Thursday, November 5, 2020
Monday, September 21, 2020
HEALTHCARE WORKERS' SAFETY AND CORRELATION WITH PATIENT'S SAFETY
As we join the rest of the regions of the world to mark World Patient Safety Day 2020 as adopted by the 72nd World Health Assembly Resolution - WHA 72.6 "Global Action on Patient Safety" in May 2019, it is important to strengthen the fact that both the safety of healthcare workers and that of the patients should be adequately protected. Owing to the COVID-19 impact on health and safety of healthcare workers as was evident globally, it became obvious the need to integrate these two issues into one for global conversation. The World Health Organisation has chosen a very apt theme for this year's event "Healthcare Workers Safety: A Priority for Patient Safety", this could not have come at a better time. This event was jointly organised in Nigeria by Occupational Health and Safety Managers (OHSM), Medical and Health Workers Union of Nigeria (MHWUN), OSHAfrica, International Trade Union Congress (ITUC), Patient Safety Movement Foundation (PSMF), Nigeria Labour Congress (NLC) and World Health Organisation (WHO).
According to the words of Florence
Nightingale over 160 years ago, “the very first requirement of a hospital is
that it should do the sick no harm”. As fresh as this statement still is today,
the question on the lips of everyone is, do we still play by this rule in
healthcare facilities? How comfortable are we when we send our loved ones to
healthcare facilities for treatment? Do we still feel sufficiently safe in
these facilities? These and many more questions are begging for answers.
As much as we advocate for the safety
of patients, we also need to remember that healthcare facilities are also workplaces
primarily before being a place where patients receive care. The need to also protect
the health and safety of the healthcare workers should be a very important
aspect in the conversations that surround patient safety. The honest truth is,
if we cannot guaranty the safety of healthcare workers, our hope of patient
safety and good treatment outcomes could be adversely jeopardized. This
multidisciplinary nature and complexity of healthcare systems is just a good
place to start. Good treatment outcomes and the safety of the patients is a
combination of many variables, it is difficult to give credit to specific sets
of professions within the system. Outcomes are always joint efforts of all
employees within the facility, this is one of the reasons why we advocate that
safety must start from the boardroom to the bedside, to the gate house and
beyond.
According to WHO, healthcare
facilities across the world employ over 59 million workers who are daily
exposed to a complex variety of health and safety hazards. Lately, the issue of
psychosocial hazards in healthcare sector has grown exponentially and this
burden has become a key indicator that could be attributed to the increasing
risk of patient’s harm. We are all aware how the work shift pattern in
hospitals have changed over the years, the increasing rate of workplace
violence against healthcare workers by patients and patients’ family members,
the increasing rate of the number of patients per healthcare worker in most
countries, the high rate of workplace stress and the increasing incidence rate
of accidental needle stick injuries among healthcare workers.
According to Dr. Teryl Nuckols, an
internist and Assistant Professor at David Geffen School of Medicine,
University of California Los Angeles “Residents are working more than 30 hours
at a single stretch and often times forgo sleep entirely”. In many healthcare
systems across the world, there seems prohibition on “mandatory” healthcare
worker overtime but nothing is seen on “voluntary” healthcare worker overtime.
Healthcare workers are at risk of violence across the world, between 8% and 38%
of healthcare workers suffer physical violence at some point in their careers.
According to 2014 report of Bureau for Labour Statistics, 52% of workplace
violence reported occurred in healthcare. Emergency Nurses Association Survey
of November, 2011 stated that 1 in 10 emergency room Nurses had suffered some
form of physical violence in a period of one week. This is the enormity of the
concern.
The poor infrastructural design in most
healthcare facilities has also posed certain levels of risks to healthcare
workers, a number of multiple floors facilities have neither elevator nor ramp.
Healthcare workers are made to lift patients or in some instances support
patients walking through the steps and this could lead to slips, trips and fall
leaving both the healthcare workers and patients with bodily harm. Advocacy for
safety at the design stage of healthcare facilities is a new conversation
coming out of this program. The Bureau for Labour Statistics in 2007 report
stated that slips, trips and fall are the second most common lost work-day
injuries in hospitals, it also added that incident rate for healthcare workers
are 90% greater than average for all private industries.
We appeal to all employers of labour
within the healthcare sector, the government and regulatory agencies to look
closely into the issues of healthcare workers safety and protection. The
healthcare work environment is highly infectious and what is needed most times
is only mitigation which comes in form of safe process designs, improved
hygiene practices, use of personal protective equipment and vaccination of
healthcare workers against infectious diseases with existing vaccines. In most
cases, the healthcare employers are never up to their responsibilities in this
regard, so obvious is the absence of duty of care from the employers. If you
recall the Ebola outbreak in West Africa 2014, over 378 healthcare workers were
infected while 196 healthcare workers death was recorded. When you again
juxtapose that with the report from the World Health Organisation (WHO) in July
2020, over 10,000 healthcare workers have been infected in Africa by COVID-19.
