Making Work Safe for Health Workers
During my medical residency, several of my friends stuck themselves with used needles while caring for patients. I remember their anxiety as they waited for the blood tests to arrive that indicated whether they were at risk for HIV, hepatitis B, or hepatitis C. More than a decade later, I now have an opportunity to help improve working conditions for health workers worldwide.
Exposure to infection
April 28 is World Day for Safety and Health at Work. We need to think about the health of the three million health workers who receive injuries that expose them to blood-borne pathogens—three million to hepatitis B and C and 170,000 to HIV. These injuries may result in 15,000 hepatitis C, 70,000 hepatitis B, and 500 HIV infections. More than 90% of these infections occur in developing countries both due to the higher incidences of these diseases and the lack of training, protective equipment, and proper disposal receptacles.
The most common form of occupational exposure to blood, and most likely to result in infection, is needle-stick injury, which is often due to two-handed recapping and the unsafe collection and disposal of sharps waste. The World Health Organization provides succinct guidance on health workers’ safety in the workplace.
Protection
Exposure risk can be minimized by adhering to universal safety precautions and in particular, wearing protective equipment (e.g., gloves, goggles, masks) and postexposure management. However, in order for health workers to use protective equipment, health facilities must have supplies available. Furthermore, health facilities need managers to develop and disseminate guidance on postexposure prophylaxis, and provide training and protocols for safe disposal of waste and sharp objects.
Violence, injuries, and other occupational risks
But occupational risks for health workers go beyond needle sticks. While there is little data on the number or rate of occupational injuries among health workers globally, the risks are numerous: nonblood-borne infectious diseases (especially tuberculosis), back injuries while lifting patients, violence from patients, families, and coworkers, latex allergies, toxic and radiological exposures, and stress. In addition, health workers often have trouble accessing health care for stigmatized conditions such as HIV/AIDS because they have to receive care from their peers and may be concerned about confidentiality, discrimination, or loss of their job due to their diagnosis. 
How we’re helping
Fortunately, all of these health risks can be addressed and there are numerous efforts to improve the health of health workers. The world’s largest union representing health workers, Public Services International, is working to get more access to self-retracting needles as well as basic protective gear such as gloves, gowns, and eye splashguards. The private sector has played a role as well, such as Johnson & Johnson’s blunt tip surgical needle that is designed to reduce the number of needle sticks in surgeries.
Previously, the Capacity Project helped the Uganda Ministry of Health develop its Guidelines for occupational safety and health, including HIV in the health services sector and worked in Kenya to improve the work climate in rural facilities. CapacityPlus continues this work through its collaboration with a consortium of the International Council of Nurses on its Positive Practice Environments Campaign. Toward the goal of improved patient care, this initiative supports health workplace settings that ensure staff members’ safety and well-being and aim to improve individuals’ and organizations’ performance.
Fortunately all my coworkers who received needle-stick injuries received proper postexposure prophylaxis, suffered no lasting effects, and continue to practice today. We need to make a supportive, safe environment a reality for all health workers, no matter where they work. No health worker should have to risk her life to do her duty.
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Photo 1 courtesy of Kate Tulenko. Photo 2 by Trevor Snapp. (Nurse washing her hands at Friends Kaimosi Hospital, Kenya)
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