Healthcare workers constituting 12% of the working population worldwide operate in an environment that is considered to be one of the most hazardous occupational settings. In addition to the usual workplace related exposures, healthcare workers encounter diverse hazards because of their work-related activities.
Occupational health and safety is a discipline with a broad scope involving many specialized fields such as physical, psychological, chemical, biological, and mechanical/electrical, which determines the health and safety of employees in a broader context.
Health care workers including physicians and nurses get regularly exposed to occupational hazards such as physical, biological, chemical, and mental hazards during care delivery process. Assessing the awareness on various hazards and imparting the knowledge required to manage such hazards is vital for quality patient care. As patients care delivery process is driven by nursing staff as instructed by the physician, the nurse's awareness on occupational safety and health hazards contributes to quality of patient care. Thus, the current study was undertaken to assess the same among the nursing staff of the hospital.
The objective of the current study is to assess the awareness on occupational health and safety among the nursing staff of a teaching hospital.
Materials and Methods
A prospective study was conducted on a pilot basis for a period of 3 months from April to June 2018 at a teaching hospital located in South India. Ethical committee approval was not obtained for the current study as the study was a part of academic requirement involving no clinical interventions.
Recruitment of study participants
A total of 170 nursing staff working in medicine wards, OBG wards, pediatric wards, orthopedics wards, nephrology, neurology, and urology wards along with various Intensive Care areas of the hospital were recruited into the study with no specific inclusion/exclusion criteria and questionnaires on assessing their awareness on occupational safety and health hazards were distributed. 150 questionnaires were duly filled and received resulting in 88% completion rate.
Data collection tool
The questionnaire was divided into two segments. Segment1 comprised demographic information of the participants, Segment 2 included 6 components and a total of 27 items under these components [Annexure 1].
Primary and secondary outcomes
Identifying participant awareness on occupational safety and health hazards is the primary outcome of the study. The secondary outcomes of the study include identifying knowledge gaps in occupational health and safety, so that necessary measures such as increasing the workplace training or re-orientation sessions can be suggested for filling the gaps.
Data analysis method
Percentages were computed on participant's demographic details such as age, gender, work experience, and marital status. Mean age of study participants was calculated along with their work experience.
Scores were assigned to each of the responses ranging from 1 (Not Aware) to 5 (Fully Aware) and total scores were thus computed. Assigning score value of 1–5 for individual items under respective components had given a total score of 135 which is obtained as below: General awareness on occupational safety and health hazards (4 items × 5), physical hazards (3 items × 5), chemical hazards (3 items × 5), electrical/mechanical hazards (3 items × 5), biological hazards (4 items × 5) and practices for hazard management (10 items × 5). A higher overall score was considered to determine complete awareness whereas a low score represented their unawareness.
Degree of correlation between participant's demographics such as age and work experience; and their total scores were measured as 0.4 which means a positive linear relationship. Cronbach's Alpha value of 0.95 was obtained which measures the reliability and internal consistency between various items mentioned in the tool.
The study had aimed at assessing the nursing staff awareness on occupational safety and health hazards.
Demographics of study participants
According to Table 1 , out of 150 study participants, 93.3% were female nurses, whereas the rest were males. Mean age of the study participants was 30.2 ± 7.2 years. Average years of work experience was 7.6 ± 6.2 and ~63% were married.
General awareness on occupational safety and health hazards
Figure 1, depicting the general awareness of nursing staff on occupational safety and health hazards demonstrated that 44% (66/150) of the study participants have shown their full awareness on occupational safety and health hazards [Figure 1a], 46% (69/150) were fully aware about occupational hazards [Figure 1b], and 48.7% (73/150) were fully aware on various diseases resulting out of occupational hazards [Figure 1d]. Moderate awareness was observed in 28% (42/150) of the nursing staff on various types of occupational hazards, whereas only 22.7% (34/150) were fully aware on occupational hazard classifications [Figure 1c]. Less than 1% of the study participants were not aware of occupational safety and health hazards [Figure 1a–c].
