Chemical EngineersThis section will provide a brief overview of selected chemicals that workers in community clinics and doctors’ offices may come into contact with. Note that this list is not extensive or all-inclusive. In the control column, E, A and P are used to designate Engineering, Administrative and PPE controls. These controls are briefly summarized and the reader should link to the references provided for additional information. The proper choice of control measures must be based on a risk assessment for the specific tasks being performed. Safe Safe work procedures should be designed to:

Limit the worker’s exposure time Reduce contact with the substance through any route of exposure to

the worker Ensure safe disposal of substances and disposable equipment that

comes into contact with harmful substances Ensure safe handling and decontamination of reusable equipment Require the use of all designated controls

Worker education is critical for safely handling harmful substances. In this section the chemical exposure hazards most commonly encountered by workers in community clinics and doctors’ offices and methods to control them are presented. Employers should carefully evaluate the potential for exposure to chemical hazards in all community clinic and doctors’ offices tasks and ensure that they have an effective hazard control plan in place. This information will be useful for inclusion into hazard assessments. Please note, this is not designed to be an exhaustive treatment of the subject, but is rather an overview summarizing the chemical hazards most frequently encountered by workers in community clinics and doctors’ offices.

Some examples of elimination of chemical hazards in healthcare:

Purchasing fragrance-free products

Use of alternative cleaning products that have less hazardous ingredients:

Replacing mercury-containing devices (manometers, thermometers) with non-mercury containing alternatives

Using hydrogen peroxide-based cleaners rather than chlorine- based cleaners

in treatment and disinfection procedures.

Exposure follow-up – emergency response equipment

Two types of exposure follow-up are considered as administrative controls. The first is the provision of appropriate emergency response equipment to reduce the impact of the exposure. The second is the medical follow-up for workers who have had chemical exposures. In the first case, emergency response equipment for workers in community clinics and doctors’ offices consists of an eyewash apparatus or drench hose, as well as a first aid kit.

Medical follow-up of the exposed worker

A worker who has had a chemical exposure may require medical follow-up. Guidelines are available to provide information on the treatment and monitoring of workers with exposure to specific chemicals. The pre-placement assessment considers the worker’s personal health status as it relates to potential workplace exposures. It is useful to identify if workers have any allergies or sensitivities to products that they may need to work with.

Chemical Waste Handling and Disposal

Chemical wastes must be addressed with a good chemical waste management system. Municipal and or Provincial codes address appropriate disposal requirements and aim to reduce contamination, possible injuries, illness or reactions related to chemical exposures.

Additional considerations for reducing risk of exposure

It is prudent to be aware of the need for modification of the work environment, conditions or required PPE for workers who may be medically vulnerable to the effects of some substances. Higher risk workers may include pregnant workers, workers with allergies or those who are sensitized to certain chemicals. Some common approaches to accommodate these workers include temporary assignment to areas or tasks where the exposure potential is eliminated; work scheduling to reduce the amount of exposure, and changes to the PPE to accommodate limitations.

PathologistIn this section the most commonly encountered biological hazards for workers in community clinics and doctors’ offices and methods to control them are presented. Employers should carefully evaluate the potential for exposure to biohazardous materials in all tasks and ensure that they have an effective hazard control plan in place. This information will be useful for inclusion into hazard assessments. Please note, this is not designed to be an exhaustive treatment of the subject, but is rather an overview summarizing the biological hazards most frequently encountered by workers in community clinics and doctors’ offices.

A comprehensive management system considers the continuum of infection prevention and control (IPC) efforts across all sites and operations. A comprehensive system should include the following components:

A process that ensures site-specific hazard assessments are conducted for all sites and tasks and appropriate controls are identified

An infection prevention and control plan with clear designation of roles and responsibilities

Consistent standards for the cleaning, disinfection and sterilization of equipment, procedures, and policies including Routine Practices, Additional Precautions, hand hygiene policies and available materials, client risk assessments, communication protocols, decontamination of clothing and dedicated clothing

Outbreak prevention and management Adequate staffing to comply with OHS and IPC policies and procedures;

work scheduling; Required orientation and ongoing education Biomedical waste handling procedures and policies A comprehensive surveillance and monitoring plan Record keeping and regular reporting of outcomes

Training

Training in biological hazards and controls should be provided to all health care workers (HCWs). Each HCW must understand the employer’s IPC and OHS programs as they relate to their job duties. For newly hired HCWs all relevant IPC and OHS policies and procedures must be provided before they start work. To ensure that HCWs understand and apply this

information to their jobs, specific training should also be provided to address job-specific biological hazards. Periodic refresher training to reinforce policies

and procedures and introduce any new practices will benefit all HCWs. Competency assessments should be provided for all training, and training records should be maintained.

