OCCUPATIONAL HAZARDS AND RISK

MANAGEMENT IN NURSING
PRACTICE
A PAPER PRESENTED AT GRAND ROUND OF FEDERAL MEDICAL CENTRE BIDA
NIGER STATE
BY
OMONIYI, S O. RN, RPN, NDPA, CIDAD, BNsc
Outlines
Introduction
Definition of terms
Classification of hazards
Causes of hazards and their safety
measures
Risk management
Conclusion
Introduction
A major concern facing Nurses and all hospital worker today,
especially in third-world communities, the increase in
hazards, is because of the poor working environment. Nurses
are exposed to practically all of the acute hazards existing in
the healthcare institution where they work.
Internationally, it is estimated that about 2.9 billion workers
are exposed to hazardous risks at their respective
workplaces, likewise the international labor organization
 
statistics revealed that, every day, 6,300 people die as a
result of occupational accidents or work-related diseases,
which are more than 2.3 million deaths per year. Over 337
million accidents occur at work annually; many of these
resulting in extended absences from work. The human cost of
this daily adversity
(Introduction contd)
is huge and the economic burden of poor occupational safety
and health practices is estimated at 4 per cent of global
Gross Domestic Product each year. There is ample evidence
that occupational hazards account for 4% of all cancer
deaths. The National Safety Council (NSC) has stated that
hospital employees are 41% more likely to lose time from
work because of injury or illness than employees in other
fields. Hospital employees who work in or around
laboratories or operating rooms are more likely to be injured
by exposure to medical gases than workers in other areas.
Furthermore, in Nigeria, a study reported annual mortality
rate of 1,249 per 100,000 workers.
(Introduction contd)
As part of the healthcare team, it is essential that all nurses
and other health care workers should familiarize themselves
with potentials hazards to avoid getting injured or exposure
to danger while they are on the job.With the knowledge of
what causes injuries and diseases at workplace, it is easier to
design and implement suitable measures towards preventing
them.

Definition of terms
Hazard: is a situation that poses a level of threat to life,
heath, property or environment. It can also be defines as a
potential source of harm or having adverse health effects on
a person.
 Occupational hazard are risks or dangers connected to a
particular job.

Risk is the combination of the likelihood of an occurrence of a

hazardous event or exposure and the severity of injury or ill
health that can be caused by the event or exposure

Classification of Workplace Hazards

Workplace hazards are often grouped into physical/accidental
hazards, biological hazards, chemical hazards and other such
as organizational & psychological hazards.  
Physical/accidental Hazards
Physical/ accidental hazards these hazards includes
but not limited to cuts, pricks, electrical shocks,
burns and falls. The release of energy in various
forms such as continuous noise or impulse can
cause damage to the ear or deafness, Conditions in
the workplace may expose the worker to unusually
high or low pressures.

Biological Hazard
Biological hazards include bacteria, viruses, and
parasites and other organisms for which exposure
can cause occupational disease, usually infections.
Other biological hazards include organisms, such as
fungi, and material of biological origin, such as
enzymes used in detergents, that may induce
allergies. They are known as allergens. Occupational
infections are diseases in which a pathogen present
in the workplace enters the body and then grows or
replicates, causing a disease. For example as HIV
and hepatitis

Chemical Hazards
Hazardous materials or substances that, on getting
contact with the body cause harm to a person or the
environment.
gases and liquid, cytotoxic drugs, disinfectants and
cleaning agents.

