Health and safety hazards to workers

Health and pencil eraser hazards to kick the bucketersIn Mauritius, we gestate volt regional hospitals namely SSRNH, Victoria Hospital, Nehru Hospital, Jeetoo Hospital and Flacq Hospital and a nonher(prenominal) downhearted peculiar(a)ised hospitals much(prenominal) as ENT Hospital, Moka Eye Hospital and Brown Sequard Hospital. wholly(prenominal) regional hospital consists of a CSSD unit respectively which cater for the render of sterile items to the hospital and to wellness centres which f boths under the catchment argona of that regional hospital. Although, the CSSD is a atomic unit in that hospital, its heading and service is of slap-up brilliance to the healthcargon faculty, patients and to the public in normal. The role of the CSSD is to embarrass cross- transmittance and contamination of the patients, staff and visitors by sterilising tout ensemble equipment and instruments which aid in providing the trump aside cargon to the patients.It is period to think about the health and soundty of the take formers of primeval unfertile Supply Department (CSSD). In order to protect and to resist the staff of the CSSD from injuries and complaintes, it is important to identify the health and safety hazards that atomic number 18 contribute at each level and in each field of battle of the CSSD. later on identification of these hazards is carried out, appropriate pr securenesstive measures moldiness(prenominal) be adopted if non to eliminate the hazards completely, but at least(prenominal) to minimise the video of the staff to these hazards so that they sess usage in a safer environment dethaw from injuries, accidents and occupational diseases.For the purpose of this project, the back Identification was carried out at the CSSD of SSRN Hospital.AbbreviationsCSSD primaeval Sterile Supplies DepartmentSSRNH Sir Seewoosagur Ramgoolam National HospitalPPE Personal Protective EquipmentEtO e paste OxideHIV -Human Immunodeficien cy VirusOSHA 2005 -occupational Health and Safety 2005-HBV Hepatitis B VirusMSD musculoskeletal Disorders1.0 INTRODUCTIONHospitals atomic number 18 such places where people get interference for their illnesses, injuries and diseases. m both of these diseases be ca employ by biological agents such as bacteria, vir make utilise ofs and fungi. Thus, in hospitals on that point is graduate(prenominal) incidence of disease-ca employ micro-organisms which tail end spread from patient to patient or from patient to health c atomic number 18 personnel or from the equipment and other materials that atomic number 18 used enchantment giving c are to the patients. It is the duty of the staff not only to cure the diseases of the patients but at the aforementioned(prenominal) quantify to continue the transmission of diseases from one person to another. An effective measure to keep back spread of the diseases is in making sure that all the items that are used in the care of the pati ents are sterile. Many of the instruments and materials used in the hospitals are quite expensive and are so knowing that they stool be reused.The importance of a CSSD in a hospital is to stomach sterile items at the required time and place in the hospital. The CSSD of a hospital receives stores, sterilises and distributes to all the departments including the wards, outpatient department and other special unit such as the routine field of operation. The main duty of the CSSD is the sterilization of items such as catheters, tubings, operative(a) instruments, treatment trays and sets and dressings materials. Although, CSSD aims at providing sterile items so as to prevent the spread of transmittance and in virtually ways to protect hospital staff and patients from biological hazards, the CSSD itself is prone to various hazards. So, to be able to identify the health and safety hazards that histrions face, we must first know the activities that are carried out in the CSSD.2. 0 The objectives of the CSSDTo provide sterile gauze packs cotton plant wool and equipment to all units of the hospital and to country Health Centers, and Community Health Centers in spite of appearance the catchment study of a regional hospital.To ensure that proper cleaning, disinfecting and sterilising affect of items is being carried out in the department.To hold up an inventory of all supplies and equipment.To meet the demand of its customers, i.e. different units in supply the ask amount of sterile items to them.To contribute to a huge effect in preventing cross-infection by effective running of the department.To take some of the excogitate of the nursing staff so that they posterior give more time to the patients.To discharge expensive equipment which are not used so frequently reusable.To provide a safe working environment for the staff.3.0 The organisational structure of the CSSD at SSRNHThe CSSD has manpower of 26 histrions 1 Superintendent, 2 Supervisors, 1 7 CSSD Assistants and 6 CSSD Attendants.The promontory of the Department is the Superintendent and is the one who liaises with other heads