CLINICAL FIELDWORK - Health and Safety Guidelines
- Introduction
- Infectious Diseases and Sharps
2.1 Standard Precautions - Manual Handling
3.1 Risk Factors for manual handling injury
3.2 Control Measures to prevent manual handling injury - Radiation
- Hazardous Substances
- Violent Patients or Clients
- Accident Reporting
- Responsibility for OH&S
- Further Information
Clinical placement/fieldwork often involves occupational hazards that present some risk to health and safety. These guidelines were developed to increase awareness of these hazards and provide some advice on how to successfully prevent or minimise exposure and subsequent injury.
These guidelines focus on fieldwork or placement in clinical situations, eg in hospitals, community health centres, aged care facilities, outpatient clinics, etc. This document is a supplement to the University's general Fieldwork Safety Guidelines.
Patients or in-mates in many clinics may be a source of infectious diseases which are transmissible to health care workers/carers via blood, blood products or other body fluids (eg urine, saliva, tears, breast milk, cerebro-spinal fluid, amniotic fluid, semen, vaginal secretions etc). The potential health effects of acquiring such a disease will depend largely on the nature of the infective organism. These effects range from being asymptomatic through to life threatening eg HIV. Transmission of infectious diseases from health care workers to patients is also possible. Students and staff should be familiar with the particular infection control guidelines of the institution in which they are placed. Health care workers are required to maintain awareness of their infection status and keep-up-to date with appropriate vaccinations. Refer to the NSW Health Department Circulars listed in Section 9.
2.1 Standard Precautions
All human blood and body fluids are to be treated as potential sources of infection. Staff and students must adhere rigorously to the specific requirements of the placement institution and the following precautions in order to minimise any exposure.
Avoid needle-stick or sharps injury:
Sharps must be handled with extreme caution. Percutaneous injury with sharps is the most common mode of blood borne pathogen transmission in health institutions. Avoid re-capping needles! Dispose of sharps safely into an approved sharps container.
Avoid contact with blood and other body fluids:
Wear disposable gloves whenever contact with blood or other body fluids is envisaged. If there is a risk of splashing or spraying blood or body fluids, wear safety glasses, goggles or face shield. Wear protective gowns, preferably closed at the front.
Wash hands with water and soap or antiseptic:
- before and after patient contact
- immediately that they are contaminated with blood or other body fluids
- whenever gloves are removed
- before eating, drinking, or leaving the facility.
Decontaminate surfaces after procedures.
Dispose of contaminated linen and waste (swabs, gloves etc) according to established safe clinical practice.
Report exposure incidents immediately to your supervisor at the institution so that the risk of disease transmission can be assessed.
Manual handling is any activity which requires physical effort by a person to push, pull, lift, or carry etc. Manual handling injuries, particularly back injuries, can be very debilitating and they are a major problem in health care and all other industries (in terms of lost time for recovery, rehabilitation costs etc). Refer to the NSW Health Department Policy and Best Practice Guidelines for the Prevention of Manual Handling Incidents in NSW Public Health Services.
Any activity which is identified as a manual handling task should be assessed for its risk of injury (see risk factors) and suitably controlled to prevent such injuries (see control measures). Consultation with the supervisor and fellow workers will facilitate this process.
3.1 Risk Factors for manual handling injury
- Frequent or prolonged bending, or reaching, or twisting of the back, or other awkward postures.
- The load is heavy, or awkward to handle, or the task is performed frequently or for long periods.
- The workspace is confined and restrictive, or the floor surface is unsafe (slippery, cluttered etc).
- The individual performing the task has some health, age related or other factor affecting their physical ability, or their clothing interferes with performance.
- The individual has had inadequate instruction, training and experience in safe manual handling.
3.2 Control Measures to prevent manual handling injury
- Do the task a different way. Use safer actions, mechanical assistance or arrange team lifting.
- Provide and use mechanical handling equipment such as wheeled trolleys, patient lifting devices etc.
- Provide training and instruction in safe manual handling technique ie, plan the lift, determine the best lifting technique, get a secure grip and hold the load close to your body.
- Redesign the job by either modifying the object to a more manageable size and weight, or improve the workplace layout or workflow (timing, paths).
- Consider the individual’s health and physical ability to perform the task and provide any personal protective equipment eg, gloves, footwear etc., which may add protection.
X-ray machines and some other irradiating apparatus generate a beam of ionising radiation and some scattered radiation within the room when the beam is turned on. Radiopharmaceuticals are also used in some patient management and the patient may effectively be radioactive for a period.
