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A Layout Of The Health Sector In Mauritius Health Essay

CHAPTER 1

Health is one of the most important aspects worldwide. In addition the introduction and set up of the World Health Organization further enhances the value and importance of Health worldwide.

In Mauritius, although it is a small island with a little gross domestic product of price 5406 us $ ( National Accounts Estimates, 2003) we have managed to put a system of health care which has brought major achievement in order to put Mauritius to the level top in health among developing countries. The general state towards health in Mauritius’ population has been improving and is in good terms for the past years. Among other countries, in Mauritius the public health care services are tax funded and free as we considered health to be a human right issue (WHO, 2008)

According to the (white paper, 2000), we are now in a situation where the trend of the health problem has improved to a large extend as we are able to provide health care services around the island. We have now at primary level 134 facilities, 5 regional hospitals and 3 hospitals in district with over bed of 2500. Mauritius also consist of separate specialist hospital like mental hospital , an ear, an eye, throat and nose hospital and also a cardiac center including a chest hospital. We also have the help of the private sector which consist of 14 private clinics to deliver health care.

In delivering the best health care services, we are missing an important point that is the safety of the health care workers who are responsible in deliver the health care services including the patient and the cleaners in the health care establishment. Among the different hazards in the hospitals, there consist of biological hazards which affect the health care workers, patients and cleaners ( guidelines for health care worker, n.d). The health safety executive suggested that the rate of infection among nurses may be at 30/100,000 a year. There may be cases which are unreported (protecting staff from infection, n.d).

Therefore using health care sector as a research way, this academic study will examined the biological hazard that the HCW, patient and cleaners are at risk. Furthermore various studies also expressed their findings and concern towards biological hazard in health care services. (John Gillis, 2000 ; Marie- Claude Lavoie et al, 2010 ; Muh- Yong yen et al, 2010; Patricia W.Stone et al , 2004 ; Albert Nienhaus et al, 2012)

PROBLEM STATEMENT

We are all concerned towards the biological hazard in the health care sector. This academic research will examined the health and safety issues towards the biological hazard mainly about the infectious disease in hospital in the term of the risk of the HCW, the control taken toward their safety and against new emerging diseases such as SARS in other countries, the training and education and information possessed by the HCW and cleaners towards the infectious disease. Furthermore we should also take in mind the working condition of these HCW and the level of illiteracy of the cleaners. The PPE worn by the worker is also considered to be a major concern as it is the main barrier for protection against the infection therefore we must also see if they are worn properly and they are effective .

AIM OF THE STUDY

In this era, to ensure a proper health and safety management in the health care services has become primordial, as it will ensure that the worker are well informed about biological hazards and the harm that infectious disease can caused in the workplace.

As a matter of fact, this academic research enhances the precaution that must be taken towards biological hazard and the main aim of the study is an assessment of the health and safety issues towards biological hazard about infectious disease in the hospital in Mauritius. We will look at the existing control to protect the worker and the lacking in terms of health and safety in the management level towards biological hazards provided by our local hospitals.

THE SET OF OBJECTIVES

In this study, the set of objectives are mainly:

To carry out an investigation of the health and safety aspect adopted in the health care services.

To analyzed the method of work of the HCW and assessing the risk.

To examined the way adopted to control the risk of biological hazards

To carry out an analysis on the information, instruction and training of the worker in the health care establishment

To examined the actual health surveillance and occupational exposure record of the worker

To understand the existing procedure towards disinfection, disposal of infectious waste and handling of PPE in the workplace.

To recommend about precaution that need to be taken towards biological hazard- infectious disease at the health care services.

To provide further recommendation on the health and safety that needs to be adopted to eliminate the risk of biological hazard.

CHAPTER 2

REVIEW OF THE LITTERATURE

2.1THE INTRODUCTION

Health care services are one among the workplaces which has a major employment for a large number of people. A guideline of (health and Safety executive, 2005) mentioned that healthcare sector are also considered to be a major employment in England and it is concerned for both the public and private sector. In this sector it has approximately one million employees. Furthermore to strengthen the fact of a large number of employments in this sector, another guideline of (health care worker, n.d) estimated that in the United States also hospitals employ about 4.5 million workers about mainly 4% of the total US workforce.