Organizational hazards
Heavy workload as a result of manpower shortage,
long working hours, night shift/over stretch call
duties and sleep deprivation, fatigue from handling
patients, and stress on managing a very sick
patients are the commonness occupational hazards
that can have adverse effect on mental skill and
reaction time, vigilance, and interpersonal
relationship among the personnel
Psychological and Organizational hazards
Stress can be considered to be a psychological reaction to
an imbalance between demand on the worker and the
workers' ability to do the job to a satisfactory degree of
comfort or expectation. The body's response to stress is the
same as the normal response to a threat, the so-called
“flight or fight” response. When the threat is not concrete,
however, or when it is unavoidable and cannot be fought,
the normal response to a threat does not work and causes
health problems. There is no one, specific health effect that
is always associated with stress. It often acts indirectly by
disturbing sleep, worsening the workers' mood, motivating
substance abuse and other addictive behaviors, and
changing behavior could lead to psychological hazards.
severely violent patients, long working hours without break /
off duty, working with bad equipments and lack of supplies
and stationeries.
CONTROL OF HAZARDS
Control of hazards requires the use “appropriate to the
situation” of four basic approaches: engineering controls,
administrative arrangements, safe work practices,
preventive maintenance, and the use of personal protective
equipment.
Engineering controls are considered to be the most
effective because they do not require unusual effort by the
worker and can be maintained easily. Ideally, the design for
engineering control s takes place before the facility is built in
the first place. However, workplaces can often be
redesigned after it has been in operation and modified to
reduce hazards, a process called retrofitting. Ventilation is
an important method of engineering controls.  
 Ventilation moves airborne hazards away from the
worker, dilutes them in the atmosphere of the
workplace and maintains a fresh atmosphere for the
worker to breathe. 
Safe work practices depend on compliance by the
workers, which requires education and training.
Written procedures are needed and the employer
should have policies that require workers to comply
and supervisors to manage health and safety in the
workplace.
Administrative rearrangement
They are considered the least effective approach to
hazard control because they require changes in the
behavior of workers and of work organization and
are easy to avoid or defeat.
provided to individual workers to prevent direct contact with
the hazard, such as respirators, gloves, safety goggles
(glasses), hardhats (helmets), safety shoes and protective
clothing.
Preventive maintenance throughout the workplace is an
important means of controlling hazards.
ERGONOMICS
Ergonomics is a scientific and practical discipline that
examines the relationship between human and physical
elements of work. This may take the form of how a
workplace is designed, what tools are used and how they fit
the worker’s capabilities and what physical actions and how
much energy the worker has to expend to get the job done.
A properly designed workplace and work process leads to
greater efficiency, more productivity, fewer injuries, fewer
musculoskeletal problems, less fatigue, less spoilage of work
product, better quality and more satisfied workers.
the worker to the demands of the task to be performed. The
field takes into account the physical demands of the
job, cognitive function (how information about the task is
handled in the brain), work organization and the economic
and social context of the work. Much of ergonomics is
devoted to improving the human-machine interface so that
the worker is able to operate equipment efficiently and with
minimal strain.
Macroergonomics is the ergonomic design of large
systems. Participatory ergonomics involves the worker in
workplace and task design. Usability refers to how easy it is
to use a particular product or device, such as a tool or
machine.
 
Much of ergonomics is based on anthropometrics,
measuring the dimensions and capacity of the human
body, with the objective of helping engineers or
designers to create products designed for all users or to
create “universal designs” that can accommodate the
widest variety of future users.
FIRE AND EMERGENCY AT WORKPLACE
If a fire event occurs during your working hours, the first
concern is the safety of the patients and personnel.
The safety of all patients employees and visitor, in the
case of fire or are aware, is of the utmost importance. It
is vital that all employees are aware of fire emergency
procedure in the facility that they are working in , where
equipment is kept and how to use it.
must ask the workplace RN/supervisor for the fire
evacuation procedure
And position of fire exists . A fire or emergency can happen
at an time and all employees must be prepared to carry out
the appropriate procedure for the facility they are working
in.
To prevent explosion, the burning article is removed
immediately from the proximity of the oxygen source if
possible and the oxygen outlet piped-in gases should be
switch off.
The shut-off values for piped in gases are turned off and
electrical power cords are unplugged. The acronym RACE
may aid in preventing panic and should enable the team to
act quickly in the event of fire anywhere within the
environment:
must ask the workplace RN/supervisor for the fire
evacuation procedure
And position of fire exists . A fire or emergency can happen
at an time and all employees must be prepared to carry out
the appropriate procedure for the facility they are working
in.
To prevent explosion, the burning article is removed
immediately from the proximity of the oxygen source if
possible and the oxygen outlet piped-in gases should be
switch off.
The shut-off values for piped in gases are turned off and
electrical power cords are unplugged. The acronym RACE
may aid in preventing panic and should enable the team to
act quickly in the event of fire anywhere within the
environment:
R- Rescue anyone who is in immediate danger.
A- Activate the fire alarm.
C- Contain the fire if possible smoke by closing doors and
windows if practicable.
E- Evacuate from the area Or Extinguish fire but do not take
unnecessary risks.
Stages of Evacuator
1. remove from immediate danger
2. remove to safe area
3. complete evacuation of a building
 