Exposure to ionising radiation should be kept as low as reasonably achievable. Staff and students should:
- minimise their time spent near radiation sources;
- maximise the distance between themselves and the radiation source;
- use effective shielding placed between themselves and the radiation source, and
- comply with the radiation safety protocol of the institution in which they are placed (Note: guidance on typical hospital radiation safety requirements can be found in the Radiation Safety Manual of the NSW Hospital and University Radiation Safety Officers Group);
- have a means of recording dose exposure.
Staff and students working regularly with or near ionising radiation should wear personal dosimeters (eg, film badges) to monitor their radiation dose.
Toxic chemicals may be encountered in various forms, from cytotoxic agents or chemicals used in chemotherapy to laboratory or cleaning chemicals. These hazardous substances can only be handled safely with appropriate information, equipment and procedures.
Information on the nature of the chemical hazard, safe handling techniques, spill clean-up, first aid, storage conditions and waste disposal should be available on the product label and/or material safety data sheet (MSDS). The supplier of the substance is obliged by law to provide this information. The facility's spill control procedures for cytotoxics should be followed. Guidelines on safe handling of cytotoxic agents are available from the Society of Hospital Pharmacists of Australia.
In some clinics there may be an increased risk of client aggression. Good communication and inter-personal skills and familiarity with the client will help to avoid most problems.
When confronted by a violent patient:
- Stand still, do not make any sudden moves. Stand slightly side on to the aggressor and avoid staring (be submissive).
- Obey the aggressor’s instructions.
- Remain calm and quiet. Avoid shouting or provoking the aggressor.
When dealing with clients with a history of violence, work in pairs. Report aggressive client behaviour to your supervisor.
All injuries and accidents must be reported in order that (a) suitable measures can be put in place to prevent any recurrence of the incident, and (b) the incident is put on record for future reference if needed, ie, if there are some future health consequences. The University's Incident Report Form is available for recording incidents.
The supervisor or preceptor has responsibility for the health and safety of staff and students working under their direction. This responsibility can only be discharged if the supervisor is made aware of the health and safety issues in their area of authority. Visiting teachers in clinical situations are also responsible for the health and safety of their students.
Staff and students on clinical fieldwork/placement must use the safety equipment and procedures put in place for their protection and not jeopardise the health or safety of others. Perceived risks should be raised with the relevant supervisor for information and resolution.
Additional information can be obtained from the following publications:
9.1 National Occupational Health and Safety Commission
Fact Sheet on Hazardous Substances
Fact Sheet on Manual Handling
Manual Handling, National Standard and Code of Practice, Worksafe Australia, 1990
9.2 NSW Health Department
Health Care Workers Infected with HIV, Hepatitis B or Hepatitis C, 2005, Policy Directive 2005_162
Infection Control Policy, 2005, Policy Directive 2005_247
Management of health care workers potentially exposed to HIV, hepatitis B or Hepatitis C, 2005, Policy Directive 2005_311
Occupational Screening and Vaccination Against Infectious Diseases, 2005, Policy Directive 2005_338
Policy and Best Practice Guidelines for the Prevention of Manual Handling Incidents in NSW Public Health Services, 2005, Policy Directive 2005_224
9.3 University of Sydney
Biosafety Notes -Decontamination and Waste Disposal, 2000
Fieldwork Safety Guidelines, 2001
Fieldwork Outside Australia - A supplement to Fieldwork Safety Guidelines, 2001
Guidelines for Working with Hazardous Substances, 1998
Occupational Health and Safety Policy and Guide for Staff, 2000
Policy on Incident and Accident Reporting and Investigation, 2004
Statement on AIDS and the University, 1995
Statement on Hepatitis and the University, 1995
9.4 Others
NSW Hospital and Radiation Safety Officers Group Radiation Safety Manual.
The following publications are available from the Risk Management Office (telephone 9351 4335, email ) :
BackPak. A guide to the manual handling regulation. NSW WorkCover Authority, 1997
Needlestick and Blood Borne Accidents. Australian National Council on AIDS, Bulletin No 16. 1994
SHPA Standards of Practice for the Safe Handling of Cytotoxic Drugs in Pharmacy Departments. The Society of Hospital Pharmacists of Australia, 1997
Guidelines for handling cytotoxic drugs and related waste in health care establishments, WorkCover NSW, 2nd Edition 1995.
National Occupational Health and Safety Commission Fact Sheets on Infectious Disease Control:
- Accident & Emergency
- Clinical Laboratories
- Dentistry
- Midwifery Services and Obstetric Procedures
- Post Mortem Procedures
- Prison Officers and Other Workers in Correctional Facilities.
Notes
Authorised by the Risk Management Office: 21/5/01
Updated: 06/06/05
By: Leanne Mumford.