Healthcare workers have the
potential to experience a wide variety of occupational injuries. Under the
Occupational Safety and Health Administration (OSHA) Healthcare Safety and
Health Topics webpage, OSHA lists the following as potential hazards:
blood-borne pathogens (BBP) and other biological hazards, chemical and
hazardous drug exposures, waste anesthetic gas exposures, respiratory hazards,
ergonomic hazards, laser, hazards, workplace violence, and radioactive and
x-ray hazards.
Chemicals such as formaldehyde,
glutaraldehyde, ethylene oxide, peracetic acid, ortho-phthalaldehyde (OPA), and environmental disinfectants are sources
of potential hazardous exposure for healthcare workers (OSHA, 2015) .
There is insufficient guidance for healthcare safety personnel to evaluate the
risks associated with the use of these chemicals. Research evaluating the
potential for synergism among chemicals used in healthcare that may adversely
affect healthcare workers is scarce. The heightened awareness of infectious
diseases such as Ebola and Middle East Respiratory Syndrome (MERS) has led to
increased use of environmental disinfectants throughout healthcare and other
workplaces. More research and expertise is needed by qualified industrial
hygienists and safety experts to properly recognize, evaluate, and control the
hazards present in healthcare.
Despite the improved focus on
patient safety, quality control and regulatory compliance, the injury and
illness rate from healthcare workers are almost twice as high as the private
industry rate. A news release from OSHA on June 25, 2015 explained that OSHA
will be expanding enforcement activity in healthcare facilities. OSHA’s enforcement
focus will be on preventable injuries, such as those from patient handling,
BBP, workplace violence, tuberculosis, and slips, trips, and falls (OSHA, 2015) .
OSHA has developed resources,
checklists, and guidance for healthcare safety relating to building
a culture of safety, injury and
illness prevention programs and/or safety and health management systems, infectious
diseases, safe
patient handling, and workplace
violence. The National Institute for Occupational Safety and Health (NIOSH)
has also developed resources for healthcare safety relating to hazardous drug exposures, waste anesthetic gases, and latex allergies. Additional
guidance is available from accrediting organizations such as The Joint Commission, DNV Healthcare, and Center for Improvement in Healthcare Quality
(CIHQ), among others.
So, with all the resources and
guidance available, why are the injury and illness rates so high among healthcare workers?
Some safety and health
professionals might argue that the healthcare organizations are too focused on
patient safety as opposed to employee safety, in order to improve their ratings
and popularity. To combat this belief, The Joint Commission developed a
monograph entitled “Improving
Patient and Worker Safety: Opportunities for Synergy, Collaboration and
Innovation” that explains the methods of coordinating quality improvement
activities that will benefit both the patients and the workers. In the Foreword
of the monograph, The Joint Commission explains that: “The organizational
culture, principles, methods, and tools for creating safety are the same,
regardless of the population whose safety is the focus. In fact, the same
principles, methods, and tools may be separately used by different groups
(clinical, human resource, and general liability personnel) within an
organization” (The Joint Commission, 2012) . This is not a
surprise to healthcare safety personnel who came to the healthcare industry
after training in other industries, but may be a pleasant discovery for
healthcare safety personnel who were promoted into their position from other clinical
or non-clinical jobs.
There is variability in the tasks
performed by healthcare safety personnel. Depending on the size of the campus
or healthcare organization, healthcare safety personnel may have many other
responsibilities beyond occupational and patient safety. Some healthcare safety
personnel serve as the Director of Materials Management, Director of
Facilities, Risk Manager, or Director of Infection Prevention, and the safety management
aspect of their job is only a small portion of their daily responsibilities.
Others may also serve as the Compliance and Privacy Officer, Radiation Safety
Officer, Laser Safety Officer, and other technical and regulatory required
positions.