However in Mauritius although we are considered to be small compare to England and United States, we also have our major employment in the health care sector that is in the public services we have approximately 17 pharmacists, 50 dentists, over 650 doctors, 2700 Nurses and in private sector employs over 400 doctors. (Government of Mauritius, 2000).

By considering the large amount of employment the Health care sector has become a complex workplace due to large number of people present under one roof. Hospital does not only provide health care but also a research and teaching academic for new recruit (guideline for health care worker, n.d). Hence due to its complexity as a workplace, hospital has given rised to a number of hazards present which can endangered both the staff and the patient. (MFL occupational health center INC, n.d). The article further stipulates that the hazard present in the hospital are divided among 5 categories namely psychosocial, physical, ergonomics, chemical and biological hazards

Among the hazards present, this academic study focuses on the biological hazards mainly about infectious diseases in hospital. A study conducted by (health and safety committee, n.d) identified that biological hazard that is exposure to infectious disease is more compared to hazard of musculoskeletal injury and repetitive strain injury in hospital. The risk of biological hazards is present in the health care sector and is considered to be a very important aspect and this issue should not be taken lightly

2.2 DEFINITION OF BIOLOGICAL HAZARDS

A biological hazard is known to be in terms of organism or by products of the organism which can be harmful to human beings. Furthermore the (MFL occupational health center INC, n.d) defined biological hazards as infectious agents such as parasites, fungi, bacteria and viruses which may be transmitted via fluids, tissues, contaminated objects or body secretions from an infected persons.

2.3 DEFINITION OF INFECTIOUS DISEASE

(WHO, 2012) defined infectious disease as diseases that are caused by microorganism which are pathogenic such as bacteria, fungi, viruses and parasites. These diseases can be spread indirectly or directly from one person to another

2.4COMMON DISEASES PRESENT IN THE HEALTH CARE SETTINGS

Most common diseases that worker in hospital are exposed to are the human immunodeficiency virus (HIV), Hepatitis C virus (HCV), or hepatitis B virus (HBV). It is caused by exposure to contaminated and infected blood pathogen. The communicable disease center (hazard recognition, n.d) stated that 5.6 million of worker in the health care services are exposed to blood pathogen virus. Hence this shows a high trend of infectious disease exposure by blood pathogen among health care worker in hospital. Basically all the exposure to blood or even to infectious materials placed the worker in the hospital at risk and everyday they are working in such environment where the risk is present.

Another infectious disease is known as pandemic influenza. It affects a high amount of population if not detected early and controlled effectively. Pandemic influenza is mainly caused by new virus and as these viruses are new, human being does not have in its possession the immunity to the influenza hence aggravating it thus become more severe. According to (Canadian center for occupational health and safety, 2012) the pandemic influenza was stated by the WHO due to its quick and emergence spread of H1N swine flu virus in 2009. However if the pandemic flu is not controlled effectively, its impact on the population can be devastating. WHO has stresses on the fact that 2 to 7.4 million deaths may be caused by 1957 influenza type (Canadian center for occupational health and safety, 2012). In addition we note that the pandemic flu spread quickly in other countries hence as we Mauritius are small compared to other countries, the spread is quicker. We must neutralize the virus in the health care itself so that it does not affect the population.

A infectious disease which is considered to be a serious problem to the health and safety atmosphere of the hospital is Tuberculosis. It is transmitted by the bacteria called Mycobacterium Tuberculosis. TB is of great concern to the working environment and its personnel as it is propagated through the breathing air. The risk of TB is known to be higher in environment such as the health care sector (Canadian center for occupational health and safety, 2012).In the hospital the infected person is placed in the isolation room. TB can be detected by a test which if the person is infected it will show a positive tuberculin blood test or skin test. In conclusion we noted that it will take time to know if the person is affected by TB and in the mean time it may affect other person due to its characteristics by propagating in breathing air.

