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The fire risk prevention in healthcare centres

2017-01-15T07:22:00+00:00

Despite fire risk is one of the major occupational hazards, it is often underestimated because these events don't happen very frequently. Nonetheless, when there is a fire hazard the damages that it can cause are very serious both for the loss of human lives and goods as well.
Anyway these events happen: three fire hazards happened last December: the first at the Paracelsus Clinic in Castaneda where two patients were intoxicated, the second at the Mellino Mellini Hospital in Chiari and the last one at the San Raffaele Hospital in Milan.
In order to both reduce the risk and manage an emergency, the law which regulates fire hazards prevention was updated last year ( Ministerial Decree 19th March 2015 ).
The Decree covers all the main themes related to fire hazard risk:

– Identification and evaluation of the dangers stemming from the activity;
– Human resources organization;
– Operational control of the subsequent adjustment stages;
– Managing changes;
– Emergency planning;
– Rescue Teams safety;
– Performances control taking into consideration Chrono programs as well;
– Protection systems maintenance;
– SGSA.

The aforementioned Ministerial Decree has established that both public and private healthcare centres should have sent by the end of last April a document called SCIA under art.4 of the Presidential Decree n.151/11 which established the adoption of a specific system to prevent fire hazards (named SGSA system) compliant with the Ministerial Decree 18th September 2002, Title V.
The SGSA, as previously pinpointed in the Presidential decree (10th March 1998) and before that in the law decree 626/94 focuses on the importance of risk handling when it comes to prevent fire hazards from happening.

In particular the SGSA should have:

– a document containing a plan of action on how to prevent fire hazards signed by the person in charge. The document must contain the budget available for safety in a set period of time.
– the analysis of the main fire-related causes and dangers affecting people safety.
– a system of preventative control tests which can guarantee that the new adopted measures are maintained at all levels ( prohibitions, limitations, procedures, etc.)
– a plan to handle emergencies;
– a training plan for the staff and an organizational chart showing the fire prevention staff, supervisors included. The number of the people involved is indicated below.

Furthermore, it is necessary to appoint a technical supervisor who will be in charge of planning, coordinating and checking the procedures and a fire prevention team that will be in charge of carrying out preventative controls, intervene in case of an emergency and supporting the other staff.

This integration among all the preventative measures can help in handling more thoroughly the risk and it sets limits both for the time frame to take actions and the necessary compensation of the residual risk during the adjustment phase.
Since healthcare centres are often over-packed and full of patients who are no longer self-sufficient they can be included among those types of activities which carry a high fire risk and therefore deserve special measures to be taken.

The manual handling of patients: how to reduce the risk of musculoskeletal diseases.

