A hospital is not an isolated social environment; it has, given its mission, very serious intrinsic social responsibilities. A hospital needs to be integrated with its surroundings and should minimize its impact upon them, thus contributing to the welfare of the people who live near it.
From a regulatory perspective, the health industry has never been considered to be on the same level as other industries when they are ranked according to the health risks they pose. The result is that specific legislation in this sphere has been non-existent until recently, although in the last few years this deficiency has been addressed. While in many other kinds of industrial activities, health and safety is an integral part of the organization, most health centres still pay little or no attention to it.
One reason for this could be the attitudes of HCWs themselves, who may be preoccupied more with research and the acquisition of the latest technologies and diagnostic and treatment techniques than with looking into the effects that these advances could have on their own health and on the environment.
New developments in science and health care must be combined with environmental protection, because environmental policies in a hospital affect the quality of life of HCWs within the hospital and those who live outside it.
Integrated Health, Safety and Environmental Programmes
HCWs represent a major group, comparable in size to the large enterprises of the private sector. The number of people who pass through a hospital every day is very large: visitors, inpatients, outpatients, medical and commercial representatives, subcontractors and so on. All of them, to a greater or lesser degree, are exposed to the potential risks posed by the activities of the medical centre and, at the same time, contribute on a certain level to the improvement or the worsening of the safety and the care of the centre’s surroundings.
Strict measures are needed in order to safeguard HCWs, the general public and the surrounding environment from the deleterious effects that may stem from hospital activities. These activities include the use of ever more sophisticated technology, the more frequent use of extremely powerful drugs (the effects of which can have a profound and irreparable impact on the people who prepare or administer them), the too-often uncontrolled use of chemical products and the incidence of infectious diseases, some of which are incurable.
The risks of working in a hospital are many. Some are easy to identify, while others are very hard to detect; the measures to be taken should therefore always be rigorous.
Different groups of health professionals are particularly exposed to risks common to the health care industry in general, as well as to specific risks related to their profession and/or to the activities they perform in the course of their work.
The concept of prevention, therefore, must of necessity be incorporated to the health care field and encompass:
- safety in the broadest sense, including psychosociology and ergonomics as part of the programmes to improve the quality of life in the workplace
- hygiene, minimizing as much as possible any physical, chemical or biological factor that may affect the health of people in the work environment
- environment, following policies to protect nature and people in the surrounding community and decreasing the impact on the environment.
We should be aware that the environment is directly and intimately related to the safety and hygiene in the workplace, because natural resources are consumed at work, and because these resources are later reincorporated into our surroundings. Our quality of life will be good or bad depending on whether we make correct use of these resources and use appropriate technologies.
Everyone’s involvement is necessary in order to contribute to further:
- nature conservancy policies, designed to guarantee the survival of the natural heritage that surrounds us
- environmental improvement policies as well as policies to control indoor and environmental pollution in order to integrate human activity with the environment
- environmental research and training policies to improve working conditions as well as to reduce environmental impact
- planning organizational policies designed to set goals and develop norms and methodology for workers’ health and the environment.
Such a programme should endeavour to:
- change the culture and habits of health professionals in order to stimulate behaviour more conducive to safeguarding their health
- set goals and develop internal safety, hygiene and environmental guidelines through adequate planning and organization
- improve the methods of work to avoid a negative impact on health and the environment through environmental research and education
- increase the involvement of all personnel and have them take responsibility for health in the workplace
- create an adequate programme to establish and publicize the guidelines as well as to monitor their continued implementation
- correctly classify and manage the waste generated
- optimize costs, avoiding added expenditures that cannot be justified by the increased levels of safety and health or environmental quality.
A hospital should be conceived as a system that, through a number of processes, generates services. These services are the main goal of the activities performed in a hospital.
For the process to begin, certain commitments of energy, investments and technology are needed, which in turn will generate their own emissions and wastes. Their only aim is to provide service.
In addition to these prerequisites, consideration should be given to the conditions of the areas of the building where these activities will take place, since they have been designed a certain way and built with basic construction materials.
Control, planning and coordination are all necessary for an integrated safety, health and environmental project to succeed.
Because of the complexity and the variety of risks in the health care field, multidisciplinary groups are required if solutions to each particular problem are to be found.
It is important for health care workers to be able to collaborate with safety studies, participating in the decisions that will be made to improve their working conditions. This way changes will be seen with a better attitude and the guidelines will be more readily accepted.
The safety, hygiene and environmental service should advise, stimulate and coordinate the programmes developed at the health centre. Responsibility for their implementation should fall upon whoever heads up the service where this programme will be followed. This is the only way to involve the entire organization.
In each particular case, the following will be selected:
- the system involved
- the parameters of the study
- the time needed to carry it out.
The study will consist of:
- an initial diagnosis
- analysis of the risk
- deciding on the course of action.
In order to implement the plan successfully it will always be necessary to:
- educate and inform people of the risks
- improve the management of human resources
- improve the channels of communication.
This type of study may be a global one encompassing the centre as a whole (e.g., internal plan for the disposal of hospital wastes) or partial, encompassing only one concrete area (e.g., where cancer chemotherapeutic drugs are prepared).
The study of these factors will give an idea of the degree to which safety measures are disregarded, as much from the legal as from the scientific point of view. The concept of “legal” here encompasses advances in science and technology as they occur, which requires the constant revision and modification of established norms and guidelines.
It would be convenient indeed if the regulations and the laws by which safety, hygiene and the environment are regulated were the same in all countries, something that would make the installation, management and use of technology or products from other countries much easier.
The following examples show some of the measures that can be taken while following the aforementioned methodology.
An advisory service can be developed involving professionals of the various laboratories and coordinated by the safety and hygiene service of the medical centre. The main goal would be to improve the safety and health of the occupants of all the labs, involving and giving responsibility to the entire professional staff of each and trying at the same time to make sure that these activities do not have a negative impact on public health and the environment.
The measures taken should include:
- instituting the sharing of materials, products and equipment among the different laboratories, in order to optimize resources
- reducing the stocks of chemical products in laboratories
- creating a manual of basic norms of safety and hygiene
- planning courses to educate all laboratory workers on these matters
- training for emergencies.
Thermometers, when broken, release mercury into the environment. A pilot project has been started with “unbreakable” thermometers to consider eventually substituting them for the glass thermometers. In some countries, such as the United States, electronic thermometers have replaced mercury thermometers to a very great extent.
Training the workers
The training and the commitment of the workers is the most important part of an integrated safety, health and environment programme. Given enough resources and time, the technicalities of almost any problem can be solved, but a complete solution will not be achieved without informing the workers of the risks and training them to avoid or control them. The training and education must be continuous, integrating health and safety techniques into all the other training programmes in the hospital.
The results that have been achieved so far in applying this work model allow us so far to be optimistic. They have shown that when people are informed about the whys and wherefores, their attitude toward change is very positive.
The response of health care personnel has been very good. They feel more motivated in their work and more valued when they have participated directly in the study and in the decision-making process. This participation, in turn, helps to educate the individual health care worker and to increase the degree of responsibility he or she is willing to accept.
The attainment of the goals of this project is a long-term objective, but the positive effects it generates more than compensate for the effort and the energy invested in it.