The last disease is about new emerging diseases known as severe acute respiratory syndrome (SARS) it was first identified in Canada in March 2003. It spread from person to person by close contact. According to (Canadian center for occupational health and safety, 2012) the HCW dealing with the person infected by SARS are mostly at risk. Hence the need for PPE and hygiene need to implemented.

These are only a few diseases which are common and posed a threat to the health and safety of the HCW and the patient in the hospital. Moreover the list of diseases is not exhaustive as there consist of many other diseases and new emerging diseases itself is a threat to the HCW if they are not prepared well to control and deal with the disease in the hospital.

2.5 MODE OF TRANSMISSION OF INFECTIOUS DISEASES

To know how HCW and patient are affected by infectious diseases and to which extend the health and safety of these worker are at risk, it is important to know how the mode of transmission of the infectious diseases are so that appropriate health and safety aspect can be developed in the workplace. According to (Jane D Siegel et al, 2007) it has stresses on the fact that the mode of the transmission diseases may vary and may not operate on only one mode of transmission. Diseases may not be transferred from person to person but can have the contribution of the working environment medical error by HCW, poor PPE or even poor intervention of health and safety aspect.

2.5.1 BY CONTACT TRANSMISSION

We have 2 contact transmissions that is the direct contact from infected person or the indirect contact. (Jane D Siegel et al, 2007) stated that the direct contact take place when an infected person has transmitted the infected microorganism to another person, without a middle person or the use of contaminated object and it may be in the form of blood or other contaminated body fluid entering the HCW trough contaminated patient by needle stick injury or even by cut and abrasion in skin.

In the term of indirect contact of transmission in the health care setting, it usually results from contact with a contaminated object. As a result in (Biological hazard safety in hospital, n.d) we concluded that to stop the spread of biological hazards, the HCW must wash their hand frequently and upon each contact with a patient and also the wearing of PPE is a must for them to ensure protection against biological hazard. There is also the risk of indirect contact if the patient used devices such as thermometers and they are not disinfected. According to (Jane D Siegel et al, 2007) the PPE used such as clothing uniform, lab coat or even isolation PPE can be a source of infection if not disinfected , wash and kept properly

2.5.2 BY DROPLET TRANSMISSION

(United States department of labor, n.d) explained on the droplets transmission by describing droplets as a source of infection which takes places by an infected person who coughs, talks or even sneeze or while doing medical test on them. The transmission of droplet which can be infectious is occurred the infected droplet come into contact with body part example as the eye, mouth or the nose of an infected person. However a plus point of droplet transmission is that they are too large to be airborne and travel long distances in the air. (Jane D Siegel et al, 2007). Thus they can be controlled and is not a great threat to the working environment if PPE is worn by worker. Study conducted by (Jane D Siegel et al, 2007) gives evidence to droplet transmission as a source of infectious and it states that the new emerging virus SARS itself is a droplet transmission infection. In addition there are also study strengthen the fact of droplet transmission the mode of transmission of SARS. A study conducted by (MUH-YONG-YEN et al, 2010) shows that HCW are at high risk of getting SARS which is a droplet transmission infection. As a result it also stated that HCW can contact the disease at 36% while caring for infected person. In addition another study conducted by (Albert Nienhous et al, 2012) expressed its concern on the disease SARS as HCW are at risk and it render them vulnerable. Hence as a conclusion, we stated that droplet transmission such as SARS in this study has posed a serious threat to the health care personnel and thus increasing the risk in the health care sector. Special attention need to be paid to these types of infectious diseases and precaution must be taken against them.

2.5.3 BY AIRBORNE TRANSMISSION

It occurs through small particles that remain suspended in the air and contain infectious agents. They are mostly breathed in by worker by the respiratory tract and infection occurs. The air current plays an important role in dispersing the infected particle suspended in the breathing air over long distances hence to acquire the infection the person may not be face to face with the infected person.

According to (United States department of labor, n.d) among the limited diseases transmitted by airborne, we have the disease of tuberculosis the most (TB). Study has demonstrated the threat of TB which is an airborne infection to the health care environment. Furthermore a study of (Marie-Claude Lavoie et al, 2010) clearly stated that in some countries the rate of contracting TB are greater for the hospital worker and overall they concluded that airborne transmission posed a hazard to HCW. TB is a threat to the HCW hence to conclude the fact a study of (Karim A Adal et al , 1994) stresses on the fact that TB must used highly effective PPE to protect against it and the PPE is costly. As a result, investment need to be made for the HCW safety so as to be able to stop propagation of TB and as we conclude prevention is better than cure.