2016-11-20T07:22:00+00:00

The manual handling of loads as regulated by the Law decree 81/2008 title VI is a type of activity that involves 30% of the workforce in Europe (according to the EWCS data from 2010). This activity is mostly carried out by men (40%), while the percentage of women who do this kind of job is just around 20%.
In fact men are mainly involved into heavy works especially in the building and manufacturing sector, while women are significantly involved when it comes to manually handling the patients (EWCS). INAIL, in its annual report for 2010 has highlighted how musculoskeletal diseases due to biomechanical overload are around 60% (26,000 cases) of the cases reported to the Institute in 2010. The cases which are most frequently reported (more than 9,000) are those related to intervertebral disc diseases that are essentially linked to all the manual handling of load activities.
The European Agency for Safety and Health at Work has published a series of reports over the last years which show the importance of all the problems related to the musculoskeletal diseases especially those affecting the spine and stemming from the manual handling of loads activities. Therefore the Agency has organized back in 2007 an informative campaign called 'Lighten the load' in order to promote a new integrated managing approach for work-related musculoskeletal diseases. If in any other activity the lifting concerns only the person who raises a load, when it comes to treatment and assistance it concerns also the recipient and no solution can be applied without taking into consideration the problems related to the human cargo. Supporting, lifting and transferring the patients are all high risk activities because all these activities can lead to back-lumbar injuries, or more generally musculoskeletal disorders according to the data from the Occupational Safety & Health Administration of the United States: these data showed that these kinds of activities led to 249 cases every 10,000 workers of absence from work in 2010, an average seven times higher than in all the other sectors.
In particular the link between physical effort and the subsequent diseases is more common when it comes to assist patients who cannot move or are not willing to collaborate.
When a person lifts, pushes or simply moves around another subject, forces which are normally felt will be produced and they will be balanced thanks to some automatic protection mechanisms of the systems involved.
However, when it is necessary to intervene very rapidly it could be necessary to increase the force level up to a point that even if it could be tolerated in a normal situation it cannot be tolerated when the biomechanical properties of the structures involved in the effort change (IPASVI). There are several activities that could be dangerous for health care assistants and there are several factors which play a role when it comes to take the right posture.
These factors are linked to the patient, who is a heavy and difficult load to move around and frequently forces the healthcare assistants to move rapidly, in difficult positions, making twists that prevent them from operating ergonomically. Furthermore, it is also important to pinpoint that the number of overweight or seriously obese patients is continuously growing.
The build of the patients makes it difficult to follow the specific procedure that needs to be followed to properly carry out those movements. Patients cannot be kept close to the body of the person who is moving them and frequently it is not possible to forecast what will happen during the movement.
In order to prevent these risks it is necessary to evaluate and choose the correct technique to be applied according to the characteristics of the patients (weight, his/her ability to cooperate during the movement, any medical condition which can affect the way the patient can be lifted and repositioned. The manual handling of the patient must be considered as a risky activity and therefore it should be kept to the strict necessary or even avoid it completely.
Anyway if it is necessary to handle a patient manually it is important to:

make patients cooperate
ask the other healthcare assistants for help;
take the right posture, keeping your legs apart and slightly bent in order to move on a large bearing surface;
avoid twisting or awkward positions;
staying as close as possible to the patient before starting any type of movement;
make sure the ways are clear and the floors are not slippery;
verify that the work surface is at the right height so that your shoulders and knees can remain relaxed;
move with the load close to your body, bend your knees and keep your back and neck relaxed and your back straight.

In order to reduce the overload stemming from the manual handling of the patient it is necessary to use equipment that help the health care assistants to move the patient as easily as possible without affecting the rachis of the health care assistant. This kind of equipment is generally made of: handy sheets, roller conveyors, rotary discs, ergonomic belts, harnesses.
Larger mechanical equipment such as transportable or ceiling lifters is very helpful but not always available.

In order to reduce the lifting activity a new model has recently been introduced in England. The new model is no longer focused on the operator but on the person in order to both overcome the limits that affect the independence of the patient and help the healthcare system to make patients more independent

Hazardous chemical substances: risk assessment in the healthcare industry.

2016-11-10T07:22:00+00:00

The European Reach agreement (CE 1907/2006), which came into force in June 2007 and it is considered 'the most ambitious legislation on chemicals in the world', aims at ensuring a high level of protection for both the health of people and the environment. It was integrated by the ruling n. 1272/2008 (CLP). This regulation introduces a system of classification and labelling (GHS) which was developed by the UN. The classification is based on the inner dangerousness of the substances without any threshold levels.
In the hospitals the identification of the chemical risk, its assessment and the choice of the handling measures to be taken it is heavily influenced by the CLP regulation and by the information on the dangers of chemical substances; the assessment must primarily identify and classify the chemical agents which can be risky for the workers taking into consideration the properties that each chemical substance carries and what inevitably changes when they are mixed together in each step of the working activity: usage, storage, transportation.
The CLP regulation precisely indicates the hazard class for hazardous chemical agents. This regulation classifies the hazardous chemical agents by making the following distinction: chemical agents dangerous for safety, chemical agents dangerous for their own chemical and physical properties, chemical agents dangerous for the health of human people because of their short, medium or long term toxicity. For each chemical substance which is present in a work environment it is necessary to disclose its chemical composition, its chemical and physical characteristics and what it is necessary to know to use them safely to handle and storage them (vapor pressure, flammability limits, incompatibility with other products). All this information is available on the Safety Data Sheet.
To sum up it is safe to say that according to the current laws on safety and health at work, the chemical risk for the workers' safety is related to all the toxicological properties of the chemical agents, while the risk for the safety of workers is related to the chemical and physical properties of the substances and to the acute toxicological property. In other words, the chemical risk for the health is related to the possibility of a work–related disease, while the chemical risk is related to the possibility that and injury may take place.
In case there was a classificatory uncertainty, the workers must always be protected as far as possible according to the PRECAUTIONARY PRINCIPLE as established by the European Regulation on chemical substances regardless the proper application of national and European models to evaluate chemical risks or the proper ways to measure the exposure to chemical agents in the workplace.
The chemical products which are used in the healthcare industry and can be hazardous can be divided in two wide categories: the chemical products that stem from the activities carried out in a specific department such as chemical deriving from disinfectants or cleansers and those that stem from the many activities carried out in the laboratories. For some products though, such as medicines, medical devices, medical devices which are particularly invasive, cosmetics which are a mixture of different chemical substances or human use, the REACH agreement doesn't apply.
Generally the evaluation of the risk is linked to how dangerous the substance is, the information on health and safety on the safety data sheet the kind of exposure in the workplace and the limits to be respected, the prevention measures and the data stemming from the sanitary surveillance. It is therefore important to consider all the above mentioned factors in a comprehensive system that takes into account these following principles: elimination, substitution, reduction. This concept is explained in the following chart below:

Once the sources for the risk and evaluation test have been identified, it will be necessary to set up a series of strategies to control and contain the risk. In other words, it will be necessary to manage the risk by applying the technical, organizational and procedural measures to the reduce the exposure for healthcare professionals.

The importance of training and information on prevention

2016-09-10T07:22:08+00:00

Training and information for the healthcare personnel who play a vital role in the field of prevention and safety at work are defined by the Consolidated Law 81/2008 as follows:

Training: educational process which grants workers or other subjects working in the prevention system the knowledge they need to carry out their duties in total safety.
Information: the group of activities which can help to identify, reduce and handle work- related risks.

Therefore there are two different aspects both extremely important as INAIL pointed out in 2002 which are essential to prevent occupational risk.

It happens quite often now that following accidents at work or, more generally, during inspections, meetings, debates, the issue of how workers can prevent a negative event from happening comes up. In fact the main scope of the training process is to enable a change of behaviour.

The training is based on learning mechanisms which take into consideration these three levels: 'Knowing', 'Doing' 'Being' to carry out a set working activities completely focusing on the safety of the worker without affecting the performance's outcome. The aim is to introduce new habits and patterns which factor risks in, thus changing what needs to be changed at an operational level. It often happens that people act following habits or consolidated procedures which do not stem from specially-made practices. The training provides staff with the learning tools to put the rules and the safety principles into practice by taking into consideration not only their role in the company but also the working environment each worker operates in.

The information is based on the transmission of contents carefully organized from the issuer to the receiver. The content of the communication is called the message and it is transmitted through various kinds of means that vary according to the context . They are often, brochures, short articles on safety at work (INAIL 2002).
Without going to too much into the details of the minimum requirements for the training which are regulated by the Agreement between the State and the Regions, (Agreement n. 221/2011), in order to make the training effective it is necessary to set an evaluation plan for the training which includes a test on its impact on the working context by:

Selecting the situations and /or the patterns to be monitored;
Defining the standards, the levels and the indicators which make these situations and patterns acceptable.
Engaging all the people working at the various levels in the organization such as the employer, managers , authorized personnel, workers.
setting up periodic checks to control, review, guarantee a constant suitability, pertinence and efficacy of the learning process to handle both the health and safety systems at work.

