Occupational Safety Training Materials in the Healthcare Sector

DOWNLOAD THE OCCUPATIONAL SAFETY DOCUMENT SUITE (6 GROUPS, OVER 300 PROFESSIONS)

The materials for the occupational safety training course in healthcare help workers equip themselves with safety knowledge and prevent hazards when working in hospitals.

PART 1: INTRODUCTION IN THE HEALTHCARE SAFETY DOCUMENT

I. Global Health Challenges in 2019

According to the World Health Organization (WHO), the world is facing numerous health challenges. These include factors such as the rise of vaccine-preventable diseases (measles, diphtheria), antimicrobial resistance of pathogens, increasing obesity rates, environmental pollution, climate change, and humanitarian crises.

To address these issues, 2019 marked the start of the WHO’s five-year strategy, a plan focusing on a target of three billion people worldwide:

• 1 billion more people benefiting from universal health coverage,
• 1 billion more people better protected from health emergencies,
• 1 billion more people enjoying better health and well-being.

To achieve this goal, the WHO called for collaboration to address 10 health-related issues from its members in 2019.

1. Air pollution and climate change in the healthcare safety document

According to the WHO, air pollution levels remain dangerously high in many parts of the world. New data from the WHO shows that 9 out of 10 people breathe air containing high levels of pollutants. Ultrafine pollutants (dust) such as PM₁₀ and PM_2.5 (*) in the air can penetrate the respiratory and circulatory systems, causing harm to the lungs, heart, and brain.

The main cause of air pollution is the use of fossil fuels (oil, coal), which contributes to climate change and affects health. It is projected that between 2030 and 2050, climate change could cause 250,000 deaths per year from related factors such as malnutrition, malaria, diarrhea, and heat stress.

In October 2018, the WHO held its first Global Conference on Air Pollution and Health in Geneva. Over 70 countries and territories made commitments to improve air quality.

In 2019, air pollution was considered by the WHO as the greatest risk to human health. Alarming estimates show 7 million deaths each year from outdoor and household air pollution ^[3] related to diseases such as cancer, stroke, heart, and lung disease. About 90% of these deaths occur in low- and middle-income countries, with large emissions from industry, transportation, agriculture, and cooking with charcoal.

2. Noncommunicable diseases in the healthcare safety document

Noncommunicable diseases include diabetes, cancer, heart disease, and obesity, and are responsible for about 70% of deaths worldwide (41 million people), including about 15 million people dying between the ages of 30 and 69. Over 85% of these deaths occur in low- and middle-income countries.

The rise in these diseases is worsened by five risk factors: smoking, a sedentary lifestyle, alcohol use, an unhealthy diet, and air pollution.

Based on these risk factors, the WHO will work with countries and territories through actions such as providing the ACTIVE toolkit to help more people become more active, aiming to reduce physical inactivity by 15% by 2030.

3. Influenza pandemic in the healthcare safety document

The world may face an influenza pandemic, but we cannot know when it will happen or how severe it will be. Influenza is a disease caused by the influenza virus, with a seasonal cycle. Influenza occurs year-round in tropical and subtropical regions. Flu epidemics occur annually, everywhere, and children are the most affected group.

No one thinks of the flu as a dangerous disease, with symptoms like headache, runny nose, cough, and muscle aches that can be mistaken for a common cold. Seasonal flu causes 650,000 deaths each year. Therefore, getting the flu vaccine is essential.

4. Fragile and vulnerable settings

Over 1.6 billion people (22% of the world’s population) live in places with difficult circumstances such as drought, famine, conflict, and displacement, where access to basic healthcare is limited.

Weak healthcare systems are common in many regions of the world, and these are also the places where 50% of the maternal and child health targets have not yet been met.

5. Antimicrobial resistance in the healthcare safety document

The development of antibiotics has played a crucial role in modern medicine. Along with medical advancements, antimicrobial resistance is rapidly increasing due to many factors: the misuse and self-medication of antibiotics in humans, the use of antibiotics to treat viral infections, and the overuse of antibiotics in animals and livestock (pigs, cows, chickens), all of which have exacerbated the problem.

The rise of antimicrobial resistance is considered a threat to human health worldwide. It leads to severe infections, longer hospital stays, and higher mortality rates, with an estimated 700,000 to several million deaths each year.

Each year, about 10 million people contract tuberculosis and 1.6 million die (including 0.3 million from TB associated with HIV infection).

In 2017, there were about 600,000 cases of tuberculosis resistant to rifampicin (an effective drug for TB treatment) and isoniazid, and 82% of these patients had multidrug-resistant TB.

6. Ebola and other high-threat pathogens

In 2018, the Democratic Republic of Congo experienced two Ebola outbreaks, affecting over 1 million people. This shows that high-threat pathogens like Ebola are very serious.

Experts believe that pathogens with the potential to cause public health emergencies but lacking effective treatments and preventive vaccines need to be prioritized for research, including: Ebola, Zika, hemorrhagic fevers, Middle East Respiratory Syndrome (MERS-CoV), and Severe Acute Respiratory Syndrome (SARS).

7. Weak primary health care

Primary health care is the first point of contact for people with the healthcare system, meeting a person’s health needs throughout their life in their community.

However, in some low- or middle-income countries, there are not enough primary health care facilities due to a lack of resources.

8. Vaccine hesitancy

Vaccine hesitancy is the delay in acceptance or refusal of vaccines despite the availability of vaccination services, which threatens the progress made in combating vaccine-preventable diseases. Vaccination is the most effective method to avoid illness, preventing 2-3 million deaths per year.

There are many reasons for not getting vaccinated or being hesitant, such as complacency, difficulty accessing vaccines, lack of understanding, and lack of trust.

Measles has increased by 30% globally. The reasons for this increase are complex, and not all cases are due to vaccine hesitancy. However, in some countries that had nearly eliminated measles, the disease is showing signs of a comeback.