PilotIn the aviation industry, pilots face a number of health risks that need to be understood. Awareness levels rises in order for pilots themselves to be able to manage the risks they take.Some of the health risks that pilots faces are -

Deep Vein Thrombosis - DVT is health conditions that can occur when a pilot (or passenger) may get if sit around too long. By understanding how this comes about, pilots are able to realize the need to move about every so often to prevent this from happening.

Cabin Radiation - This simple refers to the significantly high levels of cosmic radiation that pilots and crew and subject to. However, not much is known about what long-term effect that this exposure has.

Altitude - Not a lot is known about the long-term effects of maintaining an altitude that is not sea level for long period of times. It is understood the short term effects of too high an altitude but little is known about maintain a level just below where these problems occur.

Hypoxia - This is when the brain is not getting enough oxygen because the partial pressure of the oxygen content is too low. In other words, there is enough oxygen for the body to process. This condition is very serious, one because it can kill and two because people don't necessarily know it is happening to them. Some of the first stages affect the decision making skills of pilots

Dehydration - This is a condition where the body has not got enough water inside them. This can have some serious effects for the pilot. It can effect decision making skills, cause the body to react slower, increase fatigue.

Fatigue / Stress - Though different issues they are often related, they have a tendency to increase the other. These are about having a

balanced live and not working your body past it limits. Again, these factors can affectdecision making skills.

Hypothermia - It is a simple condition where the body gets too cold. Though simple it should not be taken lightly, this can be a serious issue especially during emergencies.

Training – Most of the health risks that pilots face can be reduced with a bit of preparation and understanding. The training program for the pilots should educate them to fight with these conditions. Knowing what your body does when faced with these issues means you can identify when a particular condition is happening and take steps to reduce or remove the situation. As mentioned above most of these even in mild cases can start to affect decision making, something that pilots need to keep a level head for.

DoctorsCommon occupational hazards are -

Illness and Disease - Treating patients with contagious illnesses and diseases is a regular hazard of medical work. Doctors are at the forefront of combating flu, respiratory illness and hepatitis, to name a few. Some contagions can be exchanged through accidental needle pricks or incidental encounters with bodily fluids.

Patient Actions - Patients can pose physical threats in certain situations. Doctors in various settings treat patients struggling with mental health disorders, who may lash out with violence. Unintentional dangers from patients are also a reality in emergency rooms where patients in shock or trying to resist treatment may fling arms and legs, causing injury.

Lawsuits - A major financial hazard for doctors is increased risks of malpractice lawsuits. Doctors in many specialty areas face the unfortunate prospect of getting sued by a patient or family if they make a mistake, or even if they don't, but the results can be bad.

Ethics - In general, doctors go to medical school and become medical professionals because they want to help people. However, balancing the desires and needs of patients with adherence to laws and ethical codes can get complex. For instance, some doctors are reluctant to overdo it on drug prescriptions for fear of aiding patients who have substance abuse troubles. Some medicines also have dangerous side effects.

Training:

Instead of undertaking core training in acute medicine, doctors may choose to start specialist training in a number of other disciplines, namely: general practice, psychiatry, public health and surgery. The desirable personal qualities for trainees include an ability to build rapport/ listen/persuade/negotiate, a capacity to take in the perspectives of others and to “see patients as people”. Doctors must also be able to work in multi-professional teams, supervise junior medical staff and show leadership. The Faculty also recommends doctors applying for specialist training to demonstrate an interest as well as showing evidence of achievement outside medicine including “altruistic behaviour” such as voluntary work.In addition, physicians must have knowledge of employment and anti-discrimination legislation, as well as of environmental and health and safety law. They must also have an understanding of epidemiology, disease prevention and toxicology.

Civil EngineerOccupational Hazards are –

Accident hazards –

Falls from elevated surfaces/levels (bridges, dams, high floor of a building veranda/surface without railing, roofs, etc.) or from ladders; falling into a cellar, shaft, trench or open pit; falling while working on a project site – falls from cliffs and slopes, falls into pits, tunnels, etc.

