Mauritius form part of the small developing countries in the world where the health service throughout the island is under the authority of the Ministry of Health and Quality of life (M.O.H. & Q.L). And the state health services are provided to the 1.3 million citizens freely. The health sector is also represented in the island by the private clinics in operation.
The government health sector employs over 650 doctors, above 3,000 nurses. This taskforce is distributed around the island among the various facilities which include Area Health Centres, Medi-clinics, Community Hospital, and community health centres amounting to about 134 building points scattered around the island. Above that there are 5 regional hospitals and 3 district hospitals with over 2500 bed capacity, excluding the specialized Eye hospital, Ear, Nose & throat (E.N.T) Hospital, a Cardiology centre and a Chest hospital. All this facilities is provided free to all the residing people in the island. Statistics shows that there are nearly 2.8 million attendances in the hospital yearly, and closely to 200,000 patients' admissions representing 75% of total bed occupancy. (White Paper on Health Sector developments & Reform (M.O.H. & Q.L), Dec 2002)). Hospitals run on 24 hour basis which require adequate staffing at every time. We are bound to accept that the health workers are the most important assets to the M.O.H. & Q.L and in providing effective health care but yet the workers are exposed to health and safety hazards. These do hinder the dispensing of quality health care to patients. And these hazards need to be identified and addressed.
Introduction
The objectives of this survey are to identify the health and safety hazards that are present in the health institutions. Its purpose is not only to identify those, but to make it known to the health workforce to which different types of hazards they are daily exposed to. To make them realise whether they are working in healthy environment or not and try to minimise these hazards.
The health workers would get to know that the health and safety hazards are present every moment during their career and that they have to find ways to reduce it as it would in the long run be beneficial to their safety at work and to their health themselves in general.
Various studies have been conducted in developed countries on this issue. And this survey is looking to using the results of the research done in the developed countries and applying their findings in the local context.
An assessment of these hazards is important is today's health sector; the reason is that there are many growing hazards to which the nurses are exposed to and which affecting our nurses and in the long run could prove very problematic to the government as it is affecting the health of the nurses. It can be said that it is ironic that the one who are supposed to care for the patients are exposed to health problems themselves….we could ask the question: if the carers themselves are sick, who would look after them? So it is primordial to identify these health and safety issues that are present in our health institutions, at some point try to address those to such effect that those could be completely removed or at a lesser extent, being drastically reduced to a lowest minimum so as to ensure a good health to the health workers which would in turn ensure an even better dispensing of health care by themselves to the ailing citizens attending the health centres in view of achieving the Mission Statement Of the Ministry of Health and Quality of life which is:
"Enhance the health status of the population."
"Improve the quality of health care delivery with view to increasing patients' satisfaction.
"Ensure that the health sector is consolidated and that the health services remain accessible to every citizen."
"Enhance social equity through the provision of a wider range of health services to the whole population."
Source: White Paper on Health Sector developments & Reform (M.O.H. & Q.L), Dec 2002)
Literature Review
The research team has made some literature reviews about some hazards that are present in health care institutions at the international level in the developed countries. The results are that there are the following health and safety liabilities:
Back injuries.
Needlesticks injuries.
Shift work.
Workplace violence.
Injuries resulting from trips and falls.
Biological hazards.
Exposure to radiation.
Back injury
Low back injuries are the cause of low back ache. And during the past ten years this is being considered as the leading occupational health problem affecting the health care workers. The rate of this health issue is at an increase among nursing staff. According to the Washington state Nurses Association (WSNA) the number risk factor leading to low back problems among nurses results from lifting and transferring patients. According to the National Institute Of Health and Safety (NIOSH) in the United States the maximum "lifting equation for the average worker is no more than 51 pound", which is equivalent to about 25 kg. But in the work environment this norm is not respected.
The University of Wisconsin conducted a survey which reveals that 38% of nurses suffer from back injuries. Out of these 38%, one third is considering quitting the nursing profession. This would result in shortage of staff.
