Occupational Health and Safety There

Occupational Health and Safety

There are hazards in most occupations. The importance lies in recognizing the hazard and how we ought to react and take care to minimize the hazard. Preventive measures ought to be inculcated in the workers and there must be care and rules to regulate the work that has health hazards. This is of paramount importance. We are concerned in this paper over the hazards of radiation and other related work hazards. (Brune; Edling, 1989, p. 167)

In hospitals the health hazards to workers come in many forms. Though we consider the effects of radiation and the use of thermal and other ions, we have to bear in mind that there are other pollution that occur in hospitals that also could be harmful. Though there is no radiation, noise for example and lighting is two areas that relates to the lighting levels and noise which affect health. Although noise does not constitute a part of the radiation hazard, noise hazards are present in hospitals with the noise above 85 decibel level. They occur at the central processing, electrical installations and in the laundry and cleaning mechanism. (Stellman, 1998, p. 7) Boiler rooms, laundry and kitchens are the source of excessive noise. There can be permanent hearing loss on constant exposure to noise over 80 decibels. Hot liquids and hot surfaces also are hazardous. (Occupational Hazards for Hospital Workers, 1995) the hazards and the working environment and stress related to the work including shifts which interfere with the biological clock can have disastrous consequences on the health of the workers and their performance. The excessive workload demand combined with the stress and the hazards and risk at hospitals can take a physical and psychological toll among health workers.

1. All lighting, non-ionising radiation and ionising radiation hazards that may be present in the workplace environment of a large general Hospital

The occupational hazards at the hospital are a broad spectrum that encompasses all activities at the hospital, health care, patient care, food, laboratory, and so on. Broadly we can classify these hazards into psycho social, biological, physical chemical and ergonomic hazards. Infections by bacteria and virus, contamination and risk that are inherent in handling body fluids of infected patients form the biological hazard. HIV, Hepatitis etc. can be spread to health workers from patients. Some other diseases that could be spread include Rubella, Pulmonary tuberculosis, Herpes simplex virus, Acquired Immunodeficiency Syndrome --AIDS and many such communicable diseases. Health workers in hospitals are subject to hazards from chemicals like cleaning and sterilizing chemicals, disinfectants, detergents, solvents, anaesthetic chemicals, anti-cancer medicines, and reagents are around and cause illness. Added to those ergonomic disasters like slippery floors, sharp instruments, and explosive gases are ergonomic hazards. The most important and health affecting hazards emanate from the electric installations, ionizing and non-ionizing radiation. (Occupational Hazards for Hospital Workers, 1995)

X-Ray, LASER therapy, nuclear therapy Magnetic resonance and more and more methods of diagnosis and treatment are creating hazards. (Brune; Edling, 1989, p. 167) X-ray, angiography, Fluoroscopy and electric equipments for example are ionizing radiation sources. High exposure to these types of radiation will cause genetic damage and reproduction issues. Fluoroscopy and X-Ray equipments scatter radiation while being used. (Occupational Hazards for Hospital Workers, 1995) Lasers, microwaves, and magnetic fields are the source of non-ionizing radiation. The Laser beams cause harm to the eye and skin. The personnel must be trained thoroughly in using these equipments. There must be appropriate eye wear, and non-reflective tools used in the hospitals. (Occupational Hazards for Hospital Workers, 1995)

Radiation - types and effects

Radioactivity is the result of an unstable atom emitting a particle to stabilize its structure. Ionizing radiation occurs where "high-energy particles or electromagnetic waves that have the ability to deposit enough energy to break chemical bonds and produce an ion pair. Ionization occurs when the process of energy transfer liberates an orbital electron from an atom or molecule producing this ion pair." (Pae S; Dill; Mothershead, 2006) Non-ionizing radiation is mostly from the electromagnetic spectrum other than x-rays like microwaves, Ultraviolet and infra red light, Laser, light, and other similar forms. (Pae S; Dill; Mothershead, 2006)

