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Health & Safety
From lone working to falls, from musculoskeletal disorders to infection control, hospital employees have to be prepared for anything. And it is worth noting in this context, that because of their caring ethos, many people employed in the care sector often show more concern for those they care for than they do for themselves, often putting their own health and/or safety at risk in the process.
But, of course, it is important to remember that hospitals deliver important services to some of the most vulnerable members of society, which means risk assessments need to be undertaken in order to ensure the necessary preventive measures are put in place for everyone affected. Employers have a duty in law to ensure not just the absence of risk to the safety and health of employees, but the safety of patients and all others who may be affected by their undertakings.
There are obviously legal and moral reasons for managing health and safety effectively and there is also a strong business case. Prosecutions for health and safety breaches have resulted in some sizeable financial penalties, and court proceedings can also severely damage the reputation of both public and private sector organisations.
The duties in the Health and Safety at Work etc Act 1974 (HSWA) require employers to ensure, “so far as is reasonably practicable”, the health, safety and welfare of all employees and anyone who may be affected by their work - something which The Management of Health and Safety at Work Regulations 1999 also builds on by requiring suitable and sufficient risk assessment.
Having a robust system in place to manage health and safety, rather than relying on one-off interventions, is just one of the many basic principles which, if implemented effectively, can enable organisations, such as hospitals, to ensure the health and safety of all employees and patients. And, of course, the right policies, people and procedures are also needed to make this work, for example, informing, training and supervising employees; reporting, recording and investigating accidents and near-misses; and periodically reviewing performance and feeding back lessons learned.
But it is not just about rules and procedures. There has to be a positive culture of health and safety led by managers, starting at board level and backed by open and honest employee involvement in decision making at every level. Health and safety is something which you can only do successfully with people and not to them.
HOW TO MANAGE THE RISKS
It is not uncommon for those employed at hospitals to spend much of their time working alone. But while it is the employer’s duty to assess risks to lone workers and take steps to avoid or control those risks where necessary, employees themselves are equally responsible for their own health and safety and that of the people they look after.
For example, employers of lone workers in primary care or any other sector who deal with patients should conduct a “suitable and sufficient” risk assessment to help define the correct people handling process to be adopted. Some staff, such as nurses, may have to adopt and hold awkward postures as part of their work, so it is paramount that any stresses and strains arising when caring for and treating people are addressed.
Training is particularly important for lone workers because there is limited supervision and guidance should an unusual situation arise. Employers should also ensure that lone workers are experienced enough to work alone and able to handle circumstances which may arise, such as aggression. Ultimately, supervisors should be available for guidance, for example, should a difficult situation arise, and able to check the lone worker’s progress and quality of work. The frequency of support contact and visits is for management to decide and should not be left down to the individual.
Meanwhile, the same approach towards planning - recording accidents and hazards and making these details clear to everyone in the workplace – also needs to be adopted for any cleaning and maintenance work undertaken in order to encourage good health and safety practice. It is by ongoing monitoring and review of management arrangements that any areas in need of improvement can be highlighted and agreed actions put in place. By involving employees in this process, the employer is ensuring that those who are often best placed to assess the effectiveness of the management system, are able to give their feedback in order to help deal with the risks.
According to 2010/11 statistics gathered by the Health and Safety Executive, about five million working days (1.78 days per worker) have been lost due to self-reported work-related illness and injury. Around 90 per cent of this was illness related. Some of the more serious injuries and fatalities have been a result of falls from or through windows, whether as the result of an accident (such as sitting on and subsequently falling from a window sill); because of a confused mental state (such as a dementia patient mistaking a window for a fire exit); or due to deliberate self-harm or suicide. A thorough risk assessment can pinpoint the windows or balconies which are at a height to cause potential harm and can help to suggest suitable safety precautions. Window restrictors are a legal requirement, where people who are vulnerable to the risk of falling and have access to the windows (both at height and ground level) may be liable to harm.
Workers in the healthcare sector are exposed to infections on a daily basis and therefore it may come as no surprise, for example, that data from physician reporting schemes indicates infection rates of about 30 per 100,000 workers per year among nurses, most of which are diarrhoeal diseases. But it is not uncommon for more serious infections to occur. For example, a healthcare worker accidentally jabbing themselves or a colleague with a needle which is contaminated with potentially infected blood material. This is why the Control of Substances Hazardous to Health Regulations 2002 (COSHH) exists to help employers protect workers’ health.
According to a report from the Health Protection Agency (HPA), the number of health workers who have been exposed to a blood-borne virus while at work has doubled over the last decade. There were 541 cases in 2011, up from 271 in 2002. Most of the “needle stick injuries” that exposed healthcare workers to the viruses occurred in wards, operating theatres, intensive care units and A&E units. The HPA said a “major proportion” of the injuries were preventable. Contact with blood-borne viruses (BBV) in exposure incidents must be treated with speed and this is why emergency planning is so important, from foreseeing these types of incidents to setting out procedures for employees to follow and identifying safety equipment to be used.
As well as fulfilling their other legal responsibilities under COSHH, employers should also identify the hazards associated with BBV exposure where required. By evaluating the risks and deciding on precautions, findings can then be recorded and the relevant control measures put in place. Further reassessment of the identified risks and control measures will ensure that standards remain high.
Another hazard to be aware of if you are employed in the health and social care sector is that of hot water and hot surfaces such as pipes and radiators. Those at risk include children, the elderly, and people with reduced mental capacity and mobility, among others. Hospitals can often have higher water temperatures (of over 44°C) which are useful, for example, to reduce Legionella contamination, but they can also pose a scalding risk. Many accidents involving scalding have been fatal and have mainly occurred during bathing or showering. Where precautions are taken, such as dropping water temperatures to below 44°C (where vulnerable people may be at risk of scalding during full body immersion), efforts should be made to make sure that other risks are not introduced such as Legionellosis. To help minimise the risk of a vulnerable person sustaining a burn from a hot surface, efforts should be made to make sure the surface does not exceed 43°C when the system is running at the maximum design output. Precautions may include insulation or providing suitable covers.
These are just a few of the hazards that give rise to risk in health care settings. Many of the risks, such as slips and trips or accidents with vehicles, both on-site and out on the road, are common to all kinds of business and much can be learned from how other organisations tackle these issues. There is also a mass of useful information on the internet.
During tough times, we can’t afford not to make difficult judgement calls about where to direct resources. RoSPA is urging organisations not to turn their backs on health and safety. Indeed, when times are hard and budgets are tight, the logic for modest spending in a targeted way to reduce costly accidents and work-related health damage is even stronger. The key priorities remain sustaining senior management commitment, engaging the whole workforce, ensuring competence and making sure there is always access to specialist advice.
Staff training in particular is of the upmost importance, even though at first glance it might seem to be putting a significant strain on budgets. The law says you must train your employees - and if necessary your contractors - but properly targeted training also pays for itself by helping to avert disasters large and small and by reducing the number of working days lost. Good health and safety is a hallmark of professionalism in the healthcare sector, but it has to be planned for and worked at, especially in today’s busy and challenging healthcare environment. Accept nothing less.
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