That report also mentioned that only 16% of the 30,000 facilities surveyed had
assessment scores up to 75%, this further explains how vulnerable the
healthcare workers are to infectious risks in their workplaces and the need to
fix this system towards improving the rate of patient safety and treatment
outcomes.
According to Dr. Moeti, WHO Regional
Director for Africa, there is an urgent need for us to rethink the entire
process, “the Doctors, Nurses, Cleaners and many other group of workers in
healthcare sector are our mothers, brothers, sisters and loved ones” and the
need to make them feel that sense of protection and care is our collective
responsibility. The world is already experiencing a high level of shortage in
healthcare workers and the increasing rate of harm, poor welfare and absence of
social safety net and protection will further increase healthcare workers shortage
and making the sector unattractive for new employments due to the prevalence of
risks with obvious lack of the culture of safety.
Our recommendations as we mark this
year’s World Patient Safety Day starts with the advocacy for the right kind of
leadership in healthcare systems globally and empathy being an integral part of
our health care systems. The need to stop the existing defensive culture and
replace it with a “just and transparent culture void of blame-game but owns up
to responsibility when things go wrong. Remember, we are only human and
everyone is fallible. “To Err is Human” according to the Institute of Medicine
(IOM).
We need patients to be at the center
of their care, if it is all about their health and wellbeing, they should be
involved in treatment decisions as it concerns their health. Advocacy for
patient-centred care is imminent.
The need to review existing health
systems legislations is important, we need policy makers to stand up for
change, healthcare technology companies to make the change by designing safe equipment
using safe new technologies. We need healthcare providers to be the change
through competency improvement and due consideration for patient safety so that
patients and their relatives can experience that change.
If we do not urgently commit to
actionable plans, the weight of the change of pain will greatly increase and
the number of people who are affected by that chain will greatly increase.
Remember, when we harm a healthcare worker or hurt a patient under our care, it
is not just that healthcare worker or the patient that we hurt, we also hurt
their family members.
In the words of a Nigerian songwriter, Timi Dakolo “There is a cry from a mother who just lost another child” The question is, who is next in line? This is a question we must all find an answer to.
Ehi Iden
References
Sharples,
T. (2009). Are medical students worked so
hard? Time Publication
http://content.time.com/time/health/article/0,8599,1900374,00.html
Sung-Heui, B. and Yoon, J. (2014). Impact of States’ Nurse Work Hour Regulation on Overtime Practices and Work Hour among Registered Nurses. Health Service Trust
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213053/
Gordon, L. (2018). Nursing Overtime: The Good, The Bad, The OMG. Elite Healthcare
https://www.elitecme.com/resource-center/nursing/nursing-overtime-the-good-the-bad-the-omg
https://www.circadian.com/blog/item/26-mandated-vs-voluntary-overtime-in-shift-work-operations.html
Violence Against Healthcare Workers. World Health Organisation
https://www.who.int/violence_injury_prevention/violence/workplace/en/
Smith, S.
(2017). Nurses Testify for National
Standard to Prevent Workplace Violence in Healthcare Settings. EHS Today
Docksai,
R. Law Makers and Hospitals Take Actions
to Curb Violence Against Nurses. Nursing Licensure
https://www.nursinglicensure.org/articles/workplace-violence.html
Hospital Workers: An Assessment of
Occupational Injuries and Illness. (2017).
The
United State Bureau for Labour and Statistics.
Epidemiological Update: Outbreak of
Ebola Virus Disease in West Africa. (2014).
European Centre for Disease Prevention and Control.
Over 10,000 Health Workers in Africa
Infected with COVID-19 Virus.
(2020). World Health Organisation.
https://www.afro.who.int/news/over-10-000-health-workers-africa-infected-covid-19
Wednesday, August 12, 2020
COVID-19, DISRUPTION ON EDUCATION AND SCHOOLS REOPENING APPREHENSION
Friday, August 7, 2020
AFRICAN OSH AND LABOUR INSPECTORS NETWORK: A STRATEGIC INITIATIVE OF OSHAFRICA
This
is a new strategic project initiated by OSHAfrica to cater for the gap in OSH
and Labour Inspection across Africa. This part of Workplace Health and Safety
in Africa currently is difficult to understand and organise because of the
different standards being used across the 54 countries and we felt the need to
look into the issues with the hope of bringing all actors together for sharing
of experiences and learning together.
When
we refer to the ILO Labour Inspection Convention 81 of 1947 and Convention 155
of 1981 which virtually all African countries have signed and ratified, it
becomes obvious how committed we should be in developing our OSH and Labour
Inspection standard. Workplace inspection processes ensure organisations
implement the practices of decent and safe workplaces especially concerning the
protection guaranteed to the workers by social laws and regulations. There is
also a requirement for the inspectors to report the gaps or defects within
these laws and processes to government for further reviews and implementation.
