Warehousing has long been a global industry; warehouses are integrally linked to commerce and transportation of goods—by rail, sea, air and road. Warehouses may be classified by the type of products stored: food products stored in dry, chilled or frozen sections; clothing or textiles; construction equipment or materials; machinery or machine parts. In the United States in 1995, for exemple, 1,877,000 workers were employed in trucking and warehousing (BLS 1996); this statistic cannot presently be disaggregated into workers by warehouse type or category. Warehouses might sell directly to external (retail) or internal (wholesale) customers, and the quantities retrieved for customers may be either full-pallet or less-than-full-pallet (one or more cases selected from a single pallet). Mechanical means (fork-lifts, conveyors or automatic storage and retrieval systems (AS/RS)) may be used to transport full-pallet or less-than-full-pallet loads; or workers, working without pallet movers and conveyors, may manually handle stored materials. Regardless of the nature of the business, the products stored or the mode of transportation servicing the warehouse, the basic layout is quite uniform, although the operational scale, terminology and technology will likely differ. (For additional information on AS/RS in warehousing, see Martin 1987.)

Products are delivered by shippers or suppliers to a receiving dock, where they are then entered into either a manual or computerized inventory system, assigned a storage rack or “slot” location (an address) and then transported to that location, usually by mechanical means (conveyors, AS/RS, fork-lift trucks or tractors). Once a customer order is received, the desired containers or cases must be retrieved from their slot location. Where full pallets are retrieved, mechanical means (a fork-lift or tractor operator) are used (see figure 1). When less than a full pallet load (one or more cases from a rack or slot) is to be retrieved, manual material handling is required, using a worker called a selector, who will choose the desired number of cases and place them either onto a mechanical pallet mover, a push cart or a conveyor. The individual customer order is assembled onto a pallet or similar container for shipment to the customer; a label, tag or other mark containing invoice/billing and/or routing instructions is then applied. This task may be performed by the order selector or fork-lift operator, or, where conveyors are used to deliver single cases for final assembly, by an assembler. When the order is ready for shipment, it is loaded by mechanical means onto the truck, trailer, railroad car or ship. (See figure 2).

Figure 1. A fork-lift truck in a warehouse in the United Kingdom being loaded with apples.

Figure 2. A dockworker in the United Kingdom using lifting machines to move quarters of beef.

Approximately 60% of the work activity in the warehouse is directly related to travel; the remainder relates to manual material handling. Aside from the important work of clerks, dispatchers, cleaners, supervisors and managers, the main work of the warehouse relating to the transporting and handling of goods is performed primarily by two classes of workers: fork-lift operators and selectors.

Intense worldwide competition and the rapid entrance of new firms have created the drive for increased labour and space efficiency, spawning a new discipline called warehouse management systems (WMSs) (Register 1994). These systems are becoming increasingly less expensive and more powerful; they rely on computer networks, bar coding, computer software and radio-frequency communications systems to vastly increase management and control of warehouse inventory and operations, allowing warehouses to improve customer order response times and responsiveness while dramatically increasing inventory accuracy and reducing costs (Firth 1995).

WMSs essentially computerize inventory and order dispatch systems. When incoming product from a supplier or shipper arrives at the receiving dock, bar code scanners record the product code and name, instantly updating the inventory database while assigning the incoming product an address in the warehouse. A fork-lift operator is then alerted to pick up and deliver the stock via a radio-frequency communications system mounted on the vehicle.

Orders from customers are received by another computer program which looks up the product address and availability of each item ordered in the inventory database and then sorts the customer order by the most efficient travel path to minimize travel. Labels with the product name, code and location are printed out for use by the order selectors who must then fill this order. While these features clearly help improve customer service and improve efficiency, they are important preconditions for engineered work standards (EWSs), which may pose additional health and safety hazards for both fork-lift operators and order selectors.

Information about each order—the number of cases, travel distances and so on—which is generated by the order dispatch programme can be further combined with standard or allowed times for each activity to calculate an overall standard time for selecting a particular customer order; it would be extremely time-consuming and difficult to retrieve this information without the use of the computer hardware and databases. Computer monitoring can then be used to record the elapsed time on each order, compare the actual with the allowed time and then compute an efficiency index, which any supervisor or manager can look up by pressing a few computer keys.

Warehouse EWSs have spread from the United States to Australia, Canada, the United Kingdom, Germany, Austria, Finland, Sweden, Italy, South Africa, the Netherlands and Belgium. While WMS systems themselves do not necessarily add safety and health hazards, there is considerable evidence to suggest that the resulting increased workload, lack of control over work pace and the impact of increased frequency of lifting contribute significantly to increased injury risk. In addition, the time pressure imposed by work standards may force workers to take risky short cuts and not utilize proper safe work methods. These risks and hazards are described below.

Hazards

In the most basic warehouse, regardless of the level of technology and computerization, there are a myriad of basic health and safety hazards; modern WMSs can be linked with a different order of health and safety hazards.

Basic health hazards begin with potentially toxic materials which may be stored in warehouses; examples include petroleum products, solvents and dyestuffs. These require proper labelling, employee education and training and an effective hazard communication programme (including MSDSs) for all affected workers, who often know little about the health effects of what they are handling, much less proper handling, spill and clean-up procedures. (See, for example, the ILO Chemicals Convention, 1990 (No. 170), and Recommendation, 1990 (No. 177).) Noise may be present from gasoline or LP-powered fork-lifts, conveyors, ventilation systems and pneumatically-actuated equipment. Additionally, workers who operate such equipment may be subject to whole-body vibration. (See, for example, the ILO Working Environment (Air Pollution, Noise and Vibration) Convention, 1977 (No. 148), and Recommendation, 1977 (No. 156).)