In a quick internet search of
posted jobs for “healthcare safety officer” or “EOC safety officer,” the
following job tasks and requirements were listed (not a comprehensive list):
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Conduct training of staff
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Know OSHA and EPA regulations
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Radiation and laser safety knowledge
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Chemical safety and proper disposal
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Develop education modules
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Know NFPA Life Safety Code
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Emergency management
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Chair the EOC Committee
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Conduct fire drills
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Process improvement
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Work independently
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Risk assessment
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Consultation and assessment
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Understand project management
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HICS and HSEEP Exercises
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5 to 7 years’ experience in safety
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Manage hazmat program
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Familiar with ADA compliance
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Act as community liaison
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B.S. or M.S. in health sciences or safety
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Conduct emergency spill response
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Assist with laboratory safety
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Provide regulatory oversight
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Professional certification(s)
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Healthcare safety personnel usually
serve on a facility’s Environment of Care (EOC) Committee, which is an
interdisciplinary team tasked with managing a facility’s physical environment
in six functional areas: safety, security, hazardous materials and waste, fire
safety, medical equipment, and utilities. The EOC Committee should have
representation from clinical staff, security, healthcare administration,
biomedical engineering, facilities engineering, infection prevention, employee
health, laboratory, and other areas such as research administration that may be
applicable to the facility.
Aspects of the Environment of Care
are an integral part of the survey instruments used to score hospitals on sites
such as Hospital Safety Score
or the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS). The results of these
surveys are supposed to be used by patients to select hospitals and health
systems based on patient safety and outcomes. The HCAPHS survey asks two
questions related to the physical environment of the hospital and patient
safety (Centers for Medicare & Medicaid Services, 2015) :
- During this hospital stay, how often were your room and bathroom kept clean?
- During this hospital stay, how often was the area around your room quiet at night?
- Leadership structures and skills
- Culture measurement, feedback, and intervention
- Teamwork training and skill building
- Identification and mitigation of risks and hazards
- Hand hygiene
- Falls and trauma
In reviewing the job tasks and
requirements listed previously for healthcare safety personnel, it quickly
becomes apparent that individuals holding a Certified
Industrial Hygienist (CIH) or Certified
Safety Professional (CSP) designation already have much of the required
knowledge, skills, and abilities. Individuals with CIH/CSP designation who have
not worked in healthcare before may need to learn more about BBP and infectious
diseases, hazardous drugs, medical terminology, ionizing radiation, patient
safety, laboratory safety, and the accreditation process.
Having a qualified, certified, and
well-trained person at the helm of health, safety, and environmental compliance
activities may help healthcare facilities to improve their overall culture of
safety – both for patients and employees. In an informal survey of hospitals
located within Arizona, 23 hospitals were awarded an “A” or “B” designation by
the Hospital Safety Score method in June 2015. After those hospitals were
identified, a search of LinkedIn
profiles was conducted to evaluate whether the hospital had a qualified and trained
safety and health professional serving in a healthcare safety role at the
facility.
If the individual held a
professional certification such as CIH, CSP, Certified Healthcare Safety Professional (CHSP),
Certified Professional in
Patient Safety (CPPS), or
Certified Healthcare Protection Administrator (CHPA), it was noted in the
survey. If the individual had also completed a master’s degree in safety,
environmental management, business administration, healthcare administration,
or other applicable degree, it was noted in the survey. The size of the
hospital – and associated complexity of environmental health and safety
management – is indicated by the number of licensed patient beds.
Table 1 details the results of the
informal survey of Arizona hospitals with a Hospital Safety Score of “A” or “B”
– identifying details such as the hospital name and actual number of licensed
beds have been replaced with an identification number and a size range. Hospitals
included in this survey range from small hospitals with less than 100 licensed
beds, to large hospitals with 700 to 750 licensed beds. If the individual
serving as the “safety officer” did so in an ancillary capacity (i.e., job
title was Director of Facilities), and did not have any formal safety training
documented in their LinkedIn profile, the “Safety Professional” selection was
“No.” If the individual performed safety functions as the primary role, the
“Safety Professional” selection was “Yes.” An “X” indicates that the individual
held the professional designation and/or had a relevant master’s degree.
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| Table 1: Informal Survey of Arizona Hospitals with a Hospital Safety Score of A or B (June 2015) |
The data from this informal survey
has been summarized into Tables 2 and 3 below. Table 2 shows the number of
Arizona hospitals with a “Safety Professional” (e.g., a “Yes” answer) as
compared with the number of Arizona hospitals with a person who acts as safety
officer in addition to their other job duties (e.g., a “No” answer). Table 3 shows
the number of Arizona hospitals with a “Safety Professional” holding a CIH/CSP,
CHSP/CPPS/CHPA, or relevant master’s degree. The hospital size ranges
associated with these trained professionals is also provided in Table 3.