The element that connects what we said so far is the transition from a traditional course to a training project, namely to define the nature of the problem, or the problems we have to deal with, the times and the resources to achieve the goals we want to achieve and evaluate the results we reach. Planning the learning activities allows to put the participants at the centre of the system and therefore highlight the problems we dealt with to trigger an analysis of the risks involved.
Therefore both the training and the information will be more worker-centred. The workers will be held accountable and they could not 'claim ignorance on risk and dangers they will be properly informed and trained on'
The importance of the training on safety at work is always growing and therefore the staff in each contest needs to be properly trained and develop new skills and abilities.
Training and professional activity are not strictly linked one to the other nor they are alternative. The training is part of the working activity in order to integrate the training activities with the working activities and effectively put the training into practice. The legislator this time gave more importance to all the themes related to safety at work. The previous Law Decree (Law decree 626/1994) was not so deeply focused on this matter despite being a point of reference on these matters for years.
The training is aimed at changing the patterns the workers are used to follow at work in order to better keep their own safety and guarantee the safety of the working environment.

Biosafety laboratories and environmental management of biological risk

2016-09-01T07:22:08+00:00

The World Health Organization (WHO) has recognized long ago the importance of safety and biosafety by providing the international guidelines on safety and security.
Among the topics discussed there is the planning of laboratories which will be divided in: basic (level 1 and 2), containment (level 3 or BLS3) and maximum containment (level 4 or BLS4). The level of biosafety needed for each laboratory is related to the structural characteristics of the laboratory, its containment capacities, equipment, activities and the necessary procedures to work with the biological agents belonging to the four categories. The level is assigned after evaluating the risk involved and it must be based not only on the group risk of the pathogen agent. For example if I was working with a pathogen agent group with highly concentrated aerosols I would need a biosafety level three because it ensures a better containment.
In order to plan these laboratories it is necessary to take into consideration not only the structures but also the equipment which is chosen according to the duration of the activity with a set biological agent.
In the following chart, taken from the WHO manual there is a summary of what has been above mentioned:

Risk groups for biosafety levels

Groups	Biosafety level	Type of laboratory	Practices	Equipment
1	Base Level 1	Basic training and research	Good laboratory practice	None, work station
2	Base Level 2	Basic diagnostics, research	Good laboratory practice, individual protection tools and warning sign	Working station plus biosefety cabinet for the procedures which produce aerosol
3	Containment level 3	Specialised diagnostics, research	As in level 2 plus special IPD, controlled access, ventilation without recirculating ventilation	Safety cabinets for all procedures
4	Maximum containment level 4	Dangerous pathogens	As in level 3 plus authorized entrance, decontamination shower and a proper disposal system for single-use materials	Class II biosafety cabinets (glove box) or pressurized suits with class II cabinets and a pass-through autoclave and a ventilation system through high efficiency filters

This article will deal with the structural measures of containment for the BS3 and BS4 laboratories which are the most important as shown in the following chart:

Containment levels characteristics

	Biosafity level
	1	2	3	4
The working area must be separated from any other activity taki ng place in the same building^a	No	No	Yes	Yes
The working area must be sealed tight in order to allow the sanitisation of the place	No	No	Yes	Yes
Ventilation
the working area must be kept under a negative pressure with respect to atmospheric pressure	No	Preferred	Yes	Yes
controlled ventilation system	No	Preferred	Yes	Yes
the extracted air in the working area must be filtered through an HEPA filter	No	No	Yes/No^b	Yes
Double door access	No	No	Yes	Yes
Filter area with interlocked sealed tight doors	No	No	No	Yes
Filter area with interlocked sealed tight doors and an airshower	No	No	No	Yes
Filter room	No	No	Yes	-
Filter room with an airshower	No	No	Yes/No^c	No
Decontamination treatment of discharges	No	No	Yes/No^c	Yes
Autoclave
nearby	No	Preferred	Yes	Yes
in the laboratory	No	No	Preferred	Yes
pass-through	No	No	Perferred	Yes

Biosafety cabinets	No	Preferred	Yes	Yes
The possibility to see the staff from the outside^d	No	No	Preferred	Yes

^a Environmental and functional to the genral traffic
^b According to where the air handler is placed (see chapter 4)
^c According to the biological agents used in the laboratory
^d Example, inspection window, internal tv circuit, double way access