Both fork-lift operators and selectors may be exposed to diesel and gasoline exhaust from trucks at the loading and receiving docks, as well as from fork-lifts. Lighting may not be adequate for fork-lift and other vehicle traffic or for ensuring proper identification of products desired by customers. Workers assigned to work in cold and frozen storage areas may experience cold stress from exposure to cold temperatures and air recirculation systems; temperatures in many freezer storage areas can approach –20ºC, even without wind chill factors being considered. Moreover, since few warehouses are air conditioned during warm months, warehouse workers, particularly those performing manual material handling, may be exposed to heat stress problems.

Safety hazards and risks are also many and varied. Besides the more obvious hazards evident when pedestrians and any motor-driven vehicle are put into the same work area, many of the injuries occurring among warehouse workers include slips, trips and falls from floors not kept free of ice, water or spilled product or that are poorly maintained; a number of injuries involve fork-lift operators who slip or fall while mounting or dismounting their fork-lift trucks.

Workers are often exposed to falling product from overhead racks. Workers may be caught in or between fork-lift masts, forks and cargo, resulting in serious physical injury. Wooden pallets handled by workers often result in exposure to slivers and related puncture wounds. Using knives to cut apart boxes and cases often results in cuts and lacerations. Workers who move boxes or containers on or off conveyors may be exposed to in-running nip points. Selectors, assemblers and other workers engaged in manual material handling are exposed to varying degrees of risk of developing low-back pain and other related injuries. Weight-lifting regulations and recommended methods for materials handling are discussed elsewhere in the Encyclopaedia.

Recordable injuries and lost workday cases in the US warehouse industry, for example, are considerably higher than those for all industry.

Data regarding injuries (and particular back injuries) among grocery order selectors, the group at greatest risk from lifting-related injuries, are not available on a national or international scale. The US NIOSH, however, has studied lifting and other related injuries at two grocery warehouses in the United States (see US NIOSH) and found that “all order selectors have an elevated risk for musculoskeletal disorders, including low-back pain, because of the combination of adverse job factors, all contributing to fatigue, a high metabolic load and the workers’ inability to regulate their work rate because of the work requirements” (NIOSH 1995).

A comprehensive application of ergonomics to the warehouse should not be confined to lifting and to order selectors. A wide focus is required, involving detailed job analysis, careful measurement and assessment (part of the job analysis begins with the job safety analyses below). A more comprehensive look at the design of racks and shelves is required, as is establishment of a closer working relationship with suppliers to design or retrofit fork-lift controls to reduce ergonomic risk factors (extensive reaches, foot flexion and extension, winging, awkward neck and body positions) and to design containers that are less heavy and bulky, with handles or grips to reduce lifting risk.

Corrective Actions

Basic health hazards

Employers, workers and trade unions should cooperate to develop and implement an effective hazard communication programme which emphasizes the three following fundamentals:

1. adequate labelling of all toxic substances
2. availability of detailed MSDSs that provide more detailed information about health effects, fire, reactivity, PPE, first aid, spill clean-up and other emergency procedures
3. regular and relevant worker training in proper handling of these substances.

Lack of an effective hazard communication programme is one of the most frequent standards violations cited in this industry by the US Occupational Safety and Health Administration (OSHA).

Noise and vibration from mechanical equipment, conveyors and other sources require frequent noise and vibration testing and worker training, as well as engineering controls where needed. These controls are most effective when applied at the source of the noise in the form of noise insulation, mufflers and other controls (since most fork-lift operators are seated on top of the engine, vibration and noise dampening at this point are generally most effective). Lighting should be checked frequently and maintained at levels sufficient to reduce vehicle-pedestrian accidents and ensure that product identification and other information can be easily read. Heat (or cold) stress prevention programmes should be implemented for workplaces in warm and humid climates and for selectors or fork-lift operators assigned to cold storage or freezer rooms, to ensure that workers receive adequate breaks, fluids, training and information and that other preventive measures are implemented. Finally, where diesel or petroleum-based fuels are used, exhaust systems should be periodically tested for emissions of carbon monoxide and nitrogen oxides to ensure that they are within safe levels. Proper maintenance of vehicles and restricting their use to adequately ventilated areas will also help reduce the risk of over-exposure to these emissions.

Safety hazards for fork-lift and vehicle operators

Vehicle-pedestrian accidents are a constant risk in any warehouse. Pedestrian lanes should be clearly marked and respected. All vehicle operators should receive training in the safe operation of the vehicle, including traffic rules and speed limits; refresher training should also be considered. Mirrors should be installed at busy intersections or at blind corners to enable vehicle operators to check for traffic or pedestrians before proceeding, and operators should sound their horn before proceeding; back-up beepers or signals may also be considered. Dockplates from loading and receiving docks to the truck, railroad car or barge need to be sufficient to support the load and adequately secured.

Table 2 gives a job safety analysis for fork-lift operators, with recommendations.

Table 2. Job safety analysis: Fork-lift operator.

Implementing ergonomic solutions will require closer coordination with fork-lift and vehicle manufacturers; relying solely upon operator training and traffic rules will not eliminate hazards by itself. In addition, safety and health regulatory agencies have prepared mandatory standards for the design and use of fork-lifts—for example, requiring overhead guards to offer protection against falling objects (see figure 3).

Figure 3. An overhead guard fitted to a fork-lift truck.

