this ppt discribes law related to hospitals like bio medical waste, fire, radiation, building act etc along with there guidelines

1. Laws and Guidelines
Related to Occupational
hazards in Hospital.
DR JASBEER SINGH
DR SUPRAJA

2. 1. Occupational Illness: - Under the occupational health and safety act occupational
illness is defined as condition that results from exposure in workplace to a physical,
chemical or biological agent to the extent that the normal physiological mechanisms are
affected and the health of the worker is impaired.
Health care facilities are exposed to a complex variety of health and safety hazards
everyday including:
a. Biological hazards
b. Chemical hazards
c. Physical hazards
d. Ergonomic hazards
e. Psychosocial hazards
f. Explosion hazard
g. Electrical hazards.
i. Radiation hazards
j. Needle stick injuries

3.  Every day, people die as a result of occupational accidents or work-related diseases –
more than 2.78 million deaths per year. Additionally, there are some 374 million non-
fatal work-related injuries and illnesses each year, many of these resulting in extended
absences from work.
 The human cost of this daily adversity is vast and the economic burden of poor
occupational safety and health practices is estimated at 3.94 per cent of global Gross
Domestic Product each year.
 Evidence shows that many of these diseases are preventable but problems like under
reporting, poor surveillance and several other factors have been known to influence
occupational health hazards .
 The burden caused by work-related accidents and illnesses on workers health are
incalculable.

4.  Because of the physical nature of many hospital jobs, private industry hospital
employees face a higher incidence of injury and illness—6.0 cases per 100 full-time
workers—than employees working in other industries traditionally considered
dangerous, such as manufacturing and construction.
 The incidence rate for workers in state government hospitals was 8.1 cases per 100
full-time workers, significantly higher than the incidence rate among workers in all
state government establishments (3.7 cases per 100 full-time workers).
 Private hospitals also had an incidence rate (6.0 cases per 100 full-time workers) that
was significantly higher than the average rate for all private industry establishments
(3.0 cases per 100 full-time workers).

5. Laws and guidelines:
 Workmen’s compensation act 1923
 PDPP (Prevention of violence and Damage to Public Property) Act, 1984
 THE PREVENTION OF FOOD ADULTERATION ACT, 1954
 Environment (Protection) Act, 1986
 THE DELHI FIRE PREVENTION AND FIRE SAFETY ACT, 1986
 Biomedical Waste (Management and handing) Rules, 1998 under the Environment
(Protection) Act
 Atomic Energy (Radiation Protection) Rules, 2004

7. VANDALISM:
 According to a study by the Indian Medical Association, over 75% of doctors have
faced violence at work.
 India is not the only country facing violence against its medical practitioners; today
this is a global phenomenon.
 In the USA, between 1980 and 1990, over 100 healthcare workers died as a result
of violence.
 Another survey conducted in 170 university hospitals revealed that 57% of all
emergency room employees had been threatened with a weapon over a 5-year
period before the survey.
 A survey of 600 doctors in 2008 by the British Medical Association revealed that
though one-third respondents had been a victim of verbal or physical attack in the
past year, over half of them (52%) did not report the incident.

8. Acts and Laws Related to Vandalism in
Hospital:
1. According to the Doctors’ protection Act in India:
 Any damage or act of violence against Medicare professionals is an act punishable by law.
Medicare professionals include (Doctors, nurses, paramedics, medical students, hospital
attendants/staff)
 Any damage to the property or the Institution of Medicare service is prohibited. Destruction of
hospital beds, burning of ambulances, smashing medical stores is punishable by law
 Imprisonment to lawbreakers for a minimum period of 3 years and fine amount of INR 50,000 to
be imposed if found guilty.
 Damage to any medical devices and equipment's is a punishable offence and the offenders are
liable to pay twice the amount of the damaged equipment’s cost.

9. 2. IPC sec 336 endangering life/ personal safety of others
3. IPC sec 337 causing hurt by endangering life/ personal safety of others.
4. IPC sec 338 causing grievous hurt by endangering life/ personal safety
of others
5. Prevention of violence and damage to public property Act, 1984

10.  Doctors and hospitals, generally, have poor marketing sense. Statements like “All
major and minor operations are done here” or “24 X 7 services” or “Gold Medalist
doctors” or “Facilities for all major surgeries available” make an impact on the
psyche of a prospective client.
 Many hospitals, especially the government hospitals, are understaffed.
Only 1,06415 doctors are employed by the government in India, of the 9,38861
doctors registered to provide healthcare to a population over 120 crore (1.2 billion). Of
these, only 27,355 are posted at primary health center's (PHCs), which serve the rural
population.

11.  Hospitalisation costs up 300%
 The 2014 report by the National Sample Survey Organization (NSSO) shows that the average
cost of hospitalization in private hospitals has more than tripled since 2004. A bout of
hospitalization in urban India may have cost you Rs 8,850 on average in 2004. Today, it would
cost you Rs 26,455. That’s a 300 per cent spike.
 According to a recent study in the British Journal of Medicine (BMJ), Indian doctors spend
less than two minutes seeing a patient. In contrast, in Sweden, doctors spend as much as 22.5
minutes per patient. In the US, a patient gets 21 minutes of a doctor’s time.

