Employee Health in Indian Hospitals

The presentation is solely meant for Academic purpose

Knowledge about blood and body fluid exposure

Personal protective equipment

Periodic immunization

Safe equipment

Reporting of exposure

PEP

Isolation precaution – MRSA, TB, H1N1, chicken pox

Sharp injuries

Blood and body fluid exposure

Deficiency in PEP

Deficiency in PPE

Care of HCWs dealing with patients under isolation

Radiation safety

Infrastructural safety

Globally a serious problem

6 to 8 L in US, 6 L in Germany

Indian data ?

3 HCW/ 10,000

3.5 million HCWs

115 L estimated injuries

Fortis Jan 2010 5

Job categories injured

Doctors

10%

Nurses

55%

Housekeeper

19%

Others

16%

Data A Data B Total data

Yes 83 (49.1) 254 (51) 337 (55)

No 66 (39) 182 (48) 248 (41)

Unknown 14 (8.2) 0 14 (2.3)

N-A 6 (3.5) 0 6 (1)

Accountability towards nurses and technicians

Budgeting expenses - HIPAC

Change attitude of ‘super’ HCWs ◦ Waste disposal

◦ Appropriate handing over of sharps

◦ Sharp disposal units

◦ Personal protection equipment

◦ Educate and re educate

Education of nurses, doctors and technicians

Providing sharp disposal in the bedside

Cheaper sharp disposals

Surveillance of waste disposal

Interventions

Use of safety device

Making sharp injury reporting more friendly

What’s that?

80%

20%

correct segregation wrong segregation

0

10

20

30

40

50

60

70

80

90

100

surgeon anesthetist technician nurse House keeping staff

24.09

42.3

78.66

97.48

63.26

Perc

en

tag

e o

f co

mp

lian

ce

Profession

33%

15% 26%

7%

19%

Surgeon Anesthetist

Technician Nurse

Housekeeping staff

Data A Data B Total data

Safety Design (SEMD)

34 (20.1) 19 (3.9) 53 (8)

Not a Safety Design

114 (67.5) 467 (95.3) 581 (88.2)

Unknown

11(6.5) 4 (0.8) 15 (2.3)

N-A

10 (5.9) 0 10 (1.5)

Only from hospital A and B

Prevalence of Hep B among the general population ranges from 2 to 8%,

Among healthcare workers seroprevalence is two to four times higher than that of the general population.

NY compensation board “compensable occupational hazard.”

1% HCWs HBsAg – positive

In the US, 57 HIV sero conversion in 2001 alone

2000/ yr infected Hep C

400 contract hepatitis B.

More than 20 infections

Exposure to HIV, HBV or HCV also has implications on personal relationships, future employment, and even insurance coverage.

Hep B vaccination

• Nursing 98%

• Doctors: 75%

• Technicians: 98%

• Housekeeping- 60%

A1 A2 B1 B2 C1 C2 D1 D2 E1 E2

Yes, partially, 1 or 2 doses 48 24 3 27 5 17 2 16 5 28

No 62 31 12 17 1 7 0 5 3 7

N-A 0 1 0 0 0 0

Total234 118 48 146 14 63 2 53 24 109 234

• Masks, caps, gowns, gloves – available mostly

• N95 masks, disposable gowns, goggles – not common

• Even if provided,

compliance to use low

Uncommon

Reprimanded and location of work changed

Asked to quit

Looked down upon

Avoiding PEP

Approx 15k per HCW

26

Rs. 750 HCV(antibody testing)

Rs. 750 HBSAg (antibody testing)

Rs. 2000 PCR test

Rs. 500 HCV(Elisa)

Rs. 450 HBV(Elisa)

Rs. 2000 HIV(Western Blot)

Rs.300 x 5 = 1500

HIV(Elisa) Immediately after injury,6 weeks,3 months,6 months & 12 months later

Costs Laboratory testing

Miserable

No statutory requirement

Unknown in many un-accredited hospitals

Under reporting – prevalent

Encouraged by administration

No insurance cover for these shots

Even decent facilities shun away when it comes to interferons

Farrell GA, Shafiei T, Chan SP. Patient and visitor assault on nurses and midwives: An exploratory study of employer 'protective' factors. Int J Ment Health Nurs. 2012 Dec 20.

Nurses are most compliant!

Housekeeping staff are next

Doctors are very poor icons

They think they know, but neither they think nor they know.

Too proud to attend sessions run by nurses

Healthcare worker safety is in jeopardy

Every healthcare worker to prioritize issues regarding safety

Set targets

Strive working ambience safe

Fortis Jan 2010 31