The influence of occupational hazards on workability of medical staff in the first aid department of a big hospital

Suhhonenko, Viktoria

Tallinn University of Technology / Ehitajate 5 / 19086 Tallinn, Estonia+372-620-3960 / Viktoria.Suhhonenko@itk.eeTint, PiiaTallinn University of Technology / Ehitajate 5 / 19086 Tallinn, Estonia+372-620-3960 / piia.tint@tseba.ttu.ee

ABSTRACT

The work conditions (WC) in hospitals and their medical personnel’s workability are closely connected and complex phenomena. The WC improvement consists of measureable factors like indoor air velocity, humidity, temperature; lighting of workplaces, noise, chemicals (sick-building syndrome), but also non-measureable hazardous (psycho-physiological) factors’ management. The level of these hazards was investigated in the first aid section of the East-Tallinn Regional Hospital (81 workers). The research aim was to clarify the structure of job characteristics with a multi- disciplinary approach considering the physical and psychological capabilities of people, mathematical methods and work environment measurements. The results showed that the indoor air humidity was 12-15.75% below, the lighting in the registration-room 54.4% below the norms and the noise level in the frames of the Estonian norms in the work environment. The part of the investigation aimed to lessen the absenteeism showed that to raise the workability it is necessary to carry out preventive training after every 200 work hours; this will hold the workability of the medical staff on the level of 76% which is mathematically assessed as good.

Keywords

Medical institution, workability, work reliability

INTRODUCTION

The main occupational hazards for the medical personnel of the first aid department are cold outdoor conditions, draught indoors, bad ventilation; violence and biological risk factors from the side of patients. The aim of the paper was to investigate the absenteeism reasons of workers, the improvement of workability and work reliability.

Several studies deal with health care employees’ risk of contracting infectious diseases from patients due to airborne contamination. An evaluation of 17 hospitals in

Canada involving all personnel who worked at least 2 days per week in the respiratory and physiotherapy departments showed that tuberculosis infection among health care workers was associated with ventilation of less than two air exchanges per hour [1].

The additional risk factors in health care settings are sterilizers, formaldehyde, acetone, benzene, toluene, anaesthetic agents and pharmacological agents. Worker exposure to hazardous drugs has been identified by OSHA as a problem of increasing health concern. Preparation, administration, manufacturing, and disposal of hazardousmedications may expose hundreds of thousands of workers, principally in healthcare facilities and the pharmaceutical industry, to potentially significant workplace levels of these chemicals. Antineoplastic cytotoxic medications, anaesthetic agents, anti-viral agents, and others, have been identified as hazardous. These hazardous medicationsare capable of causing serious effects including cancer, organ toxicity, fertility problems, genetic damage, and birth defects [2]. The possible hazardous chemicals in health care facilities: cleaners and disinfectants (glutaraldehyde, formaldehyde,ammonia, phthalates, glycol ethers, triclosan, volatile organic compounds; disposable gloves (PVCs, dioxin, phthalates); stain-resistant clothing (perfluorinated compounds); pesticide residues in cafeteria food (organophosphates, carbonyl) [3].

Musculoskeletal disorders are the most common work-related health problem in

Europe, affecting millions of workers. Across the 27 member States, 25% of workers complain of backache and 23% report muscular pains. According to the European statistics, 62% of workers in the EU27 are exposed a quarter of the time or more to repetitive movements, 46% to painful or tiring positions and 35% to carrying or moving heavy loads. The European Agency on Work and Health organized the campaign “Lighten the Load” in 2007, which indicates that manual work is still widespread in the European area. Particularly, female workers are at risk. Some authors [4, 5] argue, that there will be even more material handling as before, and at least some of it will be manual, and there will be continued time pressure on the workforce to be effective and efficient to produce high quality, low cost and on- schedule delivery. Besides, with the growth of information technology new overload factors have appeared as work in the compulsory position or monotonous work straining muscles is one-sided. Monotonous work may lead to increased worker fatigue due to continuous handling of loads, prolonged standing, and repetitive movements of both hands and wrists, awkward postures. The human body responds to stress-factors through four systems: central nervous, automatic nervous, endocrine and immune – which are constantly interacting as a complex network. There are indications of combination of exposure workers to both MSDs and psychological risk factors – together these hazards affect the workers’ health to a greater extent. The psychological and physical factors which affect the human organism at workplaces are considered to be stress factors which affect the functional state of the central nervous system [6, 7]. The main physiological stress-factor in the work environment is a poorly designed workplace [8]. Other physiological hazards include lifting of loads, physical exertion, fatigue, working long in the same posture, standing; poor support from the colleagues and from the hierarchy [9] etc. They all may affect the functional status of the nervous system.

