UNDP GEF Project on Global Healthcare Waste

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Module 6: Occupational Health and Safety

Estimated Time /

Lecture: 1 hour
Activity: 45 minutes

Module Overview /

Discuss principles of workplace health and safety
Describe how the hierarchy of controls reduce or eliminate risk
Describe components of an effective occupational health and safety program
Discuss training
Discuss personal hygiene, use of personal protective equipment (PPE), and immunization
Discuss incident and post-incident response

Learning Objectives /

Identify workplace hazards and who is at risk
Discuss how exposure can be prevented/limited
Demonstrate proper hand hygiene
Discuss use and limitations of personal protective equipment
Demonstrate the proper donning and removal of personal protective equipment
Discuss the functions of an occupational health and safety committee

Target Audience /

HCWM coordinators
Facility managers/administrators (or equivalent)
Healthcare professionals
Healthcare waste workers and certain facility support staff (laundry workers, housekeeping staff/cleaning staff, etc.)
(Note: Presentation slides should be adjusted to fit the needs of cleaners, waste workers and other auxiliary staff.)

Instructor Preparation /

Make notes pages of PowerPoint slides to hand out to class
Read Chapters 11 and 12 in Blue Book, and other materials included in the References
Make copies of any additional documents/readings that may be handed out to class, such as those included in the References
Any materials on country or local laws related to worker health and safety.
Prepare any additional notes to be discussed during the presentation
Prepare any additional discussion points or review questions

Materials Needed /

Projector
Student handouts: slides, exercise, homework
Flip chart and marker pens and/or board and chalk
Any materials on country or local laws related to worker health and safety.

Student Preparation /

Blue Book Chapter 11, 12
Read country or local laws regarding worker health and safety.
Think about any worker safety measures that exist in your facility

Review Questions /

What are some common workplace safety hazards that you see in your facility? Who do you think is at risk from healthcare wastes?
Do you know of any worker health and safety policies found in your specific country or region?
What do consider the most important elements of good personal hygiene when working in a healthcare facility? Do you think good hygiene habits are readily practiced in your facility?
Does your facility offer worker health and safety training programs, or other opportunities for specific training about healthcare wastes and hazards? Do you know of other outside training programs (aside from this one)?
What kinds of personal protective equipment, if any, do you regularly wear/use in your job at the healthcare facility?
Do you have a responsibility in incident reporting?Are PEP procedures set up in the facility?

