• Discuss principles of workplace health and safety
• Describe how the hierarchy of controls reduce or
• Describe components of an effective occupational health
and safety program
• Discuss training
• Discuss personal hygiene, use of personal protective
equipment (PPE), and immunization
• Discuss incident and post-incident response
• Identify workplace hazards and who is at risk
• Discuss how exposure can be prevented/limited
• Demonstrate proper hand hygiene
• Discuss use and limitations of personal protective
• Demonstrate the proper donning and removal of personal
• Discuss the functions of an occupational health and
Principles of Worker Health and Safety
• The production, segregation, transportation, treatment, and
disposal of healthcare wastes involve the handling of potentially
• Protection against personal injury is essential for all workers.
• Healthcare waste management policies should include provision
for the continuous monitoring and enhancement of workers’
health and safety.
Principles of Worker Health and Safety
• 11 functions integral to worker health and safety
• Identifying and assessing risk
• Surveilling workplace hazard
• Designing safe workplaces
• Developing programs to improve work practices and
evaluating new equipment
• Advising on occupational health, safety and hygiene
• Surveilling workers’ health
• Promoting adaptation of work to the worker
• Managing vocational rehabilitation
• Organizing training and education
• Organizing first aid and emergency treatment
• Analyzing adverse conditions that lead to injury and illness
Who is at risk?
• Staff nurses, physicians, ward staff, cleaners,
– Needle-sticks, blood spatter, pathogenic
aerosols, spills, ergonomic issues
– Lack of awareness, unsafe work practices
– Improperly discarded sharps found in linens
– Exposure to accidental spills
Hierarchy of Controls
• Elimination of hazard
– Most preferred method, should be used whenever possible
– Remove hazards completely from the work area if possible
– Avoid unnecessary injections
– Reduce usage of hazardous chemicals
– Substitute hazardous chemicals with less harmful materials
– Jet injectors may substitute syringes and needles
• Engineering Controls
– Puncture-resistant containers to isolate sharps
– Retractable needle syringes
• Administrative Controls
– Resources on PPE, exposure control plan, medical surveillance
program, immunizations, PEP, training
• Work Practice Controls
– Good work practices, no recapping of needles
• Personal Protective Equipment (PPE)
Occupational Health Program
• Occupational Health and Safety (OHS) Committee
– Group consisting of employee and management
• The OHS committee tracks
– Incident Reporting
– Medical Surveillance
– Post Exposure Prophylaxis (PEP)
– Personal Protective Equipment (PPE)
– Medical immunizations
– Emergency Response
• Worker health and safety training program
– When staff are hired (orientation to hazards and plan)
– Periodic refreshers
• Specialized trained personnel
– Should be available and used where circumstances
– Should have up-to-date training and certifications
– Should be trained on each specific area of focus
• Educate all healthcare workers and healthcare
• Increase awareness about hazards at the
• Outline all emergency, spill and injury response
• Educate on safe work practices
• Provide training on PPE use
• Provide annual refresher training
Examples of Specific Training
• Handling sharps containers
• Handling contaminated linen
• Handling cytotoxic or radioactive waste
• Response to injuries
• Personal hygiene including hand hygiene
• Donning, removing and cleaning PPE
• Initial and annual refresher
Handling Sharps Containers
• When 3/4th full, close and remove
• Check all sides for any holes or
protruding needles before lifting
• If there are holes in the container,
carefully place the container inside a
larger puncture-resistant container.
• Some of this training can be done
when staff are working
Handling Contaminated Linen
• Check contaminated linens for any sharps
• Handle all used linen using gloves, arm
sleeves, and coveralls
• When removing soiled linen, gather the linen
so that the contaminated area is on the
• Wash contaminated linen in hot water (at
least 88°C) for at least 20 minutes
Handling of Cytotoxic Waste
• Written procedures for safe working methods for
– Handling, use, storage, disposal
– Signs and symptoms of exposure
– Decontamination procedures
– Who to contact
– Medical surveillance
• Establish an emergency response procedure
Handling of Cytotoxic Waste
• Separate collection in leak-proof containers and
• Return of outdated drugs to supplier
– Designate a person in charge
• Safe storage
– Maintain an inventory
• Disposal methods, decontamination of
reusable equipment, and treatment of spillage
• Treatment of infectious cytotoxic waste
• Convenient washing facilities (with warm water
and soap) should be available to all, including
cleaning staff and waste workers.