Safety hazards for order selectors

Table 3 is a job safety analysis listing most of the corrective actions necessary to reduce the safety and lifting hazards for order selectors. However, just as improved fork-lift design to reduce ergonomic risk factors requires closer coordination with vehicle manufacturers, reducing safety and lifting hazards for order selectors requires similar coordination with designers of racking systems, consultants who design and install warehouse control systems and engineered standards systems and the vendors who store their products in the warehouse. The latter can be enlisted to design products that are less bulky, weigh less and have better handles or grips. Rack manufacturers can be very helpful in designing and retrofitting rack systems which allow the selector to stand upright during selection.

Table 3. Job safety analysis: Order selector.

Consultants who design and install warehouse control systems and engineered standards need to be more aware of the health and safety risks concerning the effect of work intensification on manual material-handling injuries. NIOSH (1993a, 1995) has recommended that more objective forms of determining fatigue allowance, such as oxygen consumption or heart rate, be used. They have also recommended that the height of the pallet being constructed (the “cube”) be limited to no more than 150 cm, and that there be an “order break” after one pallet has been assembled by the order selector, thus increasing the frequency of recovery periods between orders. In addition to more frequent breaks, NIOSH has recommended restricting overtime for workers based on engineered standards, considering worker rotation and installing “light duty” programmes for order selectors who return from injury or leave.

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An adaptation of current guidelines on the disposal of hospital wastes, as well as improvements in internal safety and hygiene, must be part of an overall plan of hospital waste management that establishes the procedures to follow. This should be done through properly coordinating internal and external services, as well as defining responsibilities in each of the management phases. The main goal of this plan is to protect the health of health care personnel, patients, visitors and the general public both in the hospital and beyond.

At the same time, the health of the people who come in contact with the waste once it leaves the medical centre should not be overlooked, and the risks to them should also be minimized.

Such a plan should be campaigned for and applied according to a global strategy that always keeps in mind the realities of the workplace, as well as the knowledge and the training of the personnel involved.

Stages followed in the implementation of a waste management plan are:

• informing the management of the medical centre

• designating those responsible at the executive level

• creating a committee on hospital wastes made up of personnel from the general services, nursing and medical departments that is chaired by the medical centre’s waste manager.

The group should include personnel from the general services department, personnel from the nursing department and personnel from the medical department. The medical centre’s waste manager should coordinate the committee by:

• putting together a report on the present performance of the centre’s waste management

• putting together an internal plan for advanced management

• creating a training programme for the entire staff of the medical centre, with the collaboration of the human resources department

• launching the plan, with follow-up and control by the waste management committee.

Classification of hospital wastes

Until 1992, following the classical waste management system, the practice was to classify most hospital wastes as hazardous. Since then, applying an advanced management technique, only a very small proportion of the large volume of these wastes is considered hazardous.

The tendency has been to adopt an advanced management technique. This technique classifies wastes starting from the baseline assumption that only a very small percentage of the volume of wastes generated is hazardous.

Wastes should always be classified at the point where they are generated. According to the nature of the wastes and their source, they are classified as follows:

• Group I: those wastes that can be assimilated into urban refuse

• Group II: non-specific hospital wastes

• Group III: specific hospital wastes or hazardous wastes

• Group IV: cytostatic wastes (surplus antineoplastic drugs that are not fit for therapeutic use, as well as the single-use materials that have been in contact with them, e.g., needles, syringes, catheters, gloves and IV set-ups).

According to their physical state, wastes can be classified as follows:

• solids: wastes that contain less than 10% liquid

• liquids: wastes that contain more than 10% liquid

Gaseous wastes, such as CFCs from freezers and refrigerators, are not normally captured (see article “Waste anaesthetic gases”).

By definition, the following wastes are not considered sanitary wastes:

• radioactive wastes that, because of their very nature, are already managed in a specific way by the radiological protection service

• human cadavers and large anatomical parts which are cremated or incinerated according to regulations

• waste water.

Group I Wastes

All wastes generated within the medical centre that are not directly related to sanitary activities are considered solid urban wastes (SUW). According to the local ordinances in Cataluna, Spain, as in most communities, the municipalities must remove these wastes selectively, and it is therefore convenient to facilitate this task for them. The following are considered wastes that can be assimilated to urban refuse according to their point of origin:

Kitchen wastes:

• food wastes

• wastes from leftovers or single-use items

• containers.

Wastes generated by people treated in the hospital and non-medical personnel:

• wastes from cleaning products

• wastes left behind in the rooms (e.g., newspapers, magazines and flowers)

• wastes from gardening and renovations.

Wastes from administrative activities:

• paper and cardboard

• plastics.

Other wastes:

• glass containers

• plastic containers

• packing cartons and other packaging materials

• dated single-use items.

So long as they are not included on other selective removal plans, SUW will be placed in white polyethylene bags that will be removed by janitorial personnel.

Group II Wastes

Group II wastes include all those wastes generated as a by-product of medical activities that do not pose a risk to health or the environment. For reasons of safety and industrial hygiene the type of internal management recommended for this group is different from that recommended for Group I wastes. Depending on where they originate, Group II wastes include:

Wastes derived from hospital activities, such as:

• blood-stained materials

• gauze and materials used in treating non-infectious patients

• used medical equipment

• mattresses

• dead animals or parts thereof, from rearing stables or experimental laboratories, so long as they have not been inoculated with infectious agents.

Group II wastes will be deposited in yellow polyethylene bags that will be removed by janitorial personnel.