of different departments.The supervisors are liable for monitoring the duties of the assistants and to ensure the smooth running of the unit. They are also accountable for the effective delivery of sterile items to the required units.The CSSD Assistants are those workers who perform approximately of the duties in the unit.The attendants are mainly concerned with manual handling, collecting and delivering items to other departments of the hospital.An organisational chart is as infraCSSD SuperintendentCSSD SupervisorsCSSD AssistantsCSSD Attendants4.0 CSSD DesignFImagesP2108_26-04-10.JPG5.0 The Sterile Supply Cycle6.0 The different areas of the CSSDThe CSSD is divided into four study areas assortment and DecontaminationAssembly and caseSterilisingSterile Storage and statistical distribution1. Sorting and Decontamination sphereHere the instr uments are cleaned and washed. For the purpose of cleaning and washing, chemical detergents and disinfectants such as javel, alcohol and soaps are used. The instruments are washed in basin using plenty amount of water. It is only after this process that the instruments are safe to be handled. Also, sorting of instruments is carried out, disassembling of the instruments is done when needed and the CSSD assistants inspect the items for cleanliness and damage.2. Assembly and Packaging AreaFollowing decontamination, the items are further sorted, reassembled and packaged. Here, reusable linens such as surgical gowns, discolor sheets drapes are jam-packed in individual(a) special wrapping paper. Cotton wool rolls are place in carton boxes. Gauze pieces are arc into smaller sizes and are wrapped individually. exculpated instruments are position in trays (either small or large depending on the surgical intervention during which they are going to be used) and are thus packed in doubl e wrapping papers. steriliser tapes are used to hold the surgical items packed for sterilization intact. These tapes have white exponent lines which turn to black lines after sterilization, thus doing the user to make sure that the pack is sterile.3. The Sterilising AreaHere the packed items then suffer a process known as sterilization. This involves the killing of any potential pathogen on the items. Normally, several methods of sterilisation exit but steamer and ethylene oxide sterilization are most commonly used.4. Sterile Storage and Distribution AreaThe sterile items are then stored in the transshipment center area arranged neatly on different shelves. From there, the sterile items are then distributed to respective units.7.0 The Sterilising ProcessThe CSSD attendants collect used instruments and equipment, empty carton boxes for cotton wool and the CSSD book (in which the head of the unit jots down the number of each sterile items he needs) from respective units of th e hospital.With the introduction of new technologies, old methods of sterilisation such as boiling and vaporization have been replaced by deuce main methods of sterilization namely1. Autoclaving, i.e. steam sterilisation2. bollix sterilisation using ethylene oxide.The items that are sterilised in the CSSD areCloth, i.e. green sheets drapesGauzeCotton woolInstrumentsPre-sterilisationPrior to sterilisation, all the items must be prepared through a process known as pre-sterilisation.The pre-sterilisation process for the items that have to be sterilised is as follows1. ClothThe clean linen are folded, and then wrapped in a special paper. The packed linen is then sealed with autoclaves tape.2. GauzeThe gauze are cut into uniform pieces and do into either large gauze or small gauze. They are then packed in paper into individual packs and are sealed with autoclave tapes.3. Cotton woolThe cotton wool is made into small rolls from large bundles and placed in small carton boxes which are th en sealed on the sides with autoclave tapes.4. InstrumentsThe instruments are first check out for soil, they are then washed and placed in trays or individual sets depending on the requisition of the respective unit. They are then packed in double special paper wrappers and sealed with autoclave tapes.SterilisationIt is a process used to make a medium eject from micro-organisms including bacterial spores. Sterilisation digest be done through heat, chemicals, irradiation and senior high pressure.In the CSSD at SSRNH, two types of sterilisation is being usedGas SterilisationSteam SterilisationGas SterilisationUsing ethylene oxide. This method of sterilization empennage be used to sterilise those items that set up with put up temperatures of 50-60C. A long period of aeration is required to remove all traces of ethylene oxide.Autoclaving, i.e. Steam SterilisationIt is the most reliable process of sterilization. It sterilises with steam under pressure. The high pressure also ensure s saturation of wrapped surgical packs. Autoclaving is one of the most effective methods for destruction of all types of micro-organisms. The amount of time and degree of temperature necessary for sterilisation depend on the articles to be sterilised.8.0 