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  1. 1. PROTECTING OCCUPATIONAL HEALTH OF HEALTH WORKERS FLASH DRIVETable of Contents1. WHO Guidelines1.1 Buildings • Hospital Safety Index. Washington, Pan-American Health Organizations Disaster Mitigation Advisory Group, n.d. This index helps health facilities assess their safety and avoid becoming a casualty of disasters. It provides a snapshot of the probability that a hospital or health facility continues its operations during emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. (English, Spanish) • Adams J, Bartram J, Chartier Y, eds. Essential environmental health standards in health care. Geneva, World Health Organization, 2008. ex.html This document provides guidance on essential environmental health standards required for health care in medium- and low-resource countries and support the development and implementation of national policies and have been written for use by health managers and planners, architects, urban planners, water and sanitation staff, clinical and nursing staff, careers and other health-care providers, and health promoters. (English, French) • Water safety in buildings. Geneva, World Health Organization, 2010. buildings_march2010.pdf. This document deals with all buildings where people use or are exposed to water except for sole occupancy dwellings and homes, including hospitals, schools,
  2. 2. universities, child care, medical and dental facilities, aged and residential care, apartment blocks, ambulance and fire stations, restaurants, and hotels. Exposure includes ingestion, contact or inhalation of water supplied for purposes including but not limited to drinking, bathing, food preparation, recreation and irrigation. (English, French)1.2 Chemical Safety1.2.1 Cancer • Carcinogenicity in Humans. Evaluation and Rational. Ethylene Oxide. In IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 97. 1,3-Butadiene, Ethylene Oxide and Vinyl Halides (Vinyl Fluoride, Vinyl Chloride and Vinyl Bromide). Lyon, World Health Organization and International Agency for Research on Cancer, 2008. (English)1.2.2 Mercury • Mercury in health care: policy paper. Geneva, World Health Organization, 2005 (WHO/SDE/WSH/05.08). x.html This document analyses how health-care facilities are one of the main sources of mercury release into the atmosphere due to incineration of medical waste. Non mercury alternatives are presented, and proposals are given for short-, medium- and long-term strategies to gradually achieve the substitution of mercury-based medical devices. (Arabic, English, French, Spanish) • Towards the tipping point: WHO-HCWH Global Initiative to Substitute Mercury-Based Medical Devices in Health Care, A Two-Year Progress Report. Geneva, World Health Organization and Health Care Without Harm, 2010.
  3. 3. WHO and HCWH have issued a two-year progress report on the global Mercury- Free Health Care Initiative. The report documents the progress of dozens of countries from around the world moving towards mercury-free health care. (English) • Preventing disease through healthy environments. Exposure to mercury: a major public health concern. Geneva, World Health Organization, 2007. This flyer presents information on the forms of mercury, its different toxicities and implications for health and sources of exposure to mercury. It also presents WHO recommendations to reduce or eliminate releases of mercury and its compounds to the environment. (English) • Replacement of mercury thermometers and sphygomomanometers in health care: Technical guidance, 2011. rmometers/en/ (English, Spanish)1.3 Hand Hygiene • WHO Guidelines on Hand Hygiene in Health Care. Geneva, World Health Organization, 2009. (English, French)1.4 Health Care Waste • Adams J, Bartram J, Chartier Y, eds. Essential environmental health standards in health care. Geneva, World Health Organization, 2008. ex.html (English, French) • Aide-memoire for a national strategy for health-care waste management. Geneva World Health Organization, 2000.
