|Year : 2019 | Volume
| Issue : 1 | Page : 11-16
A comparative study of the hazards management system associated with laundry operations in secondary and Tertiary Health Facilities in Nigeria
Emmanuel Nosa Omoijiade
Department of Environmental Health Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
|Date of Submission||30-Oct-2018|
|Date of Acceptance||03-Dec-2018|
|Date of Web Publication||30-Apr-2019|
Mr. Emmanuel Nosa Omoijiade
Department of Environmental Health Sciences, College of Medicine, University College Hospital, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
Background: Occupational safety and health hazards in health-care facilities (HCFs) can be grouped according to location or service offered. Contaminated laundry, noise, heat, lifting, sharps, slips, trips, falls, and fire hazards are among those located in the laundry department. Aims: This study sought to assess the measures to reduce workplace hazards, thereby providing information on the hazard management system in various HCFs, as this would prove useful to establish appropriate interventions to further ensure the health and safety of workers in hospital laundries. Materials and Methods: The study was conducted in six hospitals with a laundry department in Benin city, composed of one available tertiary HCF and five secondary HCFs. Data were collected through the hazard identification checklist, which was used to determine the safe/unsafe acts and conditions of the workplaces. Results: The percentage rating for the assessment of the hazard management system in the hospital laundry between the health facility types was 39.57% ± 7.12% for the secondary health facilities, while that of the tertiary health facility was 51.85%. A comparison of the means showed that there was no statistically significant difference in the average rating between secondary and tertiary health facility (P = 0.191), (95% confidence interval = −0.339–0.094). Conclusion: Adverse health and safety effects can be avoided or minimized drastically if the associated hazards are properly managed; however, the hazards management system in the health-care laundries was adjudged to be substandard, in both the tertiary and secondary health facilities.
Keywords: Hazards management, health facilities, hospital laundry, laundry workers
|How to cite this article:|
Omoijiade EN. A comparative study of the hazards management system associated with laundry operations in secondary and Tertiary Health Facilities in Nigeria. J Health Res Rev 2019;6:11-6
|How to cite this URL:|
Omoijiade EN. A comparative study of the hazards management system associated with laundry operations in secondary and Tertiary Health Facilities in Nigeria. J Health Res Rev [serial online] 2019 [cited 2019 Jul 17];6:11-6. Available from: http://www.jhrr.org/text.asp?2019/6/1/11/257482
| Introduction|| |
The American heritage dictionaries define health-care facilities (HCFs) as institutions that provide healthcare services for the healthy, sick, and the injured. These services include counseling, clinical, surgical, and/or psychiatric consultations and treatment services. Globally, tens of millions of workers are employed in HCFs, offering a variety of services. HCFs are classified as high-risk workplaces,, which is characterized by a high level of exposure to hazardous agents (physical, chemical, biological, ergonomic, and psychosocial) that significantly endanger the health and life of workers.
Health-care workers (HCWs) are exposed to various health and safety hazards on a daily basis, including biological hazards such as tuberculosis, hepatitis, human immunodeficiency virus/acquired immunodeficiency syndrome, and severe acute respiratory syndrome; chemical hazards such as glutaraldehyde and ethylene oxide; physical hazards such as noise, radiation, slips, trips, and falls; ergonomic hazards such as heavy lifting; psychosocial hazards such as shift work, violence, and stress; fire and explosion hazards such as using oxygen and alcohol sanitizing gels; and electrical hazards such as frayed electrical cords., However, exposure of HCWs to occupational hazards that may threaten their health and safety depend on the job category and the work environment of the HCW.,
Occupational safety and health (OSH) hazards in HCFs can be grouped according to the location or service offered. Contaminated laundry, noise, heat, lifting, sharps, slips, trips, falls, and fire hazards are among those located in the laundry department. However, of all the potential hazards in the healthcare laundry environment, sharps injuries and bloodborne pathogen exposures have been identified to be among the most injurious to workers in terms of long-term treatment required. In industrial laundries, the most common accidents involve chemical exposure, sharp objects left in soiled linen, slips from wet floors, and exposure to pathogens in contaminated linen, among others.
The high risk associated with the laundry department, especially in the health-care industry, shows the necessity for an effective hazard and risk management system in this area. According to a report by Kenya ministry of health, the main OSH issues in the laundry section are the provision of training on personal safety, provision of personal protective equipment, and guidance through administrative controls, especially the generation and use of relevant and updated standard operating procedures. The report noted that most of the staff were neither trained nor aware both of the provisions of the law on their personal safety at work and of the necessary actions to be taken to ensure their safety at work. The European Agency for Safety and Health at Work (EU-OSHA) noted that regular training and the raising of awareness of workers at risk have been positively evaluated as a protection measure against workplace risks.