As a result of this, on 8th March 2006, The Washington State Legislature passed a law to encourage safe ways to handle patients and thus prevent workplace injuries among nurses in the States.
http://www.wsna.org/Topics/Workplace-Environment-You/Workplace-Hazards/Back/
Needlestick Injuries
According to the WSNA there are between 600,000 - 800,000 injuries arising from needle prick in the States. Unfortunately half of these occurrences remain unreported. Statistically this implies that there are 30 needle prick injuries for every 100 beds annually. The danger with needle prick injuries is that this can lead to blood borne infection and diseases such as Hepatitis B (HBV), Hepatitis C (HCV), and HIV (Human Immunodeficiency Virus).
Figure 1 & Figure 2 (APPENDIX 1) represents diagrammatically the most common devices and the circumstances involved in the occurrence of needle prick injuries.
The risk of contracting Hep C is much greater than that of getting the HIV because the Hep C virus is viable in the open atmosphere far longer than the HIV. The prevention measures are post exposure prophylaxis concerning HIV and vaccination against Hep B. But there are no immunisation or post prophylaxes for Hep C up to now. The best way is to prevent exposure. The introduction of safer devices has shown that needlestick injuries are reduced by 80%.
http://www.wsna.org/Topics/Workplace-Environment-You/Workplace-Hazards/Needlestick/
Shift work
Shift work is something that many people worldwide face nowadays and it is very common in work place. People mostly affected by shift work are doctors, nurses, cleaners, factory workers construction workers etc. Morning shifts and afternoon shifts are not as dangerous as graveyard shifts; graveyard shifts being when one works at the darkest hours of the night i.e. generally between 10 at night to 6 in the morning. This time of work is inclusive in the night shift of nurses around the world and in Mauritius.
Every person has an internal biological clock known as the circadian rhythm. The main function of this circadian rhythm is to regulate the internal body sequence between daytime and night time. Biological processes are coordinated for running at an optimum level during the day and are set to restorative function during nigh time. In short the body finds all the energy possible during the day to perform strenuous duties whilst the organism is set to rest during the night to restore its energy.
The problem for a night shift worker i.e. those working the graveyard time shift (10 pm-6am) is that the activity at night will be completely out of phase with the body circadian rhythm. The most likely problem that arises out of night shift is the deprivation of sleep for the night shift workers which leads to chronic sleep deprivation. It is believed that night shift workers percentage sleep is of 15-2-% as compared to that of day of afternoon shift workers being 4-6 hours and 7-9 hours respectively.
(Shift work hazards; Allene Scott, M.D., Kittaning, PA)
In recent internationally performed studies it was found that there was an increase in breast cancer in night shift workers and a higher rate of prostatic cancer in the male counterparts. (NSW Nurses' Association)
(NSW Nurses' Association Campaigns Study Reveals Nightshift Hazards.mht)
The fact that nursing care implies that it is a service that should be provided on a 24 hr basis means that shift work is the only solution for good running of hospitals and thus nurses have to work on this night shift. This increase the work load of nurses as night shift is usually composed of less staff than during the day. This type of shift has been linked to more sleep disturbances, digestive imbalance and severe exhaustion. It has been found that nurses are the categories who have a high record of sick leaves. (www.icn.ch)
Workplace violence
Violence at the workplace has emerged as one of the most important safety issues with regards to healthcare institutions. This involves physical or verbal assaults as well as threats or violent behaviour towards hospital staff. In a joint study between the American Association of Occupational Health Nurses (AAOHN) and the Federal Bureau of Investigation (FBI), workplace violence is defined as being: "Any action that may threaten the safety of an employee, impact the employee's physical or psychological well-being, or cause damage to company property" (AAOHN, 2003)
(http://www.wsna.org/practice/resourcelibrary/documents/Violence%20in%20the%20Workplace%20Position.pdf)
According to the WSNA, within the medical profession nurses are the categories that are on the receiving end of the highest rate of workplace violence but luckily non fatal. Nevertheless mental health setup and the accident and emergency department are the department most notably exposed.