• Personnel should be trained on personal
hygiene issues that reduce the risks from
handling hazardous waste.
• Wear appropriate PPE to reduce exposures.
• Cover cuts/abrasions with waterproof dressing to
help reduce exposure of the affected area.
• Wash Hands
– Immediately after arriving for work
– Always after handling healthcare waste
– After removing gloves and/or coveralls
– After using the toilet or before eating
– After cleaning up a spill
– Before leaving work
• Steps in hand washing
– Wet hands and apply soap
– Work up lather on palms,
back of hands, sides of
fingers, and under
– Scrub vigorously with soap
for at least 20 seconds
– Rinse well
– Dry with a clean towel or
allow to air dry
Personal Protective Equipment (PPE)
• Face masks
• Eye protectors (safety goggles)
• Overalls (coveralls)
• Industrial aprons
• Leg protectors and/or industrial boots
• Disposable gloves (medical staff) or
heavy-duty gloves (waste workers)
• Arm covers
• Select gloves that are resistant to cuts and
• Select gloves that allow a good grip
• Gloves should fit well and not hinder
• Use heavy-duty gloves for handling
healthcare waste drums or transporting
healthcare waste containers
• Use heat-resistant gloves for anyone working with
hot equipment (e.g., autoclaves)
• Provides a barrier against germs in blood,
body fluids, tissues, and other healthcare
• Prevents spread of diseases to others
• Replace gloves immediately if a punctured
or tear occurs
• Check for allergies to latex gloves
• Use gloves to seal bags or containers and
when chemicals may contact human skin
– Always wash hands after removing
Safety Glasses, Goggles and Face
• Safety glasses (with side
– Help prevent being struck in the
eyes or impacts to the eyes (not
for chemicals or splashes)
• Goggles or face shields
– Help prevent blood splashes
(e.g., when pouring body fluids
down the sluice) and chemicals
from entering the eye area or
the whole face
• Use of respirators depends on the type of
exposure, job, and duration of exposure
• Positive pressure vs. negative pressure
• Full-face vs. half-face
• Single use vs. reusable (cartridge-type)
• Different filters are used for particulates,
gases, or vapors,
• Reusable respirators are maintained under a
• Closed shoes with thick soles and good traction
– Provides protection from sharp objects such as needles
and from hot surfaces, helps prevent slipping during spills
• Closed shoes or rubber boots
– Protects feet and toes from splashes of blood or body
fluids; rubber protects from some but not all chemicals
• Safety shoes or steel-toe shoes
– Provides protection from objects that may crush or
penetrate the foot or toes during heavy lifting and waste
Sequence of Donning PPE
1. Hand hygiene
2. Gown (if applicable)
4. Eyewear or eye protection
Sequence of Removing PPE
1. Gloves (assume outside of
glove is contaminated)
2. Gown (assume gown/apron
front and sleeves are
3. Goggles or face shield (assume
outside is contaminated)
4. Mask (assume front is
5. Perform hand hygiene
Response to Injuries
• Provide immediate first aid measures
• Immediate reporting
• Identify source of injury
• Obtain additional medical information
• Maintain medical surveillance
• Conduct blood tests if needed
• Investigate the causes
• Implement prevention measures for similar
• Required by WHO
• Ensure all staff have access to post-exposure
information, education, and communication
• Provide support and counseling to those
• Initiate PEP as soon as possible within first few
hours of exposure and no later than 72 hours
• Analyze reported cases of exposure to improved
• All incidents including near misses (no injuries)
should be reported to the OHS committee or a
• A report should be filed and kept on record
– Review reports to make work place or
• Type of injury
• Any witnesses
• Contributing factors
• Medical treatment
• Contact information
• Mercury exposure
• Needle-stick injuries (NSI)
• Bloodborne pathogens
• TB surveillance
– MDR TB
– May be an issue with loud equipment
– Formaldehyde, glutaraldehyde, ethylene oxide
Establish procedures in case of fire
Identify potential fire hazards
Install, test and maintain fire protection systems
Establish procedures for the safe use and storage of
oxygen, flammable and non-flammable gases such as
Maintain electrical equipment to prevent fires
Store combustible materials safely
Train staff in fire safety procedures
Create and enforce smoking policies
Comply with fire safety codes or regulations
Importance of an OHS committee
• Promotes a culture of safety and good work
• Works to reduce injuries, illnesses, and
incidents which can translate to cost savings
Savings in medical bills, workers
Avoiding costs of hiring new employee,
training new employee, cost of damaged
equipment/material in incident, etc.
