Hazard faced by home healthcare workers in field and how to minimized them

1. Environmental
Safety in
Home Health
Care
BY
DR ANJUM HASHMI
.MBBS,CCS(USA),MPH
Director Employees'
Health, East Najran
Hospital, NAJRAN,KSA

2. Workplace Safety & Risk Management
• Home Healthcare workers face a wide
range of hazards on the job, including
travel, patient care related injuries,
back injuries, latex allergy, violence
and stress.
• Transportation to remote patient
locations and weather conditions
result in additional risks to the home
healthcare workers.

3. Dimensions of Environmental Safety

4. The Environment of Care
• Patient's home environment must be
assessed to determine whether the
home medical care provider can
safely provide the service needed
for the patient.
• Patient's home should be assessed
for cleanliness, temperature control,
running water, toilet facilities and
infestation with insects or rodents.

5. Hazards for Home Health Care Workers
• Physical Hazards – Workplace Injury: Slips, trips,
falls, overexertion, back injury, temperature
extremes; unhygienic conditions & transportationrelated risks.
• Biological Hazards – Infective diseases, blood
borne pathogens, needle stick injuries.
• Chemical Hazards – Hazardous drugs, cleaning and
sterilizing agents.
• Psychological Hazards – Occupational stress,
workplace violence, guns and other weapons;
illegal drugs; verbal abuse and other forms of
violence in the home or community.

6. Physical Hazards

7. Musculoskeletal Disorders (MSD)
• The risk factors includes:
• Forceful exertions (activities that require
a person to apply high levels of force,
such as during lifting, pushing, or pulling
heavy loads)
• Awkward postures when lifting a patient
/equipments.
• Repeated activities without adequate
recovery time.

8. Awkward Postures Resulting MSD
• Rooms in patient’s homes are often small
or crowded, and workers must often use
awkward postures during patient care and
transfer tasks.
• Beds are not adjustable, thus preventing
the HCW from raising or lowering the
patient to the best position for a proper lift.
• Home healthcare workers frequently
endure long periods of standing or walking.

9. Recommendations for Home HCWs
to Avoid MSD
• Move along the side of the patient’s bed to stay in
safe postures while performing tasks at the bedside.
Do not stand in one location while bending, twisting,
and reaching to perform tasks.
• When moving the patient, stand as close as possible
to the patient without twisting back, keeping knees
bent and feet apart.
• To avoid rotating of spine, make sure one foot is in
the direction of the move.
• Use ergonomic assistive
devices if available.

10. Ergonomic Assistive Devices
Slide/draw sheet
Gait/walking belt
Slide/transfer board
Rolling toilet/shower chair
Patient moving sling

11. Recommendations for Home HCW cont
• Use a friction-reducing device such as a
slip sheet whenever possible.
• Use gentle rocking motions to reduce the
exertion while moving a patient.
• Pulling a patient up in bed is easier, when
the head of the bed is flat or down and
raising the patient’s knees & encouraging
the patient to push (if possible) can also
be helpful.

12. Chemical Hazards

13. Latex
• Latex is the milky sap obtained by tapping the
rubber tree.
• The raw material is mixed with a preservative,
such as ammonia, then concentrated as a latex
concentrate to make products such as disposal
gloves, adhesive tape, elastic bandages, rubber
aprons, stomach and intestinal tubes.
• This milky fluid contains variable amounts of
proteins that can be absorbed through the skin
or inhaled and can cause allergic reactions in
susceptible workers.

14. Latex Allergy
• The three main types of latex allergy:
• Irritant contact dermatitis: It has a gradual onset,
takes days.
• Allergic contact dermatitis/Type 4 (Delayed
hypersensitivity): Occurs 6 to 48 hours after
contact.
• Immediate hypersensitivity/Type 1 ( IgE mediated
reaction): Occurs within minutes and rarely lasts
longer than 2 hours. It can have a sudden onset
but the sufferer can use latex for years without
problems.

15. Recommendations for HCWs
• Prevent unnecessary exposure to latex
products. If gloves use is necessary then:
• Use non latex gloves.
• Avoid inhaling the cornstarch powder lining
the gloves. Choose powder free
gloves.
• Wash hands with a mild soap and dry hands
completely after using gloves.
• Avoid oil-based creams or lotions when

16. Biological hazards

17. Unsanitary Conditions
• Unsanitary conditions are of special concern as
the spread of infectious disease within the home
is well documented in literature, home care can
pose a risk of infection to HCWs.
• Cross-contamination (e.g., transfer of pathogens
through direct and indirect contact with raw
foods, animals, and contaminated inanimate
objects) can place HCWs at risk.
• One household area of potential concern in this
regard is the bathroom. Gerba, et al

18. Needlestick Injuries
• Needlestick and Sharp
Injuries (NSIs) are
accidental skin penetrating
wounds caused by sharp
instruments in a medical
setting.
• A break of skin can be from
a needle or other "sharp"
such as a scalpel / glass.