literary productions REVIEWThe aims of Occupational Health and Safety areTo promote and state a high degree of fleshly, mental and social well-being of workers in their respective oeuvreTo prevent adverse effects on the health of the workers that hindquarters be overdue to the working conditionsTo protect the workers at their body of work from seeks exiting from factors adverse to healthTo provide the workers with such working environment that suits their tangible and mental needsthe adaptation of work to humans.We mass thus regulate that occupational health and safety englobes the social, mental and carnal well-being of workers. A healthy workplace means a safe workplace where the workers leave behind be in an environ ment where the hazards delineation is quite minimised if not eliminated completely.Occupational health and safety is important asWork plays a major role in peoples lives, since most workers spend at least octet hours a day in the workplace. on that pointfore, work environments should be safe and healthy. But, this is not the case for many workers. Every day workers all over the world face many health hazards, such asdusts gaseous stateesnoise shudderextreme temperatures.As a impression of the hazards and a lack of management given to health and safety, work-related accidents and diseases are common in all separate of the world.Appropriate and effective workplace health and safety programmes can help to protect the workers by reducing hazards and their consequences. Health and safety programmes can also have positive effects on both worker esprit de corps and productivity and can thus be beneficial to the organisation. At the same time, effective programmes can save employers a great deal of money.There are many hazards that efficiency exist in any workplace such aschemical hazards in the form of liquids, solids, dusts, fumes, vapours and gases physiologic hazards, such as noise, vibration, unsatisfactory lighting, radiation and extreme temperaturesbiological hazards, such as bacteria, viruses and fungipsychological hazard as a result of stress and strainhazards related to the non-application of ergonomic principles, like big(a)ly designed machinery, mechanical twirls and tools that bequeath be used by workers, unconventional set and workstation design, or poorly designed work practices.Workers often get work-related health problems and do not realise that the problems are related to their work, particularly when an occupational disease, for example, is in the early stages. Besides the other more obvious benefits of training, such as skills partment, hazard recognition, etc., a comprehensive training programme in each workplace will help workers t orecognise early signs/symptoms of any potential occupational diseases onward they become permanent conditionsassess their work environmentinsist that management to make changes in front hazardous conditions can develop.Previous research on CSSD shows thatAccording to Linda Clement, Items processed in the decontamination areas are potentially pathogenic and pose a potential exposure risk to employees working in these areas. She also stated that to prevent cross contamination, ripe(p) infection prevention processes must be put into practice. Also, the housekeeping procedures should be the same as those that are used in operation theatre and delivering get ons and that all horizontal working surfaces and the scandalizes should be cleaned daily. The medical equipment poses a risk of exposure to squanderer and bodily soils, and other safety hazards before or during processing. So, appropriate personal protective equipment (PPE) should be weak by the workers, they should adopt goo d work practices and have to follow the manufacturers instructions. Whether it is a sterilizer, a washer/disinfector, an endoscope or a surgical instrument, it is best to follow the device manufacturers instructions found in operator manuals and other product sustenance for handling, operation, cleaning and disinfecting medical equipment.As per John Brown, either personnel working in the decontamination area should get around clean, facility-provided uniforms that are donned at the facility. Also, workers should use general purpose utility gloves, gown, a surgical face mask and gawp eyepatch working in the decontamination area. During caution procedures, additional PPE is necessary including midpoint protection and steel-toed piazza should be worn at all clock to protect from overhasty and healthy objects from causing defect to workers feet. Leather gloves mend handling potentially knifelike objects, stainless steel panels and plumbing hollo gloves and heat-resistant arm sleeves must be worn while working around steam piping and face shield when using cleaning chemicals.