Aside from the basic equipment the BSL3 and BSL4 must be separated from passage areas through a filter zone with automatically closing and interlocked doors so that they open one at a time. The whole laboratory must be easy to decontaminate and all surfaces must be easily washable. The laboratory must be sealable in order to carry out a decontamination process by gas.
In order to avoid the aerial dispersion of microorganisms, ventilation must have a negative pressure. The air in the laboratory can be filtered using HEPA filters high efficiency particu-late air. This is a high efficiency filtration system which uses reconditioned air and makes it flow in the laboratory. The air that comes out of the laboratory (with the exception of the air the comes out of the biological safety cabinet) must be directly released outside of the building in order to be far away from the other buildings and air intake devices. The air release systems must have HEPA filters depending upon the agents which are being used.
The water supply must be equipped with systems that prevent rip currents and there must be a sink with a tap that can be used without using your hands and next to each exit.

Aside from these structural characteristics, a level 4 maximum containment laboratory needs:

Primary containment: this can be made by using CLASS III laminar flow cabinets which must be placed in in a separate designated place accessible through a minimum of two doors. There must be a number of filter areas and they must be different from the one which is shower equipped. Finally to introduce any kind of material inside it is necessary to install a fumigation chamber or an Interlocking double-door autoclave. Alternatively the containment is feasible through the usage of pressurized overalls, but since they are not a planning measure they will not be treated in this article.
Decontamination of discharges: all discharges coming from the protected area, the decontamination chamber, the decontamination shower or from laminar safety cabinets must be all decontaminated before the final discharge preferably through a heat treatment and often their ph scale needs to be corrected. The water coming from the showers and the personnel toilets can be directly discharged into the sewer system without any treatment.
Emergency power system: for example
an engine generator or uninterruptible power supply.
Drain pipes for safety discharge: the floor drain must be compliant with the containment measures as well.

It is necessary to remember that especially for the BLS3 the maximum containment laboratory must be placed in a separate building or in a clearly designated area inside a safe building. The entrance and the exit must have a filter system with interlocking airtight doors. The personnel working in the maximum containment laboratory must take a shower right after they finish working. A negative pressure must be kept in the structure as it happens for the BSL3 but both the supplied air and the extracted air must be filtered with HEPA filters.

How to safely manage the waste bearing a risk of contagion

2016-07-01T07:22:00+00:00

The directive 2008/98/EC on waste gives a wide definition on hazardous waste and it establishes the rules on how to safely handle it.
Starting from June 1st 2015 the annex III of the aforementioned directive has been replaced by the 2014/1357/EU regulation. The starting point of the new regulation is the identification of hazardous waste:
Waste can be categorized as hazardous when it has one or more of the fifteen hazardous properties established by annex III of the Directive and modified by the 2014/1357/EU regulation (risk categories from HP1 to HP15).
The Commission of the 18th December 2014 (ruling n. 955) has decided to update the European Catalogue for Waste adapting it to the technical and scientific progress and to the new legislation on chemical substances (CLP, Classification, Labeling and Packaging).
The catalogue lists waste by dividing it according to the general industrial processes or according to its type and distinguishes it in hazardous and non-hazardous waste. Dangerous waste is labelled with this symbol (*).

The classification is the basis to correctly handle waste from the moment of its creation to the collection and final disposal.
The waste handling is made of several procedures which are carried out on waste fields and these are: handling, transportation, temporary storage, landfill placing and handling. These procedures must be properly carried out in order to avoid risks for people, things, and the environment.
A thorough knowledge of the potential risks which may stem from waste handling operations allows to make the right decisions in order to safely carry out all the handling operations.
The first classification for waste divides it according to its origin, therefore it could be either urban or special waste and the second criterion to classify it is based on the level of riskiness it carries.
Sanitary waste belongs to the special waste category and it is disciplined by the Presidential Decree n. 254 of 15th July 2003 which divides it into contagious hazardous waste and non-hazardous waste.
The hazardous waste which can be contagious is characterized by the danger factor HP9 and it is disciplined by national legislation. This type of waste comes from places which are isolated from any kind of infection but they carry a risk of biological transmission either by air or because the waste comes from places where there are people suffering from highly contagious diseases.
The handling of the register to load and unload the waste and any fulfillment of the law will not be treated in this article which instead focuses on the safety of the operator in all the phases of the waste handling process.
The risk evaluation process starts with the analysis of the causes which may trigger the event:

a non-careful handling of the waste carried out without using any individual protection device.
the use of non-suitable containers either for their dimensions, resistance, waterproofing capacities, the way they can be closed or because of the application of unsuitable air-conditioning techniques.

