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Health Care Worker Safety

The SafeHandS network is concerned with health care worker safety in relation to blood borne viruses. Clearly there are many other aspects of maintaining a safe workplace but they require different strategies and are dealt with in other forums.

The main principles of health care worker safety in relation to blood borne viruses are:

• to reduce health care worker susceptibility to infection
• to prevent and/or manage occupational exposures and
• to maintain the health of infected health care workers

^{Conducting venepuncture using Standard Precautions (i.e. use of gloves)}

Health care worker safety in relation to blood borne viruses is integral to but is not the same as Infection Control. The traditional primary goal of Infection Control practices is to prevent infection spreading in health care environments, which includes but is not limited to the prevention of infection of health care staff.

Although relatively few cases of occupational transmission of blood borne viruses have been recorded in the Asia Pacific Region, health care worker safety is a significant issue.

Why Focus on Health Care Worker Safety?

• Health care workers have a right to feel their health is protected when caring for patients.
• Health care workers may be afraid to work with patients with blood borne viruses and other infectious diseases.
• Health care worker fear may lead to:
  > Refusal to treat certain patients
  > Less than optimal treatment of patients
  > Discrimination against people with HIV or those perceived to be at risk
  > Leaving the health workplace

^{Cleaning instruments before sterilisation}

• If a health care worker has an occupational exposure, this fear is likely to be even greater even if there is no or low risk of acquiring an infection. It can place considerable stress on the health care worker and their partner and/or family, especially if they do not have access to occupational exposure management protocols and post exposure prophylaxis (PEP).
• Health care worker safety may be a lower priority in developing countries where resources for health care are scarce.
• Addressing health care worker safety issues can:
  > Help health care workers feel safe and supported in providing patient care
  > Encourage staff retention
  > Attract new staff
  > Improve patient care
  > Save money

^{Training WHO field staff in Beijing on the correct use of masks for SARS}

Staff retention is important because health care workers are expensive to train.

Low Cost Interventions to Improve Health Care Worker Safety

"I have seen examples of improvement in health care worker safety strategies throughout the Asia Pacific region. Some of these have been driven by national policy, but local hospital staff who have identified their own problems and issues have initiated others. One particular example was in a hospital in northwest China that had a problem with needle stick injuries due to a lack of appropriate sharps disposal units. The hospital could not afford specially designed containers so they re-used the hard cardboard boxes in which their disposable syringes were supplied. They sealed the boxes with sticky tape, printed out yellow paper labels with disposal instructions and biohazard symbols, cut a hole in the top (large enough for a needle and syringe) and then located them in places near where the needles were used and where the boxes would not get wet. This hospital has subsequently decreased the number of needle stick injuries. The cost of producing these boxes is about 15 US cents."

Peta-Anne Zimmerman, Infection Control Technical Advisor,
Albion Street Centre.

Principles and Interventions to Improve Health Care Worker Safety

Reduce susceptibility to infection:

• Vaccination programs
• Health education programs

Prevent occupational exposures:

• Reduce potential for exposure
• Engineering controls
• Standard (Universal) precautions
• Safe sharps handling
• Staff supervision
• Staff education
• Waste management and storage
• Occupational health and safety issues
• Data collection

Manage occupational exposures:

• Encourage reporting
• Simple, accessible protocols
• First aid
• Risk assessment
• Post exposure prophylaxis
• Testing
• Support
• Follow up

Maintain the health of infected health care workers:

• Protocols which support infected health care workers
• Assurance of confidentiality
• Work practices
• Infection control standards
• Compensation for occupationally acquired disease

Practices which are NOT Recommended to Prevent Transmission

• Testing of patients
• Using different or special procedures for people diagnosed with blood borne viruses
• Discriminating against patients or staff with a diagnosed blood borne virus

Source: Gold, J., Tomkins, M., Melling, P., Bates, N. May 2004, Guidance Note on Health Care Worker Safety from HIV and other Blood Borne Infections, The World Bank

• ^{Putting on personal protective equipment for a sterile procedure;}
• ^{Putting on surgical gloves;}
• ^{Cleaner wearing appropriate protection for health waste disposal (gloves and boots);}
• ^{Use of colour-coded bins for health waste management.}

^{Appropriate disconnection of intravenous tubing and disposal of sharps Using single-handed re-capping technique}

Photos courtesy of Chiang Mai University Hospital and Mahosot Hospital Lao PDR.

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