Nursing staff awareness on various occupational hazards
It was found that most of the nurses get exposed to ergonomic hazards such as skeletal and muscular disorders, and physical hazards. In the current study, according to [Figure 2], there was 24-27% (37/150–41/150) full awareness observed among the nursing staff with respect to accidental falls [Figure 2a], hearing problems [Figure 2b], and headache [Figure 2c]. 43.4% (65/150) of the nursing staff were aware of accidental falls at workplace [Figure 2a], 42.7% (64/150) were aware of hearing problems [Figure 2b] and 45.4% (68/150) were aware of headaches [Figure 2c].
As nurses get exposed to aerosolized medications, anesthetic gases also gets in contact with latex materials, in the current study, nursing staff awareness on diseases because of chemical hazards was assessed. Figure 3 represents full awareness on latex allergies among 42.7% (64/150) [Figure 3a] of nursing staff, 52.7% (79/150) [Figure 3b and c] full awareness on dermatitis and respiratory problems as well. 41.4% (62/150) [Figure 3a] of awareness was shown on latex allergies, whereas 31.4% (47/150) [Figure 3b] and 34.7% [Figure 3c] awareness on dermatitis and respiratory issues, respectively. Moderate awareness was observed in 11.4% (17/150) [Figure 3a and b] of nursing staff on latex allergies and dermatitis, respectively, and 8.7% (13/150) [Figure 3c] moderate awareness on respiratory problems. Data analysis also showed that 2.7%-3.4% (4/150–5/150) [Figure 3a–c] nursing staff were not aware of chemical hazards.
Working with electronic devices exposes the nursing staff to potential electrical/mechanical hazrds. In the current study, according to Figure 4, among 150 nursing staff assessed, 42% (63/150) [Figure 4b] were fully aware about the accidental fires at workplace, 39.4% (59/150) [Figure 4a] were fully aware about burns and 36.7% (55/150) [Figure 4c] about electric shocks at work place. 14–16.7% (21/150–25/150) [Figure 4b and c] were found to be moderately aware about electrical/mechanical hazards. Lack of awareness was observed in 4% of the nursing staff on accidental fires, 2.7% (4/150) and 4.7% (7/150) [Figure 4a–c] nursing staff were unaware on accidental burns and shocks, respectively.
While delivering patient care, nurses might get exposed to blood-borne pathogens and infectious diseases. In the current study, nursing staff awareness on biological hazards was assessed in Figure 5 as 59.4% (89/150) [Figure 5c] of the nursing staff were fully aware about infections at workplace, 54% (81/150) [Figure 5b] were fully aware on respiratory disorders, 48.7% (73/150) [Figure 5a] about skin allergies, and 46.7% (70/150) [Figure 5d] were fully aware on work place stress impacting health of the individual. 32.7–36.7% (49/150–55/150) [Figure 5d and a] awareness on biological hazards was identified. Moderate awareness was observed among 14.7% (22/150) [Figure 5] nursing staff on the impact of stress on health, 8.7% (13/150) [Figure 5b] were moderately aware on various respiratory disorders, whereas 2–3.4% (3/150–5/150) [Figure 5c, a and c] unawareness was observed in the same areas.
Awareness on occupational safety practices and incident reporting
Nursing staff should possess knowledge required to safeguard themselves from possible hazards by taking precautionary measures such as using PPE, handwash, incident reporting, and documentation.