  4. 4. (English)• Fact Sheet: Wastes from health-care activities. Geneva, World Health Organization, 2007 (WHO Fact sheet, N° 253). This fact sheet analyses the different kinds of hazardous waste and provides guidance to improve the health-care waste management. (Arabic, Chinese, English, French, Russian, Spanish)• Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. Geneva, World Health Organization, 1999. df Guidance for drug disposal during emergency situations, such as armed conflicts, natural disasters or others. The guidance consists in relatively simple and low-cost measures and is addressed to local authorities, health care personnel or other professionals confronted to this type of problem. (English)• Management of solid health-care waste at primary health-care centres: A decision-making guide. Geneva, World Health Organization, 2005. _rev_oct06.pdf Guide for selecting the most appropriate solid waste management options at Primary Health-Care centres (PHCs) in developing countries. (English, French)• Safe health-care waste management: policy paper. Geneva, World Health Organization, 2004. pdf This policy paper constitutes WHO guidance for countries to conduct assessments prior to any decision as to which health-care management methods
  5. 5. be chosen. Tools for assessment and decision-making process are also provided. (English, French, Russian, Spanish) • Prüss A, Giroult E, Rushbrook P, eds. Safe management of wastes from healthcare activities. Geneva, World Health Organization, 1999. index.html Comprenhensive guide on safe, efficient, and environmentally sound methods for handling and disposal of health-care waste. It focuses on basic processes and technologies that are affordable, sustainable, and culturally appropriate. (English) o Prüss A, Townsend WK. Teachers guide: management of wastes from health-care activities. Geneva, World Health Organization, 1998 (WHO/EOS/98.6). en/index.html Provides teaching materials and recommendations for a three-day training course, designed mainly managers of health-care establishments, public health professionals and policy-makers. (English) • WHO core principles for achieving safe and sustainable management of health-care waste: policy paper. Geneva, World Health Organization, 2007 (WHO/SDE/WSH/07.10). (English)1.5 Immunizations • Aide Memoire: Hepatitis B Immunization of Health Workers (English, Spanish) • "First, do no harm". Introducing auto-disable syringes and ensuring injection safety in immunization systems of developing countries. Geneva, World Health Organization, 2002 (WHO/V&B/02.26).
  6. 6. SPPpublicationsWM/en/index.html This guideline aims to assist policy-makers and programme managers to plan the introduction of auto-disable (AD) syringes as part of a comprehensive national policy and plan of action to improve injection safety, both for routine immunization and for mass campaigns. (French) • 63rd World Health Assembly Resolution on Viral Hepatitis, 2010. (Arabic, Chinese, English, French, Russian, Spanish)1.6 Infection Prevention and Control • Acosta-Gnass, SI, DE Andrade Stempliuk V. Manual de esterilización para centros de salud. [Sterilization Manual for Health Centers]. Washington, Pan American Health Organization/World Health Organization and USAID, 2008. Manual intended to inform health workers on the protocols and procedures to prevent hospital infections, both inside and outside the sterilization plant. It includes steps to follow in cleaning, preparing, sterilizing, storing, and transporting hospital equipment. (Spanish) • Advice on the use of masks in the community setting in Influenza A(H1N1) outbreaks, 2009. evised.pdf (Arabic, Chinese, English, French, Russian, Spanish) • Aide-memoire for infection prevention and control in a health-care facility. Geneva, World Health Organization, 2004 (WHO/EHT/04.15). Provides information on core infection prevention and control interventions for health-care facilities and includes a checklist that comprises management,
  7. 7. information, education and communication, equipment and supply and surveillance areas. (English) • Core components for infection prevention and control programmes (Arabic, English, French, Russian, Spanish) • Infection-control measures for health care of patients with acute respiratory diseases in community settings - Trainers Guide (Chinese, English, French, Spanish) • Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care – WHO interim guidelines. Geneva, World Health Organization, 2007 (WHO/CDS/EPR/2007.6). 007_6/en/index.html (Arabic, Chinese, English, French, Indonesian, Spanish)1.7 Injection Safety • WHO best practices for injections and related procedures toolkit (Chinese, English, Portuguese, Russian, Spanish) • WHO guidelines on drawing blood: best practices in phlebotomy (Chinese, English, French, Portuguese)1.8 Natural Ventilation • Atkinson, J et al., eds. Natural ventilation for infection control in health- care settings. Geneva, World Health Organization, 2009.