Slip, trip or fall on the level Injury/death as a result of collapse of an excavation, trench, floor or

wall of a building or of an auxiliary structure; collapse/buckling of components in a structure that is being built; collapse and slide of piles of materials or of stored building equipment; landslides of soil and stones

Injury caused by falling objects, by stepping on sharp objects, and by impact and collision with sharp or protruding objects

Risk of being hit by heavy mechanical equipment/vehicles working on a site

Contact with and exposure to extreme temperatures (during outdoors work, at extreme temperatures); or cold/frost bites

Electrocution as a result of unintentional contact with “live” electric wires during inspection and supervision rounds through the construction area

Eye injury, caused by flying splinters/particles of stone and metal, or created throughout demolition and building operations in the area

Injury as a result of a fire and/or explosion of flammable materials at the site (bitumen, tar, solvents)

Increased risk of traffic accidents, when working simultaneously on numerous sites, requiring much additional driving

TeacherOccupational Hazards are –

Disease Transmission - Teachers spend their days with students, colleagues and parents, making them susceptible to bacterial and viral infections.

Workplace Violence Ergonomic Issues - Ergonomics involves fitting the work environment

to the employee instead of forcing the employee to fit the work environment. Employers use the principles of ergonomics to reduce the risk of repetitive stress injuries and other occupational health problems. Teachers spend much of their time standing, and may have to bend, stretch and lift to use educational aids and equipment such as blackboards and projectors. This puts them at risk for varicose veins and for injuries, including sprains, strains, pulled muscles, and back injuries. For teachers who spend a lot of time using a computer, the risk of developing carpal tunnel syndrome is also a concern.

Work-Related Stress - Teachers have several sources of stress in the workplace. They include increased class sizes, student performance objectives, lack of control over work hours and methods, lack of student motivation, difficulty working with parents, lack of professional recognition, and inadequate salary. Although everyone reacts to stress differently, too much stress can affect mood, behaviour and physical health. The Mayo Clinic says that stress can lead to headaches, sleep problems, fatigue, muscle tension, upset stomach, chest pain and muscle pain. It can also cause anxiety, irritability, depression, anger, drug or alcohol abuse, social withdrawal, and changes in appetite.

Legal Considerations

Licensed practical nurses

Licensed practical nurses, commonly known as LPNs, take vital signs, assist patients with personal hygiene tasks and provide a variety of other medical and personal care services to patients in hospitals, clinics, nursing homes and other medical facilities. Because this job involves bending, lifting and working with biological hazards, LPNs are at risk for a number of occupational injuries and illnesses.

Occupational hazards are -

Sharps Injuries - LPNs come into contact with needles, scalpels and other sharp objects used to give injections and make surgical incisions. These objects have the potential to cause cuts and other injuries if they are not handled properly. Sharps injuries also put LPNs at risk for contracting illnesses such as HIV and hepatitis, which are transmitted via blood and other body fluids.

Biological Hazards - Licensed practical nurses may also be exposed to urine, vomit, semen and other body fluids.

Musculoskeletal Disorders - LPNs sustain these injuries when lifting patients, transferring patients from beds to chairs and performing related tasks. These tasks are especially challenging when working with obese patients or those with cognitive impairments who cannot provide assistance during their transfers.

Workplace Violence

LPNs are at risk of workplace violence, especially when they work in nursing homes. Nursing home patients with Alzheimer's disease and dementia may display aggression by biting, scratching, pulling hair, punching, shoving and throwing objects at staff members. These assaults typically occur during periods of close contact, when LPNs are performing tasks such as patient transfers and dressing changes.

Training program for LPN’s should instruct and take care of following things –

Disposing of needles in puncture-resistant sharps containers reduces to risk of needle sticks.

LPNs should give verbal announcements when passing sharps to minimize the risk of cuts and other injuries.

LPNs must protect themselves by wearing gloves whenever they touch patients.

They should also wash their hands immediately after removing gloves, before patient contact and after contact with contaminated surfaces.

Gowns and masks can protect LPNs from coming into contact with body fluids.

Using back support belts and patient handling devices can prevent back injuries, muscle strains, sprains and other musculoskeletal injuries.

Dentists

Dentistry is considered by the practitioners and most of the public as being extremely hazardous. The hazards include the following:

Infectious hazards: Needles and other sharp objects spatter, and aerosols can transmit viral infections such as life-threatening infections such as acquired immunodeficiency syndrome and hepatitis B. Bacterial infections also play an important role. The leading causes that should be concerned are syphilis and tuberculosis.