9. Dengue fever in the healthcare safety document

Dengue fever is an infectious disease caused by the Dengue virus, with the Aedes mosquito (striped mosquito) as the intermediate vector. There is no vaccine or specific treatment for Dengue fever. The disease occurs year-round and is seasonal (usually increasing during the rainy season), mainly in tropical and subtropical regions.

According to the WHO in 2009, Dengue is classified into three levels: Dengue fever, Dengue with warning signs, and Severe Dengue.

Dengue fever has a complex progression, rapidly moving from mild to severe, with diverse clinical manifestations such as sudden high, continuous fever; headache, loss of appetite, vomiting or nausea; signs of subcutaneous hemorrhage, a positive tourniquet test. The disease has a mortality rate of up to 20% if not diagnosed and treated promptly.

In recent decades, the incidence of Dengue fever has been increasing. According to WHO estimates, about 40% of the world’s population is at risk of Dengue, with about 390 million cases each year.

10. HIV in the healthcare safety document

HIV stands for Human Immunodeficiency Virus. There are two types of HIV: HIV-1 and HIV-2. HIV is transmitted through blood, sexual contact, and from mother to child.

In the 1980s, the HIV epidemic, caused by the HIV virus, broke out globally and killed thousands of people.

According to WHO statistics from 2017, there were over 36 million people living with HIV worldwide (including 1.8 million new infections), with 21 million people receiving antiretroviral therapy.

Currently, thanks to advances in HIV diagnosis and treatment, if treatment regimens are followed, people with HIV can live well and stay healthy. However, nearly 1 million people die from HIV/AIDS each year. Since the epidemic was declared, more than 70 million people have been infected and more than 35 million have died.

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II. 10 Global Issues for People with Disabilities

People with disabilities are one of the most marginalized groups in the world. They experience poorer health outcomes, lower educational achievements, fewer economic opportunities, and higher rates of poverty.

The WHO has highlighted and recommended action on 10 global issues for people with disabilities:

1. Over one billion people live with a disability

This corresponds to about 15% of the world’s population, with about 110-190 million people experiencing very significant difficulties in functioning. The prevalence of disability is increasing due to population aging and the global increase in chronic health conditions.

2. People with disabilities are disproportionately among the vulnerable

Low-income countries have a higher prevalence of disability than high-income countries. Disability is more common among women, children, older people, and people in poverty.

3. People with disabilities often do not receive the best healthcare when needed

Half of people with disabilities cannot afford health care. Global reports indicate that people with disabilities are three times more likely to be denied health care than people without disabilities.

4. Children with disabilities are less likely to attend school

A gap in educational completion is recorded for children with disabilities across all age groups and everywhere, and this gap is more pronounced in poorer countries. In India, the primary school attendance rate for children with disabilities ranges from 10%, while in Indonesia it is up to 60%.

5. People with disabilities are more likely to be unemployed

Global data shows lower employment rates for men with disabilities (53%) and women with disabilities (20%) compared to non-disabled men (65%) and non-disabled women (30%).

6. People with disabilities are vulnerable to poverty

People with disabilities experience poorer living conditions, including food insecurity, inadequate housing, and lack of access to clean water and sanitation. Poverty is caused by the costs of medical care, assistive devices, or personal support. In general, people with disabilities are poorer than non-disabled people at the same income level.

7. Rehabilitation helps maximize function and support independence for people with disabilities

In many countries, rehabilitation services are inadequate for people with disabilities. Data from four African countries show that only 26–55% of people with disabilities receive rehabilitation services, and only 17–37% receive assistive devices (e.g., wheelchairs, prostheses, hearing aids).

8. People with disabilities can live and participate in the community

40% of people with disabilities often do not have their needs for support with daily activities met. In the United States, 70% of adults rely on family and friends for support with daily activities.

9. Breaking down barriers for people with disabilities

This involves ensuring people with disabilities have access to mainstream services; investing in specific programs for people with disabilities; adopting national strategies and action plans; improving education, training, and recruitment of staff; providing adequate funding; and increasing public awareness and understanding of disability.

10. The Convention on the Rights of Persons with Disabilities (CRPD)

Over 170 countries have signed the Convention and more than 130 have ratified it, promoting, protecting, and ensuring the human rights of all persons with disabilities.

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III. Difficulties in Accessing Medical and Health Care Services

Despite many supportive policies, in reality, people with disabilities (PWDs) face numerous difficulties and barriers in accessing medical and health care services.

Many essential services are not covered by co-payments

A PWD is defined as a person with a defect in one or more body parts or a functional impairment manifested as a disability that causes difficulties in work, daily life, and learning (Law on PWDs – 2010). PWDs include those with congenital disabilities, people with impairments due to accidents, wounded soldiers, sick soldiers, etc. In Vietnam, the prevalence of mobility impairment is 29.41%, hearing and speech impairment: 9.32%, visual impairment: 13.84%, neurological and psychiatric impairment: 16.83%, intellectual impairment: 6.52%…

Associate Professor Dr. Luong Ngoc Khue – Director of the Department of Medical Service Administration (Ministry of Health) said that nearly 50% of PWDs (more than 3 million people) still have to buy their own health insurance and co-pay for medical examination and treatment services. In particular, basic and essential assistive devices for mobility and functional rehabilitation, which are crucial for PWDs, are not covered by health insurance. Meanwhile, most PWDs are from disadvantaged backgrounds, so assistive devices remain a “dream” for them.

Having a son with a neurological disability (cerebral palsy), Ms. Do Quynh Nga (Dong Da, Hanoi) shared: When visiting the National Children’s Hospital, the costs of tests, scans, etc., for her son were covered by health insurance. However, her family had to cover the costs of periodic functional rehabilitation for her son. If he trained at the hospital, he would receive training for 2 months at a time, each session lasting 20 days with a cost of nearly 2 million VND per session.

