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Health System Strengthening Through
Worker Protection in The Gambia
Led by Drs. Melissa McDiarmid & Joanna Gaitens, School of Medicine
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Why Occupational Health & Safety (OHS)?• Healthcare is a high-hazard industry and/but without the healthcare
workers, the system falls apart• The Gambia
o Lessons from Ebola epidemico OHS concerns exacerbated in resource-poor settings
Biologic: need-stick injuries, TB exposure Psychological: promoting a “no-blame” culture
• Our Project: OHS training for healthcare workerso Groundwork done by Dr. McDiarmid in 2014
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Nicole Campion Dialo (SOM), Dr. Melissa McDiarmid (SOM), Sarah Gregorini (SSW), Dr. Joanna Gaitens (SOM), Wesley Chan (SOM), Alyssa Riuli (SOD)
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Who was involved?• Partners
o University of the Gambia School of Medicine & Allied Health Sciences
o Gambian Ministry of Healtho Edward Francis Small Teaching Hospital (EFSTH)
• Attendeeso Clinicianso Regional & local public-health officers
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What did we do?• 3-day training at EFSTH• “Train-the-trainer”
o Lectures on minimizing risk of exposure to bloodborne & airborne pathogens
o Small-group case studieso Facility walk-through exercise
• Sustainability plan: next meeting was scheduled before we left
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Collaboration
Collegiality
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Occupational Health and Safety Dashboard• Assessment tool• Evaluate healthcare facility
o Organization, Infection Control, Training, etc.
• Provides a rough idea of the status of the healthcare facility and potential improvement areas
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Infection Control• Is there a policy requiring workers to wash hands
before caring for patients?53% Yes 41% No 6% Don’t know
• Do patient care areas have sinks readily available?71% Yes 18% No 12% Don’t know
• Are antiseptic soap, water and towels available?82% Yes 6% No 12% Don’t know
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Infection Control• “Not all areas have sinks readily available”• “We have sinks but not enough”• “Antiseptic soap, water and towels are only sometime
available” –Their availability is not continuous
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Protection from Blood and Body Fluids• Is there a blood and body fluids exposure policy to
protect workers?39% Yes 44% No 17% Don’t know
• Is there a policy requiring use of sharp devices that have safety features?
39% Yes 44% No 17% Don’t know• Are sharps disposal containers available in all patient
care areas?73% Yes 20% No 7% Don’t know
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Employee Training/Record Keeping
• In response to "Is a blame free environment promoted to encourage reporting of exposures and incidents"-"Somehow, no one is prevented to report an incident"
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Dashboard Summary• Great tool to focus training and discussion
• Provided a snapshot of the overall Gambian healthsystem. o Both to our team and to other Gambian health officials
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Small Group Discussion● Discussed scenarios
about TB exposure and needlestick injuries
● Allowed for application of training material
● Helped our team and participants prepare for the walk-through
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Facility Walk-through
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Workplace Inspection Tool*• General Physical Environment• Pharmacy • Laboratory • Patient Care Unit• Central Sterilization Unit
*Modified from Workplace Inspection Tool for Pelonomi Hospital September 2007- Developed by Annlee Yassi and Elizabeth Bryce
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LaboratoryItem/Description Comments
1. Equipment
a. Automated equipment clean and well maintained · The equipment in the Biochemistry Lab appeared to be in good working condition, although dust was noted on the tops of several machines.
b. Biosafety and/or chemical containment cabinets present and regularly inspected
· The Microbiology Lab had a fume hood of an unknown type. However, one employee said it was not regularly inspected.
d. Splashguards in place where specimens are opened · There were no splashguards present in any visited laboratories.
e. Compressed gases (e.g., O2, N2O) chained in place, regularly inspected, and maintained
· There were many free-standing (i.e. not secured) compressed gas cylinders between patient beds, which could injure staff or patient if they fell. There was a reported case of a falling canister where the canister neck was broken at this facility. In addition, empty canisters were left free-standing outside.
f. Equipment and supplies designated as single use not reused (e.g., blood tubes, syringes).
· In all areas observed, no single-use supplies and equipment were reused.
g. Fire extinguishers available · Fire extinguishers were available in rooms, however several were not properly fastened to the wall.
h. Eye wash facilities available · There were no specific eye wash stations.
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Assessments and Recommendations• Waste Disposal• Needlestick Injury and other blood/ bodystick injuries• Sharps• Compressed Gas Canisters• Fire Extinguishers• Chemical Storage• Chemotherapy Drugs
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Acknowledgements• Dr. William (Bill) Roberts
• Dr. Ousman Nyan and his staff
• Dr. Samba Ceesay, Mr. Janko Jimbara and Mr. Bolong Jobarteh and other Members of the Ministry of Health
• Dr. M.I.A. Kahlil, Edward Francis Small Teaching Hospital
• Mr. Gibril Sumbunu
• Mr. Baboucarr Jallow, Mr. Omar Gaye, and Ms. Yamai Secka Jack
• UMB Center for Global Education Initiatives
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Questions?