According to Figure 6, full awareness of nursing staff was observed in 55.4% (83/150) [Figure 6a]- PPE usage to prevent cuts and skin abrasions, 67.4% (101/150) [Figure 6b]- PPE usage in preventing respiratory problems, 44% (66/150) [Figure 6c]- usage of PPE in accidental fall prevention, 77.4% (116/150) [Figure 6d] - importance of handwashing, 78% (117/150) [Figure 6e]- significance of Hepatitis B vaccination, 71.4% (107/150) [Figure 6f]- usage of first aid kits in minor accidents, 62.7% (94/150) [Figure 6g]-usage of fire extinguishers, 60% (90/150) [Figure 6i]- on reporting incidents to higher authorities, and 58% (87/150) [Figure 6j]- on documentation system for incident reporting. Moderate awareness was observed among nursing staff as 9.4–12.7% (14/150–19/150) [Figure 6a–I, and j] in terms of PPE usage in the prevention of cuts, accidental falls, respiratory issues; importance of handwash and incident reporting mechanisms. However, the percentages were comparatively low with 2.7% (4/150) [Figure 6e] moderate awareness in importance of vaccination, 4% (6/150) [Figure 6f]- usage of first aid kits in minor accidents, and 3.4% (5/150) [Figure 6h]- significance of regular health checkups. It was observed that 5.4% (8/150) [Figure 6c] unawareness was observed on usage of PPE in prevention of accidental falls; 1.4–2.7% (2/150–4/150) [Figure 6a–h, and j] nursing staff were not aware of PPE usage in prevention of hazards, importance of vaccination, periodic health checkups, and documentation process in incident reporting. Less than 1% (1/150) [Figure 6d–i] of unawareness was mentioned in terms of significance of handwash, usage of fire extinguishers, and reporting of incidents to higher authorities.
Participant-wise analysis of awareness on occupational safety and health hazards
Considering the overall response of nursing staff, the awareness on occupational safety and health hazards was also analyzed component wise by individually considering various types of occupational hazards. Scores were assigned to individual responses and total scores were computed, thus determining their awareness on individual hazard classification.
Figure 7 depicts component wise analysis of nursing staff's awareness on occupational safety and health hazards. More than 50% of the study participants were found to be completely aware about fundamentals of occupational health and safety hazards, whereas 40% of them were aware and negligible percent were unaware of fundamentals of occupational hazards [Figure 7a]. Figure 7b explains that 44.6% (67/150) of the study participants were aware about physical hazards at work place and more than 30% (46/150) were completely aware, whereas only 4% (6/150) were unaware of the same. 58.6% (88/150) of the nursing staff were found to be fully aware of possible chemical hazards at workplace, 32.6% (49/150) were aware of chemical hazards at workplace, whereas only 2% (3/150) were unaware of the same [Figure 7c]. Analysis of participants awareness on electrical/mechanical hazards at workplace showed that more than 43% (65/150) were completely aware, 36% (54/150) were aware and only 2.6% (4/150) were unaware of possible electrical/mechanical hazards [Figure 7d]. With regard to biological hazards at workplace, 61.3% (92/150) participants were completely aware, 3.3% (5/150) were moderately aware, and 1.3% (2/150) were unaware of biological hazards [Figure 7e]. Analysis of participants knowledge on management of occupational hazards have revealed that 77.3% (116/150) were completely aware, 20% (30/150) were aware, and less than 1% were unaware about managing occupational hazards in terms of usage of PPE and reporting systems [Figure 7f].
Total scores were computed by assessing the overall responses of individual participants and percentages were calculated. According to Figure 8, 73.3% of the participants were found to be completely aware about all the components of occupational health and safety mentioned in the questionnaire. 22.6% were aware, 3.3% were moderately aware, and less than 1% were slightly aware of the same. Interestingly none of the participants have shown unawareness about occupational safety and health hazards.
There was a positive linear correlation of 0.4 observed when total scores were correlated with participants age and work experience.
In the current study, 44% of the nursing staff were fully aware on occupational safety and health hazards, 46% were completely aware of the occupational hazards and diseases resulting out of occupational hazards was observed in ~ 49% of the participants. Research conducted by Robert Kaba et al. (2018) on 296 participants from two hospitals, which is almost double the sample size in the current study, showed 87% general awareness on occupational hazards at workplace.
Regarding the participant awareness on physical hazards at workplace, in the current study 24–27% were found to be fully aware of accidental falls and ~44% were completely aware about hearing problems and headache. Robert Kaba Alhassan et al. (2018) had mentioned about 53% of the nursing staff were aware on physical health hazards in their research study. Karki Sabita et al. (2018) showed 92% of the nurses were aware about the physical hazards in their study. The current study had conducted a sub component analysis of physical hazards on a 5-point scale, which could be a reason for lower percentage in results.