2.5.4 TRANSMISSION FROM PATIENT

Biological hazards do occur by contact with patient and staff and according to a publication on (EHow, n.d) the patient hazards is a hazard present in the health care sector, in the form infection transmission and the aggravation of infection by poor treatment or lack of supervision.

Emphasis is also added to the safety of staff who delivered treatment to infected patients. HCW are mostly at risk while caring for patients which have highly infectious diseases contamination from (protecting staff form infection, n.d). In addition article by (Kelly M. Pyrek, 2010) underlined that by preventing transmission of infected diseases among staff this will reduce the transmission risk among patient and family member. In the health and safety aspect we need to take into consideration the safety of all therefore the patient safety against infectious disease must be taken care of. In addition study such as (Julie Louise Gerberding, 2002) talks about the infection the patient has acquired in hospital and it also state the infectious disease the patient acquired during hospitalization. This article raised a question on the patient safety in hospital. Nevertheless a plus point is that protecting patient against infectious disease reduces also the risk if transmission to staff personnel.

2.6 HEALTH CARE ISSUES THAT PREVENT THE EFFECTIVE CONTROL OF INFECTIOUS DISEASES

2.6.1 STAFFING LEVEL

The staff in the health care sector is the main pillar which helps to control the transmission of infectious diseases and provide treatment. However several studies raised concern about the staffing level which is low hence difficult to control transmission of infectious diseases or even raised poor working condition and stress also lead to a high rate of turnover of the staff. This results in a decrease in the workforce. A study conducted by (Tommy Lundstrom, 2000) elaborate on the fact that how the stress and job condition affect the working performance of the HCW. This can lead an impact on the control of infectious disease in hospital, as the performance will be poor and this will affect the health and safety of both patient and HCW. In addition we also have the study conducted by (Patricia W.Stone et al, 2004) which gives details on how the working condition and inadequate staffing level can increase the risk of getting medical error. In this study we also came to know about the high rate of turnover of the staff in hospital. Furthermore it also underlined an important fact that extended work shift lead to staff tired hence making more errors and thus increasing the risk of spread of infection. Staffing level has been also linked to the outbreak of infection at hospital level. This creates a great concern to the health and safety aspect for HCW and patient. Staffing level is an important issues as they are considered to be the well trained workforce who will deal with situation like infectious disease spread and combat them Many staff does not even realized their importance and responsibility towards the control of infectious diseases hence this lead to high rate of absenteeism and medical negligence. However concerned has been raised on the limited trained professional on NIOSH survey on (Guideline for HCW, n.d). Understaffing and overcrowding in the hospital have also been a concerned in the infectious disease control (Sepideh Bugher Nejad et al, 2011)

2.6.2 ORGANIZATION CHARACTERISTICS AND SAFETY CULTURE

Safety culture has been defined as a shared way of the workers with regards to the level of the safety that should be adopted in their workplace (Tommy Lundstrom et al, 2002). They shared a commitment on the part of the management and the workforce maintained it.

A safety culture is a major step towards the health and safety and it enhance infection control in the hospital. According to (Jane D Siegel et al, 2007) the safety culture of a hospital has a direct impact on the decreasing of the risk of transmission as a safety culture will create a positive health and safety atmosphere by implementing management commitment to the safety of patient and worker, increase worker interest in safety, make usage of PPE important, make the staff accept the safety procedures and finally integrating and trained new personnel. Safety culture is also linked towards the reducing of exposure of blood and body fluid to HCW. (Clarke SP et al, 2002 ;Grosch JW et al, n.d)

To enhance safety in the hospital, several hospitals want to improve their safety culture. Thus root of the problem will be identified, employee will be educated towards health and safety and safety issues will be taken seriously by the staff.