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| Table 2: Arizona Hospitals with Dedicated Safety Professional (June 2015) |
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| Table 3: Arizona Hospitals with a Qualified and Certified Safety Professional (June 2015) |
Of the 23 Arizona hospitals with an “A” or “B” rating on the
Hospital Safety Score site in June 2015, 13 (56.5%) had a dedicated safety
professional. One of the smaller hospitals (AZ002) was not able to be included
in the survey results due to the lack of information about the hospital’s
safety officer responsibilities and lack of presence on LinkedIn. Of the 13
dedicated safety professionals, 10 (76.9%) had obtained a professional level
certification or relevant master’s degree. Hospitals employing these trained
and qualified safety professionals ranged from small (<100 beds) to large
(600 beds). Only 3 (30%) of the trained and qualified safety professionals held
a CIH or CSP designation. The remainder of the certifications (70%) were from
organizations such as the International Board for the Certification of Safety
Managers, the Certification Board for Professionals in Patient Safety, and the
International Association for Healthcare Security and Safety.
Although
only 10 (43.5%) of the 23 Arizona hospitals earning an “A” or “B” rating on the
Hospital Safety Score site had safety and EOC responsibilities performed
ancillary to the individual’s other job responsibilities, many of the hospitals
represented in this informal survey are part of regional health systems
spanning multiple states. These health systems may have regional or corporate
level occupational health and safety personnel who serve multiple healthcare
campuses and provide technical support to the facility-specific staff.
As part
of the “Improving Patient and Worker Safety” monograph, The Joint Commission
listed several topic areas for targeted interventions with the goal of
improving safety. Individuals with CIH/CSP designation that are looking to
foray into the world of healthcare safety should research strategies,
solutions, and benefits associated with this list. Healthcare systems looking
to hire safety officers, safety managers, and directors of safety are looking
for healthcare-specific knowledge that is difficult to obtain if you have never
worked in healthcare before. An abbreviated and modified list of these topics
is included below (The Joint Commission, 2012) .
- Safe patient handling (including use of lifts and slings)
- Fall prevention (both patient and staff)
- Sharps injury prevention
- Infection prevention (including hand hygiene and personal protective equipment)
- Assault and violence prevention and management
- Security management
- Emergency management (including the Healthcare Incident Command System)
- Exposure to hazardous drugs
- Surveillance and exposure assessment
- Environmental hazards
- Ergonomics and human factors engineering
- Improving safety culture throughout an organization
- Safer design of practices and the built environment
Qualified industrial hygienists
and safety professionals are needed to take healthcare safety to the next
level. With OSHA promising to increase enforcement action, and accreditation
agencies like The Joint Commission requiring documented improvements in safety
and quality measures, opportunities for solution-oriented and collaborative safety
professionals are becoming available. Industrial hygienists are needed to
evaluate acute and chronic exposures to workers that may be inadvertently
passed on to patients. Safety experts are needed to bring the industry
knowledge from manufacturing, aviation, power generation, and other high-risk
industries into the healthcare arena.
As Dr. David Michaels, Assistant
Secretary of Labor for Occupational Safety and Health, said in the news release
from June 25, 2015: “[…] it’s time for hospitals and the health care industry
to make the changes necessary to protect their workers” (OSHA, 2015) .
Let’s accept this exciting challenge and improve safety for all of the people
that enter into, or are employed by, healthcare facilities.
References
Centers for Medicare & Medicaid Services. (2015,
March 20). HCAPHS Online. Retrieved from HCAPHS Survey:
http://www.hcahpsonline.org/files/HCAHPS%20V10.0%20Appendix%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)%20March%202015.pdf
OSHA. (2015, June 27). Healthcare. Retrieved
from Safety and Health Topics: https://www.osha.gov/SLTC/healthcarefacilities/
OSHA. (2015, June 25). OSHA adds key hazards for
investigators' focus in healthcare inspections. Retrieved from News
Release:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=28197
The Joint Commission. (2012). Retrieved from The
Joint Commission:
http://www.jointcommission.org/assets/1/18/TJC-ImprovingPatientAndWorkerSafety-Monograph.pdf
The Leapfrog Group. (2015, April). Scoring
Methodology. Retrieved from Hospital Safety Score: http://www.hospitalsafetyscore.org/media/file/HospitalSafetyScore_ScoringMethodology_Spring2015_Final.pdf