The characteristics of the containers are defined by article 8 of the Presidential Decree 254/03:

the container which is in direct contact with the waste must be made of a one way package which can also be flexible and must carry this label: Dangerous and contagious sanitary waste and a symbol which indicates the biological risk.
the external container must be impact-resistant when it is moved around. Furthermore when it is transported it must be labelled by using a specific colour which makes it easy to distinguish it from the other types of packaging used for the other types of waste. This can be a single-use container or it can be a re-usable container, but it must be disinfected each time before usage and it must carry the label: Hazardous and contagious sanitary waste and a symbol indicating the biological risk.
the packaging for sharp waste must be a rigid disposable sting- proof packaging and it must carry the label: Hazardous sharp, stinging sanitary waste which can be contagious, placed in the second layer of the external rigid packaging.

All these precautions limit the contact with the operator who plays a central role in preventing accidents from happening. The use of personal protection devices and the use of carts to safely move the waste around are fundamental precautions to take in order to prevent accidents from happening.

During the waste disposal phase, it is also necessary:

to use a container equipped with a specific bag. The size of this container will be proportional to the average daily production of waste carrying contagious risk in order to avoid to keep it for a long time in an open container;
to collect all the waste into the container without squeezing it and therefore avoiding any kind of manipulation which can result in injuries;
to fill in the container without exceeding ¾ of its capacity avoiding any risk for the operators when it comes to closing and transporting it;
to fill in the container without exceeding the weight limit while dealing with heavy waste (e.g. bags containing liquids);
to close the bag with its specific band using single-use gloves without touching or squeezing its content. Close the outer container by following its contoured lines or by applying a cover according to the type of container;
to place a label on the container. This label must indicate the origin of the container, and the date when it was closed in order to easily track the container.

The storage phase is disciplined and it must take place in specific temporary deposits which may have specific characteristics in order to avoid any waste alteration. Furthermore the waste storage phase must be no longer than 5 days starting from the closing of the content.
By a synergic handling of the aforementioned phases it will be possible to significantly reduce any risk of personal or environmental contamination.

Forum Risk Management in Sanità

2016-04-15T07:22:08+00:00

Forum Risk Management in Sanità (Forum on Risk Manaement in the Healthcare Industry), an event on technology applied to patient safety, returns for the 11th year. The event will take place from 22nd to 25th November 2016 and is the main event of its kind for the healthcare industry at a national level, as well as a chance for healthcare workers to meet.
With its programme full of talks, meetings and workshop, Forum Risk Management in Sanità is the place to put forward ideas and suggest solutions, in order to work together to improve the quality of healthcare and social care for all.

The role of health education in preventing biological risk

2016-02-15T07:22:08+00:00

Preventing biological risk centres on a principle which is common to risk prevention in general: the right to health. This concept no longer simply means 'absence of disease' and has taken on a multidisciplinary meaning – therefore health can be achieved only through manifold response.
The evolution of this concept implies the need to define clearly not only the objectives of prevention, but also the best means to achieve them.
Managing biological risk is based on adopting measures of prevention, protection and precaution which, if correctly implemented, prevent 'contact' between biological agents or prevent them from spreading.

But what does 'if correctly implemented' mean? The only effective strategy is raising awareness among healthcare workers and this can be achieved bringing about lifestyle changes and new role models through education.

Isn't it true that through education we can influence knowledge, behaviour, skills and even habits? Yes, it is.
However good 'health education' is not something that can be achieved so easily. When we go about our daily lives we are bombarded with stimuli, which may not always be consistent with our objectives, and risk-specific training is not enough to chip away at our own long-held convictions, the ones we acquired through our own education.

This is why nowadays health education plays a key role in prevention, in order to encourage everyone to make the right decision about their own health. This goes well beyond the mere communication of information, it implies fostering commitment and trust, empowering people and paving the way for primary and secondary prevention.