Group III Wastes

Group III includes hospital wastes which, due to their nature or their point of origin, could pose risks to health or the environment if several special precautions are not observed during handling and removal.

Group III wastes can be classified in the following way:

Sharp and pointed instruments:

• needles

• scalpels.

Infectious wastes. Group III wastes (including single-use items) generated by the diagnosis and treatment of patients who suffer from one of the infectious diseases are listed in table 1.

Table 1. Infectious diseases and Group III wastes

Laboratory wastes:

• material contaminated with biological wastes

• waste from work with animals inoculated with biohazardous substances.

Wastes of the Group III type will be placed in single-use, rigid, colour-coded polyethylene containers and hermetically sealed (in Cataluna, black containers are required). The containers should be clearly labelled as “Hazardous hospital wastes” and kept in the room until collected by janitorial personnel. Group III wastes should never be compacted.

To facilitate their removal and reduce risks to a minimum, containers should not be filled to capacity so that they can be closed easily. Wastes should never be handled once they are placed in these rigid containers. It is forbidden to dispose of biohazardous wastes by dumping them into the drainage system.

Group IV Wastes

Group IV wastes are surplus antineoplastic drugs that are not fit for therapeutic use, as well as all single-use material that has been in contact with the same (needles, syringes, catheters, gloves, IV set-ups and so on).

Given the danger they pose to persons and the environment, Group IV hospital wastes must be collected in rigid, watertight, sealable single-use, colour-coded containers (in Cataluna, they are blue) which should be clearly labelled “Chemically contaminated material: Cytostatic agents”.

Other Wastes

Guided by environmental concerns and the need to enhance waste management for the community, medical centres, with the cooperation of all personnel, staff and visitors, should encourage and facilitate the selective disposal (i.e., in special containers designated for specific materials) of recyclable materials such as:

• paper and cardboard

• glass

• used oils

• batteries and power cells

• toner cartridges for laser printers

• plastic containers.

The protocol established by the local sanitation department for the collection, transport and disposal of each of these types of materials should be followed.

Disposal of large pieces of equipment, furniture and other materials not covered in these guidelines should follow the directions recommended by the appropriate environmental authorities.

Internal transport and storage of wastes

Internal transport of all the wastes generated within the hospital building should be done by the janitorial personnel, according to established schedules. It is important that the following recommendations be observed when transporting wastes within the hospital:

• The containers and the bags will always be closed during transport.

• The carts used for this purpose will have smooth surfaces and be easy to clean.

• The carts will be used exclusively for transporting waste.

• The carts will be washed daily with water, soap and lye.

• The waste bags or containers should never be dragged on the floor.

• Waste should never be transferred from one receptacle to another.

The hospital must have an area specifically for the storage of wastes; it should conform to current guidelines and fulfil, in particular, the following conditions:

• It should be covered.

• It should be clearly marked by signs.

• It should be built with smooth surfaces that are easy to clean.

• It should have running water.

• It should have drains to remove the possible spillage of waste liquids and the water used for cleaning the storage area.

• It should be provided with a system to protect it against animal pests.

• It should be located far away from windows and from the intake ducts of the ventilation system.

• It should be provided with fire extinguishing systems.

• It should have restricted access.

• It should be used exclusively for the storage of wastes.

All the transport and storage operations that involve hospital wastes must be conducted under conditions of maximum safety and hygiene. In particular, one must remember:

• Direct contact with the wastes must be avoided.

• Bags should not be overfilled so that they may be closed easily.

• Bags should not be emptied into other bags.

Liquid Wastes: Biological and Chemical

Liquid wastes can be classified as biological or chemical.

Liquid biological wastes

Liquid biological wastes can usually be poured directly into the hospital’s drainage system since they do not require any treatment before disposal. The exceptions are the liquid wastes of patients with infectious diseases and the liquid cultures of microbiology laboratories. These should be collected in specific containers and treated before being dumped.

It is important that the waste be dumped directly into the drainage system with no splashing or spraying. If this is not possible and wastes are gathered in disposable containers that are difficult to open, the containers should not be forced open. Instead, the entire container should be disposed of, as with Group III solid wastes. When liquid waste is eliminated like Group III solid waste, it should be taken into consideration that the conditions of work differ for the disinfection of solid and liquid wastes. This must be kept in mind in order to ensure the effectiveness of the treatment.

Liquid chemical wastes

Liquid wastes generated in the hospital (generally in the laboratories) can be classified in three groups:

• liquid wastes that should not be dumped into the drains

• liquid wastes that can be dumped into the drains after being treated

• liquid wastes that can be dumped into the drains without being previously treated.

This classification is based on considerations related to the health and quality of life of the entire community. These include:

• protection of the water supply

• protection of the sewer system

• protection of the waste water purification stations.

Liquid wastes that can pose a serious threat to people or to the environment because they are toxic, noxious, flammable, corrosive or carcinogenic should be separated and collected so that they can subsequently be recovered or destroyed. They should be collected as follows:

• Each type of liquid waste should go into a separate container.

• The container should be labelled with the name of the product or the major component of the waste, by volume.

• Each laboratory, except the pathological anatomy laboratory, should provide its own individual receptacles to collect liquid wastes that are correctly labelled with the material or family of materials it contains. Periodically (at the end of each work day would be most desirable), these should be emptied into specifically labelled containers which are held in the room until collected at appropriate intervals by the assigned waste removal subcontractor.

• Once each receptacle is correctly labelled with the product or the family of products it contains, it should be placed in specific containers in the labs.