• What are some common workplace safety hazards that you see in
your facility? Who do you think is at risk from healthcare wastes?
• Do you know of any worker health and safety policies found in
your specific country or region?
• What do consider the most important elements of good personal
hygiene when working in a healthcare facility? Do you think good
hygiene habits are readily practiced in your facility?
• Does your facility offer worker health and safety training programs,
or other opportunities for specific training about healthcare wastes
and hazards? Do you know of other outside training programs
(aside from this one)?
• What kinds of personal protective equipment, if any, do you
regularly wear/use in your job at the healthcare facility?
• Do you have a responsibility in incident reporting? Are PEP
procedures set up in the facility?
Notas do Editor
The training modules are part of the United Nations Development Programme-supported, Global Environment Facility-funded Project on Healthcare Waste, in cooperation with the World Health Organization and Health Care Without Harm. The modules were completed in 2012 by Preethi Pratap, PhD, and Leslie Nickels, PhD, of the University of Illinois at Chicago School of Public Health, and Jorge Emmanuel, PhD, Chief Technical Advisor of the UNDP GEF Project, with input from Yves Chartier (WHO), Mohammad-Ali Hamandi, MPH, Ashley Iwanaga, MPH, Glenn McRae, PhD, Megha Rathi, PhD, Ruth Stringer (Health Care Without Harm), and Emily Warren, MSES.
This module may be used as a resource to improve healthcare waste management. The module is copyrighted but may be reproduced in its original unaltered form without permission for advocacy, campaigning and teaching purposes. Reproduction and distribution for commercial resale is strictly prohibited. UNDP GEF does not warrant that the information contained in this document is complete and correct and shall not be liable for any damages incurred as a result of its use.
The production, segregation, transportation, treatment, and disposal of healthcare waste involve the handling of potentially hazardous material.
Protection against personal injury is therefore essential for all workers who are at risk. The individuals responsible for management of health-care waste should ensure that all risks are identified and that suitable protection from those risks is provided.
Health-care waste management policies or plans should include provision for the continuous monitoring of workers health and safety to ensure that correct handling, treatment, storage, and disposal procedures are being followed.
Health-care waste should be considered as a reservoir of pathogenic microorganisms, which can cause contamination and give rise to infection. If waste is not managed properly, these microorganisms can be transmitted by direct contact, in the air, or by a variety of vectors.
Workers at risk include health-care providers, hospital cleaners, maintenance workers, operators of waste treatment equipment, and all operators involved in waste handling and disposal within and outside health-care establishments.
The ILO lists the following 11 functions as being integral to occupational health services: (1) identifying and assessing risk, (2) surveilling workplace hazards, (3) designing safe workplaces, (4) developing programs for improved work practices and for evaluating new equipment, (5) advising on occupational health, safety, and hygiene, (6) surveilling workers' health, (7) promoting adaptation of work to the worker, (8) managing vocational rehabilitation, (9) organizing training and education, (10) organizing first aid and emergency treatment, and (11) analyzing adverse conditions that lead to injury and illness.