For all these reasons, this topic has been thoroughly dealt with at the Biosafety and Biosecurity Symposium 2015. The symposium saw a real interest in the different approaches to the issue around the world, which had in common the aim of biosafety, to be achieved through education at school.

The best ally in this endeavour is the concept of 'responsible science', that is safety culture as a component of the broader culture of responsibility within life sciences. This shift in culture has already yielded some positive results, which can be seen by visiting the website of the United States' National Academy of Sciences (http://www.nasonline.org/) . The NAS has been already using this new model for years.

Building a responsible science framework to support and enhance the already-existing culture of responsible and professional conduct in life sciences is the most effective approach for prevention. Ahmet Üzümcü, the Director-General of the Organization for the Prohibition of Chemical Weapons, argued as much: "Our aim is to promote a culture of responsible scientific conduct. This will enable the generations of today and of the future to understand and respect how their work can impact safety."

This means addressing everyone, not only healthcare workers, because until the concept of responsibility is embraced by all, in all facets of life, starting with families, schools and healthcare, we won't be able to build a truly safe future.

Personal Protective Equipment: a barrier against biological risk

2015-12-15T07:22:08+00:00

Preserving workers’ health against risk hinges on protection and prevention. This comes with a priority scale, which is contained within the regulation as well: when risks cannot be avoided or reduced significantly by technical prevention measures, by collective protection or by changing work organisation, then Personal Protective Equipment shall be implemented (Legislative decree 81/2008)

Personal Protective Equipment refers to any kind of equipment or accessory designed to be worn by worker to protect himself/herself from risks that could threaten his/her safety or health at work.
The effectiveness in terms of protection of the PPE has to be certified by the manufacturer by affixing the CE marking (compulsory since 31/12/94), as per legislative decree 475/92.
PPE are classified into three categories:
Category I – the design of this kind of PPE is simple. This kind of PPE protects workers from minor damage
Category III – the design of this kind of PPE is complex. This kind of PPE protects workers from risk of death or severe and permanent injury
Category II – all kinds of PPE that do not belong in the other two categories belong here.
As we know, biological agents can be transmitted in different ways: ingestion, inhalation, droplets, contact, inoculation and through carriers. PPE acts as some kind of armour that impedes these ways of transmission and protects us from infection.
Helmet and shield were not the only defence for Greek soldiers: safety during battle depended on the strategy adopted by their leader, the terrain on which they were fighting, how well they could together with their fellow soldiers, mental and physical condition, the latter being dependent on years of training...however, when a soldier was fighting one on one with the enemy, pelted on by Persian arrows, those two pieces of 'personal protective equipment' were essential.
As any kind of armour, these pieces of equipment need to be worn properly if we want to ensure real protection.
It is important to stress that the device in itself is not effective, unless the person who as to use it has been trained to use it properly, especially during the two most critical moments – putting it on and taking it off. If a device is not put on properly it will not work as a barrier; similarly, if it is not removed in the correct way, the person might be infected by the very same device.

How does one choose the correct device to use? The first step consist in accurate risk assessment in order to choose the PPE device that best suits our purpose. There are no standard solutions: the right choice and use of a device is essential to ensure complete protection for workers.
PPE devices are classified into different categories on the basis of the body part they protect.
• PPE for the head, protecting against trauma, fall, the elements
• PPE for the hands, usually gloves, protecting against cuts, mechanical trauma, chemicals, biological agents, etc;
• PPE for the eyes, usually goggles, visors and screens, for those activities where splashes or contact with biological agents may be involved, etc.;
• PPE for the legs, usually protective footwear.
When two or more PPE devices are used at the same time, they should not clash with each other, i.e. one should not prevent or decrease the protection provided by the other.
Training the end users in the use of PPE devices is always crucial to prevention: users need to be made aware of risk and effectiveness of the devices and they should be properly trained.
This is yet another example of how safety can be achieved only if all the actors play their part in risk prevention. Therefore awareness, information and training become all the more important since even the device that offers the greatest form of protection becomes useless if it is not handled correctly.