• The person responsible for the laboratory, or someone directly delegated by that person, will sign and stamp a control ticket. The subcontractor will then be responsible for delivering the control ticket to the department that supervises safety, hygiene and the environment.

Mixtures of chemical and biological liquid wastes

Treatment of chemical wastes is more aggressive than treatment of biological wastes. Mixtures of these two wastes should be treated using the steps indicated for liquid chemical wastes. Labels on containers should note the presence of biological wastes.

Any liquid or solid materials that are carcinogenic, mutagenic or teratogenic should be disposed of in rigid colour-coded containers specifically designed and labelled for this type of waste.

Dead animals that have been inoculated with biohazardous substances will be disposed of in closed rigid containers, which will be sterilized before being reused.

Disposal of Sharp and Pointed Instruments

Sharp and pointed instruments (e.g., needles and lancets), once used, must be placed in specifically designed, rigid “sharps” containers that have been strategically placed throughout the hospital. These wastes will be disposed of as hazardous wastes even if used on uninfected patients. They must never be disposed of except in the rigid sharps container.

All HCWs must be repeatedly reminded of the danger of accidental cuts or punctures with this type of material, and instructed to report them when they occur, so that appropriate preventive measures may be instituted. They should be specifically instructed not to attempt to recap used hypodermic needles before dropping them into the sharps container.

Whenever possible, needles to be placed in the sharps container without recapping may be separated from the syringes which, without the needle, can generally be disposed of as Group II waste. Many sharps containers have a special fitting for separating the syringe without risk of a needlestick to the worker; this saves space in the sharps containers for more needles. The sharps containers, which should never be opened by hospital personnel, should be removed by designated janitorial personnel and forwarded for appropriate disposal of their contents.

If it is not possible to separate the needle in adequately safe conditions, the whole needle-syringe combination must be considered as biohazardous and must be placed in the rigid sharps containers.

These sharps containers will be removed by the janitorial personnel.

Staff Training

There must be an ongoing training programme in waste management for all hospital personnel aimed at indoctrinating the staff on all levels with the imperative of always following the established guidelines for collecting, storing and disposing wastes of all kinds. It is particularly important that the housekeeping and janitorial staffs be trained in the details of the protocols for recognizing and dealing with the various categories of hazardous waste. The janitorial, security and fire-fighting staff must also be drilled in the correct course of action in the event of an emergency.

It is also important for the janitorial personnel to be informed and trained on the correct course of action in case of an accident.

Particularly when the programme is first launched, the janitorial staff should be instructed to report any problems that may hinder their performance of these assigned duties. They may be given special cards or forms on which to record such findings.

Waste Management Committee

To monitor the performance of the waste management programme and resolve any problems that may arise as it is implemented, a permanent waste management committee should be created and meet regularly, quarterly at a minimum. The committee should be accessible to any member of the hospital staff with a waste disposal problem or concern and should have access as needed to top management.

Implementing the Plan

The way the waste management programme is implemented may well determine whether it succeeds or not.

Since the support and cooperation of the various hospital committees and departments is essential, details of the programme should be presented to such groups as the administrative teams of the hospital, the health and safety committee and the infection control committee. It is necessary also to obtain validation of the programme from such community agencies as the departments of health, environmental protection and sanitation. Each of these may have helpful modifications to suggest, particularly with respect to the way the programme impinges on their areas of responsibility.

Once the programme design has been finalized, a pilot test in a selected area or department should permit rough edges to be polished and any unforeseen problems resolved. When this has been completed and its results analysed, the programme may be implemented progressively throughout the entire medical centre. A presentation, with audio-visual supports and distribution of descriptive literature, can be delivered in each unit or department, followed by delivery of bags and/or containers as required. Following the start-up of the programme, the department or unit should be visited so that any needed revisions may be instituted. In this manner, the participation and support of the entire hospital staff, without which the programme would never succeed, can be earned.

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Departmental operations within a hotel usually consist of: reception, which oversees reservations and guest reception services; housekeeping, which cleans and stocks guest rooms and public areas; maintenance, which does heavy cleaning, setup, painting, repair and remodelling; food and beverage; office and accounting; and other miscellaneous services such as health centres, beauty salons, barber shops and gift shops.

Hazards by Department

Reception

Reception includes the following job classifications: managers, desk clerks, telephone operators, bell and door staff, security personnel, concierges, drivers and parking attendants. Key job safety and health hazards include:

Visual display units (VDUs). Desk clerks, telephone operators and other front desk personnel often use computer terminals. It has been shown that computer use under some conditions can cause various repetitive strain injuries (RSIs), such as carpal tunnel syndrome (in the wrist) as well as shoulder, neck and back problems. Employees are at special risk if workstations are poorly adjusted and require awkward body postures, or if VDU work is continuous without adequate breaks. VDU work can also produce eyestrain and other visual problems. Preventive measures include providing adjustable computer workstations, training staff on how to adjust their equipment properly and maintain correct postures, and ensuring that employees take rest and stretch breaks.

Shift work. Many guest service employees work shifts that can vary according to the level of daily hotel occupancy. Staff members may be required to work both day and evening shifts, or split shifts with random days off. Physiological and psychological health effects of shift work can include disturbed sleep patterns, stomach trouble and stress. Staff may also use drugs or medicines as sleeping aids to adjust to unusual work hours. Workers should receive training on health hazards related to shift work. Whenever possible workers should have adequate time off between rotating shifts to allow for sleep adjustments.

Special consideration should also be paid to other issues associated with swing and graveyard shifts, such as safety concerns, access to healthy meals while on duty and proper ventilation (as air conditioning is often turned off in the evening).