2.6.3 FOLLOWING OF GUIDELINES BY HCW

As it has already mentioned previously, the risk of hazards is greater to the NCW than other worker. Hence in order to decrease the risk level, certain standards and guidelines have been implemented in hospitals where the HCW has to work according to it.

These guidelines are used for the effectiveness of infection control. However study has shown that there may be limited follow up of the guideline by HCW (Center for disease control and prevention, 2002). According to an article of (Sepideh Bagheri Nejad, 2011), hospital sectors have guidelines called Universal Precaution which has been set up to protect HCW which are exposed to body fluid or blood. These guidelines in this study are rather effective as they do not allow error or even take the risk to be exposed by infectious patient .thus precaution is taken to all patients. The guideline is important as it covered all aspect of health and safety to make hospital a safety working place such as put barrier against blood and body fluid to employee and implement safe work practices, and also increasing the effective of safe handling and transportation of infectious waste. If the HCW followed these guidelines the hazard of biological will gradually be dealt on perfectly in hospital. However studies have shown that among HCW of many years of experience, the follow up to guideline are low. (Friedland LR et al, 1992 ; Helfgott.W et al, 1998). Hence in order to modified the low adhere trend, the some studies have introduced the system of educational and performance feedback which HCW has to abide by and give maximum adhere to guideline (Michalsen A et al, 1997 ; Williams CO et al, 1994). As a result this system help to increase the application to guideline therefore it deem to be a good system to be implemented in the health care sector in Mauritius.

2.6.4 EDUCATION AND TRAINING OF HCW

The training and education of HCW is primordial so as to ensure that the procedures and policies of the precaution against transmission (Jane D Siegel et al, 2007). Instead of following guideline, the training of staff is more important to HCW. The publication on (protecting staff from infection, n.d) put emphasis on saying that training must include infection control on induction training itself and it will thus be a way on reaching a wide range of staff. Understanding the procedure of working during training and education process will allow the HCW to apply the procedures and practices correctly without inducing medical error. Education is an important aspect according to (Jane D Siegel et al, 2007) as it will enable HCW to understand the practices and principles to prevent transmission of infected disease and these educations should be provided to anyone who is in contact with biological hazard.

In the health care premises the updated of new training skills and update of education, should be made at a regular interval as we are in an era where there are new emerging infected diseases. Hence HCW has to keep updated on their training skill or else it will be difficult to deal with new diseases. In addition study has stated that lack of training lead to difficult situation for HCW. According to research by (United States department of labor, n.d) they revealed that in 2003 due to little or no training, they did not know how to deal with the new emerging disease SARS. Attentions were drawn also on lack of workplace education in the health care sector. Another study conducted by (Marie-Claude Lavoie et al, 2010) underlined the fact that HCW are not aware of the risk they are into as they lack of training in the field of Occupational Health and in the field of infection control also.

Training and education is considered to be an important aspect in health and safety to the HCW as it informs and warn them against the hazard they are in contact with. However these training sessions need to be updated at regular interval and different training and education session need to be implemented to staff of all range in hospital by taking into consideration their education level.

2.6.5 ISSUES ABOUT NEEDLE STICK INJURY OR OTHER INFECTIOUS INJURY

There have been many transmission of HIV, Hepatitis associated with needle stick injury or other sharp injury in the health care sector contacted by HCW (Center for disease control and prevention, 2001). As a result the prevention of those injuries has always been a universal precaution in the health care and now has become a primordial aspect of prevention in standard precaution. Although universal precaution against sharp injury or needle stick has been adopted in health care premises, the risks of these injuries are still there and several cases are under reported. Staffs do not even report these injuries to their injury board committee or even their supervisor. To strengthen the fact that injuries are under reported, study has proved it. A study conducted by (A.B De Castro et al , 2009) stated that mostly 40% of nurses had experienced workplace injuries a year and most injuries were not reported. Although needle stick injuries appear to be rare, some studies have proved the contrary where a study performed by (Tammy Lundstorm et al, 2002) suggested in his study that blood borne exposure do occur by needle stick injuries and lower staff level increases needle stick injuries due to quick paste and stress at work. Studies also put emphasis on needle stick injuries by HCW as they are more posed to the risk of getting HIV, Hepatitis B and C (Juanita A Hagama et al, 2011). In addition a study conducted by (John Gillis, 2000) furthermore elaborated on needle sticks injuries by HCW. It stated that the nurses named accidental needle stick injuries as the main and most happening hazards among the hazards in the health care sector. An important point noted in this study is that there are among 1 million of case of accidental needle stick injury reported in North America, but many under reported cases have been noted. Thus there may be more than 1 million of accidental needle stick injuries.