The list of psychological stress-factors is large: job content (lack of variety or short work cycles, meaningless work, under use of skills, high uncertainty) [10], workoverload or underload, work pace (high levels of time pressure, machine pacing), work schedule (shift working, night shifts, unpredictable hours), control of work (low participation in decision making, lack of control over workload), inadequate equipment availability, organizational problems (poor communication, low levels of support of problem solving), interpersonal relationships, job insecurity, home-work interface (low support at home, conflicting demands of work and home) etc., but they can be derived also from physical or chemical factors such as inconvenient microclimate, excessive noise, insufficient lighting, dangerous chemicals.

The development of the occupational stress depends on the dose-response relationship: the length of time of the occupational stress, the specific character of the stressor and the functional state of the organism. The statistics of occupational diseases is the specific indicator which influences the existing hazards and risk factors on the worker in the work environment. However, occupational diseases in Estonia are usually diagnosed in the late stage of disease when the worker is already disabled and therefore, may not reflect all health disturbances adequately. The main part of these diseases is connected with musculoskeletal disorders [11], which are the most frequently mentioned problems in many surveys across Europe [12, 13]. The problems caused by the mental stress at workplace are not considered to be induced by the work conditions in Estonia yet, although in European work-related health surveys occupational diseases caused by stress occupy the second place after musculoskeletal complaints [12, 13].

METHODOLOGY

Workability is defined as the capability to take part in effective work operations. The medical personnel’s incapacity to work is connected with a high workload. The associated health disturbances might be psychological as well physiological. The indicators of workability are: the incapacity to work (failure) and the time being absent from work. Workability could also be assessed as the indicator of the organism’s strength potential and from the other side- the motivation of the worker. Productivity, on the other hand, is dependent on the work conditions and the social climate in the enterprise. The worker’s reliability and the methods how to gain it are currently very relevant. The data obtained here could be used to predict the probability of the worker’s workability failures. Dependent on the circumstances during a certain time period (day, month, year), different number of failures might happen. To gain a qualitative level of work durability, assessable values have to be calculated.

The failure flow parameter characterizes the frequency of the failure occurrence– the intensity per time interval special item and might be found according to the equation [14]:

Where λ – failure flow parameter;

x – arithmetic mean.

ë = 1 ,x

(1)

The variation factor is the quotient of standard deviation and parameter’s arithmetic mean and might be found by the equation [22]:

v = ó .

x

The normal distribution is in force if the variation factor

v < 0,399.

(2)

The Weibull’s distribution is valid if the variation factor is in the frames 0,399 ≤ v < 0,765 . The exponent distribution is valid if the variation factor is 0,765 ≤ v ≤ 1,0.

P =      1exp − (ti  − tt ) 

, (3)ó t 2ð 2 

      2ó t         

    t  

P = exp −  i  , (4)

                        

P = e−ë⋅ti , (5)where P – the probability of non-failure work; t – time interval;a, b– Weibull’s parameters;ë – parameter of failure flow ( ë = ti tt ).

Depending on the consequences caused by the failures of workers, it is recommended to establish the value for the workability parameter. According to the fuzzy logic theory, it might be acceptable in the interval of satisfactory, good, very good, excellent.

Pearson’s ÷ 2

criterion is the guidance criterion that is based on the grouped data andwill be found by the equation [25]

(6)

where ÷ 2i=1– Pearson’s criterion;mti

N – The number of intervals in the statistical selection;mi – the number of events (failures or work abilities) in the interval;mti – the theoretical number of events (failures or work abilities) in the interval.

The theoretical number of events (failures) in the interval is calculated [14]mti = n ⋅ [F (til ) − F (tia )],where n – the total number of failures;

F(til ) – integrated probability of occurrence of failures at the end of the interval i;

(7)

F(tia) – integrated probability of occurrence of failures in the beginning of the interval i.

The number of degrees of freedom might be found by the equation [14]r = N − k,where r – the number of degree of freedom; N – the number of intervals;k – the number of compulsory connections.

The number of compulsory connections for the Weibull’s distribution law is 3.