When
we look at the role of OSH and Labour Inspection from this perspective, you
will realize they are not just there to inspect safe workplace practices, they
are also very important with the feedback needed to strengthen existing OSH
and Labour legislation. Having this in mind, we should therefore see this arm
of workplace health and safety inspection as a very important component of our
work without which the system may never be complete.
In reviewing the place of OSH and Labour Inspection in Africa, we realized there were three critical issues common among all actors across all countries, they are:
Under staffing
Under funding
Inadequacies in training
Two
of those factors are not within our immediate control, though we are able to
advice different government on improved staffing and better funding. We
realized we are able to immediately bring these inspectors together in one
common platform where they can share experiences on good practices and further
training which OSHAfrica and other partners can make available to them.
In
trying to fully understand the level of under staffing that exists within this
unit in Africa, we tried looking at the current staffing levels across 5
African countries and below were the outcomes.
Nigeria: This country has over 200
million people in population (https://www.worldometers.info/world-population/nigeria-population/), there were only less than 350
inspectors until 2019 when the new employment brought the figures to 750 inspectors.
This was according to our discussions with the Director of Occupational Safety
and Health of the Ministry of Labour and Employment. We see this figure as still
grossly inadequate for the population.
Ghana: This country’s 2020 population
is estimated at 31, 072,940 people according to United Nations data (https://www.worldometers.info/world-population/ghana-population/) but there exists only 50
inspectors currently and waiting for 6 more to be recruited.
Egypt: With an estimated 102 million
population (https://www.worldometers.info/world-population/egypt-population/) has 520 inspectors currently.
Zambia: With a population of 18.3
million people https://www.worldometers.info/world-population/zambia-population/) currently has only 13 inspectors
with a plan in place to recruit an additional of 13 more inspectors.
South Africa: With a population of 59 million
people, (https://www.worldometers.info/world-population/south-africa-population/) there are 170 inspectors. From
all indications, this seems to be the only country where we have a reasonable
number of inspector per population. These information were gathered from the
interaction we had with the Directors of Occupational Safety and Health and in
some cases with the Factory Inspectors in each of these 5 countries.
In
OSHAfrica, we already have functional 3 Scientific Committees and we realised
the only way we can create an intervention in this arm of workplace health and
safety improvement will be to create an entirely new strategic forum that will
bring together all OSH and Labour Inspectors. We have succeeded in doing this,
we currently have over 170 of such inspectors from over 18 African countries.
Western, Southern, Eastern African sub regions are already well represented, we
are currently pushing Northern and Central African regional inclusion, once we
achieve this in the next few weeks, we
will have the formal launch of African OSH and Labour Inspectors Network.
The
whole aim is to be able to offer these inspectors the specific training they
need to function rightly, capacity building and competency improvement is a key
area we want to help address. We realised most of these people were just
employed without any form or requisite training, in some cases where they had
training, they were grossly insufficient. We feel the right kind of improvement
expected in workplaces may never happen until we commence the intended training
and retraining programs focused on OSH and Labour Inspection skills
improvement. All existing scientific committees of OSHAfrica will offer support
to the new network in line with their mandate. Example is the OSH Legislation
and Policy Improvement scientific committee bringing together their expertise
in helping to work with member countries in strengthening their labour legislation. The committee on Education and Competency Improvement offering
training support while the committee on Research, Data and Publication will
also be here in helping them put data together for reporting.
We
should be able to harmonize OSH and Labour Inspection across Africa through
this intervention and we will keep updating the needed skills of the
inspectors. Currently they are all together in Telegram as a group and are able
to ask questions in areas they are not so clear about. As a Nigerian inspector, you do not need to
repeat the mistake that an inspector in Congo had already made, you just throw
the issues you have into the group for discussion and at the end of the day,
and you have a solution. This is the whole idea.
We
will be extending our discussions to International Association of Labour
Inspectors (IALI), International Labour Organisation (ILO), German Social
Accident Insurance (DGUV), European Network Education and Training in
Occupational Safety and Health (ENETOSH) and others partners for support in
developing the capacity of African OSH and Labour Inspectors.
Nyambari,
S. T. (2005). Labour Inspection in
Africa- Promoting Workers Right, Labour Education, ILO https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@safework/documents/publication/wcms_108666.pdf
https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:51:0::NO:51:P51_CONTENT_REPOSITORY_ID:2543058:NO
https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C081
https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C155
https://www.ilo.org/jobspact/policy/WCMS_DOC_GJP_ARE_DLG_EN/lang--en/index.htm.
Friday, May 29, 2020
COVID-19: THE CHANGE NO ONE ANTICIPATED AND THE MENTAL HEALTH IMPACT
Friday, May 22, 2020
Wednesday, May 20, 2020
Tuesday, May 19, 2020
Friday, May 15, 2020
Tuesday, March 17, 2020
CORONA VIRUS 2019 AND SOCIAL DISTANCING
e more than ever before, this can never be too much, wash, wash and again wash. When you have reasons to leave your office for a public place, kindly proceed to the washroom to wash your hands upon return.