  8. 8. /en/index.html This guideline defines natural ventilation and explores the design requirements for natural ventilation in the context of infection control, describing the basic principles of design, construction, operation and maintenance for an effective natural ventilation system to control infection in health-care settings. (English, French, Spanish)1.9 Occupational Health and Patient Safety • Aide Memoire: Health care worker safety (English, Spanish) • Aide Memoire: Hepatitis B Immunization of Health Workers (English, Spanish) • PAHO Manual for managers on health and safety. 7&Itemid=1349&limit=1&limitstart=7 (English, Spanish) • Occupational health: a manual for primary health care workers. Geneva, World Health Organization, 2001 (WHO-EM/OCH/85/E/L). index.html The classic approach to ensuring health and safety in the workplace has depended mainly on the enactment of legislation and inspection of workplaces to ensure compliance with health and safety standards. While this approach has been effective in controlling many specific occupational hazards since the Industrial Revolution, it has not been very effective in the past several decades, particularly in developing countries, for several reasons. This manual also includes a Trainers Guide. (English)1.10 Procurement
  9. 9. • PQS device catalogue. Pre-qualified equipment for the expanded programme on immunization (EPI). Geneva, World Health Organization, 2011 catalogue_3nov2011.pdf WHO develops specifications for and "prequalifies" particular types of immunization equipment and medical devices, which can then be obtained by developing countries through large donors such as UNICEF at pre-negotiated prices. Listed here are key, relevant energy saving devices. (English)1.11 Tuberculosis • Guidelines for intensified tuberculosis case-finding and isoniazid preventive therapy for people living with HIV in resource-constrained settings (English, French, Russian) • Stop TB Partnership: TB Infection Control Subgroup Presentations 1. Introduction 2. TB epidemiology 3. Infection control basics and introduction to the WHO policy recommendations 4. Managerial activities 5. Administrative measures a. Exercise: managerial activities and administrative controls 6. Environmental control a. Ventilation concepts, natural ventilation b. Mechanical and mixed mode ventilation c. Ultraviolet germicidal irradiation (UVGI) d. Filtration e. Facility design, renovation and use 7. 7.1 Respiratory protection 7.2 Respirator fit testing 8. Advocacy and resource mobilization 9. Human resources development 10. Monitoring and evaluation 11. Laboratory safety 12. References
  10. 10. (English) • WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Housing (English, French) • Implementing the WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households amework1288971813.pdf (English)1.12 Violence • Joint Programme on Workplace Violence in the Health Sector e/documents/en/index.html The Framework guidelines for addressing workplace violence in the health sector are intended to support all those responsible for safety in the workplace, be it governments, employers, workers, trade unions, professional bodies or members of the public. The tool will guide you through the complexity of issues to be considered when developing anti- violence policies and strategies for all work-settings in the health sector. These can be adapted to meet local and national needs and constraints. (English, French, Russian, Spanish) • Research Instruments (English) o Focus Group Guidelines: al/en/WVfocusgroupdiscussion.pdf o Questionnaire: al/en/WVquestionnaire.pdf o Research Protocol: al/en/WVresearchprotocol.pdf
  11. 11. o Sample Design: al/en/WV_sampledesign.pdf • Working Papers (English) o State of the Art: rkplace/WVstateart.pdf o Synthesis Report: rkplace/WVsynthesisreport.pdf1.13 Water • Thompson T, et. al. Chemical safety of drinking-water: Assessing priorities for risk management. Geneva, World Health Organization, 2007. Provides information about: a) priority chemicals in drinking-water for risk management, b) identification of specific chemicals in individual water supply systems, c) sources of potential contaminants and identification chemicals that could be of concern in particular circumstances. (English)2. WHO Tools and Resources2.1 Needlestick Injuries Toolkit Protecting Healthcare Workers: Preventing needlestick injuries toolkit. Geneva, World Health Organization, 2005. This toolkit includes sections related to general information, training materials, ICN fact-sheets and guidelines, ILO code of practice (COP) on HIV/ AIDS and implementing the ILO COP, post exposure prophylaxis (PEP), resources, surveillance and WHO injection safety materials.2.1.1 Training materials • Core presentations (English, Spanish) o Best Practices for Giving Safe Injections
  12. 12. o Efficacy of Control Measures o Epidemiology of Needlestick Injuries o PEP Post Exposure Prophylaxis Guideline • Mini-presentations (English, Spanish) o Efficacy of Control Measures o Epidemiology of Needlestick Injuries o Needlestick Prevention Committees o Post Exposure Prophylaxis o Mini Presentation Evaluation Form • Case studies (English, Spanish) o Needlestick Case Studies Exercise Video o Policy planning Case Study • Selecting Safer Devices: 2011 Health Care Workers Safety Device Forms (English) • Additional Presentations (English) o Case Studies Video Exercise Response Video Exercise - Linda o Committees - Prevention and Control Occupational Health and Safety Committee and Needlestick Prevention Committee o Epidemiology of Blood Borne Pathogens o Good practices at the national level protecting the occupational health of health workers o Healthy Workplace Action Plan/Next Steps… o How to Conduct a Workplace Assessment o Rapid Assessment Tool o Efficacy of Control Measures Used to Prevent Needlestick Injuries - sharps boxes3. WHO White Papers and Position Papers • Health in the Green Economy - Health Facilities Executive Summary (English, Spanish) • WHO Workers health: global plan of action (Arabic, Chinese, English, French, Russian, Spanish) • Working together for health: The World Health Report 2006.