However, the rehabilitation equipment at the hospital (provided by health insurance) is quite basic and not continuous. Meanwhile, functional rehabilitation needs to be regular and daily. She decided to take her son to a private rehabilitation center for treatment. In addition to mobility rehabilitation, her son also receives cognitive and language rehabilitation, health care, etc. According to Ms. Nga, this level is only average and basic, but the cost has reached 15-20 million VND per month.

According to Ms. Vu Thi Minh Hanh – Deputy Director of the Health Strategy and Policy Institute (Ministry of Health): In reality, PWDs face many difficulties in accessing assistive devices. “According to Article 23 of the amended Law on Health Insurance in 2014, procedures such as surgery, orthopedic massage, etc., are covered by health insurance. But orthopedics cannot be done with bare hands; it requires splints, spinal braces, orthopedic shoe molds, single or double canes… Although they are linked to the technical list: mobility, cognitive, and other sensory aids like seeing, hearing, speaking… these important devices for intervention are still not covered by health insurance.”

In addition to the lack of support devices, according to Ms. Nguyen Hong Ha – Director of the Center for Independent Living of PWDs in Hanoi, the physical facilities to ensure accessibility for PWDs at many medical centers do not meet the standards (according to the set of standards for public access for PWDs) issued by the Ministry of Construction. For example, if a health station or hospital does not have a dedicated wheelchair ramp, PWDs who use wheelchairs will face many difficulties without assistance. Or, deaf individuals who cannot hear also cannot speak, making it very difficult for them to describe their medical condition to a doctor during an examination.

Many PWDs have to adapt and consider themselves as normal people. For example, a pregnant woman with a mobility disability has different characteristics from a healthy person, but there are currently no prenatal examination facilities specifically for this group. When they go for an examination, they cannot move to the ultrasound table on their own and need to be lifted.

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IV. Speak up for health worker safety!

This is the call from the World Health Organization to all stakeholders globally on World Patient Safety Day (September 17, 2020).

This year’s World Patient Safety Day is particularly significant as the COVID-19 pandemic continues to evolve complexly worldwide. It can be said that never before have the health systems of all countries faced such great challenges and a major crisis in patient safety, which includes the safety of health workers. The COVID-19 pandemic has put unprecedented pressure on every country’s health system, requiring each health worker to be equipped with the best and most appropriate knowledge, skills, and motivation to provide the safest possible health care to patients.

World Patient Safety Day was officially proposed at the 72nd World Health Assembly (May 2019) to adopt Resolution WHA72.6, drafted by the World Health Organization on “Global Action on Patient Safety,” which established September 17th annually as World Patient Safety Day.

The main objectives of World Patient Safety Day are to raise understanding of patient safety, increase public engagement in healthcare safety, and promote actions to enhance safety and reduce harm to patients globally. World Patient Safety Day also aims to recall the most fundamental principle of medicine: “First, do no harm.”

The main objectives of World Patient Safety Day 2020, as defined by the World Health Organization, are as follows:

(1) Raise global awareness of the importance of caring for and ensuring the safety of health workers, an activity directly linked to patient safety.

(2) Engage multiple stakeholders and apply multi-modal strategies to improve the safety of health workers and patients.

(3) All stakeholders simultaneously implement urgent but sustainable actions aimed at changing perceptions and investing in ensuring the safety of health workers, considering this a priority activity to ensure patient safety.

(4) Recognize the dedication and hard work of health workers, especially in the current fight against the COVID-19 pandemic.

The World Health Organization calls on all stakeholders to speak up for health worker safety! The COVID-19 pandemic has highlighted the enormous challenges that health workers currently face globally. Working in a stressful environment exacerbates safety risks for health workers. In many countries, health workers are facing an increased risk of infection, violence, accidents, stigma, illness, and death.

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PART 2: PREVENTING OCCUPATIONAL DISEASES IN HEALTHCARE WORKERS

I. Characteristics of Working Conditions for Healthcare Workers

The working conditions of healthcare workers (HCWs) are quite specific and involve many factors that cause neuropsychological stress:

• Working schedules in most departments follow administrative hours. However, to meet the specific demands of specialties like hematology, the working hours of HCWs in some departments are unstable due to the unpredictable volume of samples (such as the Blood Screening Laboratory, Blood Component Preparation Department) or require starting early and finishing late when working in the community (Blood Donation Department; mobilizing and organizing blood drives…).
• The work of HCWs has a high risk of contracting blood-borne diseases (Hepatitis B, Hepatitis C, HIV…) as most staff have direct contact with patients’ blood and secretions (especially before test results are available) in departments like the Outpatient and Emergency Department, Blood Donation Department, Blood Screening Laboratory, etc.; exposure to highly dangerous viruses (HBV, HCV, CMV, EBV) (Genetics and Molecular Biology Department).

• HCWs specializing in hematology are also exposed to many chemicals (Bleomycin, Cisplatin, Cyclophosphamide, Arsenic Trioxide, Cytarabine, Daunorubicin, Etoposide, L-Asparaginase erwinase, Fludarabine, Ifosfamide, L-Asparaginase, Melphalan, Busulfan, Methotrexate, Rituximab, Mitoxantrone, Vinblastine…) during drug preparation (Pharmacy Department); during patient treatment (Clinical Departments); exposure to xylene, toluene, ethyl alcohol, formaldehyde, benzene… during bone marrow biopsy, cutting, and staining (Histology and Cytology Department); exposure to Javel water and detergents (Infection Control Department).
• HCWs specializing in psychiatry regularly have contact with psychiatric patients with criminal elements (for forensic psychiatric assessment); who are unable to control their abilities and behavior, and can attack or harm staff at any time, potentially directly threatening their lives (a dangerous aspect) – a specific feature of HCWs in the psychiatric field.
• HCWs specializing in HIV/AIDS, although performing different roles and tasks, share the common point of direct or indirect contact with HIV/AIDS patients who often have other co-morbidities (such as respiratory infections, tuberculosis, hepatitis B, C, etc.); contact with patient specimens like feces, sputum, pus, blood, urine… of HIV/AIDS patients; contact with microorganisms… thus facing a high risk of infection and significant pressure from community and social stigma.
• HCWs also have to work night shifts, on average 1-2 times a week; after a shift, they still have to spend time resolving related work issues.
• The very high level of responsibility required of HCWs in their work, demanding absolute precision and allowing no room for error (due to serious consequences affecting human life), is also one of the specific labor characteristics in the medical industry.

