Overview of OHS in CMC

1. OVERVIEW OF OCCUPATIONAL HEALTH IN CMC
AN UPDATE
Reginald G Alex
Occupational Health – CMC Vellore 1

2. SCOPE OF THE PRESENTATION
 Introduction
 Hazards in Hospitals
 OHS
 OH team and activities in CMC
Occupational Health – CMC Vellore 2

3. FOOD FOR THOUGHT !
By the seventh day God had finished the work He had been doing; so
on the seventh day He rested from all His work
Genesis 2:2
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4. FOOD FOR THOUGHT !
Define “WORKAHOLIC” !!
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5. 24hr Working Society
No workplace is
HAZARD free
Adverse Health
Effects
Sick Workforce Absenteeism
Prolonged illness
Poor performance
Poor safety
Substandard / Poor productivity
Occupational /
Work Related
THE RATIONALE
5

6. HAZARDS IN HOSPITAL
 Physical
 Dust and Occupational Asthma
 Occupational Dermatitis
 Radiation
 Noise
 Temperature
 Eye injuries
 Chemicals including anesthetic gases
 Biological hazards including animal bites
 Ergonomical hazards including man-machine handling, poor posture
 Psychosocial hazards including workplace stress
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7. WHY IS OH NEGLECTED IN HOSPITALS?
 Considered as low risk group
 Lack of awareness
 Lack of priority
 Lack of scientific evidence
 Priority to certain hazards
 Priority to certain groups
 Part time / Contract workers
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8. Premedical Checkup &
Vaccination
OCCUPATIONAL HEALTH SERVICE
Selection
Health Promotion
Hazards
Physical
Chemical
Biological
Ergonomical
Psychosocial
Surveillance
Health Protection
Biological Environmental
Clinical Non-Clinical
Periodic check up Sickness
Absenteeism
Persistent absence / ill
health
Appropriate guidelines for
control
Evaluation
Hazard Identification
RISK ASSESSMENT
Appropriate guidelines for
control
Reporting & Documentation Periodic Evaluation
Education Programs
Promotion Programs and Policies
Information/ Counseling Centers
8

9. CHRISTIAN MEDICAL COLLEGE
 located in Tamil Nadu in the southern part of India in a district called Vellore.
 Out patient : 6000 and In patient : 2500
 Working staff : 8809 (doctors, nurses and support staff )
 Students : 1462 (health science and allied health science students)
 Employees are the asset of an organization and they needs to be protected.
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10. INITIATIVE TAKEN BY CMC
One year training in National University of Singapore on
Occupational Health
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11. POST TRAINING INITIATIVES
 Need Assessment
 Staff awareness training on occupational hazards
 Hazards identification in specific areas
Small studies carried out
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12. SAMPLE STUDIES
Occupational Health – CMC Vellore 12

13. VISUAL AND MUSCULOSKELETAL ERGONOMICS STUDIES
 Visual and musculoskeletal ergonomics among professionals using
microscope in a tertiary care hospital in South India
Occupational Health – CMC Vellore 13
61.3% of people using microscope had at least 1 eye symptom
59.7% had neck pain
66.1% had back pain
Occurrence of eye symptoms and strain increase with increase in working hours on microscope
Occurrence of musculoskeletal symptoms increase with increase in working years on microscope

14. STUDIES ON NECK PAIN AMONG HEALTH CARE WORKERS
• Prevalence and risk factors for neck pain among Health Care
Workers
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The prevalence of neck pain among support staff in this tertiary care hospital was
36.9%
Women and those with a BMI of more than 25 were found to have a higher risk for
developing neck pain.
A lack of job control, bad posture and repetitive movements were also found to be
risk factors for developing neck pain.

15. ASSOCIATION BETWEEN SHIFT WORK AND METABOLIC SYNDROME STUDY
 The Association Between Rotating Shift Work And Metabolic Syndrome
Among Hospital Employees
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The prevalence of metabolic syndrome among the hospital employees studied
in CMC, Vellore was 33.1%
No significant statistical difference between the two groups for the prevalence
of metabolic syndrome after adjusting for other confounding factors.

