Occupational Hazards for Hospital Workers

"If you've ever wondered how people can manage to work with the sick and always stay healthy themselves,
the answer is that they can't." — Jeanne Stellman, Women's Work, Women's Health (1977)

Hospitals present numerous hazards in common with other complex employment settings and industries as well as having some unique hazards. A great variety of jobs are performed in health care facilities including: direct patient care, laboratory and research work, laundry, food preparation, trades, security work, waste disposal, driving, office and library work, housekeeping and maintenance, and pharmacy. The myriad of occupational hazards to which hospital workers may be exposed can be classified into five broad categories: biological, chemical, physical, ergonomic/safety and psycho-social hazards.

Biological Hazards

Biological hazards are infectious agents such as bacteria, viruses, fungi or parasites which may be transmitted via contact with infected patients or contaminated objects, body secretions, tissue, or fluids. Health care workers, particularly those in hospital settings, are regularly exposed to biological or infectious agents.

In the workplace both Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV), can be transmitted by infected blood and body fluids when they are in direct contact with the inside of the mouth, the eye, or with broken, scraped, chapped or inflamed skin. The exposure of greatest concern, however, is when the skin is broken by a contaminated object such as a needle or a scalpel. Neither HBV nor HIV can be transmitted by casual contact. The risk of HBV infection far exceeds the risk of HIV infection.

"Universal Precautions" should be established in any care setting where exposure to blood and body fluids is possible. Their purpose is to eliminate or reduce the risk of transmission of blood-borne pathogens. Because patients infected with HBV or HIV cannot always be reliably identified, blood and body fluid precautions should be used with all patients. In other words, the precautions should be applied universally.

Immunization against HBV is recommended for health care workers at greatest risk of exposure. In addition, depending on a person's immune status, HBV vaccine or hepatitis B immune globulin or both may be recommended after accidental exposure to blood or body fluids. There is no vaccine against HIV.

Table 1provides a list of some other infectious agents or diseases to which health care workers may be exposed. Most institutions have infection control policies. Although usually developed to prevent the spread of infection to patients, these policies should also cover health care personnel. Such policies could include directives for worker training, immunization, cleaning, disinfecting, and sterilizing equipment, treatment of infective waste, housekeeping, and processing laundry. Hand washing remains the single most important procedure for preventing the spread of infectious disease in health care settings.

Chemical Hazards

Numerous chemicals found in hospitals may be toxic or irritating to body systems. They may be present as dusts, vapours or gases, or liquids and they may be medications and other substances used for therapeutic purposes. Chemicals can enter the body through contaminated food or cigarettes, absorption through the skin, inhalation or by accidental needle stick. The major routes of entry are by inhalation or skin absorption.

Exposure does not always produce adverse health effects. Chemicals for which there is little or conflicting information about potential toxic effects, should be treated as toxic. Toxic chemicals are best dealt with by preventing worker exposure. This can be done by identifying the chemicals, considering their toxic properties and potential health effects and implementing control measures.

Table 2 lists a number of toxic chemicals commonly used in hospitals and the types of staff most likely to be exposed to them.

Ergonomic and Safety Hazards

Ergonomic and safety hazards cause or worsen accidents, injuries, strain or discomfort. Ergonomics is the application of scientific knowledge to the design of environments, tools, workstations and the content of work to suit the mental and physical limitations and capabilities. Work environments and procedures that incorporate ergonomic principles can anticipate accidents and avert injury and error. Health care safety hazards include: slippery floors, cluttered hallways or blocked exits, explosive gases used in laboratories and operating rooms, various power tools and other maintenance equipment, sharp utensils and instruments, and materials handling.

One of the most common and most severe hospital injuries is musculoskeletal injury, particularly of the lower back. In 1990 Canadian hospitals reported 30,487 time-loss injuries. People employed in nursing occupations sustained 53% of these injuries. The most frequent time-loss injury was to the back resulting from overexertion while moving objects or handling patients. Approaches to reducing back injury and disability must be comprehensive and involve ergonomic strategies, education, early and aggressive injury treatment and appropriate rehabilitation programs.

Injuries also frequently experienced by health care workers include cuts, bruises and needle sticks.

Another problem is repetitive strain injuries (RSIs) of the upper limbs related to improper workstation and task design. RSI risk factors include: high rates of manual repetition, use of excessive manual force, and awkward postures of the wrists and shoulders. Workers in dietary and laundry departments and clerical positions, such as data entry operators and medical transcriptionists, may be at increased risk.

Violence against health care workers is an emerging occupational hazard. Preventing injury from aggressive acts starts when the employer acknowledges that the potential for violence exists. There must be strong management commitment to violence prevention programs. Strategies should encompass workplace design; patient care approaches to reduce anger, frustration, and agitation; staff training on recognition and interventions for potentially violent situations; and support systems for workers who do experience a violent event.

Physical Hazards

Ionizing and non-ionizing radiation, electricity, noise and heat are examples of physical hazards found in hospitals. Ionizing radiation is used in diagnostic procedures such as x-ray, fluoroscopy, and angiography, and in treatments using radioactive implantations or injections. Cumulative and long-term health effects include genetic damage and adverse reproductive outcomes. The risks of long-term low-level exposure to ionizing radiation are not fully known. Measures to minimize exposure include maximizing distance between the radiation source and the worker, using appropriate shielding and minimizing exposure time. Special attention should be given to the maintenance of portable fluoroscopy and x-ray equipment which may scatter radiation during procedures.

Non-ionizing radiation includes microwaves, magnetic fields, and lasers. The intensity of the light beam of lasers poses a risk especially to the eyes and skin. Procedures for the safe use of lasers should include training, posting warning signs, using appropriate safety eyewear, and using non-reflective tools.

Excessive noise and heat are commonly found in kitchens, laundries, and boiler rooms. Cold, heat and sunlight are hazards for grounds and building maintenance personnel. Permanent hearing loss can result from long term exposure to noise in excess of 80 decibels (a measure of sound intensity). At lower levels, noise from equipment, alarms, conversation and other sources can impede communication and interfere with concentration. Comprehensive hearing conservation programs should reduce noise through engineering controls, detect hearing loss early, provide worker education, and provide hearing protection devices.

Skin burns can result from exposure to hot surfaces or liquids or from exposure to excessive sunlight. Cold temperatures can produce frostbite or a dangerous generalized cooling of the body (hypothermia). Engineering controls to prevent contact with hot surfaces or to reduce hot indoor temperature, protective clothing such as hats and long sleeved shirts to reduce sun exposure, and administrative guidelines for working in hot and cold environments are important measures to reduce the risk of injury.

Psycho-social Hazards

Many factors in the hospital environment can affect the psychological and social well-being of workers. Examples of work organization which can have an adverse impact on workers include: little decision-making latitude, excessive job demands, role ambiguity, poor management ability, inadequate resources, and shiftwork. Rotating shifts and night work can have a negative impact on general well-being and performance because of the constant disruption of an individual's biological clock. Shiftwork can also negatively affect workers' social roles.

Combative patients, terminally-ill patients, and coworkers or managers are also stressors. The current economic climate in health care can create excessive workload demands and a sense of insecurity at work.

Health care organizations should maximize worker participation in decisions affecting their daily work and the organization as a whole. Employers can also effectively resolve conflicts, help staff to respond positively to change and provide social support systems.

Greater detail on any of the above topics can be found by consulting the resources in the MFL Occupational Health Centre Library.

February 1995