According to the list of heavy, hazardous, and dangerous occupations, the health sector has 12 occupations in Category VI, 19 in Category V, and 17 in Category IV. Among the 28 occupational diseases covered by insurance in Vietnam, those in the health sector account for a high proportion, such as occupational tuberculosis, occupational viral hepatitis, HIV due to occupational accidents, and some other poisoning diseases.

As a specific sector, healthcare personnel regularly come into contact with easily transmissible diseases, work in radiation environments, and use pressure equipment such as boilers and autoclaves…. there are many risk factors affecting their health. Therefore, raising awareness of ensuring labor safety for healthcare personnel is considered a practical and urgent task by units in the sector.

In practice, medical staff, regardless of their position, from the patient’s room to the injection room, operating room, as well as the laboratory, and examination room.. can all be infected. Staff working in direct emergency departments, surgery, obstetrics, pediatrics, and intensive care have the highest rate of sharp-related injuries, with nurses, midwives, and technicians being the most affected, as they are the ones who directly care for patients, perform injection and infusion techniques, draw blood for testing, change dressings, assist in childbirth, assist in surgery, and handle instruments after surgery and procedures…

They can be exposed to pathogens through blood, body fluids, air, and digestion. Some common occupational infectious diseases include HIV, hepatitis B, hepatitis C, SARS, tuberculosis, dengue fever, influenza, cholera, dysentery…

Healthcare workers are laborers who are carrying out the task of caring for and protecting the health of the people at medical facilities. Healthcare workers are at risk of exposure to many factors harmful to their health, such as:

• Microbiological factors (viruses, bacteria, parasites, fungi); physical factors (radioactive substances, infrared radiation, ultraviolet radiation, noise…);
• Chemical factors (drugs, sterilization chemicals, laboratory chemicals…);
• Physicochemical factors, dust: dust in fabrics, clothes, sheets; Ergonomic factors (high work pressure and intensity, working posture).

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II. Occupational Diseases Healthcare Workers May Contract, Grouped by Hazard Factor

1. Occupational diseases due to microbiological factors in the healthcare safety document

This is the most common group of occupational diseases (ODs) among healthcare workers because they are in direct contact with patients, blood and blood products, and infected secretions (saliva, sputum, pus, urine, feces) through activities such as examination, treatment, laboratory testing, animal experiments, vaccine production, etc.

