Occupational Safety and Health of Healthcare Workers

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Occupational Safety and Health of Healthcare
Workers NGO Forum for Health 24 May 2006 World
Health Assembly Susan Wilburn WHO Occupational
Health
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Objectives

• Review WHO commitment to Occupational Health of
  Healthcare Workers and Resources
• Identify hazards in health care setting and
  measures to prevent or control risks
• Describe WHO Project Protecting healthcare
  workers preventing needlestick injuries

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28 April World Day for Safety and Health at
Work7 April World Health Day

• 28th April decent work, occupational and
  safety, HIV/AID
• Celebrated by ILO, ISSA, UNIONS world wide
• 7th of April Human resources for Health
• Support and protect health workers Safe and
  supportive working conditions must be ensured,
  and salaries, resources and management structures
  improved.
• Opportunities for joining forces and creating
  synergies

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Health care workers in WHO

• No person should be injured or harmed at work
  basic human right, fundamental principle on which
  occupational health is based
• Health care workers are workers (59 million
  including from direct care providers to medical
  waste handlers)
• Without a healthy, safe and motivated workforce
  the public health goals of the countries cannot
  be met

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Occupational Health in WHO

• Global Strategy on Occupational Health for All
  (96)
• Global Plan of Action on Workers Health to be
  presented at the WHA 2007
• Focus on primary prevention 25 of the Global
  Burden of Disease is due to occupational and
  environmental risk factors
• Partnerships
• ILO, ICN, Unions, Employers
• Network of 70 Collaborating Centers on
  Occupational Health
• Focus on priority areas, including health care
  workers

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Healthcare WorkersOccupational Hazards

• Biological (Avian Influenza, SARS, TB, HIV,
  Hepatitis)
• Chemical (drugs, disinfectants, pesticides)
• Ergonomic (lifting, transfers)
• Stress/Violence (staffing shortages, shift
  rotation)
• Physical Hazards (radiation,heat,noise)

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Adapting the definition from the Safe Injection
Global Network (SIGN)A safe health care
practice does no harm to the recipient, does not
expose the provider to any avoidable risk, and
does not result in any waste that is dangerous
for other people
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• Be sure to secure your own oxygen mask first
  before helping another.

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Protecting Healthcare Workers
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Occupational Exposure to Bloodborne Pathogens

• 2 million exposures per year
• In Healthcare workers
• 40 of Hepatitis B
• 40 of Hepatitis C
• 4.4 of HIV
• Are due to needlestick injuries
• Although only 1,000 hcw deaths per year from
  occupational HIV, all can and should be
  prevented!
• And fear/stigma affects care and migration
• WHO Environmental Burden of Disease, 2003

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Risk of Virus TransmissionFollowing Percutaneous
Injury

• Virus Chance of HCW Infection

HBV 6 30 out of 100 people HCV 3 10 out
of 100 people HIV 1 out of 300 people
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Highest Risk Needlesticks
Of the 55 CDC documented cases of
occupational transmission of HIV, 90 were
from contaminated hollow- bore needles that
pierced the skin
CDC, HIV-AIDS Prevention, 12/98

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Occupational Health Hierarchy of ControlsIn
Order From Most to Least Effective (applied to
needlestick injuries)

• Elimination or substitution of sharp (eliminate
  unnecessary injections, jet injectors, needleless
  IV systems, blunt suture needles)
• Engineering Controls (A-D syringes, safer needle
  devices, sharps containers)
• Administrative (policies and training programmes)
• Work Practice Controls (Universal Precautions, no
  recapping, provision placement removal of
  sharps containers)
• Personal Protective Equipment (gloves, masks,
  gowns, etc)
• See www.who.int/hiv/pub/prev_care/healthservices/e
  n/index.html Annex 4

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Decline in HBV Cases Among Healthcare Workers
Following Vaccination
17,000
OSHA mandates HBV vaccination
800
This regulation had the greatest impact in
eliminating HBV transmission among healthcare
workers.
Mahoney F et al. Archives of Int Med 157 (1997)
2601-2603
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Fraction of HCV, HBV, HIV by Region
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But . . . Over 80 of Healthcare Workers Remain
Unimmunized in many parts of the world

• Despite 95 Efficacy of HBV Immunization

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WHO-ICN Protecting Healthcare Workers
Preventing Needlestick Injuries project

• Prevention of needlestick injuries in health care
  workers, to prevent infection with HIV and
  Hepatitis B and C, a collaborative effort lead by
  WHO and ICN, in close coordination with ILO
• Pilot in South Africa, Tanzania, and Vietnam
  resulting in development of new tool kit,
  expansion throughout southern Africa, Egypt and
  Venezuela
• Key elements
• National collaborative planning (OH, NNA, MOH)
• Assessment of products, practices then implement
  surveillance
• Needlestick prevention committee (using data for
  prevention)
• IEC, control measures, supplies (sharps
  containers, PPE, safer devices)
• HBV Immunization, PEP and Treatment

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Thank You for Caring for those who care !

• Susan Wilburn
• wilburns_at_who.int