Presentation

Slide Number/Title / Teacher’s Notes
Slide 1: Title Slide
Slide 2: Module Overview / Introduce the outline and major points of the presentation
Slide 3: Learning Objectives / Describe what participants will learn at the end of this module.
Slide 4: Principles of Worker Health and Safety / The production, segregation, transportation, treatment, and disposal of healthcare waste involve the handling of potentially hazardous material.
Protection against personal injury is therefore essential for all workers who are at risk. The individuals responsible for management of healthcare waste should ensure that all risks are identified and that suitable protection from those risks is provided.
Healthcare waste management policies or plans should include provisions for the continuous monitoring of worker health and safety to ensure that correct handling, treatment, storage, and disposal procedures are being followed.
Healthcare waste should be considered as a reservoir of pathogenic microorganisms, which can cause contamination and give rise to infection. If waste is not managed properly, these microorganisms can be transmitted by direct contact, in the air, or by a variety of vectors.
Slide 5: Principles of Worker Health and Safety / The ILO lists the following 11 functions as being integral to occupational health services: (1) identifying and assessing risk, (2) surveilling workplace hazards, (3) designing safe workplaces, (4) developing programs for improved work practices and for evaluating new equipment, (5) advising on occupational health, safety, and hygiene, (6) surveilling workers' health, (7) promoting adaptation of work to the worker, (8) managing vocational rehabilitation, (9) organizing training and education, (10) organizing first aid and emergency treatment, and (11) analyzing adverse conditions that lead to injury and illness.
World Health Organization.Global strategy on occupational health for all. (Geneva, 1995)
Slide 6: Who is at Risk? / Workers at risk include health-care providers, hospital cleaners, maintenance workers, operators of waste treatment equipment, and all operators involved in waste handling and disposal within and outside health-care establishments.
Slide 7: Sources of Infection / In a healthcare facility, the sources of infection may be the personnel, the patients, or the inanimate environment.
For this reason, it is essential to practice good hygiene.
Slide 8: Hierarchy of Controls / -Elimination of hazard at the source is the most preferred method and should be used whenever possible
-Substitution with less harmful materials
-Engineering controls: controls that isolate or remove a hazard from the workplace
-Administrative controls: policies aimed at limiting exposure to a hazard
-Work practice controls: controls that reduce exposure through behavior of workers
-PPE: barriers and filters between worker and hazard (least desirable method)
Slide 9: Occupational Health Program / Instructor: Please note that in most facilities this committee may not exist. You may only have a person in charge of training. This is a step for all facilities to consider in their HWWM program.
Slide 10: Training / All healthcare workers should receive training in their specific area.
Healthcare waste workers should be trained before starting work handling waste (such as with this training program), and then on a routine basis to keep them knowledgeable and up-to-date about important control measures and procedures
Slide 11: Training
Slide 12: Examples of Specific Training / These are examples of specific training for workers; there may be additional training in your own facility. Ask class if they have received or know of any specific training options in their facility.
Slide 13: Handling Sharps Containers / Go over the proper procedures for handling sharps containers
Slide 14: Handling Contaminated Linen / Steps for proper handling of contaminated linen
Slide 15: Handling of Cytotoxic Waste / Written procedures should be clearly laid out for safely working with drugs. Emergency plans should also be set forth in case an incident occurs.
Slide 16: Handling of Cytotoxic Waste
Slide 17: Personal Hygiene / Describe/discuss the essential components of good personal hygiene.
Slide 18: Personal Hygiene / Go over when it is important for workers to wash their hands. Ask class when they generally wash their hands or notice others washing their hands while working.
Slide 19: Hand Hygiene / - As the hands of healthcare workers are the most frequent vehicle of hospital infections, hand hygiene, including both hand washing and hand disinfection, is the primary preventive measure.
-Thorough hand washing with adequate quantities of water and soap removes more than 90% of the transient bacteria/flora, including all or most contaminants.
-Killing all transient flora with all contaminants within a short time (a few seconds) necessitates hygienic hand disinfection: only alcohol or alcoholic preparations act sufficiently fast. Hands should be disinfected with alcohol when an infected tissue or body fluid is touched without gloves.
Slide 20: Personal Hygiene / Go over the steps involved in proper hand washing
Slide 21: Hand Hygiene Technique with Soap and Water (Diagram)
Slide 22: Hand Hygiene Technique with Alcohol-based Formulation (Diagram)
Slide 23: Personal Protective Equipment (PPE) / Talk about the importance of PPE
The following should be made available to all personnel who collect or handle health-care waste PERSONAL PROTECTIVE EQUIPMENT (PPE):
•Helmets, with or without visors depending on the operation.
•Face masks depending on operation.
•Eye protectors (safety goggles) depending on operation.
•Overalls (coveralls) obligatory.
•Industrial aprons obligatory.
•Leg protectors and/or industrial boots obligatory.
•Disposable gloves (medical staff) or heavy-duty gloves (waste workers) obligatory.
Industrial boots and heavy-duty gloves are particularly important for waste workers. The thick soles of the boots offer protection in the storage area, as a precaution from spilled sharps, and where floors are slippery.
Many facilities do not have resources for PPE. The instructor should ask participants what PPE do they have access to, and discuss ways in which they can protect workers withour the use of PPE.
Slide 24: Gloves / Factors for selecting appropriate gloves
Slide 25: Gloves / Discuss importance of proper glove use
Optional: Discuss article in References: Blenkharn, JI. Glove use by ancillary and support staff: a paradox of prevention? J Hosp Infect. 2006 Apr;62(4):519-20. Epub 2006 Feb 7.
Slide 26: Safety Glasses, Goggles, and Face Shields / Overview of face protection
Slide 27: Coveralls and Aprons
Slide 28: Respirators / Respiratory protection is of primary importance since inhalation is one of the major routes of exposure to chemical toxicants or infectious agents.
Positive-pressure respiratorsmaintain a positive pressure in the facepiece during both inhalation and exhalation. They are usually powered units that include an internal fan.
Negative-pressure respiratorsdraw air into the facepiece via the negative pressure created by user inhalation. The air passes through one or more filters. The simplest are light, single-use face masks. Other types utilize replaceable cartridges that attach to a half-face or full-face respirator.
Different cartridges are available for different types of chemical vapors. The main disadvantage of negative-pressure respirators is that if any leaks develop in the system (e.g., an ill-fitting mask), the user draws contaminated air into the facepiece during inhalation.
Under the U.S. NIOSH classifications, the N95 and N99 face masks filter 95% and 99% of airborne particles, respectively, but are not resistant to oils. Under the European standards, P1, P2 and P3 particulate filters remove at least 80%, 94% and 99.95% of airborne particles.
The facepiece of the respirator covers either the entire face (full-face) or the bottom half of the face (half-face) including the nose and mouth.
Slide 29: Shoes / How particular safety shoes provide worker protection
Slide 30: Sequence of Donning PPE / Refer to:

Slide 31: Sequence of Removing PPE
Slide 32: Immunization / Immunization against viral hepatitis B is recommended for all healthcare personnel and tetanus is recommended for all waste workers. Additional immunizations may apply, as well.
Slide 33: Response to Injuries / Ask participants what happens if they have a needlestick injury on site?
Do you think people do not report injuries? Discuss barriers to reporting- stigma, management, fear of punishment etc.
Slide 34: Post-Exposure Prophylaxis / Discuss the aspects of post-exposure prophylaxis.
PEP should be included as part of a universal precautions package that reduces staff exposure to infectious hazards at work.
Slide 35: Incident Reporting / INCIDENT — an incident is an unplanned, undesired event that hinders completion of a task and may cause injury or other damage.
NEAR MISS — an incident where no injuries occurred but, given a slight shift in time or distance, an injury or other damage could have occurred.
Slide 36: Incident Report / Discuss what is included in an incident report
Slide 37: Medical Surveillance / Ask participants if there is any surveillance in their facility as of now.
Slide 38: Fire Safety / Go through proper protocols of fire safety
Slide 39: Importance of an OHS committee / Main reasons for why an OHS is essential
Slide 40: Discussion / Major discussion points that tie in with review questions.
References (in order as they appear in slides) / Blue Book, Chapters 11, 12
World Health Organization.Global strategy on occupational health for all. (Geneva, 1995)
WHO: WHO Guidelines on Hand Hygiene in Health Care.

Blenkharn, JI. Glove use by ancillary and support staff: a paradox of prevention? J Hosp Infect. 2006 Apr;62(4):519-20. Epub 2006 Feb 7. There a number of other articles by the same author that you may find useful.
Donning and Removal of PPE.

Activity: Module 6: Exercise (45 minutes)

The purpose of this activity is to identify worker health and safety program needs in healthcare settings.

Instructor: Break class into groups of three or more, and distribute exercise at beginning of class. You may group participants by facility, department, or job type. Participants will complete the activity in groups and record their answers. Instructor should record participant/group responses on a wipe board, flip chart, or transparency, categorize their responses.

Instructor will go over the responses, once again, during the de-brief.

Module 6 Exercise: Identifying worker health and safety needs.

Instructor should describe the module overview and objectives and then ask participants:

Who is in charge of worker health and safety in your facility?
What worker safety programs exist?
Is there any regular training?
Do you have access to PPE? If so, what kind of PPE?
Do you have an occupational health and safety (OHS) committee, or a needlestick injury prevention committee?
What do you do if you get injured on the job? What are your concerns?
Think about how you can set up a OHS committee.
Do you know of country specific or local laws regarding workers health and safety?

De-brief

Instructor will discuss advantages of an occupational health and safety committee and how this can benefit workers.