• Jobs or departments/wards where infection can occur:
  • HIV care and treatment wards;
  • Infectious diseases wards;
  • Tuberculosis and lung diseases wards;
  • Intensive care units, examination departments;
  • Surgical departments: surgery, trauma, obstetrics, ENT, ophthalmology
  • Pathology;
  • Biochemistry, hematology, cytology, microbiology laboratories;
  • Contact with epidemic outbreaks (healthcare workers working in epidemic areas; staff disinfecting outbreaks; staff collecting and treating medical waste…).
  • Staff in animal laboratories, vaccine production…
• Insured occupational infectious diseases in Vietnam:
  • Occupational tuberculosis;
  • Occupational hepatitis B virus disease;
  • Occupational hepatitis C virus disease;
  • HIV infection due to occupational accidents;
  • Occupational Leptospirosis.
• Occupational infectious diseases not yet on the insured OD list:
  • Viral diseases: SARS, Ebola, influenza A/H5N1, herpes, measles, influenza, rubella, mumps…
  • Bacterial infections: tuberculosis, diphtheria, typhoid, streptococcus A…
  • Parasitic infections: malaria, plague, dengue fever
  • Fungal infections
• Occupational Hepatitis
  • Hepatitis B virus is an occupational infectious disease like tuberculosis, hepatitis C, HIV… In reality, there are many risk factors that can cause skin injuries in hospitals: subcutaneous injections, glass fragments, sutures, butterfly needles, drills, blood drawing… The risk of hepatitis B infection can be up to 25% for healthcare workers injured by needlesticks, who come into contact with the blood or body fluids of patients with positive HBsAg.
  • Viral hepatitis is an occupationally related infectious disease. This is recognized by the joint Ministries of Health, Labour – Invalids and Social Affairs, and the Vietnam General Confederation of Labour because the prevalence of HBsAg antibodies among healthcare workers is 3-5 times higher than in the general population. About 17.6% of healthcare workers may be infected with the hepatitis B virus. With its ability to survive for months in dried blood, the hepatitis B virus is 50-100 times more infectious than HIV. High-risk groups include: laboratory staff, dentists, emergency responders, waste handlers, embalmers, soldiers, police… According to the World Health Organization (WHO), out of 35 million healthcare workers worldwide, 2 million are exposed to infectious diseases through the skin each year. Among them, about 40% are exposed to hepatitis B, 40% to hepatitis C, and 2.5% to HIV due to needlestick injuries.
  • Groups who are frequently exposed due to the nature of their occupation to patients with viral hepatitis, blood samples, and contaminated items… may develop syndromes:
  • Hepatitis is a viral infection that enters the liver and can cause acute and chronic hepatitis. The virus is transmitted through contact with the blood or body fluids of an infected person and not through casual contact. The disease poses a high risk of death due to cirrhosis and liver cancer.
  • Transmission routes
    • The hepatitis B virus is transmitted from person to person through wounds or skin lesions that come into contact with the blood or body fluids (semen and vaginal secretions) of an infected person. The mode of transmission is similar to that of the human immunodeficiency virus (HIV), but HBV is 50 to 100 times more infectious. Unlike HIV, HBV can survive outside the body for at least 7 days. During that time, the virus can still cause infection if it enters the body of an uninfected person. Common modes of transmission in developing countries are: perinatal (from mother to child at birth); early childhood infection (inapparent infection through close personal contact with infected family members); through unsafe injection practices; through blood transfusions; through sexual contact. HBV is not transmitted through contaminated food or water and is not transmitted casually in the workplace. The incubation period of the virus is on average 90 days but can range from 30 to 180 days. HBV can be detected 30 to 60 days after infection and can persist for longer periods.
  • Symptoms of the disease
    • The hepatitis B virus can cause an acute illness with syndromes lasting several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain. It can take several months to a year for people to recover from these syndromes. HBV can also cause a chronic liver infection that can later develop into cirrhosis or liver cancer. About 90% of healthy adults infected with HBV will recover and completely clear the virus within six months. HBV is a major occupational infectious hazard for healthcare workers.
  • Treatment and prevention
    • There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and adequate nutritional balance, including replacing fluids lost through vomiting and diarrhea. Chronic hepatitis B can be treated with drugs, including interferon and antiviral agents that can help some patients. However, the cost of treatment is very high and the response to the drugs is limited. Liver cancer is almost always fatal, and it often develops in people at an age when they are in their prime working years with many family and social responsibilities. In developing countries, most people with liver cancer die within a few months of diagnosis.
    • In higher-income countries, surgery and chemotherapy can extend the lives of some patients for a few years. Patients with cirrhosis are sometimes given liver transplants with varying success. Full vaccination produces protective antibody levels in over 95% of infants, children, and young adults. For people over 40, the initial vaccination doses are less than 90% effective. At age 60, protective antibody levels are achieved in only 65% to 75% of those vaccinated. Protective antibodies last for at least 20 years and provide lifelong protection.
    • All children and adolescents under 18 years of age who have not been previously vaccinated should be vaccinated. People in high-risk groups should also be vaccinated, including: people with high-risk sexual behavior; sexual partners and household contacts of people infected with HBV; injecting drug users; people who frequently need blood or blood products; solid organ transplant recipients; people at occupational risk of HBV infection, including healthcare workers; and international travelers to countries with high HBV prevalence.
• Occupational Tuberculosis
  • Globally, tuberculosis remains a heavy burden in developing countries. Each year, up to 2 billion people are exposed to TB, with 9 million new cases and 2 million deaths (HIV/AIDS causes 3 million deaths, malaria 1 million). Vietnam ranks 12th among the 22 countries with the highest TB incidence. The rate of new TB cases in all forms is 173/100,000 population per year, with a mortality rate of 23/100,000 population. Statistics show that 80% are pulmonary TB, which is the main source of transmission, and 20% are other forms of TB. Furthermore, up to 80% of TB patients are between 16 and 60 years old, the main productive workforce.
  • Close and prolonged contact with a source of infection, such as people with pulmonary TB who cough, sneeze, or talk, spreading small droplets containing TB bacteria, creates a risk of TB infection for those around them, including healthcare workers who directly and regularly examine, treat, and serve TB patients. Police, prison guards, and those who monitor TB patients in prisons are also at risk. Next are veterinarians, cattle slaughterers, and milkers who can contract bovine TB from infected cattle. According to Circular 12/2006/TT-BYT dated November 10, 2006, Appendix 1, individuals who contract TB in the course of their work are identified as having occupational TB and are entitled to state compensation.
  • When ill, the body’s organs and tissues are destroyed. If detected late and not treated promptly or correctly, the affected organs can be severely damaged and may not recover even if the bacteria are cured. Cavities and fibrous scars from pulmonary TB can lead to respiratory failure, cor pulmonale, etc. Bone and joint TB can lead to kyphosis, scoliosis, joint stiffness, and lifelong disability. According to Circular 04/2015/TT-BLĐTBXH dated February 2, 2015, on guiding the implementation of compensation and allowance regimes.
  • To prevent TB, the general principle is to eliminate the source of infection, detect cases thoroughly, and treat them successfully. Other important measures include: Patients: Pulmonary TB patients must wear masks, not spit indiscriminately but into paper or cups placed in designated areas for disinfection and disposal. Sputum samples should be collected in designated, well-ventilated areas, preferably outdoors. Healthcare workers serving TB patients must wear standard protective masks (N95). They should interact with patients through a glass partition and conduct examinations, treatments, and counseling from behind the patient. Medical facilities serving TB patients must properly implement infection control regulations, invest in necessary protective equipment for staff and patients, and have specific plans and procedures to fully implement and guide staff and patients. TB is an infectious disease, an occupational disease, and a social disease that significantly affects the health of workers. To protect workers, careful protective measures must be followed by both patients and staff, and this is the responsibility of medical facilities and the livestock industry. Furthermore, workers must be conscious of protecting themselves, avoiding situations that facilitate infection, and adhering to treatment principles if they become ill. The treatment of occupational TB also follows the same treatment regimens as community-acquired TB.

2. Occupational diseases due to physical factors in the healthcare safety document

Diseases caused by ionizing radiation (radioactive substances) are of greatest concern in this group, affecting healthcare workers in the following departments/wards:

• Diagnostic Imaging Department: X-ray, SPECT-CT, PET-CT, CT-Scanner, interventional radiology, bone densitometry…
• Laboratory and Radiotherapy Departments that use radioactive substances for cancer diagnosis and treatment.

Diseases caused by non-ionizing radiation: use of lasers (infrared, ultraviolet) in the treatment of internal medicine, dermatology, and in surgery. Use of ultraviolet radiation to kill bacteria and mold in operating rooms, microbiology labs…

Diseases caused by electromagnetic field pollution in hospitals are mainly in rehabilitation departments, where shortwave therapy machines are used.

