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Hospitals are potentially dangerous workplaces with employees facing a multitude of hazards on a daily basis, ranging from an outbreak of Legionella bacteria to falls and musculoskeletal disorders. And it is worth noting in this context, that the vast majority of 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 at risk in the process.
There are obvious legal and moral reasons for effectively managing health and safety, 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 public and private sector organisations.
The duties in the Health and Safety at Work etc Act 1974 (HSWA) require employers to ensure the health and safety 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.
Maintaining good health and safety
Good health and safety management is not just about legal compliance. During tough economic times, it pays to maintain a good health and safety record, not least because an accident or work-related ill health incident can disrupt service delivery and can also be very costly. In their daily work, healthcare workers can face a very wide range of threats to their safety, health and wellbeing, not just slips and trips, manual handling, microbiological tasks and so on, but issues associated with shift work, violence and aggression, not to mention work related driving. But it is also 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. Essentially, employers have to ensure, “so far as is reasonably practicable”, the absence of risk to the safety and health of employees and others who are affected by their undertakings, such as patients.
There are certain basic principles which, if implemented effectively, enable organisations, such as hospitals, to achieve this. Essentially, these include: having a robust system in place to manage health and safety, rather than relying on one-off interventions; identifying principal hazards and the organisation and assessing the associated risks to establish if sensible and balanced safety measures are in place. And, of course, the right policies, people and procedures to make this work, include informing, training and supervising employees; reporting, recording and investigating accidents and near-misses; and periodically reviewing performance and feeding back lessons learned. Working in a hospital environment means employees have a responsibility of care to many vulnerable patients, with moving and handling making up a large part of the day’s activities.
Moving and Handling
According to the Health and Safety Executive, around 5,000 moving and handling injuries are reported each year in health services and around 50 per cent of reported accidents in the sector are incurred when helping to move patients of reduced mobility. Slips and trips are also one of the most common accidents and make up over a third of all major injuries. In 2010/11, there were 11,390 reported injuries to employees in the health sector and 6,453 in social care. According to RIDDOR, the majority of reported injuries were handling injuries (making up 39 per cent in the health sector) and a quarter were attributed to slips and trips.
Preventing handling injuries is a major challenge. How people are moved and handled is essential in promoting recovery, maintaining independence and providing a feeling of wellbeing. It is not only a basic human right for people to be treated with dignity and respect during the handling process, but also a legal requirement. It is therefore vital for staff to understand how to minimise the risk to their backs and limbs and thus it is advisable for residential homes and authorities to purchase appropriate handling aids. Some ways of minimising risk are: avoiding lifting patients manually; encouraging patients to assist in their own transfers; and thoroughly evaluating equipment and furniture before it is purchased.
A commitment to support - and if possible, rehabilitate - those who have been injured in connection with their work is also important. Whether you are in primary care or any other sector, a ‘suitable and sufficient’ risk assessment is obviously the place to start and, again, whether you are in primary care or any other sector, assessment should be used to help define the correct handling process to be adopted. For example, 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 may help to prevent injury arising in such circumstances and reduce the number of days taken off work as a result.
Planning, informed by risk assessment, and setting goals for improvement are also central to reducing slips and trips, as is the day-to-day spotting of hazards such as spills, trailing cables, poor lighting and unsuitable footwear. It is a collective responsibility and one that should be taken seriously by everyone. This is why it is important for all managers to work with employees to minimise risks, for example, by identifying possible hazards and selecting, for example, anti-slip floorings in areas which cannot be kept dry. Planning means there needs to be a record of who is responsible; for example, for getting spillages and objects cleaned up quickly and making these details clear to everyone in the workplace.
And the same approach to planning needs to be adopted for any cleaning and maintenance work undertaken in order to encourage good health and safety. Then by monitoring and reviewing management arrangements, any areas in need of improvement can be highlighted and agreed actions put in place. It is important to involve employees in this process, as they are often best placed to assess the effectiveness of the management system in its ability to deal with the risks.
Legionnaire’s disease has been in the news again. Healthcare providers should ensure that a full risk assessment is carried out of their hot and cold water systems, as Legionella bacteria, a potentially fatal type of pneumonia, can multiply where temperatures are between 20-45°C and nutrients are available. Temperature control is the best method to help combat an outbreak and these systems should be routinely checked, inspected and cleaned. The presence of sludge, scale and fouling can also increase the risk of Legionella, which is contracted by inhaling infected airborne water droplets. And, with the pressure on hospitals to keep up with hot water demands, increased water temperatures mean there is also a scalding risk to the vulnerable people who use their services. Where there is a risk, water temperatures must not exceed 44°C, as those with reduced mobility, for example, often cannot react appropriately, or quickly enough, to prevent the injury from arising.
Another hazard to be aware of is asbestos, a naturally occurring fibrous material that was extensively used in the UK from the 1950s through to the mid-1980s. Lives continue to be lost to it as the dangerous fibres when inhaled can cause a string of diseases, some of which are fatal. These conditions, which include fibrosis of the lung, lung cancer and mesothelioma, a deadly cancer of the lining of the lung, will not affect you until later on in life, so it is necessary and sensible to take action now. Any building built before the year 2000 (including hospitals) is likely to contain asbestos, so it is a legal duty for employers to identify whether asbestos is present and to maintain a register so that a risk assessment can be carried out before any work such as repair, modification or demolition can be undertaken.
According to the Health and Safety Executive, approximately 20 tradesmen die from asbestos-related diseases every week and so it is important to know how to handle it safely and be aware of the risks. To find out more, visit www.hse.gov.uk/hiddenkiller
Covering all of the issues above, training and competence are essential skills to help contribute to the smooth running of the workplace and in a hospital environment a lack of either could prove to be a costly mistake. Training can also give each member of the team the safety knowledge and skills necessary for them to play their part effectively. And this is not just the case on traditional “health and safety” issues. A recent Care Quality Commission (CQC) report, which looked at care issues including dignity, identified 12 UK hospitals as a “moderate” concern, after they were found not have met the required standard in “respecting and involving” those who used the services. A key finding from the CQC’s 2011 dignity and nutrition inspection programme revealed that both staff and patients felt there were not always enough staff with the right training on duty to spend enough time giving care. Half of the 12 hospitals were also found to be failing in standards of staff training. Examples of the findings included: “None of the staff we spoke to were able to recall having specific training in how to ensure people’s privacy and dignity was supported,” and “Staff told us they had very little training on dysphasia, rehabilitation, privacy, dignity or dementia”.
First off, while patient care is a top priority, we must not turn our back on ensuring good health and safety for staff, patients, contractors and visitors. Quite simply we can’t afford to. As in any undertaking, the keys to managing successfully in health and social care for good health and safety outcomes are senior management commitment and leadership, workforce involvement, competence and access to specialist advice.
Staff training in particular is of the upmost importance; for example, safer people handling training can prevent musculoskeletal disorders, meaning the number of working days lost will go down as will the associated costs which otherwise put a significant strain on health and safety budgets. But, as outlined earlier, a systematic approach to health and safety management is required, not a disjointed series of one-off interventions.
The important thing to remember is that good health and safety is no accident. It has to be planned for and worked at. Indeed, a positive safety culture is a key performance indicator in today’s busy and challenging healthcare sector. L
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