Occupational health and safety risks in the healthcare sector Guide to prevention and good practice This publication is supported by the European Union Programme for Employment and Social Solidarity - PROGRESS (2007-2013). This programme is implemented by the European Commission. It was established to financially support the implementation of the objectives of the European Union in the employment, social affairs and equal oppor- tunities area, and thereby contribute to the achievement of the Europe 2020 Strategy goals in these fields. The seven-year Programme targets all stakeholders who can help shape the development of appropriate and effective employment and social legislation and policies, across the EU-27, EFTA-EEA and EU candidate and pre-candidate countries. For more information see: http://ec.europa.eu/progress Occupational health and safety risks in the healthcare sector European Commission Directorate-General for Employment, Social Affairs and Inclusion Unit B.3 Manuscript completed in December 2010 Neither the European Commission nor any person acting on behalf of the Commission may be held responsible for the use that may be made of the information contained in this publication. © Cover photos: iStock For any use or reproduction of photos which are not under European Union copyright, permission must be sought directly from the copyright holder(s). This guide has been produced by the Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA), Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), contec Gesellschaft für Organisationsentwicklung mbH, Deutsches Netz Gesundheitsfördernder Krankenhäuser (DNGfK) and BAD/ Team Prevent GmbH. Europe Direct is a service to help you find answers to your questions about the European Union Freephone number (*): 00 800 6 7 8 9 10 11 (*) Certain mobile telephone operators do not allow access to 00 800 numbers or these calls may be billed. More information on the European Union is available on the Internet (http://europa.eu). Cataloguing data as well as an abstract can be found at the end of this publication. Luxembourg: Publications Office of the European Union, 2011 ISBN 978-92-79-19454-2 doi:10.2767/27263 © European Union, 2011 Reproduction is authorised provided the source is acknowledged. Printed in Luxembourg PRINTED ON ELEMENTAL CHLORINE-FREE BLEACHED PAPER (ECF) Contents Preamble 7 Introduction and vision 11 1. Prevention and health promotion as a management task 13 Description of good company practice 21 2. How to carry out a risk assessment 23 2.1. Introduction 24 2.2. Roles and responsibilities 24 2.3. What should be considered before I start the risk assessment 28 2.4. How do I get started with the risk assessment? 28 2.5. Inclusion of gender aspects in the risk assessment 34 2.6. Description of good company practice 35 2.7. Links 40 2.8. Relevant European Union directives 43 2.9. OiRA: Online risk assessment tool, EU-OSHA 43 2.10. Literature 43 2.11. Example of a risk assessment based on the task of manually handling patients 44 2.12. Example of a risk assessment based on the task of surface disinfection 45 3. Biological risks 49 3.1. Introduction 50 3.2. General risk assessment of potential occupational exposure to infection 51 3.3. Special risk assessment of biological risks 69 3.3.1. Risk of blood-borne infections 69 3.3.2. Risk of airborne infection 80 3.3.3. Risk of direct and indirect contact infection 84 3.3.4. Description of good company practice: 88 - handling contact infections - preventive measures in the ambulance service 90 3.3.5. Special infections 92 3 3.4. Pregnancy 101 3.5. Relevant European Union directives 102 3.6. Links 103 3.7. Literature 105 4. Musculoskeletal risks 107 4.1. Risks for the development of musculoskeletal disorders 108 4.1.1. Introduction 108 4.1.2. Nature of the risk 109 4.1.3. Basic criteria for a specific risk assessment for the prevention of MSDs 111 4.1.4. Work situations with the greatest exposure 116 4.1.5. Effects on health and safety 121 4.1.6. Preventive and protective measures 124 4.1.7. Behaviour in critical situations — Recommendations for workers 132 4.1.8. Main messages and conclusions 136 4.1.9. Relevant European Union directives 137 4.1.10. Description of good company practice 139 4.1.11. Links 151 4.1.12. Literature 156 4.2. Prevention of accidents due to slips, trips and falls (85) 157 4.2.1. Introduction 157 4.2.2. Nature of the risk 158 4.2.3. Basic criteria for a specific risk assessment for the prevention of slip, trip and fall accidents 159 4.2.4. Work situations with the greatest exposure 160 4.2.5. Effects on health and safety 161 4.2.6. Preventive and protective measures 161 4.2.7. Personal