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.

They include gases use in the O R, toxic fumes from 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.

Exposure to severely traumatized patients, multiple injure victims of a
disaster or catastrophic event or exposure to 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.

Personal protection equipment, depends on equipment 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.

Fundamentally, ergonomics is about matching the ability of 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.

Before commencing work in any health facility the employee 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:

Before commencing work in any health facility the employee 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.

10. Routinely use barriers (such as gloves eye protection 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

Conclusion
There are a variety of safety precautions measures 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