Psychological hazards: Stress is the leading psychological condition that occurs in the dental profession. Many studies implicate that dentists perceive their profession as more stressful than other jobs.

Negative picture induced by the media of dentistry as a profession filled with dangers may be the leading causes.

Allergic reactions: Gloves containing latex are the main causes of the allergic skin irritation, but dental materials, detergents, lubricating oils, solvents, and X-ray processing chemicals could lead to an allergic skin reaction.

Physical hazards: These include musculoskeletal complications which have direct relation to dentistry procedure, like postural situations that may increase the risk of twisting and contorting the body, varicose, etc.

Mercury health hazard: It has been proved that high mercury vapor high dose exposure can lead to biological and neurological insults. Sealed amalgam capsules use with lower mercury level, water irrigation and high suction, good ventilation and proper collection, and discarding of amalgam have substantially diminished the mercury dangers.

Ionizing radiation: Taking X-ray machines in the dental office predispose dentists to suffer from ionizing radiation.

Non-ionizing radiation: This has recently become a concern since the use of composites and other resins, next to the use of lasers in dentistry procedures, which has added another potential hazard to eye and other tissues that may be directly exposed.

Anaesthetic gases in the dental office: Using nitrous oxide gas regularly over an extended period of time may contain hazard.

Concerning prevention, the global literature focuses strictly on control of infections and appropriate management of potentially infected materials, owing to the high profile of dentistry regarding infection transmission. Barrier utilities such as gloves, masks, protective eye wear, high power suction, and good ventilation reduce aerosols and vapour hazards. Hypoallergenic non-latex gloves can decline latex allergy. Lead aprons, periodic maintenance of

the X-ray machine and radiation level sensors deal with radiation dangers.The current paper reviews studies relating to occupational health problems in dental practice.

Analytical Chemists

A worker who conducts analysis, synthesis, and experimentation on substances, for such purposes as product and process development and application, quantitative and qualitative analysis, and improvement of analytical methodologies.

Occupational hazards for Chemists –

Accident hazards –

Slips, trips and falls on wet, damaged or uneven straight floors (esp. Dangerous when handling chemicals stored in glass vessels)

Clothes, hair, fingers and/or arms being caught in rotating and moving parts of electro-mechanical equipment, in particular centrifuges, mixers, blenders, etc.

"Freeze burns" from skin contact with very cold surfaces or fluids, e.g., liquefied gases

Electric shock or electrocution from defective electric laboratory equipment

Acute poisoning by a wide variety of poisonous gases, liquids and solids that might be released in chemical reactions and in the use of equipment for preparing samples for analysis

Cuts and pricks caused by sharp objects (knives, syringes, etc) broken glass, (explosion/breaking of glass, while inserting glass tubes within the cork)

Burns from flames, hot surfaces or/and liquids, and released hot gases from explosions, during work with flammable materials (solids, liquids and gases) and from uncontrolled exothermal reactions

Explosion of equipment that operates in overpressure or vacuum conditions may cause injuries to different parts of the body

Burns caused by corrosive liquids and gases Injuries caused by flying particles that escape during a outbursts from

centrifuges and autoclaves Damage to eyes from exposure to laser beams, corrosive gases,

splashes of chemicals and flying particles

Physical hazards –

Exposure to ionizing radiation during work with radioactive materials and/or defective laboratory equipment using radioactive sources

Exposure to non-ionizing radiation: infrared radiation, visible light, ultraviolet light, laser radiation, microwave and radiofrequency radiation; high and extremely low frequency electromagnetic fields due to work with defective laboratory equipment/instruments and/or incorrect habits of work

Exposure to high amplitude whole-body vibration and noise in subsonic (including infrasound) or ultrasonic ranges from vibrating and rotating mechanical equipment and from ultrasound equipment)

Chemicalhazards –

Exposure to a wide variety of chemicals: corrosive, irritating, suffocating, allergic, radioactive, etc.

Exposure to carcinogenic, mutagenic and teratogenic substances Exposure to substances that can cause damage to the nervous system Exposure to chemicals that may cause different allergic reactions:

respiratory tract Irritations, asthma, eyes irritations and skin rash

Biological hazards – Possible exposure to biological hazards such as viruses, microbes, fungus, parasites, etc. through pathways such as

inhalation, swallowing, skin contact, eye contact, as well as during handling of laboratory samples.