Poor indoor-air quality. Employees can be exposed to second-hand smoke in the lobby, bar, dining rooms and guest rooms. Where ventilation is inadequate, second-hand smoke can pose a risk of cancer and heart disease.

Lifting. Lifting hazards affect staff who load, unload and carry luggage and convention supplies. Back, neck, knee and ankle injuries can result when staff are not trained on proper lifting techniques. Luggage carts should be available. They should be well maintained and equipped with smooth-rolling wheels and safety locks.

Parking and garage hazards. Garage jobs in hotels range from valet parking, to collecting fees, to site maintenance. Employees may work part time, and turnover is often high.

Workers can be struck by vehicles, can inhale exhaust fumes (which contain carbon monoxide among other toxins), or can be exposed to chemicals in automotive products, cleaning products and paints. They can be exposed to asbestos from brake dusts. They can fall from ladders or other maintenance equipment, and can trip or fall due to fluid spills, broken pavement or snow. They can also be assaulted or robbed.

Measures to prevent auto accidents include having clearly marked traffic lanes and walkways, warnings indicating the direction of traffic flow, stop signs for crossing lanes and roped-off areas wherever maintenance work is being done.

Workers exposed to car exhaust, paint fumes and other chemicals should have access to fresh air. Training should be provided about chemical hazards and health effects.

Kerosene heaters sometimes used to warm workers in parking garages can release toxic fumes, and should be prohibited. If heaters are necessary, properly guarded and grounded electric heaters should be used.

Oil spills, water and debris should be cleaned up immediately to prevent falls. Snow should be removed and not allowed to accumulate.

Housekeeping

This group includes housekeepers, laundry workers and supervisors. The department is usually responsible for cleaning and maintaining guest rooms, public areas and meeting and recreational facilities. It may also supply laundry services for guests. Typical safety and health hazards can include:

Repetitive strain injuries (RSIs). Housekeepers are subject to strains from repeated lifting, pushing, bending, reaching and wiping when cleaning bathrooms, changing bed linen, vacuuming rugs, wiping furniture and walls and pushing supply carts from room to room. Laundry workers are also at risk for to RSI injuries due to reaching and to rapid motions from folding, sorting and loading laundry.

Housekeeping carts help transport supplies and equipment, but carts need to be well maintained, with smooth-rolling wheels, and designed to carry heavy loads without tipping over. Carts also need to be relatively light and easy to manoeuvre, with sufficient clearance above the cart so housekeepers can see where they are going.

Training in both ergonomics and proper lifting should be available for housekeepers and laundry workers. Training should include RSI risk factors and methods for reducing them.

Chemical products. Housekeepers and maids use chemical cleaning products for sinks, tubs, toilets, floors and mirrors. Some products can cause dermatitis, respiratory distress and other problems. Some general cleaning agents containing ammonia, detergents and solvents can irritate the skin, eyes, nose and throat. Certain solvent-based products can damage the kidneys and reproductive organs. Disinfectants often contain phenol compounds, which can cause irritation and are suspected to cause cancer.

Preventive measures include supplying protective gloves and substituting with less hazardous products. Proper ventilation should be provided through open windows, mechanical air vents or fans. Chemical storage areas should be well maintained and away from break and eating areas.

Training should be provided about chemical hazards and health effects. It should be conducted in a way staff can understand. To be effective, some training procedures may need translation into workers’ first languages.

Trips and falls. Housekeepers are required to move quickly. Speed can result in slipping on wet floors, falling from tubs and other surfaces when cleaning, and tripping over cords, sheets and bed covers and debris. Laundry staff may slip on wet floors.

Training should be offered emphasizing safety measures to prevent falls and work methods that reduce the need to rush.

Cuts. Cuts from glass, discarded razor blades and debris can be reduced by using liners in wastebaskets and by installing razor blade disposal devices in bathrooms. Workers should be trained in proper waste-handling techniques.

Needlesticks. Used hypodermic needles left by guests in wastebaskets, linens or rooms put hotel staff at risk of getting infectious diseases from accidental punctures. Housekeeping and laundry personnel are the most likely to encounter a discarded needle. Staff should be instructed on how to report and dispose of needles. Staff should have access to approved types of needle receptacle boxes. Management should also have effective medical and counselling procedures to assist staff who have been stuck by a discarded needle.

Heat stress. Hotel laundry workers wash, iron, fold and deliver linen. Heat from machinery, combined with poor ventilation, can result in an oppressive work environment and cause heat stress. Symptoms may include headache, nausea, irritability, fatigue, fainting and accelerated pulse. Eventually these can lead to convulsions and more serious problems if early symptoms are not treated.

Heat stress can be prevented by installing air conditioning, insulating sources of heat, ventilating hot areas with hoods that draw hot air away, taking frequent short breaks in cool areas, drinking plenty of water and wearing loose-fitting clothes. If the work area is only moderately hot (below 35°C), fans may be useful.

Maintenance

Maintenance staff do heavy cleaning, set-up, painting, repair, remodelling and grounds work. Hazards include:

Chemical products. Maintenance staff may use toxic cleaning products to strip and polish floors as well as to clean carpets, walls, furniture, brass fixtures and marble. Certain products can irritate the skin, eyes, nose and throat; can affect the nervous system; and can damage the kidneys, lungs, liver and reproductive system.