Order of Evacuator
1. ambulatory patients
2. semi ambulant patient
3. non ambulant patients
The above advice is for general guidance. Employees will follow
the emergency procedure of health facility they are working in.
1.Wear shoes design for nurse, with non-slip shoes.
2.Handle sharp objects with extreme care; use special safety
needle if available.
3.Install ground fault circuit interrupters; call qualified
electrician to test and repair faulty or suspect equipment.
4.Comply with all safety instructions on the installation and
periodic inspection of electrical medical equipment.
5. Wear a radiation dosimeter (badge or other) when exposed
to radiation; comply with all safety instructions to reduce
exposure to a minimum.
6. Install air condition with effective general ventilation top
reduce heat stress and remove odours, gases, and vapours.
7. Provide eye flushing bottles or fountains.
8. Nurses sensitive to natural latex must use non-latex, gloves
and avoid contact with other latex product.
9. Follow established appropriate infection control precautions
assuming blood, body fluid and tissue are infectious.
goggles or face shield and gowns)
11. Wash hands and other expose skin surface after coming
into contact with blood or body fluids.
12. Follow appropriate procedures in handling and disposing
of sharp instruments or needles.
13. Provide lifting aids for the lifting and transport of
patients; consult an occupational safety specialist on the
safe handling of heavy patients.
14. Procedures and counseling services should be available
to workers exposed to post traumatic stress syndrome.
Risk Management
Risk management is a process that identifies, analyses and
treats potential hazards within a given setting. The risk
management programme of a hospital is designed to
“enhance the safety of patients, visitors and employees and
minimize the financial losses through risk detection,
evaluation and prevention.
Risk management consists of four (4) related elements:
Administration; prevention; correction and documentation. To
be more effective in the hospital setting, risk management
involves a multidisciplinary and proactive approach.
Administration
Regulation, recommendations, guidelines and laws should be
enforce to prevent disastrous consequences of occupational
hazards.
Policies and procedures should be written, reviewed
periodically and updated as appropriate
Protective attires and safety equipments should be made
available to employees as appropriate
Monitoring devices should be used in all hazardous location
as recommended by regulatory agencies
Employees health services should be provided for
immunization, and in the event of injury for e.g PEP
Prevention
Regular in-service training programs should be
conducted to keep employees informed about
hazards and safeguards measures
Employee should be taught on how to use and care
for new equipments before its been put to use
Employee must know the location and the use of
emergency equipments such as fire extinguishers
and shut-off valves
Employee must wear PPE as appropriate
Routine preventive maintenance should be provided
for all potentially hazardous equipments.
Correction
Faulty or malfunctioning equipments should be taking out of
services with immediate effect to prevent harm to the
patients and the users
Any form of injury should be reported, with medical attention
sought for, as soon as possible
Unsafe conditions should be reported.
Any form of injury should be reported, with medical
attention sought for, as soon as possible
Unsafe conditions should be reported.
Documentation
Record all information about equipment in the
ENT,Theatre,ICU and A&E units
A well planned orientation program for newly employed staff
or students in MHU and OR should be organized
Incident report regarding injuries to health care giver and
patients should be filed in line with the facility procedures.
Constant vigilance, awareness with timely
intervention, regular maintenance of medical tools,
and an educated team culture can make the
working environment a safe heaven for the patient
as well as for the nurses. The standard procedure
manuals for equipments are to be followed precisely
to minimize the risk of accidental, inappropriate
practice. The prevention of injuries is vital to
maintaining a safe working environment; therefore,
it is the responsibility of all the nurses and other
team
nurses and institutions use in preventing injuries.
these include, comfortable non-slip shoes to prevent
back pain and falls, handling sharp objects with
caution, and having equipment routinely monitored
for signs of breakdown or unsafe conditions.
Assessing equipment is essential in preventing
electrical/radiation related accidents; it ensures that
the machines are properly grounded. Thus, proper
ventilation is also important in any setting to ensure
that gases and other airborne substances are not
trapped in the rooms.
Inadequate safety measures thus can result in
multiple ill effects in the wards.
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It is better to be safe
than to be sorry.
Thanks 4 listening