(Occupational Health and Safety, Susan Wilburn, MPH, RN)
Slips and falls
Nursing staff are subject to potential trips, slipping and falls during their career. These situations seem very unlikely to happen but yet still it is hazards that exist and has the potential to cause harm to the workers. This can result due to wet floors after regular cleaning that is recommended to reduce proliferation of micro organisms; or due to spills of solutions on the floor due to manipulation of those solutions itself during nursing duties. This can thus result in serious injuries to the workers due to heavy falls.
Occupational Health and Safety Administration (OSHA) prioritise slips and falls as the third most potential health and safety hazard that affect the nursing staff worldwide. (The journal of SH&E Research- The American Society of Safety Engineers, summer 2005, Volume 2, Num 2)
Biological hazards
Biological hazards enclose anything of biological nature and having the ability to cause harm to human beings. Biological hazards may be classified as viruses and bacteria leading to infection and disease, dangerous plants and animals. In the healthcare environment however the nurses are exposed mostly to viruses and bacteria and most prominently to blood borne pathogenic exposures such as HIV, HCV and HBV. These can lead to serious illness if the nurses are affected by these viruses because at present there are no cures for diseases related to HIV, and other infectious viruses. These viruses can be transmitted through percutaneous needle stick injuries (NSIs) as described above. About 600,000 to 800,000 of these NSIs occur yearly in all healthcare centres in the U.S.), injections representing 21% of exposure, suturing being 17% and blood drawing and collection 16%. (Perry et al., 2003)
(The journal of SH&E Research- The American Society of Safety Engineers, summer 2005, Volume 2, Num 2)
Exposure to radiation
Radiation is extensively used for diagnostic purposes. The most commonly known is x-ray, ct-scans and MRI but also include fluoroscopy and angiography as a non exhaustive list. Imagery procedures are generally performed in a separate room for the patient undergoing the scanning. The property of radioactive materials to emit radiation is also considerably used for treating patients suffering of malignancies. These sources emit (β) Beta rays and gamma (γ) rays and are used singly or as a combination as prescribed doses to irradiate body tissues. Nurses who assist the physician and the patient during these procedures are therefore exposed to the irradiation present in the room.
X-rays are also performed at ward level for patients who are unmovable e.g. in I.C.U, where patients are generally not awake.
Radiation techniques are used also in operating theatres, where during surgical interventions; surgeons may require the use of x-rays to determine the right course of action to be taken for the surgery. This is mainly used for orthopaedic surgical interventions using an apparatus called C-arm. The C-arm (APPENDIX 4) produce a live X-ray image displayed on a TV screen and which is interpreted by the surgeon for the ongoing surgery.
Methodology
Below are described the ways that had been recourse to for the methodology used for this survey:
A set of questionnaire (APPENDIX 2) was distributed among the nursing staff working at the four regional hospitals of the island namely Dr A.G.J Hospital, J.N.H, V.H and S.S.R.N.H located at Port Louis, Rose Belle, Quatre Bornes and Pamplemousses respectively. The staffs responding to the questionnaire were posted on the following wards namely surgical ward, paediatric ward, gynaecological ward, Accident and Emergency Department, Operating Theatres, orthopaedic ward.
For the purpose of distributing this questionnaire a letter requesting permission was sent to the Senior Chief Executive of the MOHQL, a copy of which is as in APPENDIX 3. We would like to point out that the questionnaire ensured confidentiality and anonymity of the persons to whom it was distributed. From the questionnaire and the information gathered the team will show how and to what degree the nursing staffs of Mauritius are exposed to occupational hazards in their duty.
Computer software tool Microsoft Excel will be used to represent the data obtained. The data will be represented in form of charts and percentage for both male and female nursing categories.
The research team has also performed some on site observations within the working areas to assess in real time the hazards exposure of the nursing staff of the various health institutions.
Results and discussions
After having read the above….kindly submit your
Views, discussions and recommendations
With regard to the results..i.e. the 2
Charts above!!!
Please give well structured answers!!
Please submit by Monday 23.11.09!!!!
THANKS