We may say that the effects of radiation will be in direct proportion to the quantity pertaining to the energy which is deposited and the destruction of the system as a consequence. A low level exposure may lead to a mild toxic state. On the other hand acute illness or even death may occur while handling high radioactive agents. Not only that the environment in the hospital is charged with danger from radiation, the modern days has brought with it the additional risk of terrorists diffusing such a chemical in the hospitals and the 'bomb' so released can cause additional risk to the already exposed staff and patients. (Pae S; Dill; Mothershead, 2006) patient who receives radiation that is directed in controlled doses like an X-Ray or CT scan gets irradiated on being exposed to the radiation. But in the case when the machine is switched off, the radiation also ceases. The patients are placed in the middle of a radiation path and therefore are not themselves carriers of radiation and are not at risk to themselves or others. Contamination occurs when a person's skin or clothes come into contact with the radioactive material and the radiation continues until the material is removed. Such persons may as well cause risk to themselves and others. The best policy is to prevent the entry of such materials into the human system. (Pae S; Dill; Mothershead, 2006)

Electro magnetic radiation is the important type of radiation which transports energy by both the energizing and non-energizing methods. (Brune; Edling, 1989, p. 170) Ionizing of the body causes damage to cells and breaks the DNA and the cell is damaged for ever in extreme cases. The human cells if exposed to low level radiation can "exhibit activation of a signalling cascade that leads to DNA fragmentation and rapid cell death." (Pae S; Dill; Mothershead, 2006) Initial symptoms and impacts are noted in bones, skin, and the gut. Kidneys and the liver could also be affected. This may lead to cancer. It also may cause Hodgkin disease, leukaemia, and breast cancer among other complications. Exposure to high heat emitting radiation may also cause burns, blisters, ulcers, erythemia, and desquamation. Common sickness symptoms that occur with the exposure will be fatigue, vomiting, nausea, and these symptoms are exhibited within fifteen minutes of the exposure. In twelve hours this can further escalate to blood pressure, fever, and diarrhoea. In cases where the radiation is severe, it can further develop into complications related to the blood or the intestine and the brain and heart. (Pae S; Dill; Mothershead, 2006)

Cardiology is a special area where the risk of radiation is high. There must be hierarchy of control established to see that proper handling of equipments is done. Monitoring of persons and systems for exposure to radiation is very essential for preventing hazards. The common problem that occurs with the interventional radiology and cardiology are in using the fluorography and fluoroscopy with the chance of the staff getting irradiated by the patients. The open couch X-ray systems used also poses a significant risk. Constant radiation over a same spot can lead to erythematic or dermal necrosis, which can occur when the level crosses 2 Gy to 20 Gy. (Hanson, 2004)

An authoritative study concluded that even power lines have electromagnetic radiation. In 2001 the study found that electromagnetic fields created by current causes childhood leukaemia. The study was done by the 'International Commission on Non-Ionizing Radiation Protection -- ICNIRP'. The report says that there is no "chronic disease for which a causal relation to EMF can be regarded as established, but there is evidence for an approximate doubled risk of leukaemia in children exposed to high levels of EMF." (International Study gives an authoritative view on Health Risks from Electricity Power Lines, 2001)

2.Describe how you would assess the risk associated with each of these hazards (including any necessary surveys and measurements)

The effects of the radiation are hard to measure. One of the suggestions is to develop better radiation less technology. The development of a measuring and quantifying strategy revolves around creating a health chain and figuring out the appropriate points from where the analysis of the safety factors can begin. (Corvalan; Briggs; Zielhuis, 2000, p. 57) the science of environmental epidemiology has found the method called the HEADLAMP methodology. Routine monitoring of selected sources form the data with regard to this type of study. Data was also collected by survey. A health effect variable - like death associated with the use of the technology was identified and the method used the grouped data and established scientific knowledge to postulate a better safeguard or methods of use and prevention. It was also used to identify the risk and analyze the alternate options that exist to any given technology. (Corvalan; Briggs; Zielhuis, 2000, p. 103) This method was used to study radiation effects in six cities like across the developing nations. Combined with the human development index these studies showed that using parameters that affect the standards like education, longevity, and standard of living it is possible to predict the environmental health factors, and find the actual health indicators. (Corvalan; Briggs; Zielhuis, 2000, p. 159)