Under reported cases among HCW has been underlined by several studies. Among these studies we have that of (Umayya M.Msharra Fiehi et al, n.d) who did a research on on exposure to blood borne pathogen among worker and stated that it is difficult to know the exact amount of needle stick injuries due to a number of under reported cases. Sharp injuries have also been very common to HCW and according to research in other countries most cases are under reported. That is why a study conducted by (Bradley N.Doeddeling et al, n.d) suggested that under reporting of sharp injuries overall is among 32% of the total 100%. Hence it show high rate of sharp injuries among the HCW.

However there has been another hypothesis developed by (Patricia W.Stone et al, 2004) who further elaborated on issues about needle stick injuries and associate those injuries as poor working condition of those nurses. This study state that the working condition such as high level of stress, poor management, poor training and education and extended shift gives rise to a high rate of needle stick injuries. This is an important fact raised by this study as if a HCW is tired, they do give rise to medical error. The sharp and needle stick injuries are always considered to be a risk in Health care sector although it is considered to be fully managed and controlled. To strengthen the fact a study conducted by (Marie Claude Lavoie et al, 2010) elaborated that the exposures to needle stick and sharp are still present and moreover it is considered to be highest among HCW.

All these studies do show the proof that the risk is still present in other countries and many cases are under reported. Hence we also need to consider the fact in the hospital in Mauritius as there may be under reported cases in our health care sector.

2.6.6 INFECTION TRANSMISSION IN WAITING AREAS AND FROM VISITORS

In waiting areas, there is a risk of high transmission of infectious diseases. The infection through airborne transmission posed a threat to the patient or even to the HCW. Infection by airborne such as Tuberculosis, required many precautions to be taken so as person are not infected. Moreover several studies put emphasis on airborne disease such as Tuberculosis in waiting area in hospital (center for disease control and prevention, 2005 ; Beck-Sague et al, 1992)

According to (Jane D Siegel et al, 2007) the patient suspected of Tuberculosis should be isolated and wear PPE such as respiratory mask to avoid transmission of infection. However the isolation method is considered to be the best method as it will isolate the patient from the waiting areas, thus reduce the risk of exposing other people. Furthermore several studies also stated that the person accompanied the patient can also be infected hence posed a hazard to HCW. (Varia M et al, 2003 ; Bitnun A et al, 2003)

Moreover visitor also is considered to be a threat to the health and safety aspect concerning infectious transmission controlled in health care sector. Visitors have been known to be a source of transmission of infectious disease. (Jane D Siegel et al, 2007) stated that in the health care sector visitor screening as a method to reduce risk of infection diseases has not been implemented yet and this method will proved to be very reliable in case of an infectious disease outbreak. In the case of visitor, the number and the frequency of visit can be noted down and monitored in case of infection outbreaks. It will be considered to be a plus to the aspect of health and safety in the health care sector.

The use of PPE by visitors has not been clearly elaborated in the studies. This can be a negative point on the biological hazard control as according to ( Jane D Siegel et al, 2007) visitor in close contact with patient may contribute to the risk of transmission in the absence of not wearing PPE for acting as a barrier against infectious diseases. However different units has different cases of infectious disease with different mode of transmission, the PPE that will be used by the visitors also will vary depending on the mode of propagation of the infectious diseases

2.6.7 CLEANERS AT RISKS IN HEALTH ACRE SECTOR

Cleaners are the worker that are mostly more prone to be at risk by blood borne pathogen in the health care sector. They are likely to come into contact with sharp and contaminated needle as well as infected body fluid. According to (European Agency for Safety and health at work, 2009) HIV, or even hepatitis virus are the most common risk and hazard for hospital cleaners. It also that article such as (Kurger et al, 1993) found that cleaners in hospitals were not contaminated by hepatitis A type.