Diseases caused by exposure to high noise levels: from generators, boilers, washing machines in laundry areas (infection control department) and kitchen areas…

Insured occupational diseases in Vietnam:

• Occupational radiation sickness;
• Occupational hearing loss due to noise;
• Occupational cataracts.

3. Diseases related to physicochemical and dust factors in the healthcare safety document

• Jobs or departments/wards where these can occur:
  • Infection control department: laundry staff exposed to cotton dust from clothes, towels, sheets, cotton balls, gauze…
  • Surgical department: exposure to talc dust from medical gloves, in casting for fracture treatment.
  • Microbiology, laboratory, pathology departments… exposed to chemicals; orderlies using chemicals for disinfection, cleaning, and sterilization.
• Insured occupational diseases in Vietnam:
  • Occupational chronic bronchitis
  • Occupational asthma

4. Diseases due to chemical factors in the healthcare safety document

• Jobs or departments/wards where these can occur:
  • Microbiology Department; Biochemistry and Hematology Laboratory; Pathology Department; Oncology Department
  • Orderlies using chemicals for disinfection, cleaning, sterilization.
  • Management of chemical and hazardous drug storage
• Insured occupational diseases in Vietnam:
  • Occupational chronic bronchitis
  • Occupational asthma
• Other occupational diseases not yet on the insured OD list:
  • Occupational skin diseases: contact dermatitis, allergies
  • Respiratory diseases: acute poisoning, pneumonia…
  • Cancer, nervous system diseases, kidney and urinary diseases, reproductive organ diseases…

5. Occupational diseases due to ergonomic factors (diseases due to improper work organization, work stress…)

Due to the nature of the job requiring 24/7 examination, emergency care, and treatment of patients, healthcare workers must work shifts and night duties. The job demands concentration, pressure, and high responsibility, with uncomfortable working postures… leading to work stress and the emergence of musculoskeletal disorders.

6. Skin infections in the healthcare safety document

Staphylococcus aureus: Bacteria spread through direct or indirect contact, or less commonly, through skin abrasions. HCWs with staphylococcal skin lesions (e.g., boils or other skin lesions) are more likely to transmit the disease to others than those who are nasal carriers. Depending on the work duties of each HCW, work restriction measures should be implemented.

During periods of high staphylococcal disease prevalence or during outbreaks of methicillin-resistant Staphylococcus aureus (MRSA), it is necessary to identify carriers (patients and HCWs) by bacterial culture.

Group A Streptococcus: (GAS) is a pathogen of the skin and pharynx. Other bacterial reservoirs are the anus and female genital tract. The main mode of transmission is through direct contact and large respiratory droplets. An investigation should be conducted when an increase in group A streptococcal infections is observed, focusing on identifying carrier HCWs. HCWs with active group A streptococcal infections should be off work until 24 hours after treatment and a negative culture is obtained. Most infections occur in the mouth and face and are transmitted through direct contact. Saliva can also be infected with the virus. Because the main route of transmission is through contaminated hands after direct contact, hand washing and disinfection before and after contact with patients is the most important preventive measure. Herpetic whitlow (herpetic paronychia) is an occupational disease in HCWs due to direct contact with contaminated fluids (e.g., vaginal secretions or skin lesions). HCWs with herpetic whitlow should wear gloves to prevent viral transmission to patients. When caring for patients at high risk of severe infection, such as newborns, severely malnourished patients, severely burned patients, or immunocompromised patients, HCWs with active herpetic infections should be considered for temporary leave from work.

7. Prevention and management of occupational exposure in the healthcare safety document

Injection is the most common invasive medical procedure. According to the World Health Organization (WHO), there are about 16 billion injections worldwide each year, with 90-95% (an average of 1.5 injections/person/year) for treatment purposes and 5-10% for prevention. However, about 70% of injections used for treatment are actually unnecessary and could be replaced by oral administration. Many types of antibiotics, analgesics, and vitamins taken orally have effects comparable to injections and are safer.

Each year, unsafe injections cause: 1.3 million premature deaths; the loss of 26 million years of life; and indirect economic losses of 535 million USD/year. New estimated blood-borne infections: 22 million HBV cases (1/3 of all infections); 2 million HCV cases (40% of all infections); 260,000 HIV cases (5% of all infections). The new viral infection rate among healthcare workers: HBV 6-30/100 cases; HCV 3-10/100 cases, HIV 1/300 cases.

The most common occupational exposure is to blood; The most common infection-causing injury is from a needlestick. Occupational accidents from needlesticks and other contaminated sharps can occur on any part of a HCW’s body, putting them at high risk of exposure: HBV (percutaneous): 22-40%; HCV (percutaneous): 10%; HIV (percutaneous): 0.3%; HIV (mucous membrane): 0.09%; HIV (non-intact skin): 0.01%.

Needlestick injuries not only happen to patients and healthcare workers who directly perform technical procedures, but can also occur to orderlies, cleaning staff, administrative staff, and visitors. According to a study by Angela K. Laramia, USA Massachusetts 2002-2005, SIGN, WHO 2008: nurses 44-72%; doctors 28%; laboratory staff/technicians 15%; orderlies, cleaning staff 3-16%; administrative staff and visitors 1-6%.

Risky behaviors related to injections: overuse of injections; reuse of unsterilized syringes and needles; practices that pose a risk to the person being injected; improper classification, collection, and disposal of post-injection waste.

Modes of occupational exposure: Percutaneous injury from contaminated sharps (through injections, infusions, punctures, suture needles, scalpels…), blood and body fluids of patients splashing onto damaged skin of HCWs during procedures (burns, ulcers, abrasions), and scratched skin of HCWs coming into contact with patients’ blood and biological fluids.