The first problem is the distinguishing between health promotion and health education. Work place health actions tend to be concerned about disease prevention. So far it was up to the institutions to take care of workplace hazards. There were no proper evaluation methods. In Britain safety and health was not given any importance and this trend is changing with the claims filed by employees for damage. Today employers are more concerned with health issues, and health promotion has gone beyond occupational health promotion. (Wilkinson, 2001, p. 50) the management of risk begins with the evaluation of the risk qualitatively and quantitatively. The quantitative analysis of risks for environmental hazards has not yet been attempted in a larger context. There is a difficulty in assessing the acceptable levels of risk, and how to frame the risk reduction policy. Objective analysis when contrasted against the intuitive reasoning of people appears to be at tangents. The cost factor also enters the scene and technical risk analysis becomes subjective. (Smith, 2004, p. 35)

The type of perceptions of risk varies from location, gender, individuals and the lifestyle and usage. Technological hazards are often man made in the sense that they occur by the action of human beings or their inaction. Today terrorism is also to be considered as a possible hazard using the technology for destruction. (Smith, 2004, p. 35) There are no developed methods or program especially for non-ionizing radiation safety. Firstly there are no state regulations, and secondly the standards are based on industry consensus and therefore the methods to measure 'actual or potential exposure' and the myriad of tasks like establishing controls, training and implementation and the norms of safety are all at the research stage. (Lewandowski; Hinz; Entwistle, 2004, p. 31)

3. State the relevant general Hospital UK legislative requirements Occupational health and safety radiation relating to the control of the risks relating to these hazards

The regulation passed by the government is embodied in the Ionising Radiation (Medical Exposure) Regulations 2000 which became an act in 2001. The act seeks to bring about measures of safety in relation to the radioactive substances as well as ionizing radiation and the regulations of the act bind the persons who fall under the defined categories in the act. Along with the 'Ionising Radiations Regulations 1999 (S.I. 1999/3232)' which is implemented in Great Britain, the laws of health protection and avoiding the hazards pertaining to the ionising radiation in the field of medical practice also exist. The sections of the act namely section (2) with various sub-sections have clearly defined terms like 'adequate training', 'roles of the employer and employee etc. (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000) for example Section 3 of the act makes the act applicable to "(a) the exposure of patients as part of their own medical diagnosis or treatment; (b) the exposure of individuals as part of occupational health surveillance; - the exposure of individuals as part of health screening programs; (d) the exposure of patients or other persons voluntarily participating in medical or biomedical, diagnostic or therapeutic, research programs and (e) the exposure of individuals as part of medico-legal procedures." (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000)

The law casts duties on the employers to the extent that they ought to make sure that there are written procedures and manuals that they shall ensure compliance by the staff, and written protocols are displayed for radiological practices. There are adequate rules for medical exposures. For example regulation 4 requires a sole medical practitioner to frame and follow his or her own guidelines. However there are requirements common to all enumerated in the schedule one of the act which all practitioners are bound to follow. The schedule requires that there must be standard procedures to identify the persons who are at risk of being exposed to radiation, and a clear documented list of the procedures that ought to be followed by the risk group in the operation of the hazardous equipment. There must be methods of ascertaining if female patients are pregnant and the effect of the radiation on the breast feeding issues are settled before procedures involving radiation are conducted. (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000)

The schedule also requires that quality assurance and the diagnostic reference levels for radio diagnostic examinations are well within the definitions and scope of regulation (3) and sub-sections. There must be clearly set documentation of dose procedures and the limits of medical and paramedical research issues with no health benefit to the person exposed be also attended to. The employer is bound to take adequate steps to ensure that clinical records are available for each exposure that occurs during the course of practice. That there ought to be adequate experts for consultation and the hospital ought to keep proper inventory of the hazardous substances which ought to be at all times be limited to the minimum necessary amount. The practitioners and staff are enjoined to follow all regulations and guidelines and framework procedures set by the industry or the employer and the operators are made responsible for their own and the patient's safety. (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000)