Cleaners at the hospital are subjected to biological hazards namely blood and body fluid. The transmission of infection routes can be from open or dry skin or even needle stick injuries. (Kurger. D et al, 1997; Cleaning Industry Research Institute, 2006). In addition the (European agency for safety and health at work, 2009) stresses on the fact that now if the cleaners come into contact with body fluid or blood , the risk is higher as there is an increasing rate of HIV nowadays. However an important point underlined was that cleaners who handle medical waste are mostly at risk by handling needle in the waste or even cleaning laundry for infected person and also included the cleaning of bathroom containing infected blood

According to (Cleaning Industry Research Institute, 2006) these cleaners must be protected by protective equipment such as gloves and apron. To help to minimize the risk of transmission and to protect cleaners, a framework has been signed concerning sharp injuries in health care sector (European Public Services Union, 2009). Cleaners do not possessed enough knowledge on the hazard or the risk present in the infected waste or when cleaning as due to their illiteracy. Hence, these person must be protected and sensitize them on the risk present in their workplace.

2.6.8 PROTECTING STAFF BY USE OF PPE

The use of PPE according to a guideline on (protecting staff from infection, n.d) is a physical separation between the wearer and biological hazards. It helps to protect the person from micro organism. However the drawback about PPE is that PPE does not eliminate the risk of acquiring infection entirely. That is why it is important to use the PPE correctly, appropriately and effectively and to use it in all places where there is risk of infection transmission. In addition an important fact is that PPE cannot replace hygiene such as hand hygiene as it is considered to be a vital part in the elimination of infection transmission and it is also important even if gloves are worn. PPE is known to be difficult to wear or work in and also uncomfortable, furthermore it also needs to be maintained well to avoid being a source of infection itself. PPE selection is always based on the mode of transmission of biological hazard and nature of patients.

2.6.8.1 GLOVES

Gloves are used to prevent direct contact with body fluid, blood or infected material and also they prevent direct contact with infected person also. According to (Duckro et al, 2005) gloves protect the HCW from exposure to infected material that may handle by hands. But the disadvantages of gloves is that it is not 100% leak proof as it cannot act as a barrier to needle stick injury where they punctured the gloves. (Jane D Siegel et al, 2007) stated that gloves cannot be reused frequently or rewashed as it reduces the barrier and damaged the gloves. The gloves should also be removed well to avoid contamination and hand hygiene is a must after removal of gloves to prevent infection transmission.

2.6.8.2 GOWNS

Gown is used as a protective equipment to protect the HCW against the contamination of the clothes by contaminated body fluid and blood or even other infected material. (Center for disease Control and Prevention, 2003). However for the gown to be effective and protect the worker, certain criteria must be taken into consideration such as nature of interaction with patient, the degree of contact with infected material. The wearing of gown is an importance as it is mandate by the occupational safety and health administration of the blood borne pathogen standard. (Occupational safety and health administration, 2001).

There are certain standard and way of wearing the gown that should be respected to avoid contamination and according to (Jane D Siegel et al, 2007) the standard are that the gown are usually the first PPE to wear. Gown also should cover the staff well and it should be removed in a manner so as not to contaminate all.

2.6.8.3 MASK

An article of (Jane D Siegel et al, 2007) suggested that mask in health care sector are used to protect HCW against respiratory infectious material, also protect patient from infectious agent found in HCW’s nose or mouth and limit patient coughing. However masks are not that effective compared to the high respiratory PPE used in case of an airborne outbreak. Mask is considered to be a very protective for HCW. (Loeb M et al, 2004)

2.6.8.4 GOGGLES

The role of goggles is not needed in the health care sector but it is mainly used in the laboratory section in the hospital to prevent splashes in the eyes of the worker. Compared to goggles face shield is mainly used as it provide protected not just the eye but also the face. The article of (Jane D Siegel et al, 2007) explained that goggles and face shield has to be removed well and after removal must do hand hygiene as the front of the goggle or face shield is considered to be a contaminated area.