The importance of a sound safety culture in the healthcare laundry cannot be overemphasized. According to the Center for Disease Control and Prevention, to create a culture of safety, organizations must direct measures to reduce hazards in the environment as well as address those factors known to influence employees' attitudes and behavior.
Secondary health centers are involved with the prevention of illnesses as well as all treatments and management of minimal complex cases. However, the more complicated cases are referred to the tertiary or specialist hospital. Secondary HCFs can either be comprehensive health centers or general hospitals. While the general hospitals are owned and funded by the government, the comprehensive health centers are often owned by private individuals.
A tertiary health institution also referred to as specialist or teaching hospitals, handle complex health cases either as referrals from secondary and primary health-care centers or on direct admission to its own. They provide the most specialized health care administered to patients with complex diseases who may require high-risk medical and surgical procedures with high-cost technological resource. Beyond the provision of various health-care services, teaching hospitals also conduct researches and provide outcomes to the government as a way of influencing health policies. Hence, this type of health institution is often university based. In Nigeria, tertiary health institutions are controlled and funded by the Federal Government and by some states that have and run state universities.
This study sought to assess the measures to reduce workplace hazards, thereby providing information on the hazard management system in various HCFs, as this would prove useful to establish appropriate interventions to further ensure the health and safety of workers in hospital laundries. The objectives of this study were to assess the hazard management system in each of the various hospital laundries as well as to make a comparison among the different hospital categories in the Benin metropolis, with the hypothesis that tertiary HCFs are examples of good practices with international and acceptable standards in the health-care industry, as opined by Ademiluyi and Aluko-Arowolo and re-echoed by Aluko et al.
| Materials and Methods|| |
Benin City, the capital of Edo State, Nigeria, has a land area of 1219.626 km2 and is bounded by latitude 6°20' North and longitude 5°39' East.
The study was conducted in six hospitals with a laundry department in Benin city, composed of one available tertiary HCF and five secondary HCFs. The study was approved by the Ethics Committee of University of BENIN TEACHING HOSPITAL, BENIN NIGERIA (certificate nos. ADM/E 22/A/VOL. VII/1338) and is in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The tertiary health facility located on the Benin-Lagos expressway with coordinate 6.3337°N 5.60002°E. It came into being in 1973 and boast facilities to accommodate over 500 inpatients. The other hospitals included in the study are secondary care health facilities which provide a wide range of health-care services. [Table 1] shows the characteristics of each of the health facilities involved in the study.
Data were collected through hazard identification checklist. The “Hazard identification checklist” by the Workplace Health and Safety, Queensland, was adapted and used to determine the safe/unsafe acts and conditions of the workplace. Each hospital laundry was assessed using this checklist and percentage scores were taken and used as the rating of the workplace hazard management system. The checklist included sections on ergonomic hazards, biological hazards, chemical hazards, physical hazards (including noise, heat and slip, trip, and fall hazards), safety/mechanical hazards, and first aid and emergency procedures.
IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp., Armonk, NY) was used for data entry, management, and analysis. Descriptive statistics (table and bar graph) were used to summarize the data. Furthermore, the hazard management scores for both health facility types were compared using the independent samples t-test analysis, while one-way ANOVA was used to check for difference in hazard management scores between private secondary, government secondary, and government tertiary health facilities at a 95% confidence level in both cases, such that, a P < 0.05 resulted in the rejection of the null hypothesis, thereby stating a significant difference in the hazard management system.
Ethical approval and informed consents were obtained from the University of Benin Teaching Hospital Ethical Committee, the State Hospital Management Board, Ringroad, Benin city, as well as from the administrators of all the private hospitals included in the study.
| Results|| |
As shown in [Table 2], the hazard management system of each hospital laundry was assessed and converted to percentage [Figure 1].
|Figure 1: Percentage rating of the hazard management system in the studied hospital laundries|
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The average rating was 43.38% ± 6.71% for private secondary, 33.86% ± 2.02% for government secondary, and 51.85% for government tertiary [Table 3]. A comparison of the means showed that there was no statistically significant difference in the average rating among the various hospital categories (P = 0.154) [Table 4].
|Table 3: Descriptive statistics for percentage rating of the hazard management system|
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|Table 4: ANOVA of the percentage ratings among the various hospital categories|
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The percentage rating for the assessment of the hazard management system in the hospital laundry among the various health facility types was 39.57% ± 7.12% for the secondary health facilities, while that of the tertiary health facility was 51.85% [Table 3]. A comparison of the means showed that there was no statistically significant difference in the average rating between secondary and tertiary health facility (P = 0.191); however, the observed difference may be as a result of chance (95% confidence interval = −0.339–0.094) [Table 5].
|Table 5: Independent samples t-test of the percentage ratings between the health facility types|
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| Discussion|| |
A comparison of the means showed that there was no statistically significant difference in the mean score between secondary and tertiary health facility; however, the observed difference may be as a result of chance. This finding supports an observation by Aluko et al., who identified flaws in a study carried out in a tertiary HCF that debunked the hypothesis that the situation in tertiary HCFs should be seen and emulated as an example of good practices in the health-care industry.