8. Occupational stress in healthcare workers in the healthcare safety document

Stress was defined by Hans Selye in general terms as a syndrome comprising the non-specific responses of the body to environmental stimuli. Occupational stress is defined as an imbalance between work demands and an individual’s abilities.

Although many workplace factors are causes of stress, which can be overload or underload, the ability to predict stress reactions in any individual is still very poor. Measuring stress is difficult because it is still being studied. First, psychosocial stress cannot be clearly defined. Second, there is great individual variability in the perception of stress. Third, psychosocial stress and psychosomatic conditions do not always change in parallel. Furthermore, non-specific symptoms such as fatigue, digestive disorders, difficulty sleeping… are characteristic symptoms of stress.

Healthcare workers, especially those in treatment settings, work in high-stress conditions.

Many studies have shown that healthcare workers in patient care have a much higher risk of stress than those in other professions. Research by Linn LS, et al. (1985), Agius RM et al. (1996) showed that up to 25% of clinicians suffer from stress, depression, anxiety, and burnout. The health effects of occupational stress include fatigue, anxiety, depression, job dissatisfaction, reduced quality of patient care, alcohol addiction, high rates of sick leave, early retirement, and some stress-related diseases such as stomach ulcers, myocardial infarction, high blood pressure… etc.

Demiral et al. (2002) studied 300 doctors in different specialties and found the overall prevalence of depression and anxiety to be 18.9% and 27.4% in doctors. A large number of studies have shown that 25-30% of healthcare workers suffer from burnout as a result of their work in the health sector (Grassi & Magnani, 2000). According to a study by Shams and El-Masry (2013), the rate of occupational stress among healthcare workers in anesthesiology and intensive care was 69.4%. Risk factors include workload, poor work organization, group conflicts, and caring for critically ill patients. Daily contact with death and dying, and overreactions from patients’ families are major sources of stress. Estrin-Behar et al. (1990) studied the psychological burden on 1505 female healthcare workers in France in 1990. Five health indicators were studied: fatigue, exhaustion, use of antidepressants, use of sleeping pills, use of tranquilizers, and psychological disorders. The results showed that insomnia was strongly related to occupational stress.

A study by Nguyen Thu Ha (2006) on 811 healthcare workers showed that 10.7% had high stress levels; 37.9% had moderate stress levels, and 51.4% had low stress levels. Among healthcare workers with signs of stress (48.6%), doctors had the highest level of stress (12.9%), higher than nurses and orderlies. A study by Le Thanh Tai (2008) showed that among nurses with occupational stress at Can Tho Central General Hospital, Can Tho City General Hospital, and Chau Thanh – Hau Giang General Hospital: 45.2% had high stress, and 42.8% had moderate stress. Can Tho Central General Hospital had the highest stress rate at 53.1%. In 2016, Nguyen Thu Ha’s research showed that the stress rate among healthcare workers in the psychiatric field was relatively high (66.7%), with most stress being well-managed (61.7%) and only 5% requiring early intervention. The research results also showed a negative correlation between stress and the work ability index (WAI) in healthcare workers (r= -0.37; p=0.004), meaning that the work ability index decreases as the level of occupational stress increases. This result is similar to previous studies, such as those by Bresić J [2], Golubic [4], Kumashiro [7]… However, the change in WAI also depends on the nature of different jobs.

Occupational stress is a major damaging factor for the nervous system, contributing to an increased rate of cardiovascular and musculoskeletal diseases, as well as an increased rate of early retirement due to frequent work in a high-pressure environment. Many recent studies indicate that 50-60% of work absences are related to occupational stress;

To ensure the health of healthcare workers and effectively prevent stress, the best approach is to have preventive measures and control occupational stress.

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III. Prevention of Occupational Diseases in Healthcare Workers

1. Diseases due to microbiological factors in the healthcare safety document

The development of this group of diseases involves three factors:

• Source of infection (agent);
• Route of transmission, environment;
• Susceptible host.

In principle, to prevent the disease, at least one of these three factors must be eliminated through the following measures:

• Acting on the source of infection with measures such as:
  • Isolating the source of infection; this measure is very important for airborne diseases.
  • Sterilizing and disinfecting specimens, biological products, waste (feces, urine), and contaminated items.
  • Regularly cleaning and disinfecting equipment and the workplace.
  • Properly disposing of waste in designated areas.
• Interrupting the route of transmission:
  • During work, be careful and strictly adhere to aseptic principles, follow infection control procedures, and practice safety when using sharps. Prevent occupational accidents from needlesticks and sharps.
  • Regularly wash and disinfect hands after examining patients and performing procedures.
  • Correctly and fully use personal protective equipment such as masks, hats, gloves, protective clothing…
  • Implement good hygiene practices for drinking water and food, and effectively control intermediate disease vectors.
• Susceptible host
  • Strictly adhere to safety and hygiene principles at work.
  • Proactively get vaccinated against diseases: hepatitis B, A; tuberculosis, mumps, rubella, measles, chickenpox…

2. Diseases due to physical factors in the healthcare safety document

• Strictly ensure adherence to radiation safety and hygiene principles. Periodically measure and check ionizing radiation safety in the workplace.
• Comply with safety principles when using ionizing radiation-emitting machines and when using radioactive isotope chemical sources.
• Use personal protective equipment against ionizing radiation and noise (earplugs).
• Wear a personal dosimeter and have it checked periodically.
• Regularly measure and check the noise environment, and measure ultraviolet radiation when used for sterilization in operating rooms, microbiology labs…
• Conduct health check-ups for people exposed to radioactive substances, paying attention to skin and eye examinations and conducting blood tests and other tests to detect occupational radiation sickness early.
• Conduct health check-ups for people exposed to noise: ENT examinations and hearing tests…

3. Diseases due to chemicals and dust in the healthcare safety document

• Understand the safety rules when working with chemicals. Recognize risk factors and initial management.
• Use personal protective equipment correctly and fully.
• Know the toxicity of chemicals used, routes of entry, disease symptoms, and preventive measures.
• Know first-aid measures in case of an accident.
• Ensure ventilation and hygiene in the workplace.