19. Epidemiology of NSIs
• Infections are caused by needlestick injuries
• An injury from a contaminated sharp object
exposes workers to bloodborne pathogens
that can cause serious or fatal infections like:
• Hepatitis B
• Hepatitis C
• HIV
• HCW must ensure that he/she should
receive proper follow-up medical care after

20. Activities Associated with NSIs
•
•
•
•
Disposing of needles attached to tubing.
Manipulating the needle in the patient.
Recapping and bending needles.
Transferring body fluid between containers
using needles or glass equipment.
• Failing to dispose of used needles in sharps
containers.
• Rapid work pressures.
• Bumping into a needle, sharps, or other

21. NSI Prevention Recommendations
• Follow standard precautions
i.e., use gloves.
• Avoid recapping, if needed use
use one hand scoop method.
• Do not bend needles.
• Before starting a procedure, plan for
the safe handling and disposal of

22. NSI Prevention Recommendations
• Dispose the used needles and any other
contaminated sharps materials promptly
in designated sharps disposal containers.
• Carry standard-labeled, leak-proof,
puncture-resistant, sharps containers
with you to homes.
• Secure used sharps containers
during transport to prevent
spilling of sharps.
• Discard when 2/3rd filled.

23. Care of Needlesticks Injuries
• Wash immediately needlesticks injury or
cuts with soap and running water. Do not
squeeze and do the antiseptic dressing.
Care of Blood & Body Fluid Splash
• Flush splashes to the nose, mouth, or skin
with running water.
• Irrigate eyes with clean water, saline and
seek medical treatment immediately.
Inform the supervisor & write OVR of the
incident to receive follow-up care.

24. Psychological Hazards

25. Workplace Violence
• The patient’s home may be in a highrisk area for violence; there may be
drug traffic or high-crime areas nearby.
• A patient’s history of mental illness
alcoholism, drug abuse, or violence may
also increase the risk.
• More time spent in the patient’s home
may result in a higher risk of violence.

26. Types of Workplace Violence
• Threats: Expressions of intent to cause
harm (verbal, body language, written).
• Physical assaults: Attacks including
slapping, beating, rape, homicide, and
the use of weapons such as firearms,
knives.
• Mugging: An aggressive assault, usually
by surprise and with intent to rob.

27. Recommendation for HCWs
• Always know where you are going. Have
accurate directions to the house.
• Always let administration know where you
are and when to expect you to report back.
• Park the car in a well-lighted area.
• Keep glass windows of car closed.
• Keep your mobile phone in pocket.
• Keep healthcare equipment, supplies, and
personal belongings locked & out of sight.

28. Recommendation for HCWs
contd
• Before getting out of the car, check the
surrounding location and activities.
• During the visit, use basic safety precautions:
— Be alert.
— Evaluate each situation for possible violence.
— Watch for signals of impending violent
assault, such as verbally expressed anger and
frustration, threatening gestures, signs of
drugs or alcohol abuse, or presence of
weapons.

29. Recommendation for HCWs
contd
• Maintain behavior that helps to diffuse anger:
— Present a calm, caring attitude.
— Do not match threats.
— Do not give orders.
— Acknowledge the person’s feelings.
• Avoid behaviors that may be interpreted as
aggressive (for example, getting too close,
touching unnecessarily, or speaking loudly).
• Write OVR for any type incident of violence.

30. Waste Management
• Infectious Wastes generated in the home
care setting should be handled properly.
• Non sharp wastes should be placed into
designated containers e.g., yellow plastic
bag followed by hand hygiene.
• Dispose sharps (e.g., needles, lancets) in
sharp container to prevent NSI.
• Store waste at designate place at Home
Medical care office for disposal with
hospital waste.

31. Surface Decontamination
• If a surface in patient home become
contaminated should be cleaned and
disinfected with 1:10 dilution Clorox
spray (100ml Clorox {bleach} in 900ml
water contact time 5min) or disinfect
with spray solutions approved by
infection control department.
• Then clean with tissue / gauze and
dispose it, in yellow biohazard bag.

32. Blood & Body Fluid Spill
• Don appropriate PPE (gloves, mask & gown).
• Cover the spill with paper towels or other absorbent
materials.
• Carefully pour a freshly prepared 1:10 dilution of
Clorox/bleach around the edges of the spill and into
the spill. Allow a 10 minutes contact period.
• Use paper towel to wipe up the spill, working from
the edges into the center.
• Clean spill areas with fresh paper towels soaked in
Clorox.
• Dispose paper towels into a yellow biohazard bag.

33. Emergency Preparedness Plan
• Home healthcare workers may be
exposed to disasters like floods,
earthquakes, sand storms etc.
• HCWs should be trained during
their orientation to follow the
hospital emergency preparedness
plan.

34. Summary
• Measures to manage risk do not
require highly sophisticated
resources but do require good
planning and adherence to safe
practices.
• As the saying goes “An ounce of
prevention is worth a pound of
cure”.

35. Reference
• Niosh Hazard Review Occupational Hazards In
Home Healthcare, Department Of Health And
Human Services, Centers For Disease Control
And Prevention, National Institute For
Occupational Safety And Health.

36. THANK YOU