According to Ademiluyi and Aluko-Arowolo, teaching hospitals are supposed to be fully developed and accredited for teaching of various medical disciplines. They further noted that teaching hospitals are to confirm international and acceptable standards. Hence, even in the management of workplace hazards, ensuring employee and patient safety, teaching hospitals (tertiary health facilities) should be at the fore, showing an example to other hospitals (secondary health facilities).
This sentiment was shared by Aluko et al. in their study carried out to assess the occupational hazards and safety practices among the health-care personnel in a tertiary HCF in Osun state, Nigeria, stating that the situation in a tertiary HCF should be seen and emulated as an example of good practices in the healthcare industry. They, however, identified various flaws that have far and wide consequences on the health of workers in the HCF, and consequently, on the quality of health care delivered to patients, recommending the need for joint efforts by all stakeholders, including the hospital infection control committee, the management of the HCF, as well as government to adequately neutralize work-related hazards across the healthcare industry in Nigeria.
It has been realized that the performance of facilities is greatly dependent on their proper management, including maintenance. The same goes for HCFs. Oladejo et al. stressed that HCF management is an essential element for the successful delivery of health-care services. They went ahead to explain that all-encompassing maintenance builds in the performance of the buildings, maximizes personnel safety, and minimizes operational costs, environmental threat, and the risk of material damage. However, they noted in their research carried out among tertiary health facilities in Southeast Nigeria that many maintenance organizations in the hospitals still do not realize the importance and benefits of effective facility maintenance, observing that the maintenance culture in the hospitals was that of a reactive approach, which could have dire consequences on both employee and patient safety due to the increased pressure exerted on the available facilities that are in constant use all through the year.
Obi highlighted the hallmarks of public enterprises in Nigeria as low profitability and low efficiency, poor accounting, and reporting systems, while Lewis gave reasons for these lack of accountability and poor management as a result of political and bureaucratic interference. On the other hand, Ajila and Awonusi are of the view that the private sector is synonymous with efficiency, noting that practices common within the sector include a differential wage payment as incentive to increase production and to attract more experienced staff from rival organizations as well as improving and being open to the adoption of new management techniques.
Shebbs argued that the operations of public corporation is focused on service delivery, as these institutions do not engage in profit-making but in full-time service delivery, as opposed to private corporations, believing that it is contrary to the spirit of public service, and its methods and practice are contrary to the general interest of the public. He went further to note that unlike private corporations which perform the same services as their public counterparts, they may be elitist in their costing and that may not be in the interest of the middle-income earners. He concluded by noting that although Nigeria's public corporations in the 21st century are focused at providing solutions to problems of dire consequences, there is a need for rationalization or restructure, with recommendations on the development of personnel policy, adequate funding, and infrastructural development.
Smith in his comparison between the Nigerian public and private sectors noted that the public sector depends on the legislature, which approves the budget, submits the executive arm of Government, and ensures that the budget is implemented as approved by the same administration. This is different from the private sector which has its finance and administration departments completely separated. Citing an example of the National Program on Immunization, a public sector initiative, it was reported by the World Health Organization that the program had a limited effectiveness due to poor management and poor reporting arrangements.
Comparing public and private sectors, Smith notes that the influence of sector goals has an extremely far-reaching effect on the management practices. He explained that the public sector, focused with public goods and service delivery, has the aim of providing these public services at reasonable cost, without trying to make profit or loss, to operate efficiently and safely, and to act in the interest of the citizens of the country, while the private sector, on the other hand, is profit driven and is characterized by free enterprise, capitalism, and a voluntary exchange economy.
Only one tertiary HCF was compared with five secondary health facilities, and this does not provide a suitable ground for proper comparative analysis, as a minimum of two units for each category would provide a more solid basis of comparison. Furthermore, the various psychosocial hazards, which laundry workers may be exposed to, were not assessed. Hence, the need for further research that would include a wider coverage and take into account every area of hazards management, including psychosocial hazards.
| Conclusion|| |
Adverse health and safety effects can be avoided or minimized drastically if the associated hazards were properly managed; however, the hazards management system in the health-care laundries was adjudged to be substandard, in both the tertiary and secondary health facilities. Hence, based on the findings from this study, there is the need for concerted efforts by all stakeholders in the health-care sector (including the government, public, and private entities) to effectively manage workplace hazards in both secondary and tertiary health facilities alike.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]