12. It is advisable to look for indicators of violent behavior such as staring and eye contact, tone and volume of
voice, anxiety, mumbling and pacing (STAMP)
MEASURES TO BE TAKEN
 Restrict entry.
 Insurance of hospital property .
 Do not meet anger with anger. Remain calm in the face of provocation.
 Depute someone (preferably beforehand) to take photographs and, even, audio/video records of the violence.
 Depute someone to immediately (preferably as part of the SOP) get the medical record of the patient photocopied.
If the mob carries away the original record, the photocopies will be useful.
 Inform your lawyer.
 Inform the police immediately by phone, etc. and keep a record of such phone call, etc.
 Get written, signed statements from the persons present (doctors, staff, patients, relatives, others) regarding the
occurrence of violence.
 Lodge an FIR with the police.
 When making a police complaint the doctor/hospital should make sure that a request is made to register an FIR
under the relevant Act for protection of medical personnel.
 Do not try to ‘settle’ the issue by paying hush money (more often than not it is taken as admission of guilt).

14. Biomedical Waste (Management and handing) Rules,
1998 under the Environment (Protection) Act.
 In exercise of the powers conferred by section 6, 8 and 25 of the Environment (Protection) Act,
1986 the Central Government notifies the rules for the management and handling of bio-
medical waste.
 SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE
 TREATMENT AND DISPOSAL
 AUTHORISATION
 ADVISORY COMMITTEE
 ANNUAL REPORT
 MAINTENANCE OF RECORDS
 ACCIDENT REPORTING

17. THE PREVENTION OF FOOD ADULTERATION ACT, 1954
 An Act to consolidate the laws relating to food and to establish the Food Safety and
Standards Authority of India for laying down science based standards for articles of
food and to regulate their manufacture, storage, distribution, sale and import, to
ensure availability of safe and wholesome food for human consumption and for
matters connected therewith or incidental thereto.
 The new FSSAI Act has been implemented for all those in food business and hospital
kitchens are not excluded.
 India has 35,416 government hospitals with around 1.37 million beds, according to
directorate general of state health services data. Of these, 26,604 government
hospitals are located in rural areas. Each of these hospitals has a canteen that serves
food to patients.

18. Workmen’s compensation act 1923
It came into force on the first day of July 1924.
Employer’s liability for compensation :
1. If personal injury is caused to a workman by accident arising out of and in the
course of his employment his employer shall be liable to pay compensation.
Amount of compensation:
 Subject to the provisions of this Act the amount of compensation shall be as
follows namely :-
a. where death results from the injury an amount equal to fifty per cent of the
monthly wages of the deceased workman multiplied by the relevant factor; or an
amount of fifty thousand rupees whichever is more.
b. where permanent total disablement results from the injury an amount equal
to sixty per cent of the monthly wages of the injured workman multiplied by the
relevant factor; or an amount of sixty thousand rupees whichever is more.

19. The benefits depends on the monthly wages earned by the worker, the nature of injury and relevant factor defined in the Act, used
to calculate the lump-sum amount for compensation. The compensation also depends on the age of the injured employee. Lower
the age higher the benefit and vice-versa.
Penalties: - Compensation must be paid as soon as its due. If the employer is not able to make the payment within this time there is
delayed payment penalties of 6% per annum for a sum not more then 50% of total amount.

20. Fire Accidents in Hospitals:
 Fire broke out in Murshidabad Medical College and Hospital in West Bengal. The
August 2016 fire killed two staff members of the hospital.
 In November 2015, a major fire broke out at Shishu Bhawan hospital in Cuttack that
gutted machines worth Rs 11 lakh, and left one child severely injured.
 Faulty electric wiring caused a fire outbreak at PBM Hospital, Bikaner in January 2013,
injuring three infants and damaging property.
 On December 2011, a major fire broke out in the hospital, leaving 89 dead.
The fire began in the basement, where highly inflammable material was allegedly
stored.

21. NABH Fire Prevention and Control Infrastructure:
 The organization has a multi disciplinary safety committee with a senior person as the chairman of the
safety committee. The safety committee meetings are held at least once in 3 months
 The organization has a written plan for Fire Prevention and Safety and has a Fire Safety Manual
approved by the safety committee.
 A multi disciplinary committee, which has Fire Safety Officer as a member, holds facility rounds at
least once a year for non-clinical areas & twice a year for clinical areas.
 The Fire Signages are appropriate and placed at the right locations.
 Emergency fire signages should glow in dark signages.
 There is a proper training program for handling fire emergencies
 The staff is aware of the fire fighting systems, responsibilities during fire emergencies, evacuation
routes & techniques, conversant with the type of fire extinguishers and their area of use, trained to
operate fire extinguishers, code announcements and assembly points in case of fire

22. Atomic Energy (Radiation Protection) Rules, 2004.
Responsibilities of the employer:-
1. Every employer shall:
a. Ensure that provisions of these rules are implemented by the licensee,
Radiological Safety Officer and other workers.
b. Prior to employment of a worker, procure from his former employer, where
applicable, the dose records and health surveillance reports.
c. Upon termination of service of worker provide to his new employer on request
his dose records and health surveillance reports.
2. The employer shall be the custodian of radiation sources in his possession and
shall ensure physical security of the sources at all times.
3. The employer shall inform the competent authority, within twenty four hours, of
any accident involving a source or loss of source of which he is the custodian.