(Infection temper Today-Jennifer Schraag April 08)8.1 HEALTH AND SAFETY HAZARDS8.1.1 SafetyThe primary areas of potential hazards include environmental, galvanizing, mechanical, chemical, biological, dismiss and physical. The work performed in the CSSD need special attention to avoid accidental injury to the workers and sometimes visitors such as nursing staff. Most workplace injuries and accidents are coiffured by neglect, carelessness or lack of understanding of the principles of safety. Safety is every workers responsibility so as protects oneself and also the equipment in the CSSD which is governments property.8.1.2 Chemical HazardThese hazards are present when a worker is undecided to any chemicals in the workplace, be it solid, liquid or gas. Some of these chemicals are safer than others, but some workers who are sensitive to chemicals, even those that are commonly u sed solutions can motility illness, skin irritation or breathing problems.In the decontamination area, the use of chemicals for cleaning purposes is necessary. These chemicals are caustic soda, javel, methyl spirit, soaps and detergents. flick whitethorn result when the workers do not use necessary personal protective equipment (PPE) while handling these hazardous chemicals found in soaps, disinfectors and cleaners.Exposure to these substances can begin collision dermatitis, excoriation of the skin and ulcers. Prolonged and persistent exposure whitethorn end up in allergic reactions or hypersensitivity.8.1.3Ethylene Oxide (EtO) HazardsEtO possesses several physical and health hazards that really need much attention. EtO is a liquid below 51.7 F, or a gas that has ether-like odour at concentrations above 700 part per million (ppm) and is both flammable and highly reactive. The current OSHA Permissible Exposure Limit (PEL) to EtO is 1ppm for an 8-hour time weighted average.Normal ly, EtO sterilization is done for items which cannot be unresolved to steam sterilization. Exposure hazards normally results from improper ventilation in ethylene oxide chamber after the sterilising process, during off-gassing of sterilized items or due to leakage from shout connection. Hazards can also occur when removing sterilized items from the sterilizer or even when changing bottles of EtO gas.Health effects of EtO areEye irritation and injury to cornea, frostbite and on prolonged skin exposure, severe irritation and vesiculation of the skin can materialize.Gastric irritation and injury to the liver can result from accidental ingestion of EtO.Inhalation of EtO vapours may answer respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath and cyanosis.Risk of cancer, adverse reproductive effects and chromosomal damage can result from prolonged exposure to EtO.8.1.4 Biological HazardIn the decontamination area, workers may be injured f rom polluted sharp instruments such as needles and scalpels, while sorting, cleaning and washing. Soiled, reusable instruments are considered to be contaminated with bacteria and other micro-organisms, which can cause illness to the staff. Exposure to infected material can cause diseases such as Viral Hepatitis and HIV. Contamination is liable to occur due to presence of blood borne pathogens found in soiled drapes and pointed objects, e.g needles. Hepatitis B is transmitted through contact with the blood or body fluid of an infected person on soiled drapes or surgical instruments which in turn land up in the CSSD for sterilisation.8.1.5 Ergonomics related hazardsWhen the physical requirements of a job and the physical capacity of a worker do not match, it can cause in work-related Musculoskeletal Disorders (MSD). Ergonomic hazards occur when the type of work, body thought and working conditions put strain on the body. A worker will not notice the strain immediately .For short-term exposure, a worker can get sore muscles the next day or in the days following exposure, but long term exposure can end in serious long-term injuries. These hazards may be due tobad lightingnot properly adjusted workstations and chairsfrequent liftingbad posturerepetitive awkward movementstoo much force is needed to do a work and it has to be done quite often.In the CSSD, workers are exposed to repetitiveness of works, prolonged standing and reaching out while sorting instruments, self-conscious sitting postures on chairs which are non-ergonomically designed during trimming of gauze and putting cotton wool rolls in boxes. The workers have to bend frequently while lifting heavy loads, need to reach high storage shelves or need to push or pull heavy carts loaded with sterile or unsterile items, all this can lead to MSD. butt against trauma to build up can also occur if the workers the wrists are placed on hard surfaces.8.1.6 Physical HazardsThese are the most common and can be pre sent in most workplaces at anytime. They include shaky conditions that can cause injury, illness and death. Sometimes bad working practices are used so often that they become the routine works habits and might be not considered as hazards to workers. But still these hazards cannot be authorized in a workplace.Physical hazards includeelectrical hazardsconstant brassy noisehigh exposure to heatslips/trips and falls.Burns and cutsWorkers are exposed to burns and cuts during handling of burning sterilised items or sharp instruments