ASSESSMENT OF THE OCCURRENCE OF WORK-RELATED HAZARDS AMONG HEALTHCARE WORKERS IN THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU/OZALLA ENUGU

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ABSTRACT
Background: Controlling and minimizing workplace hazards for healthcare personnel in hospitals present a unique challenge because the health and wellbeing of hospital patients must also be considered. Health care workers need protection from these workplace hazards just as much as do mining or construction workers. Yet because their job is to care for the sick and injured, Health Care Workers are often viewed as “immune” to injury or illness.
Study objective: This study aimed at assessing the occurrence of work-related hazards among healthcare workers in UNTH Enugu, Nigeria.
Methodology: The study population was selected from health care workers who work in the clinical departments of the hospital and are involved in active patient management. Simple random sampling was employed in selecting 255 respondents from the study population. A cross sectional descriptive study design was then used to collect information from the respondents using a semi structured self-administered questionnaire. The data collected were analyzed using the SPSS package version 17.0
Results: Two hundred and-forty six (96.5%) had good knowledge of health-related hazards in the workplace with workshop and seminars (25.7%) constituting the greatest source of knowledge. As many as 251 (98.4%) had come in contact with infectious body fluids while 248 (97.3%) were exposed to sharps. Washing the exposed body part with jik and water was the best preventive measure adopted by the health workers while 29.4% of them received the complete dosage of Hepatitis B vaccine. Sixteen respondents admitted to have suffered from various illnesses resulted from health hazards which resulted to various days of work absence and varying degrees of decreased productivity. 
Conclusions: The knowledge of health-related hazards was high among the healthcare workers in the workplace with a higher proportion of them having been exposed to infectious body fluids and sharps.
Very poor strategies were available for the protection of these health workers leading to a higher percentage being absent from duty at various intervals with a resultant decreased productivity. Continuous education, training and vaccine provision are recommended to minimize the occurrence of health hazards among healthcare workers. 

TABLE OF CONTENTS

Title page
Table of contents
List of tables
List of figures
List of Acronyms
Abstract

CHAPTER ONE
INTRODUCTION
1.1       Background Information
1.2       Problem Statements
1.3       Justification
1.4       Research Questions
1.5       General and Specific objectives of the study
1.5.1 General objectives
1.5.2 Specific objectives

CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
2.2 Knowledge of work-related hazards in the workplace
2.3 Occurrence of work-related hazards
2.3.1 Mechanical Hazards
2.3.2 Physical hazards
2.3.3 Psychological hazards
2.3.4 Chemical hazards
2.3.5 Biological hazards
2.4 Preventive strategies adopted by health care workers against health hazards
2.5 Effects of hazards on the work output of health care workers

CHAPTER THREE
METHODOLOGY
3.1 Study area
3.2 Study design
3.3 Study population
3.3.1 Inclusion criteria
3.3.2 Exclusion criteria
3.4 Sample size determination
3.5 Sampling technique
3.6 Study instruments
3.7 Data collection methods
3.8 Data management plan
3.8.1 Measurement of variables
3.8.2 Analysis of data
3.9 Ethical considerations
3.10 Limitations

CHAPTER FOUR
RESULTS
4.1 Socio-demographic characteristics of health workers
4.2 Knowledge of health-related hazards among health workers
4.3 Occurrence of work-related hazards among health care workers
4.4 Preventive strategies adopted by health care workers against health hazards
4.5 Effects of health –related hazards on the health workers

CHAPTER FIVE
DISCUSSIONS
5.1 Socio-demographic characteristics of the health workers
5.2 Knowledge of health-related hazards in the workplace
5.3 Occurrence of work-related hazards
5.4 Preventive strategies adopted by healthcare workers against health hazards
5.5 Effects of work-related hazards on the work output of the health care workers