2.6.8.5 RESPIRATORY PPE

Respiratory protection in health care sector is mainly used in the protection against airborne infectious transmission. However the issues concerning the use of respiratory protection are still debated (Jane D Siegel et al, 2007). It also underlined the fact that the respiratory protection was used first in 1989 to protect HCW from infectious diseases known as Tuberculosis. This was rather a good initiative as it was effective to prevent transmission of tuberculosis. The use of mask is sufficient to stop the transmission of Tuberculosis and for worker protection. (MC Gowan J E JR et al, 1995) but the center for disease recommend the use of respirator in case of Tuberculosis outbreak or of suspicion of Tuberculosis. In some health care, the use of respirator is reused again when dealing with patient with Tuberculosis (Jane D Siegel et al, 2007). But the drawbacks is that the respirator must be checked first if damaged and a professional person only can check its effectiveness and moreover no data were found of the time length that the respirator can be reused. The application of respirator as a PPE must be integrated in the Health care sector as it is considered to be effective in other countries.

2.6.9 WASTE MANAGEMENT IN HOSPITAL

In the past years the medical and hospital waste have been increasing in number and has witnessed a great expansion. Therefore if these wastes are not managed or disposed properly they can be a source of infection, risk of injury and even be hazardous to patient and HCW. (R.Mohee, 2005). Health care waste in general is known to be all wastes generated by the hospital establishment. However, between 75% to 90% of the waste produced in health care sector are usually that of housekeeping or administrative and the remaining about 10% to 25% is known to be hazardous waste and there is risk of infectious.

Unfortunately issues about medical waste management has been raised in developing countries(Eugene C.Cole,2000) where the general waste of hospital such as housekeeping or administrative waste is not separated from sharp waste and they are even disposed untreated in surface dumping near the hospital. This can be a source of injury to the personnel handling the waste

2.6.9.1 INFECTIOUS WASTE

Infectious wastes are all waste items that are infected or suspected of contaminated of enough concentration or quantity to cause diseases and according to a publication of (WHO,n.d) some categories of infected waste are: instrument which has be contaminated by infected person, infected waste of an infected person during dialysis, infected protective equipments, infected waste from surgery, stock or culture of infectious agent form laboratory example blood and body fluid.

The treatment of the infectious waste should be chosen according to the local and national condition. Eliminating infectious micro organism by chemical, by heat or by radiation of microwave is considered to be an easy process. Highly infectious waste is disinfected at the earliest stage by autoclave method known mainly as wet thermal treatment of waste. However to prevent transmission of infectious diseases by sharp waste, it need to be incinerated whenever possible together with infected waste. Thus the residue can be landfilled.

As previously in the review of literature, we know that sharp has been associated to needle stick injury responsible for transmission of infectious disease, therefore special precaution need to be taken with them. According to (Ira F Salkin et al, 2000) the sharp should be disposed in a leak proof container puncture resistant , rigid with lid and must be found in area where sharp is generated to avoid transportation and injury while transportation. The size of the container should be of a reasonable size to avoid blocking of space. In addition, the disposal of infectious blood or body fluid may posed a serious occupational problem when emptied container. PPE should be used by all staff that is in contact with that liquid. The infectious waste should be placed in a red container, rigid, puncture resistant, and outside the container should be labeled infectious biohazard. Usually incineration and autoclaving are the most common method. According to (R.Mohee, 2005) stated that as always all infectious waste in Mauritius are burn on site by incineration process. Incineration is the best option as due to its high temperature (1300 degree Celsius) it destroys all micro organisms and reduces the waste amount.

2.6.9.2 HEALTH IMPACT OF INFECTIOUS WASTE

All person exposed to hazardous hospital waste are at risk. Person at risk may be the staff of the health care, patient, visitor or even worker at waste disposal and laundry. Infected waste consist of a great amount of micro organisms which can enter human body by ingestion, inhalation, skin , cut or skin abrasion.

According to (WHO, n.d) there are strong proof of transmission of HIV or even hepatitis via health care waste. However there may be also bacteria and disease emanated from the poor management of medical waste. There have been many evidence that many cases of infectious disease is due to improper management of health care waste in developing countries

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