(8)

CONTRIBUTION TO SCIENCE

In the current study the workability and work reliability are firstly connected with the working conditions. The hypothesis is if the work conditions would be improved then the work reliability has to arise. This hypothesis is studied in the work of nurses with the help of statistics.

RESULTS

The data of measurements of working conditions in the big hospitals emergency centre are given in Table 1.

Table 1. Results of measurements of indoor climate in nurses’ workrooms (measured in warm season)

*c.- correspondent to the normsn.c.- not correspondent to the norms

The temperature of the air in the workrooms was within the norms. Modern air conditioners are recommended to use in hot summer days (June, July).

The air humidity - is under the norms (optimal 40-60%, not >70%).

The measured noise level is over the norms for office-rooms (40-45 dB(A)), but not in the general rooms in the buildings.

The lighting of workplaces is generally satisfactory. Considering the ageing workforce,the lighting of workplaces could be improved using the local lighting. The demands for higher lighting - indicators are increasing with age. If 300 lx is enough for peopleunder 20 years old, then 500 lx is optimal for people over 25.

The measured radiation dose (0.12-0.14) is rather low compared with exposure limits (>0.15 µSv/h). So the radiation is considered as negligible risk for workers in the

North part of Estonia.

The measurement of workability and work reliability were carried out in 2005 and 2008. In 2005, the mean work duration was 822 hours, after that the workabilityof workers began to fall and the probability of the anti-failure work is 37%, that according to the fuzzy logic theory the assessment: bad. To raise the probability of workers anti-failure work, the preventive work has to be organized after every 300 work hours (calculated by the equation 5), then the workability of workers is on thelevel of 70%: good level.

In 2008 the mean work duration was 712 hours, after that the workability of workers began to fall. To raise the probability of the workers’ off-failure work, the preventive technological education and other activities are needed, and already afterevery 200 working hours, then the workers’ workability is stayed all the time on the level of 76% or considering the hazy amounts theory- on a good level.

Humans differ from each other psychologically and physiologically. One will rehabilitate faster, the other slower. The more the human being works, the bigger the probability of failure becomes. The data calculated by the equations 1-8 are presented in the Table 2.

Table 2. The work duration of nurses (2005)

Table 3. The failure duration of nurses (2005)

Table 4. The work duration of nurses (2008)

Table 5. The failure duration of nurses in 2008

N1- work duration, days;

N2- failure duration, days;

F- probability of worker’s rehabilitation time; Fi - operative probability of failure occurrence; P- operative probability of work duration;

Pi - integrated probability of work duration;

The analysis of the data in Tables 2-5 show that the number of failures has decreased in 2008 compared with the year 2005.

CONCLUSIONS

• 1. The measured parameters of microclimate generally (Table 1) corresponded to the norms, except the humidity of the air that was under from 1215.75% in different rooms and the lighting of the workplaces was under the norms in the registration room (54.4%).
• 2. The workers’ mean work duration per failure was 822 hours and the mean failure duration or the rehabilitation time was 94 hours in 2005. In 2008 the mean work duration was 712 hours and the mean failure duration or the rehabilitation time was 68 hours.
• 3. The formulas on the work without failures and the prognoses of the rehabilitation time probability have been worked out (on the bases of the data

of 2008), accordingly:

P = e−0,0014∗xi

(9)



x

P = 1 − e−  i  (10)

   80 

• 4. To raise the probability of the work without failures, the preventive technological education and other activities are needed, and already after every 200 working hours, then the workers’ workability is stayed all the time on the level of 76% or considering the hazy amounts theory on a good level.
• 5. Most  of the noise sources are unnecessary  and  can  easily be eliminated.

Important gains in the psychological work environment of health care can be achieved by improving room acoustics. Proper lighting can allow people tofunction more independently by improving social contact, appetite, mood, self- confidence, and anxiety levels. The hospital infection rates are related to the types of air filter, directions of airflow, air pressure, air change rates, humidity,and ventilation system cleaning and maintenance regimes. Health care workers are at risk of contracting infectious diseases from patients due to airborne contaminants. Hospital staff may perceive naturally ventilated hospital buildings more favourably than artificially ventilated buildings.

ACKNOWLEDGMENTS

The work has been carried out with the help of the project SF0140022s10 “Chemical Engineering Aspects in Environmental Risk Assessment” (Estonia).

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