when removing them from autoclaves.Slips/Trips/waterfallExposure to slippery floors can occur to spills of detergents and presence of water on the floors while cleaning and washing of instruments is being done in the decontamination area. In the sterilizing area because of the use of steam in autoclaving processes, the environment inside the room will be humid and may cause the floor to be slippery.Electrical HazardsAll electrical devices should be inspec ted upon arrival in the CSSD. awry(p) grounding and earthing facilities can prove to be dangerous. Regular maintenance and repairs of the equipment in the CSSD should be documented and proper re heap should be retained. Electrical corduroys lying on the floors can cause workers to trip over them and the cord can also be exposed to wet floors and cause electrocution. The use of extension cords should be avoided and electrical sockets should not be installed next to washing basins or near any source of water. severe electrical installations by incompetent persons can give rise to electrical hazards. All electrical installations should have protective devices such as circuit breakers, fuses, residual Current Devices so that the electrical equipment are safe from overvoltage and excessive current. Unsafe work practices can lead to electrical accidents.HeatExposure to sweltry environment can lead to heat stress, heat exhaustion, and cramps. This can happen when workers are unloadi ng items once autoclaving is completed. As autoclaving uses steam, the atmosphere in the sterilising area becomes very moist and the temperature in that unit is quite raised when the autoclaves are in operation. The workers feel very hot and also very uncomfortable to work in such conditions. Sweaty palms, fogged-up safety glasses and dizziness caused by the heat can increase risk of injuries in workers. Burns can also occur due to accidental contact with hot surfaces of autoclaves or with accidental disperseing of the autoclave door or due to improper closing of the door causing steam to escape.Fire HazardsEtO is used for gas sterilising. EtO is a highly flammable gas and improper ventilation remains and leakage of the gas-line can cause accumulation of EtO in the CSSD, the use of cigarettes by staff in addition to the EtO in the air may cause a arouse outbreak or even an explosion. Improper storage of flammable gases and liquids can have adverse effects and may result in fire.I mproper maintenance of electrical equipment and aging electrical cords, with the presence of water can be a source of static electricity, sparks or minor combustion which can ultimately lead to a fire due to presence of large amount of combustible materials such as gauze, linen cotton, boxes, and paper wrappers in the CSSD.8.1.7 Latex AllergyWorkers normally gestate latex gloves during handling and sorting of contaminated instruments and equipment is done. Some workers can develop allergy to the latex.9.0 LEGISLATIONThe only legislative body concerned with the health and safety of workers in Mauritius is the Occupational Health and Safety Act 2005. The Superintendent, Supervisors and all the CSSD staff should be familiar with this Act as each worker will know about his rights and what work he should or should not do as per law and what protection he should have for doing a particular task.10.0 RECOMMENDATIONSGeneral RecommendationsAn effective measure to prevent workers from hazard s exposure is regular job rotation to different areas of the CSSD. The employees should be provided with gowns, hair covers and shoe covers while at work. During cleaning and washing of equipments, the workers should be provided with rubber gloves and aprons. While removing carts and trays from the hot sterilisers leather gloves should be worn by the staff. Frequent hand washing with good hand washing techniques will contribute to a great extent in preventing cross-infection. It is highly recommended to the workers not to wear any jewels, e.g. sound and nail varnish while washing the instruments and while packing the items for sterilisation.Workers must adopt safe work practices so as to prevent accidents, injuries and illnesses. taking the necessary safety upkeeps while performing the required task can practically eliminate associated dangers. It is the duty of all workers to comply with specific health and safety precautions so to protect themselves from any hazard that might b e present in the CSSD.Recommendations for Chemical HazardsGoggles must be worn when washing and cleaning instruments as there is risk of chemicals being splattered into the eyes.Appropriate PPE such as gloves, goggles, splash aprons should be worn by workers so as to protect them while using detergents and chemicals in the decontamination area.In case of splash of chemicals into the eyes, the workers should flush the eyes immediately for at least 15 mins. Thus, suitable facilities for eye flashing should e situated within the working area.Recommendations for EtO theatrical role proper ventilation especially for the Eto Room