Needlestick prevention devices to lower healthcare workers’ exposure to biological risk

2015-11-15T07:22:08+00:00

The importance of implementing Needlestick Prevention Devices (NPDs) has been touched upon in several instances, especially since Directive 2010/32/EU was implemented into national law.
Occupational exposure to biological risk is a frequent and potentially severe event which concerns millions of healthcare workers in the whole world. Percutaneous exposure is the most common: it occurs in 75% of cases (while mucous membrane contact accounts for 25% of cases)..

The effectiveness of NPDs has been confirmed by several studies, such as the following examples.
A study carried out by Jagger in 1998 at 6 different hospitals for 15 months found out that 30% of percutaneous injuries were potentially preventable if safer devices had been used. In France a study that was carried out in 32 hospitals between 1999 and 2000 (GERES) saw a decrease of 75% in accidents.
Similar studies were carried out in Spain and in the UK and they reached similar conclusions: Spain saw a decrease of 93% in accidental sharps injuries while the UK reported a decline of 72% (and a decrease of 88% for accidental sharps injuries during venipuncture/injection).
Data from Canada and the US are encouraging. Introducing NPDs gradually in 87 monitored hospitals in the US reduced accidental sharps injuries by 59% for phlebotomy needles and by 53% for I.V. catheter stylets. In Canada using NPDs reduced accidental sharps injuries by 80%.
When it comes to epidemiological analysis carried out in Italy, the SIROH project (Italian Study Group on Occupational Risk of HIV Infection and other bloodborne pathogens ) is a point of reference at a national level. The SIROH project has been going on for 25 years thanks to volunteers in about one hundred hospitals in Italy. It monitors occupational exposure to biological risk and gives a great contribution in terms of prevention. The data gathered by SIROH shows that using NPDs, together with correct information, training and awareness-raising initiatives, is effective in reducing occupational exposure to sharps injuries and its effects are constant in time.

Implementing NPDs is not enough to ensure an effective reduction in accidents in the healthcare setting, though: providing adequate training for the workers who use the devices is equally important.
Furthermore, the effectiveness and safety of any treatment or diagnostic action shouldn't be affected by the implementation of NPDs. The patient's wellbeing and safety is always the ultimate goal, together with the healthcare professional's safety.
Healthcare institutions are encouraged to implement a management and organisational plan, much like the Phase Group did at a national level, assessing the benefits of introducing NPDs against the risk of accidents. These are benefits for the workers' health and safety but they also represent a financial gain –it is estimated that 400€ can be saved for each sharps injury that is prevented, while annual figure for accidents is 70 thousand. Looking at this data, what is more expensive then, the implementation of NPDs or the accidents themselves? We can all draw our own conclusions...
Staff who work in this area should undergo specific health monitoring.
MEASURES ON HANDLING SHARPS: they are regulated by the Health Ministry Decree 28/09/90 et seq. Article 2 states: "disposal of sharps, used on any patient, shall be carried out using appropriate precautions to avoid accidental injuries. In particular, needles, scalpel blades and other disposable sharps shall never be removed from syringes or other tools and shall never be recapped. They shall be put in the appropriate container for disposal."
All healthcare workers should take measures to prevent accidental sharps injuries, when using, cleaning and disposing of sharps.
Using only safety devices, prescribing blood tests only when really necessary and keeping sharps handling to the minimum are highly recommended.
MEASURES TO BE TAKEN IN CASE OF AN ACCIDENT: when an accidental sharps injury to the hand occurs, the first pair of gloves shall be disposed of in the patient's room. The worker should then leave the filter zone, dispose of the second pair of gloves, clean his/her hands thoroughly and disinfect his/her wound.
All accidents should immediately be reported to the doctor in charge of monitoring and carrying out the follow-up procedures.
Isolating healthcare workers who are at risk, especially when it comes to highly dangerous viruses such as Ebola, is the key to avoid exposure. Thus, taking all the preventive measures and using correctly personal protective equipment is vital and so is taking the utmost care in dressing, undressing and disposing of disposable devices. Using safety devices is therefore even more important, as they eliminate the risk of accidental sharps injuries and increase safety for healthcare workers.