Regulation (5) covers this aspect and prohibits any person from exposing himself or a patient to radiation except by the authorized prescription of a medical practitioner and with adequate data. Regulation seven caters to the optimization procedure, "which involves ensuring that doses arising from exposures is kept as low as reasonably practicable. The practitioner and the operator are responsible for elements of the optimization of medical exposures as specified in regulation seven." (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000) "Regulations (6) and (7) provide that special attention be given to exposures in medico-legal procedures, health screening or voluntary participation in research, where no direct medical benefit is expected from the exposure or where exposure involves high doses, pregnant or potentially pregnant or breastfeeding females and children. Regulation seven also provides that certain information and instructions be given where radioactive medicinal products are administered." (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000)

The important regulation which brings about compliance are regulation eight to ten which makes it mandatory for institution sand practitioners to have a clinical audit and also ensure that clinical audit to be carried out in consultation with 'medical physics experts' and maintaining of proper inventory of all equipments and that the equipments are limited to what is absolutely necessary. These mandatory provisions also bar the untrained personnel from handling equipments or prescribing or in anyway being involved with the radiation process. The act has also identified various radiation sources and prescribes specific rules for the same. This act overrides the "Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 (S.I. 1988/778)." (Statutory Instrument 2000 No. 1059: The Ionising Radiation (Medical Exposure) Regulations 2000)

4.Outline a Suitable Control Strategy that will:

a) adequately control the risks

The most important aspect of controlling risk is informing and education all concerned staff and practitioners about the hazards. Radiation protection is a subject that is now current with people, at least with patients. Patients are becoming aware of radiating risks. Strict procedures ought to be adopted to avoid unnecessary radiation exposure. (Raza, 2006) Education on radiation hazard for doctors and hospital staff is woefully inadequate. Steps must be taken not only to educate the people on the hazard but also train then adequately in monitoring and controlling the use of radiation equipments.

A b) clearly specify what actions need to be taken

The importance of making medical practitioners and staff regarding the hazards cannot be overstressed. In a research conducted by surgeons and radiologists, like S. Shiralkar, consultant surgeon, a Rennie, and others, the startling fact was revealed that in the sample population of doctors taken for study of their knowledge regarding radiation and its effects, very few had any idea of the hazard. The doctors subject most patients to one X-ray investigation at least. They were woefully unaware of the ionizing risk of radiation from X-rays. The survey was conducted in two regions in the United Kingdom. The study revealed that most doctors do not have any idea of the risks of radiation on the patients, and the doctors had undergone a radiation protection course which would it is believed have apprised them of the issue. The research found that there was a great lack of awareness among doctors and the patients receive more than one prescription for X-Ray in the course of treatment. (Shiralkar; Rennie; Snow; Galland; Lewis; Gower-Thomas, 2003, p. 371)

The most important thing to do is therefore to create a national campaign in the matter and re-educate the doctors, staff and layman about the hazards of radiation and make it mandatory that there be a consensus evolved in the use of X-Rays and other systems. The methods of reducing radiation exposure vary with different departments and equipments. The general guidelines for the use of these equipments and the prescribed precautions in using them ought to be made mandatory. The law enacted makes some of the procedures mandatory, but most practices are still left to the institutions. The common exposure that occurs to the staff and patients relate to for example specialized departments like the diagnostic coronary angiogram. (Raza, 2006) Some of the simple methods that can prevent exposure are adhering to the time, using shields, keeping distance and avoiding multiple exposures without time gap and so on. The lower time the operator spends in the radiation area the lesser the risk. The time taken depends on the operator's efficiency. (Raza, 2006) the surgeon or attendants thus must take care to minimize the fluoroscopy or 'cine screening' time taken. The important aspect that the worker in the hazardous zone has to remember is to keep distance. Keeping distance from the radiation source or the path of the beam is a must. This by itself reduces the risk by four factors. The positioning of the camera also contributes to the reduction of risk. The risk is not only to the operator but also to the other staff. (Raza, 2006)