16. DISEASE PROFILE & OUTCOME OF CMC STAFF /STUDENT ATTENDING THE ED
Total number studied – 1129
 73.39% of people belong to the age group 16 – 35
68.92% are female
33.16%) of the cases reporting to ED are GI illness/ Fever
An alarming 16.83% cases are trauma cases
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17. EMERGENCE OF THE OH TEAM
 Formation of Occupational Health Team under the HR directorate - 2013.
 The core committee
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Chairman Associate Director, HR
Convener Occupational Health officer
Members
Medical superintendent Nursing superintendent
General superintendent Dean (CON) or nominee
Deputy Director (Quality) Radiation Officer
Head SSHS Audit facilitation officer
Safety officer Head – Staff & training
Head Personnel

18. OCCUPATIONAL HEALTH TEAM
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19. SUB-COMMITTEE
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Physical
Dust and occupational Asthma Dr. Barney issac
Dermatology Dr. Dincy Peter
Radiology Dr. Rabbi Raja singh, Dr. Livingstone, Dr. Deva Kumar
Noise Dr. Anajali Lepcha, Ms. Jessi Sharma, Mr. Arul Prakash
Temperature/ Electrical,/Electromagnetic Mr. Eswaran
Vision Problem Dr. Padma Paul
Chemical
Lab Dr. Joe Fleming, Dr. Asha, Dr. Vijay Kumar
OP/Ward/Theatre Ms. Florence Ponnie, Ms. Margret
Biological
SSHS Dr. Henry
HICC Dr. Hema
Ergonomics Dr. Judy, Mr. Leny
Psychosocial Dr. Anju Kuruvilla

20. OBJECTIVE OF THE TEAM
Identifying potential Occupational Hazards or risk
Appropriate preventive strategies
Hazard communication to the employees
Educating employees regarding Occupational Hazards
Conduct frequent audits and checks to ensure compliance
Documentation of the health hazards and occupational diseases
Follow up
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21. APPROACH OF THE TEAM
 Specific hazards group formation
 Hazard Mapping
 Periodic Meetings
 Preventive strategies
 Implementation of preventive measures
 Education on safety practices
 Periodic monitoring
 Reporting and documentation
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22. HAZARD MAPPING
Occupational Health – CMC Vellore 22

23. HAZARD MAP OF CMC VELLORE
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24. POTENTIAL HAZARDOUS AREA IN CMC
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RADIATION RISK ZONES
Main Block R ward, Dept. of Radio diagnosis
Main Block Cardiology, Cath lab
Main Block Main OR
ISSCC Block CB OR
RT Block Basement1 and Basement 2
HIGH TEMPERATURE RISK ZONES
Main Block Laundry
Main Block CSSD
Main Block Main OR and TSSU
Engineering Block Boiler Section
NOISE RISK ZONES
Main Block Laundry
Main Block CSSD
Engineering Block Boiler Section
Engineering Block Generator room
Engineering Block Dietary

25. HAZARD MONITORING AND REPORTING
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26. NOISE HAZARD
High Risk Areas identified - CSSD,
Laundry and Boiler section
Measurement of Noise level
Audiogram testing of the Respective
staff
Personnel Protective Equipment's were
provided
Education on safe practices
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27. Noise level MEASUREMENT in BOILER, LAUNDRY & CSSD
 Noise levels were measured for 3 days on 3 different timings and on difference locations with
the help on an Audio Technician from ENT department
 Noise levels were found to be very high in Boiler, high in Laundry and CSSD
 Main source of noise were found to be the Equipment
Boiler Laundry CSSD
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28. AWARENESS PROGRAM
 Classes were conducted for Boiler Section Staff & CSSD
 Classes will be combined with Mandatory Training in future for all other
CMC staff
SIGNAGE’S & POSTERS
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29. SIGNAGE AND POSTERS
Occupational Health – CMC Vellore 29

