Controlling Risks and Hazards in Community Health Service

Sterile Glove Management and Procedures

Glove Integrity and Replacement: * Gloves must be changed to a new pair immediately if their integrity is compromised (e.g., if a puncture occurs). * Hand hygiene is mandatory between the removal of compromised gloves and the donning of a new pair. * Personnel must avoid the unnecessary or inappropriate use of gloves. * Reuse of gloves is strictly not recommended.
Procedure for Wearing Sterile Gloves: 1. Perform hand hygiene before starting an aseptic procedure using a surgical hand scrub. 2. Check the sterile package for intactness to ensure it has not been breached. 3. Open the first non-sterile packaging by peeling it completely off the heat seal (cover) to expose the second sterile wrapper, ensuring the sterile wrapper is not touched. 4. Place the second sterile package on a clean, dry surface without touching that surface. 5. Open the inner package and fold it toward the bottom to unfold the paper and keep the wrapper open. 6. Using the thumb and index finger of one hand, carefully grasp the folded cuff edge of the glove. 7. In a single movement, slip the other hand into the glove, keeping the folded cuff at the wrist level. 8. Pick up the second glove by sliding the fingers of the already gloved hand underneath the cuff of the second glove. 9. In a single movement, slip the second glove onto the ungloved hand. During this step, avoid any contact or resting of the gloved hand on any surface other than the glove being donned. (Contact or resting constitutes a lack of asepsis and requires a glove change). 10. After donning both gloves, adjust the fingers and inter-digital spaces until the gloves fit comfortably. 11. Unfold the cuff of the first gloved hand by gently slipping the fingers of the other gloved hand inside the fold, ensuring contact with the outer surface of the glove is avoided.

Introduction to Occupational Health and Safety (OHS)

General Scope: * Occupational health and safety involves the anticipation, recognition, evaluation, and control of hazards and risks arising in or from the workplace. * Importance: Mismanagement can lead to sickness, impaired health, well-being issues, and significant discomfort for workers and community members.
Core Definitions: * Occupational health: Deals with all work-related health and safety aspects, focusing strongly on prevention for both infectious (e.g., disease exposures) and non-infectious risks (e.g., injuries). * Hazard: A situation or item that has the potential to cause harm. * Risk: The chance (ranging from high to low) that a hazard will cause harm, injury, or ill health. It represents the likelihood or possibility of harm (injury, illness, death, damage, etc.) occurring from exposure to a hazard.
Exposure Statistics for Health Care Workers: * Occupational infections due to sharps injuries have a substantial global impact. * Estimated percentages of infections among health care workers worldwide attributable to occupational exposure from sharps injuries: * Hepatitis C virus (HCV): $39\%$ * Hepatitis B virus (HBV): $37\%$ * Human Immunodeficiency Virus (HIV): $4.4\%$

Hazard Management and Risk Assessment Processes

Hazard Identification: * The process of examining work areas and tasks to identify hazards "inherent in the job." * Relevant work areas: Machine workshops, laboratories, office areas, agricultural/horticultural environments, stores, transport, maintenance/grounds, reprographics, lecture theatres, and teaching spaces.
Risk Assessment: * The process of assessing risks associated with identified hazards to understand the nature of the risk. * Includes analyzing the nature of potential harm, the severity of that harm, and the likelihood of occurrence.
Risk Control: * Taking actions to eliminate health and safety risks as far as is reasonably practicable. * If risk cannot be eliminated, control measures must be implemented to minimize risk using a "hierarchy of controls."
Health Care Context for Risk Assessment: * Effective Infection Prevention and Control (IPC) is central to high-quality healthcare and safe working environments. * Two key considerations for IPC Risk Assessment: * Understanding the transmission methods of particular microorganisms. * Using this knowledge to identify IPC principles to prevent transmission.
Infection Risks Defined: * The state in which an individual is at risk of being invaded by opportunistic or pathogenic agents (viruses, bacteria, fungi, protozoa, parasites) from endogenous or exogenous sources.

