According to the World Health Organisation (WHO) health care facilities around the world employ about 60 million people and these employees face biological, chemical, physical, ergonomic, psychosocial, and electrical hazards including fire and explosion at their workplaces. Healthcare professionals and workers need protection from these workplace hazards. However, in healthcare, attention and resources are always geared toward delivering patient care, and the health, safety, wellbeing and quality of life of the healthcare employees are considered secondary or peripheral: employees are often viewed as "immune" to injury or illness. Healthcare is a major and rapidly growing sector of employment in Bangladesh, and it is time to take the health and safety issues of the employees seriously. The Covid-19 pandemic has starkly exposed their vulnerability.
Exposure to potentially hazardous allergens and irritants is frequent for health care employees, especially those working in hospitals. During diagnostic and therapeutic procedures, laboratory work, and preparation and remediation activities, healthcare professionals and workers are exposed to chemicals, radiation, latex, dust, and blood and body fluids. Those involved in cleaning, laundry, painting, plumbing, and maintenance tasks also bear the risk of chemical exposures. Laboratory technicians are exposed to a broad range of chemical reagents; histology technicians are exposed to dyes and stains and pathologists to fixative and preservative solutions. Furthermore, many health care employees are exposed to anesthetic gases. Occupational exposure to medications can cause allergic reactions among nurses and pharmacists. Techniques such as laser surgery and electro-cauterisation and the use of other radiofrequency and high-energy devices can lead to thermal degradation of tissues.
Painters and maintenance workers are exposed to solvents and lubricants, whereas plumbers and workers engaged in soldering are exposed to lead and flux fumes. Housekeeping workers are exposed to soaps, detergents, cleansing agents, and other chemicals. Cooks and food service workers are exposed to broiling and frying fumes and nitrogen oxide emitted by natural gases used as fuel. There are long-term health effects of allergy and irritation-inducing reagents as well. However, despite the constant and serious nature of exposure risk and the large number of staff in the health care sector, little attention is given in Bangladesh to ensure occupational health and safety to date to identify the types of events, causes, or the specific groups of employees at risk of contracting workplace allergies or irritations.
Healthcare employees, particularly those working in hospitals, are found to have highly reported risks of allergy and irritation incidents. Among them, younger workers, female workers, facility support service workers, laboratory assistants and technicians and maintenance workers have been found to be the most vulnerable, suggesting that prevention efforts should be prioritised in these areas. The types of jobs performed, and the agents handled in hospitals are numerous and diverse. Previous research studies have shown that women are at higher risk for injury in the health care sector. Regarding age, older workers, possibly due to more experience or awareness of potential hazards, would experience fewer allergy and irritation incidents or older workers may have seniority and work in positions with less injury risks.
Evaluation and control of chemicals and other exposures in the workplace are major components of an effective health and safety programme. Workplace controls (e.g., personal protective equipment) at the source of release or potential exposure are difficult to manage at the worker level. If direct physical contact with particularly hazardous substances can be avoided, workers can be separated from the source of exposure. Air quality can be improved by isolating the source of exposure through actual physical enclosure, preferably with separate rooms or buildings, closed doors, and unidirectional airflow into the restricted areas. Proper ventilation devices that fully fumigate areas prone to airborne allergens must be designed and employed in the required vicinities. The exclusion of dust or particulate, cleaning chemicals, and other allergens from rooms and work surfaces is necessary. For example, floors, walls, ceilings, doors, stairs, tables, chairs, diagnostic equipment, and tools should be maintained to prevent hazardous materials from contaminating the skin or food of health care employees. Wet wiping and mopping will raise less dust and result in cleaner surfaces. Prompt spill remediation by properly trained and equipped personnel will aid in avoiding exposures. Use of fragrance-free materials may also decrease allergy-related incidents that can be associated with smell or odour.
All staff exposed to chemicals should be informed of the generic chemical name, brand or trade name, chemical mixture, and health and safety hazards of the substances. Hospital authority should provide this information along with offering safety training for chemical use. Written operating procedures for all activities involving chemicals are required, including safety guidelines for handling spills. Hospital authorities will determine the appropriate personal protective equipment (PPE) for each hazard and train employees on how and when to use such equipment. It may be less expensive to control a hazard at the source than to provide PPE and monitor its use.
Furthermore, alternatives to PPE should be made available to individuals who have experienced previous allergies and irritations when using them. Latex glove allergies among health care staff have been reported before and research has found that non-powdered or non-latex gloves are useful alternatives for staff who suffer from latex-related allergies. Masks that prevent inhalation of chemicals and allergens can safeguard the respiratory system and should be used. Gloves can provide some protection from chemicals when skin contact cannot be avoided. Special protective clothing such as coveralls, aprons, head covers, shoes, and boots can be used to protect parts of the body potentially exposed to chemicals. Splash-proof chemical goggles, face shields, and respirators with full face pieces provide some protection against chemical splashes. Employees should be instructed to wash their hands and face prior to eating, drinking, or smoking to prevent transfer of allergens and irritants.
Healthcare employees are at high risk of occupational allergy and irritation exposure given their job nature. More research and investigations should be conducted in Bangladesh on health care employees as hospitals differ by size, location, ownership (public and private), task, pace, environment, work processes, and materials handled. Prevention policies should be developed to reduce hazards present at these workplaces and promote safer work practices. Simple prevention, worker training, and education programmes on hazard identification and reduction can substantially decrease occupational risk among them.
Hasnat M. Alamgir is Professor, Department of Pharmacy, East West University, Dhaka, Bangladesh.