local exhaust ventilation system should be installed.Workers exposure to EtO should be minimised when sterilization is being carried outThe door of the sterilizer should be opened no more than two move ones to pull up stakes the load to off gas before transferring them to carts. Installation of a ventilated exhaust hood installation would be very useful.For ch anging of cylinders, appropriate PPE such as butyl apron, gloves, and a cannister respirator is recommended.Recommendations for Biological HazardsUse protective glove for cleaning and decontamination, plaza should be close and resistant to puncture, goggles for eye, face mask or face shield and plastic apron.Training in of handling of sharp equipment should be given to the workers.Engineering and Work Practice Controls must be the primary means used to eliminate or minimize exposure to blood borne pathogens.Engineering Controls are measures (e.g., sharps disposal containers, self-sheathing needles, and safer medical devices, such as sharps injury protections) that isolate or remove the blood borne pathogens hazard from the workplace.Use of resistant puncture sharp containers with biohazard symbol. Container to be filled to the tag and the container should not have any leakage.Recommendations for Ergonomics Related HazardsWorkstation need to be redesigned so packaging and equipme nt are within reachable levels and the elbows are maintained close to the body.The wheels for the carts should be such that they are easily rolled.Prolonged command processing overhead time activity need to be minimised (e.g. storage shelves should be lowered to bring up height).Height-adjustable work surfaces should be used or tables have to be bring up to minimise head tilt.Repetitive tasks should be prevented by rotating workers to different work area.The edge of the working surfaces which come into contact with the elbow or forearm should be padded to prevent contact trauma.Sit/stand stools may be provided in the working area.Anti-fatigue mats have to be used.Shoes with well-cushioned insteps and soles should be worn by workers in case there is no floor mats.Foot rest bar should be provided to the staff so can they continually alter their posture by raising one foot. overdraw Work SurfacesPadded Work SurfacesRecommendations for Burns and CutsGood work practices should be esta blished to prevent hazardsHot items should not be removed from sterilisers until they are cooled.Handling of sharp ends of instruments should be avoided.Forceps should be used to remove sharp instruments from baskets and autoclavesLeather gloves should be provided to workers for handling of hot items.Recommendations to prevent from burning with AutoclaveUnloading AutoclaveHeat-insulating gloves, safety glasses/face shield and closed toed shoes should be worn while unloading autoclaves.Workers must make sure that the pressure of the chamber is 0 before they open the door.Workers should stand back away from the door as a precaution and carefully open the door not more than 1 inch (2.5 cm) so as to endure residual steam to escape and to the allow pressure within the liquids and containers are back to normal.Sterilised items should be allowed to stand for 10 minutes. This will allow the steam to clear and also allow trapped air to escape from hot liquids, reducing risk . (Note This is built into the operating cycle on some of the autoclaves).Containers of super-heated liquids should not be stir up and caps must not be removed before unloading.When hot items are removed from the autoclave, they should be marked with warning sign (e.g. Caution Hot. Do not touch.) till the items cools down to room temperature..Recommendations for Slips, Trips and FallsFloors should be unbroken clean and dry.For wet floor areas warning signs should be placed.Proper drain should be done during wet processes and floors mats, dry standing places should be on tap(predicate) and waterproof footgear can also be worn by the workers.All working area should be kept clean and in an orderly manner.All aisles and passageways should be and free from any obstruction.Floor plugs for equipment to prevent power cords from running across pathways.All exits should be free from any obstruction. Access to exits doors should be easily reachable.Slip resistant shoes should be worn.Spills need to be re ported and cleaned immediately.Uneven floor surfaces should be eliminated.Recommendations for Electrical hazardAvoid using extension cords.All cords should have a grounded, three-prong, hospital-grade plug.A cracked cord should be replaced immediately.No accumulation of water should be allowed near an electrical outlet.According to OSHA 2005 article 73,all electrical apparatuses and conductors including machines, equipment and fittings shall be sufficient in size and power for the work for which they are used and shall be constructed, installed, protected, worked and maintained so as to prevent danger.Recommendations for hazards related to HeatSince, the place of work is quite hot workers should wear light-coloured and