Protecting and promoting the health and safety of health care workers
PAHO, WHO, and its Collaborating Centers in Occupational Health have provided technical cooperation to several member states to protect and promote the health and safety of health care workers. Health care work has been identified as one of the most hazardous jobs. Common occupational risks include infectious diseases, heavy patient lifting, ionizing radiation, shift work, and many other chemical, biological, physical, and psycho-social factors. For example, in Latin America and the Caribbean, the proportion of HBV, HCV, and HIV infections among health care workers due to occupational sharps injuries are the highest in the world at 55, 83, and 11 percent, respectively.
The need to make health care work healthier and safer was highlighted by the Regional contribution to the WHO draft Code of Practice on the International Recruitment of Health Personnel, in which countries indicated that poor working conditions and environments found in many health care settings interact to significantly undermine the health of health workers, patients and communities. Improving work in the health care sector helps to meet the basic needs of health care workers in order for them to perform their jobs effectively, to efficiently support patient health, and to help strengthen health care systems.
For more information, tools and publications about what countries are specifically doing to improve the health and safety of health care workers, please see the country projects.
In 2005, WHO, PAHO, NIOSH, and Latin-American partners developed a model project for the region.The WHO toolkit “Protecting health care workers: preventing needlestick injuries” was culturally and linguistically adapted to Latin American audiences. Venezuela agreed to conduct the pilot project. In 2007, international, national and state partners participated in national and train-the-trainer workshops. The partners agreed to have Aragua State as a model for the country.
The model aims at transferring expertise through a research institution. This conceptual approach involves strengthening research and surveillance capabilities within a research institution, which in turn trains and supports government officials and other professionals to implement preventive interventions, and ensures sustainability of the intervention. In one year,this project has been successfully expanded to four neighbouring states and continues its expansion. About 25 hospitals and three Networks of Outpatient Care have started to implement this project. Also, 750 students from national universities and health care professional institutions were trained with the toolkit.
The WHO Global Plan of Action on Workers’ Health calls for member countries to develop national occupational health and safety policies, including hepatitis B immunization policies for health care workers. The burden of diseases associated with hepatitis B is preventable; since the early 1980s, there has been a hepatitis B vaccination available which is the best defense against hepatitis B infection and is safe, efficacious and cost effective.
Peru has demonstrated strong commitment and leadership to vaccinate its health care workers by providing accessibility to the hepatitis B vaccine directly in their workplaces. As part of a massive hepatitis B vaccination campaign in Peru in 2007, over 500, 000 health care workers have been immunized with the support of WHO, PAHO and NIOSH. A national and multi-institutional occupational health and safety committee is actively involved in the planning and implementation of policies and programs supporting the vaccination campaign. In the initial phase, more than 80 public health professionals in Peru received “train-the-trainer” training based on the Protecting health care workers: preventing needlestick injuries toolkit. Each participant is responsible to train a minimum of ten health care workers in their local institution to help build local capacity. PAHO is also collaborating with the ILO to include hepatitis B vaccination coverage among health care workers as one of the key indicators of decent work.
Guyana has made significant progress in the standardization of the immediate disposal of sharps at medical facilities, as previously this was characterized as ad hoc and inefficient. This improvement is attributed to the training of staff at district hospitals, health centers and health posts across the country on the safe disposal of needles immediately after use. Proper kits for the storage and disposal of needles after use were also provided. This process is ongoing to ensure training and provision of sharps disposal equipment to all of the approximately four hundred facilities providing medical care in Guyana.
However, the situation related to final disposal of sharps is bleak and is one of the major challenges with regard to medical waste disposal in Guyana. Most of the sharp storage kits, including those of the main hospitals in Georgetown, are disposed at dump sites. Two of the district hospitals are equipped with incinerators, which burn sharps not only from their facility, but from nearby health centers and health posts. However, these incinerators are in urgent need of repair and do not function effectively. This inefficient final disposal of sharps may lead to injury and exposure to blood-borne pathogens by waste handlers at medical facilities, and people who collect refuse at dumpsites. Inappropriate medical waste disposal may also pollute the environment, directly affecting the community members.
To minimize the problems associated with the final disposal of sharps, the Pan American Health Organization in Guyana (PAHO-GUY) in collaboration with the Ministry of Health in Guyana is in the process of constructing De Montfort prototype incinerators at key small-medium health care facilities. These incinerators will also accommodate sharp disposals from nearby facilities. Training will be provided to medical waste handlers to ensure efficient operation of these incinerators.
The transmission of nosocomial infections is a major global public health concern affecting both healthcare workers and patients. The WHO estimates that over 1.4 million people worldwide are suffering from infections acquired in hospitals.
The Healthy Hospitals Project, financed by the Canadian Government, aims to strengthen Ecuador’s capacity to promote healthier and safer hospitals by reducing occupational transmission of infectious diseases.
The main activities of this project include:
1. Identifying primary disease hazards and health risks;
2. Strengthening existing occupational health and safety committees;
3. Conducting OHS workshops for healthcare workers and managers; and,
4. Promoting the development of micro projects to address priority hazards
The needs assessment revealed several good occupational health and infection control practices such as the establishment of a medical waste disposal program and widespread dissemination of health information. Challenges included a high frequency of recapping needles, limited resources and training available to enable workers to apply consistent infection control measures. There was also a high percentage of under-reporting of exposure to blood and bodily fluid, and limited occupational health and safety training. These findings guided the design and content of a training program. Following the workshop, existing occupational health and safety committees implemented micro projects and participated in delivering standard precautions. The knowledge and experience gained throughout the project formed a basis for the implementation of other occupational health and safety projects across the country.
Occupational Health and Infection Control: Preparing for Biological and Bioterrorism Events Preventing the spread of highly infectious biological agents is a global safety and security priority worldwide. The willingness of healthcare workers to work during a disaster is significantly influenced by their perceptions of the risk, as well as their knowledge and ability to provide the care required in a catastrophic situation. This situation is preventable as health workers are more likely to respond comfortably and effectively to natural and intentional disasters if they understand the risks involved, and are trained in risk reduction strategies. Conversely, without proper training and infrastructure capacity prior to the onset of such events the health and safety of first responders and other health workers can be severely comprised. This risk is then directly transferred to patients and families of healthcare staff.
This project, financed by the Canadian Government, was therefore conceived and designed to strengthen the capacity of the health workforce to protect itself, patients and the public to respond to biological events.
The main activities include conducting a situational analysis of existing infection control and occupational health practices, developing and delivering training materials and programs, and providing technical support to build capacity to counter biological threats.
The project focuses on four main areas of work:
1. Infection control and occupational health practices;
3. Laboratory safety; and,
4. Risk management and communication
Tools for Health-care Workers