Organization selected: Mallesons Hospital
Mallesons Hospital is a 150-bed working emergency hospital in Sidney, New South Wales, Australia.
Hospitals are classified as hazardous workplaces as they face compound challenges of risk of illness and injury. Efficient and timely management of work health safety of a working hospital is crucial to reduce the detrimental affects on environment and people. Environmental friendly practices are initially costly ventures and therefore are given less preference while delineating a working policy for any working organization; what needs to be understood globally is the long-term benefits of a timely endorsed environmentally friendly work health safety policy. In a hospital setting with casual and non-strict adherence to environmental health practices there can be widespread disease scatter for example hazardous organic waste improperly disposed can cause diseases in both flora and fauna located in the locality. The effects of these malpractices go a long way; cause and affect can be geographically distant. To elaborate let us take a hypothetical situation: a hospital with improper marking of non-hazardous waste, throw some hazardous waste with the non-hazardous in a deep-water dumping site. The fish can become sick, when consumed by people: they can get sick. In this way the affect of a local malpractice can have long reaching global affects. (Jonathan, 2016)
There are numerous challenges to developing an environmentally friendly Work Health Safety. These can be political, institutional, or economic however there are many policies and agencies keeping a check on organizations to ensure adherence to environmentally friendly practices safeguarding Work Health Safety. New South Wales implements a “Get Healthy at Work” (GHaW) state-wide program to support a healthy workplace environment. (Richard Johnstone, 2012)
Work Health Safety
Work Health safety is a concept devised to prevent work related injury or illnesses to employees, customers, or associated personnel. Potential hazards are widespread in almost all workplace environments. Their identification and effective management or prevention is key to a flourishing work environment.
Work Health Safety Risk Management Steps
Step 1: Hazard Identification
Hazard means anything that may cause harm or injury to a person. Hazard identification requires an intense inspection of the workplace. Observation of working practices, usage of equipment, knowledge of chemicals used in the organization, and inspection of the design of the workplace are critical to the identification of risks. (Xinhao Wang, 2018)
Following can be the hazards in a hospital:
- Hospital design
- Improper disposal of organic and inorganic waste produced or present in the hospital
- Psychosocial, workload on staff: stress
- Hazardous chemicals
- Use of paper: improper disposal
- Confined spaces
- Excessive carbon footprint
- Improper ergonomics of the doctors’ offices
Step 2: Risk Assessment
Company name: Mallesons Hospital
Task or Scenario
Existing Risk Controls
Current Risk Rating
Additional Controls required
Residual Risk Rating
|Improper Hospital design||Mechanical Hazard||Building design, saturation of beds in wards, flooring (slippery), ventilation, parking etc.||The hospital is single story, with proper ventilation and good parking design||Likely, severe||Flooring of the hospital is slippery and there are too many beds in a ward||Marginal upon addressing issues|
|Improper disposal of organic and inorganic waste produced or present in the hospital||Waste Material||Organic waste is about 25% of all waste produced in the hospital when normal individuals, animals and plants are exposed to it (M. Zamparas, 2019)||The hospital has marked disposal containers for sharps, infectious materials, non-infectious materials, and hazardous material||Likely, severe||There is a need to ensure effective adherence to the distinctive disposal for each type of waste||Negligible upon addressing issues|
|Workload on staff: stress||Psychosocial Hazard||Doctors are often over worked which decreases their efficiency especially in an emergency setting (Kerstin H. Wyssusek, 2018)||There are continuously rotating shifts||Likely, moderate to severe||There is a need to hire more doctors and staff||Negligible upon addressing issue|
|Chemicals used in the hospitals||Chemical Hazard||Flammable and corrosive chemicals used in hospitals can be lethal if misused||Only special personnel are allowed in storage areas and laboratory||Likely, Moderate||Staff working and accessing the storage areas must be in PPEs and trained in safe use of these chemicals||Marginal upon addressing issues|
|Use of paper: improper disposal||Waste Material||Paper being used must be recyclable to ensure environmental safety||The paper used is low quality and is not recyclable and no steps have been taken in this regard||Likely, Marginal (mild)||The papers used must be changed to recyclable||Negligible upon addressal of issues|
|Confined spaces||Structural Hazards||There are some confined spaces in the hospital like the storage areas and janitor rooms||Storage areas and janitor rooms are confined with no windows and usually a single door entry and exit||Likely, Moderate||Double entry and exit doors must be installed and confined spaces must be minimized in the building||Marginal upon addressal|
|Violence in hospitals||Violence Hazard||Terrorism, vandalism, noise etc. can occur in hospitals||The hospital has multiple security guards and security cameras||Likely, Severe||With too many beds in each wards the noise control is insufficient||Marginal upon addressal|
|Excessive carbon footprint||Environmental Hazard||Greenhouse gas (carbon dioxide) emission||Greenhouse gas emission annual calculation and mitigation program||Unlikely, Negligible||The hospital has a robust emission control policy||Negligible|
|Improper ergonomics||Structural Hazard||The doctors’ cabins, nurses’ station, and hospital beds need to be ergonomically planned to ensure effective usage||The doctor’s cabins, nurses’ stations are ergonomically improper, and the beds are placed to close to one another||Likely, Severe||There is a need to make the hospital more spacious and the offices more ergonomically efficient to ensure the health of staff and patients||Marginal upon addressal|
|Micro-organisms||Biological Hazard||Hepatitis, HIV/AIDs, allergies are common in hospital patients||Patients with transferable diseases are kept in isolation||Likely, Severe||More stringent steps are required to ensure no disease spread||Marginal upon addressal|
Step 3: Effective Risk control
To mitigate risk and formulate a risk control program the first step is to identify the people affected then identify
Identification of vulnerable groups
Vulnerable groups in a hospital setting are
- Medical Staff: doctors, paramedics, staff
- Healthy attendees
- Individuals, animals, flora, and environment exposed to toxins (improperly disposed waste) released by the hospital
- Special groups: Children, pregnant women, handicaps, older individuals, immunocompromised patients, and socioeconomically compromised individuals.