Solvents may be present in painting and remodelling materials. Fast-drying paints are used to enable rooms and public areas to be available quickly, but these paints contain high solvent concentrations. Glues used in laying carpet and flooring and in other remodelling jobs may also contain toxic solvents. Solvents can irritate the skin, eyes, nose and throat. Some may damage the nervous system, kidneys, lungs, liver and reproductive organs. Certain solvents are known to cause cancer.

Pesticides and herbicides may be applied in kitchens, dining rooms, public areas, locker rooms and outside the hotel in gardens and driveways. Some of these chemicals can cause respiratory problems; can irritate the skin, eyes, nose and throat; and can damage the nervous system, kidneys, liver and other organs.

Preventive measures include training about chemicals, proper ventilation and proper use of personal protective equipment. If respirators are required, staff should be trained on how to select the proper respirator and cartridge, and how to fit test, use and maintain the equipment. In addition, employees should be given a medical exam to ensure that they are physically fit to work wearing a respirator. Wherever possible, less toxic chemicals should be used.

Asbestos. Asbestos is present in many hotels. Used for years as an insulator and fire retardant, it is found around pipes and in ceiling materials and floor coverings. This highly toxic substance can cause asbestosis, lung cancer or mesothelioma (another form of cancer).

Asbestos is most hazardous when it ages or is damaged. It may begin to break up, creating dust. Hotels should regularly inspect areas where asbestos-containing materials are present to ensure that the asbestos is in good condition.

Extreme caution must be used to protect workers and guests when asbestos dust is present (through ageing or damage or during asbestos abatement jobs). Hotel workers and guests must be kept away from the area, warning signs must be posted and only skilled and licensed personnel should be hired to abate the hazard. The area should be inspected by qualified professionals when work in completed. In new construction or renovation, substitute products should be used in lieu of asbestos.

Trips and falls. Maintenance staff may fall when using ladders and hoists to reach high places such as ceilings, chandeliers, light fixtures, walls and balconies. Training should be provided.

Food and beverage

These staff members include kitchen workers, dishwashers, restaurant servers, room service personnel, hosts and bartenders. Among the hazards are:

Repetitive strain injuries (RSIs). RSIs can occur when room service personnel or restaurant servers deliver food. Trays can be heavy and the server may have to walk long distances. To reduce the risk of injury, room service carts can be used to deliver orders. Carts should be easy to manoeuvre and well maintained. If carts are equipped with heating boxes, the staff should be trained on their proper use.

Trips and falls. Floor surfaces in the kitchen, as well as in all areas to which serving personnel must go, should be kept clean and dry to prevent falls. Spills should be cleaned up immediately. See also the article “Restaurants” in this chapter.

Miscellaneous services

Swimming pools and fitness centres. Many hotels provide swimming facilities or fitness centres for guests. Often showers, saunas, whirlpools, weight rooms and locker rooms are available.

Chemicals used to clean and disinfect showers and locker rooms can cause skin and respiratory irritation. In addition, employees who maintain swimming pools may handle solid or gaseous chlorine. Chlorine leaks can cause burns and severe respiratory problems. If mishandled, it can explode. Employees should be trained on how to handle all these chemicals properly.

Workers who maintain pool and fitness facilities are exposed to injuries from slips and falls. Nonskid, well-maintained and well-drained walking surfaces are important. Water puddles should be wiped up immediately.

Gift shops. Hotels often provide gift and convenience shops for guests. Employees are subject to falls, strains and cuts associated with unpacking and stocking merchandise. They should be trained on proper lifting techniques and should have hand carts to aid in transporting merchandise. Aisles should be kept clear to avoid accidents.

Beauty salons and barber shops. Barbers and cosmetologists risk injuries including skin irritation from hair chemicals, burns from hot towels and curling irons, and cuts and punctures from scissors and razors.

Special hazards include a risk of respiratory problems and possibly even cancer from repeated exposure to certain chemicals such as some hair dye ingredients. There is also a risk of RSIs due to continual use of the hands in awkward postures. Employees should be trained to recognize chemical and ergonomic hazards, and to work in a way that minimizes the risk. They should be supplied with proper gloves and aprons when working with dyes, bleaches, permanent-wave solutions and other chemical products. Shop areas should be properly ventilated to provide fresh air and remove fumes, especially in areas where employees are mixing solutions. Scissors and razors should be properly maintained for ease in cutting, as discussed elsewhere in this Encyclopaedia.

All Occupations

Sexual harassment. Housekeepers and other hotel employees may be exposed to sexual advances from guests or others. Employees should be trained about sexual harassment issues.

Management should have a clear policy on how to report and respond to such incidents.

Fires and other emergencies. Emergencies and disasters can result in loss of life and injuries to both guests and staff. Hotels should have clear emergency response plans, including designated evacuation routes, emergency procedures, an emergency communication system and methods for clearing guests out of the hotel quickly. Certain managers as well as the switchboard operators should have clear instructions on how to coordinate emergency communication with guests and staff.

Staff training and joint labor-management safety meetings are vital components of an effective emergency prevention and response programme. Training sessions and meetings should include translation for staff who need it. Training should be frequent since there is high turnover among hotel workers. Periodic emergency drills should be scheduled, incorporating “walk-throughs” of evacuation routes, staff roles and other emergency procedures.

There should also be a fire prevention programme, including regular inspections. Management and staff members should ensure that exits are not blocked, flammable materials are properly stored, kitchen hoods are regularly cleaned and electrical equipment is well maintained (without frayed wires). Fire retardant materials should be used in interior decorating projects, and there should be screens around fireplaces. Ashtrays should be properly emptied, and candles should be used only in semi-enclosed containers.