protective equipment 164 4.2.8. Behaviour in critical situations — Recommendations for workers 166 4.2.9. Main messages and conclusion 166 4.2.10. Relevant European Union directives 166 4.2.11. Links 168 4.2.12. Literature 170 5. Psychosocial risks 171 5.1. Introduction 172 5.2. Stress and burnout 176 5.2.1. Nature of risk dealt with 176 5.2.2. Basic criteria for a specific risk assessment 176 5.2.3. Work situations with the greatest exposure 182 4 5.2.4. Effects on health and safety 182 5.2.5. General preventive and protective measures 183 5.2.6. Description of specific preventive techniques and procedures 184 5.3. Prevention and monitoring of violence and mobbing (bullying and harassment) at the workplace 186 5.3.1. Nature of the risk dealt with 186 5.3.2. Basic criteria for a specific risk assessment 188 5.3.3. Work situations with the greatest exposure 192 5.3.4. Effects on health and safety 192 5.3.5. General preventive and protective measures 193 5.3.6. Description of the specific preventive techniques and procedures 194 5.3.7. Examples of good corporate practice 194 5.3.8. Appropriate modes of behaviour in critical situations 194 5.3.9. Most important knowledge and conclusions 195 5.4. Working hours 196 5.4.1. Nature of risk dealt with 196 5.4.2. Basic criteria for a specific risk assessment 196 5.4.3. Description of the work situations with the greatest exposure 198 5.4.4. Descriptions of the effects on health and safety 198 5.4.5. General preventive and protective measures 200 5.4.6. Description of the specific preventive techniques and procedures 201 5.4.7. Examples of good corporate practice 201 5.4.8. Appropriate modes of behaviour in critical situations 202 5.4.9. Most important knowledge and conclusion 202 5.5. Drug abuse 203 5.5.1. Nature of the risk dealt with 203 5.5.2. Basic criteria for a specific risk assessment 203 5.5.3. Work situations with the greatest exposure 205 5.5.4. Effects on health and safety 205 5.5.5. General preventive and protective measures 205 5.5.6. Specific preventive techniques and procedures 205 5.5.7. Appropriate modes of behaviour in critical situations 206 5.5.8. Most important knowledge and conclusions 207 5.6. Relevant European Union directives 208 5.7. Description of good company practice 209 5.7.1. Interview with Havelland Clinics, Nauen, on psychosocial risks 209 5.7.2. Interview with St Elisabeth Hospital, Tilburg, on psychosocial risks 211 5.8. Links 213 5.9. Literature 215 Annex 217 5 6. Chemical risks 219 6.1. Introduction 220 6.2. Nature of the risk dealt with: Special risks attributed to dangerous substances and preparations 221 6.3. Basic criteria for assessing chemical risks 221 6.3.1. Risk assessment 225 6.4. General preventive and protective measures (135)(136): Implementation of protective measures taking into account the risk assessment 227 6.4.1. Protective measures (137)(138) 227 6.4.2. Provision of information/instruction to workers 229 6.4.3. Monitoring the effectiveness of measures 230 6.5. Cleaning and disinfection work 230 6.5.1. Descriptions of the work situations with the greatest exposure 231 6.5.2. Description of the effect on health and safety 232 6.5.3. Specific preventive techniques and procedures 233 6.6. Cytostatic/cytotoxic drugs 234 6.6.1. Description of the work situations with the greatest exposure 234 6.6.2. Description of the effect on health and safety 236 6.6.3. Specific prevention techniques and procedures 236 6.7. Activities involving anaesthetic gases 241 6.7.1. Description of work with maximum exposure 242 6.7.2. Description of the effect on health and safety 242 6.7.3. Specific prevention techniques and procedures 244 6.8. Activities involving substances which endanger reproduction 247 6.9. Relevant European Union directives 250 6.10. Description of good company practice 251 6.10.1. Interview with General Hospital Vienna (AKH Vienna) on safe working in disinfection activities 251 6.10.2. Working safely with cytostatic drugs 254 6.11. Links 258 6.12. Literature 263 Imprint 265 Annexes 269 6 Preamble OccupaTional healTH and SAFETY risKS in The healThcare secTor About 10 % of workers in the European Union belong to the health and welfare sector, and many of them work in hospitals. These workers may be exposed to a very wide variety of risks. EU legislation on health and safety at work currently covers most of these risks — nevertheless, the combination of such diverse risks arising at the same time and the fact that this is clearly a high-risk sector have given rise to a debate on the need for a specific approach in order to improve the protection of the health and safety of hospital personnel at Union level.