Effects of risks on vulnerable groups:
Vulnerable groups are at higher risk of catching airborne infections. Aerosol chemicals and disinfectants can affect the pregnant women and the baby. Older people are more prone to get transmissible infections and to get a physical trauma. Socioeconomically poor patients cannot afford the standards of a high-class expensive treatments. (Selin Aslantaş, 2019) (Theresa Gorman, 2016)
- Guide the newly admitted patients about the hazards of the hospital management and risks
- Specific visiting hours implemented; no visitor allowed after the given time
- Infants and immunocompromised patients should be isolated from their history
- General awareness should be done by advertisements, posters etc.
- Older patients should be kept with high level care and with 1 attendant.
- Not more than 2 visitors per patient.
Risk control measures
The WHS Regulations require risk specific management protocols. The controls explained thereafter will be regarding the risks identified above. (Styliani Gewrgios Tziaferi, 2011)
- Waste collection and Separation:
Waste collecting personnel must use PPEs (personal protective equipment) i.e. masks, aprons, gloves, boots as per provision 44 of WHS regulations. (South Australia, 2011)
Risk and hazardous waste should be separated from non-risk elements with the use of coloured bags and trolleys.
- Proper Transportation (administrative control):
Efficient and safe transportation of waste is a must to isolate the hazards from people.
On site waste should be bagged in separate trolleys and bags in an area isolated from public.
Location of the storage should be away from the food and water supply. Proper maintenance and timely disinfection of the storage space should be done. Waste should not be stored for more than 24 hours.
- Waste disposal (Engineering measures):
Risk wastes should be disposed of using high heat incinerators and furnaces using high temperatures and oxidation techniques. Chemical disinfection can also be helpful. To kill pathological waste materials. Other engineering techniques include dry heat thermal treatment, microwave heat treatment, underground land disposal.
Microorganisms spread should be controlled for prevention of dangerous infections like HIV, Polio, hepatitis etc. Nurses and paramedic staff should be careful towards such exposed and immunocompromised patients. Their trolleys, needles, food, medications, and beds should be marked red for danger signs. The needles and sharps should be dumped accurately and disposed of for incineration. Urine and blood samples of the patients should be handled with care to avoid any spillage, with stringent steps to decompose and dispose them. (World Health Organization, 2001)
- Hospital Design:
Hospital should be proper ventilated with Proper infection and temperature control. Spacious wards with at least 5 feet distance between beds. Functional elevators applied for multi-storey building. Windows and doors should be wide. Floors should be made non slippery and rough with use of marbles and tiles for prevention of falling or slipping.
- Psychosocial stress:
Workload tends to increase the risk of impaired mind and attitude of medical staff towards their patients. Implementation of timely schedules and timetables for doctors should be done. No doctor should be called on duty for more than 8 hours. Number of doctors in each department should be hired according to AMC (Australian Medical Council). Doctors and other medical staff should be granted leave per yearly for personal vacation or for rest to get rid of their normal whole year hectic routine.
- Reduction in Carbon Footprints:
Carbon footprints and greenhouse effect are the silent killers of the modern World. Hospitals rules should be made on no excessive use of electronic machinery and computers with the help of conservational measures. Hospital design should be climate friendly and should adopt the low energy demand. Hospital staff travelling contributes to the major carbon footprints. Low fuel vehicles i.e. cycle, trains, public transport should be used by the staff to decrease pollution. Recycling and reuse of waste materials will decrease carbon production, instead of burning them in incinerators.
Doctors and hospital staff face violence from patients, their attendees or sometimes natural source of violence like noise pollution, air pollution etc. Hospital should be well equipped with security team of guards, CCTV cameras, ammunition. They should be always ready for emergency situations like sabotage, robbery etc. Psychiatry ward should be made as separate unit to avoid stress.
Implementation of these controls is done by incorporating policy change, active inter-departmental involvement, providing training and guidance to staff, and forming associations and unions within the hospital. Implementing of controls must be cost effective and scrutinized under regular audit to ensure maintenance of controls.
Step 4: Reviewing controls
Maintenance of practices is crucial and is the final step of an efficient work health safety program.
All personnel working in the hospital must be guided as per the protocols of Work Health Safety Policy.
Regular workshops and training
Regular in-hospital workshops and training sessions must be planned to ensure dissemination of information regarding the working principles of the hospitals Work Health Safety Policy.
Regular review and consultation
Maintenance process includes a regular review and consultation process to quantify the level at which the policy is being implemented. Questionnaires with anonymous respondents can be distributed to calculate level of policy implementation.
Up-to-date Hazard information
Regular organizational hazard identification studies must be planned with expert consultation and review to ensure no new hazard is present in the hospital.
Record keeping is a practice which inherently improves organizational adherence to set policy procedure to prevent punitive measure upon malpractice. Record keeping is key to the reviewing process. (Glenn Pransky, 2010)
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