  13. 13. (English, French, Spanish) • The world health report - Health systems financing: the path to universal coverage, 2010. (Arabic, Chinese, English, French, German Summary, Portuguese, Russian, Spanish) • The World Health Report 2008: Primary Health Care (Now More Than Ever) (Arabic, Chinese, English, French, Portuguese Russian, Spanish)4. WHO Global Burden of Disease • Sharps injuries: Assessing the burden of disease from sharps injuries to health-care workers at national and local levels (English) • Sharps injuries: Global burden of disease from sharps injuries to health- workers (English)5. WHO-ILO Guidelines • Joint ILO/WHO guidelines on health services and HIV/AIDS. Geneva, World Health Organization and International Labour Organization, 2005. Guidelines for legislation, policy development, labour relations, occupational safety and health, and other technical subjects HIV/AIDS related. They discuss the basis for action, identify roles and responsibilities, set out the key policies and actions needed for sound management of HIV/AIDS in health services, and include core references in each section. (English, Spanish) • WHO-ILO-UNAIDS policy guidelines for improving health worker access to HIV and TB prevention, treatment care and support, 2010.
  14. 14. ndex.html The health sector is responsible for the prevention, diagnosis, treatment and care of illness and can contribute to reducing stigma and discrimination in the context of health services. Countries must protect the health and rights of their health workers by optimizing their working conditions. By protecting health workers, countries would ensure that those providing health services are themselves healthy. This will in turn facilitate people’s rights of access to quality health services. o Guidance note (English, French, Spanish) o Systematic review of evidence (English)6. ILO6.1 Conventions • C155 - Occupational Safety and Health Convention, 1981 (No. 155) 256:::55:P55_TYPE,P55_LANG,P55_DOCUMENT,P55_NODE:SUP,en,C 155,/Document (English, Spanish) • C161 - Occupational Health Services Convention, 1985 (No. 161) 335496::NO:12100:P12100_ILO_CODE:C161:NO (English, Spanish) • C187 - Promotional Framework for Occupational Safety and Health Convention, 2006 (No. 187) 796597::NO:12100:P12100_ILO_CODE:C187:NO (English, Spanish) • R197 - Occupational Safety and Health Recommendation, 2006 (No. 197) 402887::NO:12100:P12100_ILO_CODE:R197:NO (English, Spanish)6.2 HIV/AIDS • ILO Code of Practice on HIV and the World of Work
  15. 15. ilo_aids/documents/publication/wcms_113783.pdf The code provides invaluable practical guidance to policy-makers, employers and workers organizations and other social partners for formulating and implementing appropriate workplace policy, prevention and care programmes, and for establishing strategies to address workers in the informal sector. It is the product of collaboration between the ILO and its tripartite constituents, as well as cooperation with its international partners. (English, French, Spanish) • Implementing the ILO code of practice on HIV/AIDS and the world of work. An education and training manual. A valuable educational and training tool, this comprehensive manual offers practical guidance for formulating viable policies and programmes to combat HIV/AIDS in the world of work. Aimed at protecting the rights and dignity of workers, their families, and all people living with HIV/AIDS, the education and training material provided here can be applied to all sectors, public and private, formal and informal. (English, Spanish) • Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200) ilo_aids/documents/normativeinstrument/wcms_142706.pdf The new labour standard is the first human rights instrument to focus on HIV and AIDS in the world of work, and was adopted - by an overwhelming majority - by governments, employers and workers representatives from ILO member States at the International Labour Conference in June 2010. (English, French)7. CDC • CDC Workbook: Sharps Injury Prevention (English, Spanish) • Exposure to Blood Brochure (English, Spanish) • Hepatitis B and the Health Care Worker