Identified Workplace Risks and Hazards

Exposure to Chemicals: * Substances: Fumes, gases, liquids, solids, dust, vapors, and corrosives. * Routes of entry: Ingestion, inhalation, and absorption through the skin.
Fire Accidents: * Institutes must have functional fire extinguishers fixed in appropriate locations. * Health workers and clients require information on extinguisher use and emergency exit/escape routes.
Repetitive Use Injury: * Areas of the body prone to injury: Back, shoulder, forearms, wrists, and hands.
Electrical Hazards: * Affects those working directly with electricity and those using electrical equipment.
Accidental Falls and Falling Objects: * Causes: Slippery floors or steps that are too high or too low. * Consequences: Broken bones, bruising, etc.

The Five Steps of the Risk Assessment Process

Risk Identification: Finding things and situations that could potentially cause harm. Involves identifying sources, events, causes, and consequences of risk.
Risk Analysis: Gaining a better understanding of the identified risk and its associated level. This takes existing controls into account.
Risk Evaluation: Determining if the level of risk is acceptable. This facilitates decisions on appropriate treatment based on the findings.
Risk Treatment: Selecting and implementing measures to modify/mitigate the risk based on the evaluation.
Monitoring and Review: * Assessing risks regularly to make informed management decisions. * Identifying new threats and updating plans. * Reviewing control measures if they appear ineffective or if workplace changes occur.

Case Study: Influenza in a Residential Care Setting

Scenario Details: * A cluster of verified influenza cases followed a group dancing activity in a dining room. * An unwell resident with nasal discharge and cough attended the activity and sat at dining tables. * The ill resident placed used tissues on the dining table during the meal. * Service users remained near the dining room post-activity because their rooms were nearby. * Facilities: No hand hygiene facilities were available in the dining room. * Outcome: Six service users reported symptoms within $2$ to $3$ days. Samples from $4$ users were tested: $3$ out of $4$ were confirmed for Influenza A. Two staff members also fell ill. * Vaccination Status: Service users: $66\%$ ; Staff: $41.7\%$ .
Applying Risk Assessment to the Case: * Establishing Context: Risk of acute respiratory virus infection cannot be eliminated in residential facilities; it must be managed. * Risk Identification: Cross-transmission of influenza virus (noting identification should ideally happen before incidents occur). * Risk Analysis: Large assemblies increase droplet transmission; used tissues on tables and lack of waste receptacles increase transmission opportunities; absence of hand hygiene facilities leads to poor compliance; low immunization rates contribute to spread. * Risk Evaluation: Combined likelihood and consequences identify this as a "very high risk" situation.
Risk Treatment Measures: * Inform the department of public health of the outbreak. * Implement IPC guidelines. * Provide hand hygiene facilities and waste receptacles in common areas. * Promote immunization for all users and staff. * Educate on limiting contact when ill, respiratory hygiene, and cough etiquette. * Display posters and signage regarding hygiene.

Safety Management Systems and Occupational Health Programs

Occupational Health Activities Goals: * Protect healthcare workers (HCWs) and patients from acquiring infections or hazards. * Identify and prevent work-related risks. * Ensure prompt management of occupational exposures. * Train HCWs on IPC, patient safety, and self-protection. * Monitor and investigate outbreaks among HCWs.
Key Elements of Occupational Health Programs: * Oversight by a qualified professional or team. * Coordination among multiple departments. * Medical evaluation at the start of employment. * Staff education and training. * Immunization programs. * Management of work restrictions and post-exposure treatment. * Counseling regarding blood-borne and infectious pathogens. * Maintenance of personnel health records.
Prevention Strategies: * Standard Precautions for all patients at all times. * Transmission-Based Precautions (disease- or syndrome-specific). * Mandatory vaccines for HCWs. * Adherence to national guidelines for blood and body fluid exposure management.
Special Groups: * Pregnant HCWs: Pregnancy generally does not increase the risk of acquiring an infection, though outcomes for the fetus or the mother may vary depending on the specific pathogen.

Questions & Discussion

Self-check questions 2.3: * Question 1: List activities and tasks that put clients and health workers at risk and indicate what should be done to minimize these risks. * Question 2: Which activity is the first in the risk management process? * A. Risk analysis * B. Monitoring * C. Risk Treatment * D. Risk identification * Answer to Question 2: D. Risk identification.