24. Health surveillance of workers:-
1. Every employer shall provide the services of a physician with appropriate
qualifications to undertake occupational health surveillance of classified workers.
2. Every worker, initially on employment, and classified worker, thereafter at least
once in three years as long as the individual is employed, shall be subjected to the
following –
a. general medical examination as specified by order by the competent
authority; and
b. health surveillance to decide on the fitness of each worker for the intended
task;
3. The health surveillance shall include –
a. special tests or medical examinations as specified by order by the competent
authority, for workers who have received dose in excess of regulatory constraints.

28. Needlestick Injuries
 Injuries due to needles and shrapnel's are caused to the medical fraternity and these expose them to the blood-
borne infections, Hepatitis B and other pathogens, according to a study carried out in the trauma center in All
India Institute of Medical Sciences.
 The study found that 36 per cent of doctors, 14.6 per cent of nurses and 7 per cent of housekeeping staff had
accidental needle stick injuries.
 India accounts for 30 per cent of the 16 billion injections administered worldwide and it has been estimated that
63 per cent are unsafe injections. Injections are labelled unsafe due to improper sterilization, reuse and faulty
administration.
 These are found to be a major cause of infections in patients and doctors. The needle stick injuries expose
healthcare workers to the blood-borne pathogens of which the highest number of cases are those of Hepatitis B
and C.
 Needle prick injury is an occupational hazard. World Health Organization records state that accidental injuries
are the cause of 37 per cent new Hepatitis B cases, 39 per cent new Hepatitis C cases and 5.5 per cent new HIV
cases.
 Thirty-six per cent injuries are found to occur while handling patients in emergency units and shifting them,
according to the study. The sites identified for injury are emergency units, laboratories, out-patient rooms,
procedure rooms, operating tables and laundry. The National surveillance system of healthcare workers (NASH)
have found that 42 per cent of physicians and 30 per cent of nurses suffer from injuries.

30. IF YOU SUSTAIN A NEEDLESTICK INJURY, TAKE THE FOLLOWING
ACTIONS IMMEDIATELY:
• WASH THE WOUND WITH SOAP AND WATER.
• ALERT YOUR SUPERVISOR AND INITIATE THE INJURY REPORTING SYSTEM USED IN
YOUR WORKPLACE.
• IDENTIFY THE SOURCE PATIENT, WHO SHOULD BE TESTED FOR HIV, HEPATITIS B,
AND HEPATITIS C INFECTIONS. YOUR WORKPLACE WILL BEGIN THE PROCESS TO
TEST THE PATIENT BY SEEKING CONSENT.
• REPORT TO EMPLOYEE HEALTH SERVICES, THE EMERGENCY DEPARTMENT, OR
OTHER DESIGNATED TREATMENT FACILITY.
• GET TESTED IMMEDIATELYAND CONFIDENTIALLY FOR HIV, HEPATITIS B, AND
HEPATITIS C INFECTIONS.
• GET PEP WHEN THE SOURCE PATIENT IS UNKNOWN OR TESTS POSITIVE FOR HIV.

31. Other Laws governing the safety of patients, public and staff
within hospital premises
 AERB safety code 2001
 Arms act 1950
 Boilers act 1923
 Explosives act 1884
 Insecticide act 1968
 Periodic fitness certificate for operations of lift
 The Indian fatal accidents act 1955
 The Tamil nadu Medicare service persons and Medicare service institutions Act 2008.

32. References:
 Human Resources in Health Sector. National Health Profile 2015. New Delhi: Central Bureau of Health
Intelligence, Directorate General Health Services, Ministry of Health and Family Welfare, Government of
India.
 The WORKMENSCOMPENSATIONACT1923
 THE EMPLOYEES’ STATE INSURANCE (CENTRAL) RULES, 1950 ; MINISTRY OF LABOUR
 ATOMIC ENERGY (SAFE DISPOSAL OF RADIOACTIVE WASTES) RULES, 1987. (February 3, 1987)
 Incidence of violence against doctors in India, journal by Neeraj Nagpal Convener, Medicos Legal Action
Group (MLAG)
 Sections 6, 8 and 25 of the Environment (Protection) Act, 1986 ;MINISTRY OF ENVIRONMENT &
FORESTS.
 Monthly labor review by U.S. Bureau of Labor Statistics, June 2017.
 International labor organization.
 Times of India 4 May 2015