4. Diseases due to ergonomic factors in the healthcare safety document

It is necessary to arrange work and rest periods reasonably. Increase physical exercise and perform appropriate mid-session exercises to reduce musculoskeletal pain.

Healthcare workers are responsible for guiding, caring for, and protecting the health of the public and other workers, but in reality, they receive less health care at their own workplace compared to other workers.

In 2011-2012, the National Institute of Occupational and Environmental Health was tasked by the Ministry of Health to conduct monitoring at several hospitals in the northern region, including both general/specialized central-level hospitals and provincial/city-level hospitals. The results showed that the healthcare of healthcare workers has many limitations. Many hospitals do not regularly conduct annual periodic health check-ups for their staff. Some hospitals do not have health records for their employees. The person in charge of health is often part-time and changes frequently, so the healthcare of staff is not a priority. Occupational disease examinations for healthcare workers are not implemented in many hospitals.

To assist in the diagnosis and assessment of occupational diseases for healthcare workers at medical facilities, each facility needs to:

• Have a person in charge of occupational safety and hygiene, and a person in charge of health.
• Establish occupational hygiene records, measure and check the working environment, and have an exposure assessment for microbiological factors (working environment monitoring reports are implemented according to Decree No. 44/2016/ND-CP dated May 15, 2016).
• Have health records for each healthcare worker.
• Pay attention to tests such as chest X-rays, HBsAg, anti-HCV, HIV… during recruitment health check-ups.
• Conduct annual periodic health check-ups.
• Conduct occupational disease examinations for some departments at risk of occupational diseases. The record forms and indications for examinations and tests for insured occupational diseases are according to Appendix 4 of Circular 28/2016/BYT.
• Properly report occupational accidents while on duty. Certify exposure to harmful factors causing acute occupational diseases.
• Organize training classes on occupational safety and prevention of occupational diseases for healthcare workers.

5. Preventive measures to minimize exposure risk:

• Limit unnecessary injections and infusions;
• Use needleless replacement devices to connect parts of the intravenous line system, or use safety-engineered catheters;
• Train HCWs on safe injection practices;
• Avoid passing sharps by hand and be cautious when passing sharps; place sharps in a tray to pass to colleagues;
• Arrange injection and procedure tables within easy reach of both hands;
• Use standardized sharps collection containers;
• Do not recap needles before and after procedures to prevent injury;
• In surgery, wearing double gloves is recommended. Some safe practices can be applied, such as minimally invasive surgery, using electrocautery for incisions, and using forceps to close wounds;
• Do not leave used needles scattered in the environment;
• Correctly follow the procedure for collecting and transporting medical waste, especially the storage, transport, and safe disposal of sharp waste;
• Provide adequate and appropriate protective equipment (injection carts, syringes, needles, hand sanitizer, sharps containers…);
• Adhere to the reporting, monitoring, and post-exposure treatment procedures.

6. Steps for managing occupational accidents due to exposure to blood and body fluids:

• First aid immediately after exposure

INJURY OR EXPOSURE	TREATMENT/ACTION
Needlestick or sharp injury	1. Immediately wash the injured skin area with soap and water under running water
	2. Let the wound bleed freely, do not squeeze the wound
	3. Cover the wound
Blood and/or body fluid splash on broken skin	1. Immediately wash the affected skin area with soap and water under running water
	2. Cover the wound
	3. Do not use disinfectants on the skin
Blood or body fluid splash in the eye	1. Gently but thoroughly rinse with running water or sterile 0.9% saline for at least 5 minutes while keeping the eye open, gently everting the eyelid.
	2. Do not rub the eye
Blood and/or body fluid splash in the mouth or nose	1. Immediately spit out the blood or body fluid and rinse the mouth with water several times
	2. Blow the nose and rinse the affected area with water or sterile 0.9% saline
	3. Do not use disinfectants
	4. Do not brush teeth
Blood and/or body fluid splash on intact skin	1. Immediately wash the area contaminated with blood or body fluid with soap and water under running water
2. Do not scrub the contaminated area

 

• Report to the person in charge and file a report:
  • Record all information such as date, time, circumstances of the accident, wound assessment, and risk level of exposure. Obtain signatures of witnesses and the person in charge.
• Assess the risk of exposure:
  • High risk:
    • Injury from a blood-contaminated needle penetrating the skin causing bleeding;
    • Deep skin injury from a scalpel or broken test tubes containing patient’s blood and body fluids;
    • Patient’s blood and body fluids splashing onto pre-existing inflamed, ulcerated, or abraded skin and mucous membranes.
  • No risk:
    • Patient’s blood and body fluids splashing onto intact skin.
• Determine the HIV status of the exposure source:
  • Assess the risk based on the clinical symptoms of the source patient. If the patient is confirmed HIV (+): Inquire about history and response to ARV drugs. If the HIV status of the source is unknown: Provide counseling and take a blood sample for HIV testing.
• Determine the HIV status of the exposed person:
  • Provide pre- and post-test counseling for HIV as regulated. If immediately after exposure, the exposed person is HIV (+): They were already infected with HIV, not from this exposure. If HIV(-): retest after 3 and 6 months. Perform a complete blood count and liver function test (ALT) at the start of treatment and after 2-4 weeks. Retest for HIV after 3 and 6 months. Provide psychological support if necessary.
• Post-exposure counseling and treatment:
  • A person confirmed to be exposed to blood, body fluids, and sharps from a source containing HIV, HBV, HCV should see an infectious disease specialist for counseling and prophylactic treatment as soon as possible.

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PART 3: FURTHER REFERENCE

1. Group 3 Safety Training and Certification Services

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2. Group 3 Occupational Safety Test

• Group 3 Occupational Safety Quiz

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3. Price List for Occupational Safety Training Services

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