Data analysis in the current study showed full awareness on latex allergies among 42.7% of nursing staff, 52.7% on dermatitis and respiratory problems as well. Research conducted by Mahadeo Shinde et al. (2015) showed that 22.9% of the participants completely agreed about dermatitis as a chemical hazard at workplace when research was conducted on 105 nursing staff. Karki Sabita et al. (2018) found that 91% of the nurses have knowledge regarding the chemical hazards at workplace in their study. As the assessment on participant analysis was done on a 5-point scale, combined awareness (Moderate-Complete awareness) would yield similar results.
The current study found 42% of the nursing staff were fully aware about the accidental fires at workplace, 39.4% were fully aware about burns, and 36.7% about electric shocks at work place. In Mahadeo Shinde et al. (2015) study conducted on 105 nurses, 46.7% strongly agreed that nurses are prone to have burn injuries while handling hot sterile equipment's. Thus, being consistent with the current results.
It was found that 59.4% of the nursing staff were fully aware about infections at workplace, 54% were fully aware on respiratory disorders, 48.7% on skin allergies, and 46.7% were fully aware on work place stress impacting health of the individual. Study conducted by Robert Kaba Alhassan (2018) had observed 20% awareness among nursing staff on biological hazards. Study conducted by Mahadeo Shinde et al. (2015) found that 44.8% strongly agreed and 46.7% agreed that many medical diseases are acquired by nurses from patients. Robert Kaba Alhassan (2018) stated that 20% of their study participants experienced biological hazards at workplace.
Utilization of Personal Protective Equipment (PPE) at workplace is one of the ways to prevent occupational hazards. In the current study, 55.4% nursing staff were completely aware that PPE usage prevents cuts and skin abrasions, 67.4% were fully aware that PPE usage prevents respiratory problems and 44% complete awareness was observed in usage of PPE to prevent accidental falls. Research conducted by Ilesanmi (2016) showed that among 249 study participants, 88.8% respondents were aware of the use of face mask to prevent injury and 35.3% were aware on regular use of safety boots.
77.4% of the nursing staff in the current study were completely aware on importance of handwash and 78% were fully aware on significance of vaccination. Study by Karki Sabita et al. (2018) showed that 86.4% participants were fully aware on hand washing practices.
As mentioned by A. B. de Castro (2009), underreporting of work-related injuries and illnesses has also been noted as a significant problem among nurses in the United States. However, in the current study, full awareness was observed in 60% of the nursing staff on incident reporting to higher authorities and 58% awareness on documentation system for reporting the incidents.
Current study has observed complete awareness among 73.3% of nursing staff on all the components of occupational health and safety mentioned in the questionnaire. This demonstrate that approximate to 3/4th nursing staff in the current study were aware about occupational safety and health hazards. Analyzing individual data had revealed that very few individuals were lacking the necessary knowledge required to understand the concepts of occupational health, possible hazards, safety precautions, and incident management. The results demonstrated the prevalence of occupational safety climate within the hospital yet identified minor gaps for improvement.
The study had highlighted the areas that require knowledge enhancement on occupational safety and health hazards. Addressing the identified gap areas and staff orientation towards the same would create a comprehensive safety environment in the healthcare facility.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
ASSESSING THE AWARENESS ON OCCUPATIONAL SAFETY AMONG NURSES IN THE HOSPITAL
GENDER: □ MALE□FEMALE
MARITAL STATUS: □ SINGLE □ MARRIED □ OTHERS
AREA OF WORK: .............................................................................................................
TOTAL EXPERIENCE: .......................................................................................................
ORIENTATION GIVEN:□ YES □NO
PERIODIC EDUCATION (CNE):□ YES □ NO
KINDLY CIRCLE / TICK THE QUESTIONS
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