World Health Organization. Global strategy objectives and actions for occupational health for all.1994. [cited 2008 Sep 2]. Available from: URL:http://www.who.int/occupational_health/publications/globstrategy/en/index6.html.
In a healthcare facility, the sources of infection, may be the personnel, the patients, or the inanimate environment.
For this reason, it is essential to practice good hygiene.
Elimination of hazard at the source is the most preferred method and should be used whenever possible
-Substitution with less harmful materials
-Engineering controls: controls that isolate or remove a hazard from the workplace
-Administrative controls: policies aimed at limiting exposure to a hazard
-Work practice controls: controls that reduce exposure through behavior of workers
-PPE: barriers and filters between worker and hazard (least desirable method)
Instructor: Please note that in most facilities this committee may not exisit. You may only have a person in-charge of training. This is a step for all facilities to consider in their HWWM program.
Importance of PPE.
- As the hands of health-care workers are the most frequent vehicle of hospital infections, hand hygiene including both hand washing and hand disinfection is the primary preventive measure. - Thorough hand washing with adequate quantities of water and soap removes more than 90% of the transient bacteria/flora including all or most contaminants. - Killing all transient flora with all contaminants within a short time (a few seconds) necessitates hygienic hand disinfection: only alcohol or alcoholic preparations act sufficiently fast. Hands should be disinfected with alcohol when an infected tissue or body fluid is touched without gloves.
Source: WHO Guidelines on Hand Hygiene in Health Care
Source: WHO Guidelines on Hand Hygiene in Health Care
Talk about the importance of PPE
The following should be made available to all personnel who collect or handle health-care waste PERSONAL PROTECTIVE EQUIPMENT (PPE):
Helmets, with or without visors depending on the operation.
Face masks depending on operation.
Eye protectors (safety goggles) depending on operation.
Overalls (coveralls) obligatory.
Industrial aprons obligatory.
Leg protectors and/or industrial boots obligatory.
Disposable gloves (medical staff) or heavy-duty gloves (waste workers) obligatory.
Industrial boots and heavy-duty gloves are particularly important for waste workers. The thick soles of the boots offer protection in the storage area, as a precaution from spilled sharps, and where floors are slippery.
Many facilities do not have resources for PPE. The instructor should ask participants what PPE do they have access to, and discuss ways in which they can protect workers withour the use of PPE.
Instructor: Discuss importance of proper glove use. Read article: Glove use by ancillary and support staff: a paradox of prevention?
Blenkharn JI. J Hosp Infect. 2006 Apr;62(4):519-20. Epub 2006 Feb 7.
Respiratory protection is of primary importance since inhalation is one of the major routes of exposure to chemical toxicants or infectious agents.
Positive-pressure respirators maintain a positive pressure in the facepiece during both inhalation and exhalation. They are usually powered units that include an internal fan.
Negative-pressure respirators draw air into the facepiece via the negative pressure created by user inhalation. The air passes through one or more filters. The simplest are light, single-use face masks. Other types utilize replaceable cartridges that attach to a half-face or full-face respirator. Different cartridges are available for different types of chemical vapors. The main disadvantage of negative-pressure respirators is that if any leaks develop in the system (e.g., an ill-fitting mask), the user draws contaminated air into the facepiece during inhalation.
Under the U.S. NIOSH classifications, the N95 and N99 face masks filter 95% and 99% of airborne particles, respectively, but are not resistant to oils. Under the European standards, P1, P2 and P3 particulate filters remove at least 80%, 94% and 99.95% of airborne particles.
The facepiece of the respirator covers either the entire face (full-face) or the bottom half of the face (half-face) including the nose and mouth.
Instructor: Ask participants what happens if they have a needlestick injury on site?
Do you think people do not report injuries? Discuss barriers to reporting- stigma, management, fear of punishment etc.
INCIDENT — an incident is an unplanned, undesired event that hinders completion of a task and may cause injury or other damage.
NEAR MISS — an incident where no injuries occurred but, given a slight shift in time or distance, an injury or other damage could have occurred.
Instructor: Ask participants if there is any surveillance as of now.