  16. 16. (English, Spanish) • Immunization of Health Care Workers (English, Spanish)8. CDC/NIOSH • Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C - Safer Medical Device Implementation in Health Care Facilities o Lessons, each with 4 hospitals and 1 dental facility Form a sharps injury prevention team Identify priorities Identify and screen safer medical devices Evaluate safer medical device(s) Implement and monitor the use of the new safer medical device (English) • NIOSH Alert Protecting Needlestick Injuries (English, Spanish) • NIOSH Brochure: How to Protect Yourself from Needlestick Injuries (English, Spanish) • Selecting, Evaluating, and Using Sharps Disposal Containers (English)9. World Health Professions Alliance9.1 Positive Practice Environments Campaign Toolkit (English, French, Spanish)9.1.1 About the Positive Practice Environments Campaign • A Call to Action: Positive Practice Environments for a real and lasting impact on patients and health professionals
  17. 17. Action.pdf • Campaign Overview: Positive Practice Environments for a Health Care Quality Workplace for Quality Care ign-Overview.pdf • Campaign Poster Poster.pdf9.1.2 Tools and Resources • Fact Sheet: Positive Practice Environments for Health Care Professionals Sheet-PPE-for-Healthcare-Professionals.pdf • Checklist: Key Characteristics of Positive Practice Environments for Health Care Professionals Characteristics-of-PPE-for-Health-Care-Professionals.pdf • Fact Sheet: Incentive Systems for Health Professionals Sheet-Incentive-systems-for-health-care-professionals.pdf • Guidelines: Incentives for Health Professionals nes-incentive-systems-for-health-professionals.pdf • Promoting Health: Advocacy Guide for Health Professionals ing-health-Advocacy%20Guide.pdf • Sample Press Release e-Press-Release.pdf • Fact Sheet: PPEs: Meeting the information needs of health professionals ctSheet_Meeting_the_information_needs_HIFA2015.pdf10. International Council of Nurses
  18. 18. • Occupational health and safety for nurses nts/C08_Occupational_Health_Safety.pdf (English)11. Greening Health • H2E Self-assessment guide. Hospitals for a Healthy Environment This guide includes sections on overall environmental policies and procedures, as well as information on specific waste streams (e.g., solid waste, regulated medical waste, chemical waste and mercury). It also includes a section on environmentally preferable purchasing for hospitals. This self-assessment guide also suggests collecting baseline data including the annual weight of every waste stream leaving the facility and the costs to manage that material. Hospitals for a Healthy Environment (H2E: a collaboration between the American Hospital Association, American Nurses Association, US Environmental Protection Agency, and Health Care Without Harm). (English)12. EPINet • EPINet Instructions for Access • EPINet Confidential • EPINet FullAfrica • Africa Uniform Blood & Body Fluid Exposure • Africa Uniform Needlestick and Sharp Object Injury • Africa-RSA Post Exposure Follow-Up • Continental Africa Directions • Continental Africa-RSA Access EPINet 2003 formatU.S. • New US Post Exposure Follow-Up (English, Spanish) • US Uniform Blood & Body Fluid Exposure (English, Spanish) • US Uniform Needlestick and Sharp Object Injury (English, Spanish) • 2003 Access U.S.
  19. 19. Acknowledgements:The production of this collection of materials was made possible thanks to thekind technical and financial support of the US National Institute of OccupationalSafety and Health (USAID WHO Consolidated Grant GHA-G-00-09-00003).