CHAPTER SIX
CONCLUSIONS AND RECOMMENDATIONS
6.1 Conclusions
6.2 Recommendations

REFERENCES

CHAPTER ONE
INTRODUCTION
1.1 Background Information
Occupational hazard can be defined as a risk to a person usually arising out of employment.1 It can also refer to a work, material, substance, process or situation that predisposes or itself causes accidents or disease at a workplace.1 The history of occupational hazard awareness can be traced back to the 18th century when Bernardino Ramazzini (1633 - 1714), who is referred to as the father of occupational medicine, recognized the role of occupation in the dynamics of health and disease.1
The occupational hazards found among healthcare workers (HCWs) are similar worldwide and include physical, chemical, biological, mechanical and social hazards.
Physical Hazards: HCWs are constantly at risk of physical injury during many procedures. Sources of physical injury include ionizing and non-ionizing radiation, extremes of temperature, noise and electrical injury.
Mechanical Hazards: These include needle stick injuries and cuts from sharp objects and instruments (percutaneous injuries) which have been reported in 1-15% of surgical procedures mostly associated with suturing.2 In the United States more than 800,000 needle stick injuries occur each year despite continuing education and efforts to prevent them.2 Other mechanical hazards include sprains and back injuries.

Chemical Hazards: The chemical environment is one of the most rapidly expanding components of the work environment because new chemicals and solutions are being introduced regularly. Many of these chemicals are among those whose health effects may not be known and may pose health problems taking years to manifest.
Many biomaterials and auxiliary products used in the hospital are chemically reactive. Hazardous chemical agents used in clinical practice include mercury, powdered natural rubber latex (NRL), cleaning compounds, hazardous drugs, disinfectants, nitrous oxide (N2O) and other anesthetic agents. By far the most important and most dangerous of these agents is mercury.2 Its use in clinical practice has the potential for continuous exposure of a medical practitioner to mercurial vapor which can be absorbed via the skin and the lungs. The active component in the mercurial vapor has a particular affinity for brain tissue. Mercury poisoning can be characterized by tumors of the face, arms or legs and can also be associated with progressive, tremulous illegible handwriting and slurred speech.2 The exposure risk for mercury can be minimized by careful handling procedures.
The continued use of powdered NRL gloves and disinfectants has predisposed HCWs to dermatitis, contact dermatitis, contact urticaria and allergic dermatitis.2
Biological Hazards: Hospitals have many unique biological hazards that potentially affect the health of its workers.3 HCWs are in direct or indirect contact with traumatized tissues, blood and saliva on a daily basis and are at risk of exposure to Hepatitis B virus (HBV), Hepatitis C virus (HCV), HIV/AIDS, tuberculosis and other types of communicable diseases. In the United Kingdom for example the carrier rate of HBV in the general population is 0.5% while HCWs have a carrier rate of approximately 1.6%.2
Finally psychological and work organization stressors include shiftwork, burnout, and the threat of workplace violence.3 Burnout viewed as the exhaustion of physical and emotional strength as a result of prolonged stress or frustration has been detected in a wide variety of health care providers. The HCWs at risk include physicians, nurses, social workers, dentists, care providers in oncology, and AIDS-patients care personnel, emergency service staff members, mental health workers, and speech and language pathologists among others4. Early identification of this emotional slippage is required to prevent the depersonalization of the provider-patient relationship.2
 Controlling and minimizing workplace hazards for healthcare personnel in hospitals present a unique challenge because the health and wellbeing of hospital patients must also be considered. Health care workers need protection from these workplace hazards just as much as do mining or construction workers. Yet because their job is to care for the sick and injured, HCWs are often viewed as “immune” to injury or illness. Their patients come first. They are often expected to sacrifice their own wellbeing for the sake of their patients. Indeed, protecting the health of health care workers has the added benefit of contributing to quality patient care and health system strengthening.5,6 Unsafe working conditions contribute to health worker attrition in many countries due to work-related illness and injury and the resulting fear of health workers of occupational infection, including infections from HIV and Tuberculosis. The 2006 World Health Report Working Together for Health reported on a severe health workforce crisis in fifty-seven countries, most of them in Africa and Asia.5 Thus, protecting the occupational health of health workers is critical to having an adequate workforce of trained and healthy health personnel.

1.2. Problem Statement
Health care facilities around the world employ over 59 million workers who are exposed to a complex variety of health and safety hazards everyday.6 The WHO Global Plan of Action on workers’ health calls on all member states to develop national program for health workers occupational health and for WHO to develop national campaigns for immunizing health workers against hepatitis B. Among health workers infected with hepatitis B, the WHO global burden of disease from sharp injuries to health care workers showed that 37% of the hepatitis B among health care workers was the result of occupational exposure.6 Infection with the hepatitis B virus is 95% preventable with immunization but less than 20% of health workers in some regions of the world have received all three doses needed for immunity.......

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