZARDOUS CHEMICALS

12. 12
Case Report 1:Chemical Health Risk
Assessment in a hospital laboratory
 Over 70 chemicals present in the laboratory with only 17
were used regularly. Out of 6 work units, 2 have
significant exposure to dangerous chemical. Items that
need improvement include:
 Storage of chemicals- poor ventilation, no safety signage
 Poor labelling of chemicals
 Housekeeping- chemical containers placed in walk-way
 PPE (e.g glove)- poor compliance
 Emergency shower- too far, not located in strategic place

13. 13
 A trainee staff nurse complained of skin lesion
on both hands - worse after using latex glove
 Patch test: positive to latex allergen
 Use alternative glove: latex-free glove
Case Report 2: Allergic
Contact Dermatitis (Latex
allergy)

14. 14
Physical/Mechanical hazards
•Radiation
•Noise
•Vibration
•Slips and falls

15. 15
Case Report 3: Noise Induced
Hearing Loss
 A 55 year old medical assistant, worked at
POP Room & Orthopaedic OT
Presented with progressive and marked
hearing loss, associated with depression
30 years exposure to noise (85-100 dBA)

16. 16
Ergonomic Problems
•Lifting heavy objects/patients
•Awkward posture
•Static posture

17. 17
Case Report 4: Injury while manual
handling
 55 y.o staff nurse @
Ortho Ward
 c/o: Acute, severe pain at
lower back while
transferring an obese
patient from bed
 Diagnosis: Compression
Fracture L1

18. 18
Computer Work Station
•‘Typing Injuries’
•Eye Strain
•Back Pain
•Psychological Stress

19. 19
Psychosocial factors
•Stress
•Shift work

20. 20
Stressor at Workplace
 S- Support
 T-Task
 R-Role
 E-Environment
 S-Shift work
 S-Superior
 O-Organization
 R-Reward not
sufficient

21. 21
Signs of Stress
How you feel (emotion)
Anxious
Depressed
Angry/frustrated
Bored
How you think (cognition)
Poor concentration & memory
Poor organization and decision
making
Less creative in problem solving
Hypersensitive to criticism
How you behave
Accidents/mistakes
Sleeping problems
Take drugs
Problematic social behavior
Your Body
Aches and pain
Sweating, dizzy, breathless
Frequent infections
Asthma, cardiac problems,
hypertension

22. 22
Occupational Safety and Health Programs
as ‘Barrier’ and ‘Support system’ for workers
Workers population
Health promotion
& wellness program
Health surveillance
Industrial hygiene program
Regulatory compliance
Disability management
Emergency preparedness
Program planning &
evaluation
Medical care
services Ergonomic program
Alcohol & drug testing
Chemical hazards
Occupational stress
Biological hazards
Injuries &
physical hazards

23. 23
FIVE STEPS OF RISK ASSESSMENT
1. Look for hazards
2. Decide who might be harmed and how
3. Evaluate risks from hazards and decide whether
existing precautions adequate or more should be
done
4. Record findings
5. Review assessment and management periodically.

24. 24
Risk Management Strategies in
OSH
 Enforcement of laws, regulations and rules
 Elimination of hazards
 Engineering controls- ventilation system
 Administrative controls- safe standard operating
procedures, training, health promotion
 Personal protective equipment
 Health surveillance
 First aid and emergency response
 Treatment and Rehabilitation

25. 25
OSH Laws & Regulations
1967 1994
•Government
dependent
•Limited scope
•Too prescriptive
•Self regulation
•Wide coverage
•Flexible
OBJECTS OF OSHA 1994
 To secure safety,
health and welfare
of persons at place
of work against
risks arising out of
work
 To promote suitable
work environment
that fulfills needs
of persons at work
 To provide means for
the development of
flexible OSH
legislation
Include Medical
Services

26. 26
No Question %
correct
1. Are you covered under this Act? 67.1
2. This Act was intended to:
a) Ensure employee’s safety and health at the workplace.
b) Provide compensation to the employee who has been disabled because of an accident in the
workplace.
74.3
18.9
3. Employers who have more than 5 employees need to prepare an occupational safety and health policy. 67.1
4. This Act imposes duties on: a) Employers and self-employed persons.
b) Employees.
c) Designers, manufacturers and suppliers.
55.8
64.0
41.6
5. Employers with 20 or more employees need to establish a safety and health committee at their place of
work.
8.1
6. A safety and health committee shall have representatives from: a) Employees
b) Employer
c) Government
68.7
63.2
18.8
7. All workplaces need to have an occupational safety and health officer. 10.2
8. This Act is enforced by the Ministry of Health, Malaysia. 15.6
9. Below are persons that can be charged in court because of contravening provisions of this Act:
a) Employer
b) Employee
75.0
32.8

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Conclusion
 Heightened awareness among healthcare
workers, management commitment, well
coordinated risk management activities are
critical in minimizing occupational injuries &
diseases in medical services
 We need to continuously inculcate safety
behavior & values among the workers, leading
to a strong safety culture