30. NOISE RISK MITIGATION
• Audiogram
 Baseline audiogram tests for all staff in vulnerable areas
 Extend this test to all CMC staff & new all comers
 Include this test in Annual Medical Checkup
• RECOMMEND PROTECTIVE DEVICES & CONTROLS
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 Hearing protectors
 Ear Muffs
 Ear Plugs
 Administrative controls
Decreasing the exposure time
Limiting the number of personnel
exposed
 Engineering controls (costly)
 Enclosure
 Sound barriers
 Sound proof cabs
 Mufflers
 Equipment and exhaust

31. RADIATION HAZARD MITIGATION
 Personal monitoring devices
 Radiation safety accessories
 Radiation safety survey in diagnostic rooms
 Regular radiation dose monitoring of staff in cath labs
 Training modules on radiation safety
 Radiation safety awareness programs
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32. RADIATION HAZARD MITIGATION
Occupational Health – CMC Vellore 32

33. ERGONOMICAL HAZARD
 “Back school” with Physiotherapist, Occupational Therapist, Staff Clinic
Physician and Physiatrist started in 2010
 Awareness workshop on Point prevalence of Pain, Workstation design
and Exercises for WRMSDs
 Audits on Musculoskeletal health of staff
 Warm up exercises for staff in the department
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34. ERGONOMIC RISK MITIGATION
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35. CHEMICAL HAZARD
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36. CHEMICAL HAZARD
 Audit on Hazardous Chemical Spill (Mercury)
 Phasing out Mercury containing devices
 World Day for Safety and Health at Work 28.04.2015
 Sensitization of Staff on Occupational Hazards related to chemicals
 Hazmat Safety (e.g. Acid Safety)
 Chemical Spill Clean-up Protocol e.g. Mercury
 Significance of MSDS and their availability in their work place in our hospital
 Future Plan:
 HIRA Mapping of Chemical Hazards
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37. CHEMICAL HAZARD MITIGATION
Occupational Health – CMC Vellore 37
Dr. Joe Fleming addressing the gathering Mrs. Florence Ponnie explaining access to MSDS

38. BIOLOGICAL HAZARD
 Segregation protocol in place
 Training at all levels
 Labeling of bags
 Audit and feed back
 Construction of Temporary storage area
 Usage of PPE while handling waste
 Monthly review meetings
 Periodic site visit
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39. STUDY OF COMPLIANCE ON WASTE SEGREGATION
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40. PSYCHOSOCIAL HAZARD
 Increasing awareness on identification of and consequences of
stress in the workplace
 Increasing awareness on methods of dealing with stress
including life style modification, environmental modification,
meditation, yoga, regular exercise.
 Providing a help-line and dedicated counsellors
 Providing confidential and effective redressal processes.
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41. PERIODIC MEETINGS
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42. PERIODIC MEETINGS
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43. OTHER ACTIVITIES
 In the 1st National Conference on Safety held on January 2014,
one of the component was focused on Occupational Health
 Occupational Health Day was celebrated on 28th of April 2015
and the Occupational Health logo was released which was
designed by one medical student and one nurse.
 The 1st National Conference on Occupational Health is going to
held on 30th and 31st of October 2015
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44. OH DAY CELEBRATION – APRIL 28TH, 2015
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45. OCCUPATIONAL HEALTH IN CMC LOGO
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46. ACADEMIC ACTIVITIES
 Introduction of Occupational Health subject in MBBS, MPhil,
Occupational Therapy, Physiotherapy and nursing curriculum
 Seminars on importance of occupational health and hazards
 Factory visits
 Research activities by MBBS, PG and Nursing students
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47. THE ROAD AHEAD
 Strengthening of the team
 Creating modules
 Improving staff awareness and education through CMEs and
Quality circle
 Improving monitoring system
 Proper reporting system
 Policy making
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48. THANK YOU
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