MITIGATING OCCUPATIONAL HAZARDS IN A CRITICAL CARE ENVIRONMENT

The best way of mitigating hazards at the workplace is to eliminate or substitute the hazard with a less hazardous option. Where this is not possible, engineering controls are applied to contain the hazards, so they don’t become risks. Administrative practices e.g. standard operating procedures may be the next option where engineering controls fail. The use of personal protective equipment (PPE) is the last option. However, in low-resource settings, hazards control is otherwise.

To control the various hazards in a critical care setting, conscious effort is needed through risk assessment to design targeted interventions to manage these hazards and reduce accidents in the clinical setting.
Physical Hazards
 Avoid temperature extremes at the work environment
 Improve ventilation and humidity
 Ensure adequate lighting
 Eliminate uneven floors and clear obstructed passageways
 Remove electrical hazards (do not overload plugs, eliminate trailing wires that could be tripped over and easily damaged, etc.)
 Reduce exposure to radiation (limit exposure time, avoid unnecessary exposure, use PPE; leaded aprons)
 Be prepared for emergencies (accidents and first aid, fire prevention)
 Disaster preparedness

Chemical hazards
 Eliminate hazardous substances or reduce their concentration if possible, reduce handling time, use appropriate PPE, improve ventilation, etc.
 Keep records of all chemical agents which are being used in the ICU and prepare emergency action plans in acute and chronic exposure cases.
 Label all chemical substances used at the workplace, keep them in their original containers as much as possible.
 Control latex allergy
 Know the effects on male and female reproductive health, give additional protection to pregnant women

Biological hazards
 High standards of hygiene
 Ensure staff immunization against hepatitis B and influenza
 Safe management of sharps and ICU waste
 Contaminated spillage area should be cleaned immediately
 Use PPE
 Control airborne hazards

Ergonomic hazards
 Work in neutral postures where the body is aligned and balanced
 Keep everything within easy reach
 Work at proper heights
 Relieve pressure points
 Avoid lifting where possible-use mechanical devices, ensure that at least two nurses lift the patient

Psychological hazards
 Supportive supervision
 Promote a “no blame” culture
 Training
 Ensure a well organized work environment
 Maintain mutual respect
 Provide appropriate motivation
 Reduce noise levels in the ICU
 Reduce workload

Staff training
Training should include different time periods such as orientation programs when workers start working in the ICU (pre-employment training); periodical training; condition-based training where ICU workers need information about an unexpected or unusual situation (e.g. when they are caring for patients with an epidemic disease); return to work programmes for staff who have been absent after having a workplace accident or long-term leave from the ICU.

There must be an ICU emergency evacuation plan with staff training, fire safety training, etc. Protocols and procedures to follow after an incident must be clearly made known to all ICU workers.

Article by Oscar Johnson