A Safe Workplace. Theme 2. Commonwealth Nurses Federation. Jill ILIFFE Executive Secretary. Commonwealth Nurses Federation

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1 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Theme 2 A Safe Workplace Jill ILIFFE Executive Secretary Commonwealth Nurses Federation

2 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 (a) WORKPLACE HEALTH AND SAFETY The focus is on the prevention of injuries and the fair and equitable treatment of nurses who are injured at work or develop a work- related illness. Nurses have the right to work in an environment that does not threaten their health, safety or welfare.

3 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 WORKPLACE HEALTH AND SAFETY A safe nurse, a safe patient, a safe workplace, a safe profession are all embodied in the concept of workplace health and safety. Workplace health and safety is a PRIORITY requirement for work.

4 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 WORKPLACE HEALTH AND SAFETY! Safe work environments! Healthy work environments! Safe workplace design! Safe work processes and systems! Safe work procedures and practice! Safe patient care

5 Commonwealth Nurses Federation South Asia 4 Safety Workshop Safe Work Environments means the existence of:! Safe equipment! Hygienic conditions! Safe walking and working surfaces! Freedom from violence! Non-hazardous and toxic materials, and if they are present, provision for safe handling, storage and disposal of them

6 Commonwealth Nurses Federation South Asia 4 Safety Workshop Healthy work environments Safety measures are in place in relation to blood borne and body fluid pathogens to prevent contamination of nurses and patients

7 Commonwealth Nurses Federation South Asia 4 Safety Workshop Safe workplace design Good ergonomics in relation to:! Seating! Equipment use! Adequate lighting! Safe exits/egresses (clearly marked, open and well-lit)

8 Commonwealth Nurses Federation South Asia 4 Safety Workshop Safe work processes and systems! Written and up-to date standards, protocols, policies, procedures! Adherence and compliance with these! Adequate staffing! Safe delegation of duties

9 Commonwealth Nurses Federation South Asia 4 Safety Workshop Safe Work Procedures and Practices! Lifting techniques! Prevention of needle stick and other injuries! Adequate break times for nurses to prevent tiredness and increase the risk of medication and other errors

10 Commonwealth Nurses Federation South Asia 4 Safety Workshop Safe patient care! Safe administration of medication and other skills! Competent staff (skilled and knowledgeable)! Adherence to proper work standards and ethics

11 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 The patients rights are the nurses responsibilities (professional, ethical, legal) The nurses rights are the employers responsibilities (liability laws, ILO conventions, labour laws, occupational health and safety legislation)

12 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 A nurses right to safety is the employers responsibility The law mandates of the employer:! Safe systems of work! Safe equipment! Competent colleagues

13 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Safe systems of work! Written practice standards! Written policies, protocols and procedures! Appropriate documentation systems! Systems of accountability for care given, or not given and actions taken! Adequate staffing systems

14 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Safe equipment! Available! In good working order! Well maintained! With staff knowledgeable in its use

15 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Competent colleagues! Continuing education! Fair system of appraisal! Supervisors and managers with the necessary skills to manage! Requires: recruitment, training, deployment, promotion and retention strategies

16 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 ILO Convention No: 155 Concerning Occupational Safety and Health and the Working Environment. 22 June

17 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Workplace or occupational health and safety legislation can provide a framework, but what is required is the development of a culture of safety in health care.

18 ! Exposure to hazardous drugs and blood borne pathogens! Air quality compromised by toxic environmental cleaning substances! Heavy lifting and moving of patients and medical equipment,! Workplace violence and abuse (intruders, patients, relatives, other staff)! Needle stick injuries! Excessively long working hours and heavy workloads

19 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 Nurses, at all levels, need to embrace safety and consider it an integral part to the way work is planned, resourced, performed, monitored and evaluated

20 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 (b) INFECTION CONTROL Every patient encounter should be viewed as potentially infectious

21 Standard Precautions 1. Hand hygiene 2.! Gloves 3.! Facial protection 4.! Gown 5.! Prevention of needle stick injuries 6.! Respiratory hygiene and cough etiquette 7.! Environmental cleaning 8.! Linens 9.! Waste disposal 10.! Patient care equipment

22 CHAIN OF INFECTION Causative agent (Pathogen) Susceptible host Reservoir Portal of entry Portal of exit Mode of transmission All must be present to transmit an infectious agent

23 Infection control is all about interfering with the chain of infection at as many points as possible Use standard precautions

24 Hands are the most common mode of disease transmission

25 Hand hygiene * When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. * If hands are not visibly soiled, use an alcohol-based hand-rub for routinely decontaminating hands.

26 Ability of hand hygiene agents to reduce bacteria on hands % 99.9 Time After Disinfection log minutes 3.0 Bacterial Reduction Alcohol-based handrub (70% Isopropanol) Antimicrobial soap (4% Chlorhexidine) Plain soap Baseline Adapted from: Hosp Epidemiol Infect Control, 2 nd Edition, 1999.

27 World Health Organisation One of the most powerful approaches to fighting health care related infections is also the simplest; health care providers need to clean their hands every time they see a patient

28 Immunization of all health care workers Recommended vaccinations * Hepatitis B * Measles/Mumps/Rubella * Varicella (chicken pox) * Diphtheria/Tetanus * Polio * Influenza * Others depending on disease prevalence in the area

29 Prevention of injury: * Use instruments to retract * Use safety needles and re-cappers * Pass instruments correctly and safely * Use sharps containers and replace before full

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31 Needle Stick Injuries!Persons providing routine nursing care (38%) and cleaning (15%)are the most common situations where needle stick injuries occur.!invasive procedures such as injections and venipuncture are the most commonly reported causes of injury.

32 Risk of infection after needle stick injury Source HBV HCV HIV Risk % 1.8% 0.3% 1:3 1:300

33 Environmental safety: * Appropriate medical waste disposal - sharps - blood - contaminated disposable products

34 Who has the responsibility? GOVERNMENT - recognise the need - set the policy in public and environmental health - provide resources and facilities - education and training

35 Who has the responsibility? HEATH ADMINISTRATORS -! establish a safety culture -! encourage and support reports of unsafe practices or situations -! view errors and adverse events as opportunities to make systems safer -! put systems in place to avoid predictable adverse events

36 Who has the responsibility? HEALTH CARE WORKERS - recognise the need for action - undertake training - universal use of universal precautions - conduct yourselves appropriately - persuade others to do the same

37 Who has the responsibility? PROFESSIONAL ASSOCIATIONS -! monitor quality in professional training -! regulate and monitor safe health practices -! protect the public from unsafe practitioners -! establish and promote codes of ethics and conduct

38 Who has the responsibility? The public YOU and ME - recognise the need for action - don t tolerate inappropriate behaviour - conduct ourselves appropriately - persuade others to do the same

39 Commonwealth Nurses Federation South Asia 4 Safety Workshop 2009 (c) SAFE STAFFING LEVELS The environment in which health care is provided influences not only the quality of care delivered but also the safety and well being of the care provider.

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44 Nurses need their sleep and they need their breaks at work! The effects of fatigue on the brain from sleep deficiency are similar to those of alcohol! Fatigue appears more rapidly with irregular work schedules! Risk of accidents is 7 times higher between midnight and 8 am

45 Measures that promote a safe work environment! Ongoing employee education! Adequate staff so there are reasonable shift lengths and workloads! Supervision and support for inexperienced staff! Measures to prevent stress, isolation and burnout! Adherence to universal precautions! Provision of personal protective equipment

46 The challenge for nurses is to further improve work practices to ensure they do not risk their life making a living.