Hotel accommodations as well as all facilities attached to the hotel, such as beauty shops, restaurants and gift shops, should be in compliance with all fire codes. Guest rooms and public areas should be equipped with smoke detectors and water sprinklers. Fire extinguishers should be available throughout the hotel. Exits should be well marked and illuminated. Back-up generators should be available to provide emergency lighting and other services.

Evacuation instructions should be posted in each guest room. Many hotels now provide in-room videos with information on fire safety. Guests who are hearing impaired should have rooms equipped with alarms using bright lights to alert them to an emergency. Visually impaired guests should receive emergency procedure information in Braille.

There should be a central alarm system which can display the exact location of a suspected fire. It should also automatically communicate to local emergency services, and broadcast messages over the public address system for guests and staff.

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A formal Environmental Management System (EMS), using the International Organization for Standardization (ISO) standard 14001 as the performance specification, has been developed and is being implemented in one of the largest teaching health care complexes in Canada. The Health Sciences Centre (HSC) consists of five hospitals and associated clinical and research laboratories, occupying a 32-acre site in central Winnipeg. Of the 32 segregated solid waste streams at the facility, hazardous wastes account for seven. This summary focuses on the hazardous waste disposal aspect of the hospital’s operations.

ISO 14000

The ISO 14000 standards system is a typical continuous improvement model based on a controlled management system. The ISO 14001 standard addresses the environmental management system structure exclusively. To conform with the standard, an organization must have processes in place for:

• adopting an environmental policy that sets environmental protection as a high priority

• identifying environmental impacts and setting performance goals

• identifying and complying with legal requirements

• assigning environmental accountability and responsibility throughout the organization

• applying controls to achieve performance goals and legal requirements

• monitoring and reporting environmental performance; auditing the EMS system

• conducting management reviews/ identifying opportunities for improvement.

The hierarchy for carrying out these processes in the HSC is presented in table 1.

Table 1. HSC EMS documentation hierarchy

ISO standards encourage businesses to integrate all environmental considerations into mainstream business decisions and not restrict attention to concerns that are regulated. Since the ISO standards are not technical documents, the function of specifying numerical standards remains the responsibility of governments or independent expert bodies.

Management System Approach

Applying the generic ISO framework in a health care facility requires the adoption of management systems along the lines of those in table 1, which describes how this has been addressed by the HSC. Each level in the system is supported by appropriate documentation to confirm diligence in the process. While the volume of work is substantial, it is compensated by the resulting performance consistency and by the “expert” information that remains within the corporation when experienced persons leave.

The main objective of the EMS is to establish consistent, controlled and repeatable processes for addressing the environmental aspects of the corporation’s operations. To facilitate management review of the hospital’s performance, an EMS Score Card was conceived based on the ISO 14001 standard. The Score Card closely follows the requirements in the ISO 14001 standard and, with use, will be developed into the hospital’s audit protocol.

Application of the EMS to the Hazardous Waste Process

Facility hazardous waste process

The HSC hazardous waste process currently consists of the following elements:

• procedure statement assigning responsibilities

• process description, in both text and flowchart formats

• Disposal Guide for Hazardous Waste for staff

• education programme for staff

• performance tracking system

• continuous improvement through multidisciplinary team process

• a process for seeking external partners.

The roles and responsibilities of the four main organizational units involved in the hazardous waste process are listed in table 2.

Table 2. Role and responsibilities

 Process description

The initial step in preparing a process description is to identify the inputs (see table 3 ).

Table 3. Process inputs

The next process component is the list of specific activities required for proper disposal of waste (see table 4 ).

Table 4. List of activities

Communication

To support the process description, the hospital produced a Disposal Guide for Hazardous Waste to assist staff in the proper disposal of hazardous waste materials. The guide contains information on the specific steps to follow in identifying hazardous waste and preparing it for disposal. Supplemental information is also provided on legislation, the Workplace Hazardous Materials Information System (WHMIS) and key contacts for assistance.

A database was developed to track all relevant information pertaining to each hazardous waste event from originating source to final disposal. In addition to waste data, information is also collected on the performance of the process (e.g., source and frequency of phone calls for assistance to identify areas which may require further training; source, type, quantity and frequency of disposal requests from each user department; consumption of containers and packaging). Any deviations from the process are recorded on the corporate incident reporting form. Results from performance monitoring are reported to the executive and the board of directors. To support effective implementation of the process, a staff education programme was developed to elaborate on the information in the guide. Each of the core participants in the process carries specific responsibilities on staff education.

Continuous Improvement

To explore continuous improvement opportunities, the HSC established a multidisciplinary Waste Process Improvement Team. The Team’s mandate is to address all issues pertaining to waste management. Further to encourage continuous improvement, the hazardous waste process includes specific triggers to initiate process revisions. Typical improvement ideas generated to date include:

• prepare list of high hazard materials to be tracked from time of procurement

• develop material “shelf life” information, where appropriate, for inclusion in the materials classification database

• review shelving for physical integrity

• purchase spill containing trays

• examine potential for spills entering sewer system

• determine whether present storage rooms are adequate for anticipated waste volume

• produce a procedure for disposing of old, incorrectly identified materials.

The ISO standards require regulatory issues to be addressed and state that business processes must be in place for this purpose. Under the ISO standards, the existence of corporate commitments, performance measuring and documentation provide a more visible and more convenient trail for regulators to check for compliance. It is conceivable that the opportunity for consistency provided by the ISO documents could automate reporting of key environmental performance factors to government authorities.

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