About 100 injuries among healthcare workers take place every day due to their use of medical equipment. This data can be found in scientific publications. It can be largely underrated, though. According to estimates, one in six injuries is reported. Others are either marginalised or ignored both by employees and employers.
What is the threat? Potentially, not less than 247.5 thousand healthcare workers (nurses, midwives, paramedics, dentists, specialists in: surgery, obstetrics and gynaecology, anaesthesiology and intensive care, rescue medicine) are exposed to injury and not less than 192.5 thousand to radiation (nurses, electroradiology technicians and radiologists). In case of employees, hazardous incidents stand for possible health problems, potential high costs for employers due to compensation payments, employee absence, situations where employees quit or become entitled to disability benefits.
In hospitals audited by NIK, 1130 cases were reported where employees providing healthcare services were exposed to hazardous and dangerous factors. The cost analysis of proceedings related to such incidents in 10 hospitals showed that their costs ranged from PLN 17 to PLN 961 and from about PLN 3.2 thousand to about PLN 3.6 thousand, including employees’ temporary inability to work. However, only in one case two persons demanded compensation for injury (only one received it). The NIK auditors did not identify any legal proceedings conducted against the audited institutions.
Is medical equipment safe?
In the hospitals audited by NIK, venues for providing healthcare services were organised in a way to minimise this type of threat. Also, proper procedures were developed and personal protective equipment as well as adequate vaccinations were guaranteed.
The NIK also showed that in 11 hospitals (92%) the personnel was not provided with safe medical equipment. In five hospitals, there were no safe needles to collect blood, and needle-free vials were not used in two facilities. It needs to be emphasised that glass vials are the most frequent cause of injuries in healthcare institutions.
In the audited period, only 4 of 12 audited hospitals reported a constant, annual increase in safe equipment purchases (5%-23% against the last year). In three other hospitals expenditures for safe equipment were going down and in one they equalled zero (safe vials were used there, though).
According to NIK, hospitals should successively boost safe equipment purchases so as to reduce the risk of injuries as much as possible.
A detailed study of a random sample of 548 cases of employees’ exposure to dangerous and hazardous factors (out of 1130 registered cases) showed that in the event of injury, most hospitals (8) reacted properly, applying procedures determined in this situation. In four cases NIK auditors identified some procedures against applicable rules (e.g. follow-up blood tests were not always made to injured persons). They resulted from employees’ negligence or inadequate supervision on part of the employer.
Besides, the NIK findings reveal that in the audited period a significant, though gradual decrease in injury cases was reported.
In line with the EU directive, from May 2013, hospitals have been obliged to report injuries immediately, on a daily basis. The NIK audit indicated that hospitals put that procedure into practice. Irregularities were related to the way hospitals prepared mid-year reports on injuries. In as many as 8 of 12 hospitals, those documents were prepared improperly, which – according to NIK – made it more difficult to correct mistakes on an ongoing basis and avoid them in future.
It is also problematic that healthcare institutions are not obliged to submit these reports to any external institution. It not only makes it impossible to collect complete and reliable data but also plan and take effective preventive measures, reducing the risk of negative incidents also in the places where they have not occurred yet. Therefore, NIK made a recommendation to the Minister of Health to make it obligatory to inform the State Sanitary Inspection about the number of injuries in positions threatened with such incidents.
Effective radiation prevention?
NIK auditors did not identify any cases of uncontrolled radiation but they found irregularities which pointed to insufficient protection of employees. As much as 14% of them could be exposed to direct radiation. Irregularities occurred in all the audited hospitals, although to a variable degree.
Under the Atomic Law, before hiring a candidate to work in the conditions of ionising radiation exposure, the employer is obliged to obtain information from the President of the National Atomic Energy Agency about the radiation dose absorbed by the candidate in a given calendar year and in four preceding years. Only one of eight audited hospitals requested such information.
According to heads of the audited hospitals, the obligation to acquire information on radiation doses pertains only to category A employees (the ones who may be exposed to a specified effective yearly dose). Category B covers employees not included in category A. According to NIK, the Atomic Law does not make such categorisation, so NIK recommended that the Minister of Family, Labour and Social Policy amend the regulations and further specify the Atomic Law in that respect. The Ministry of Health is positive that the provisions are clear-cut and the employer’s obligation to obtain information about the dose of radiation absorbed by its employees refers to both employee categories.
The NIK audit also revealed that two of four hospitals did not provide their employees with appropriate medical supervision, including among other things an occupational health check at least once a year. Besides, some category A employees performed work without a valid medical opinion, which was against the Labour Code.
Other irregularities:
- in four hospitals (33%) irregularities were identified in terms of preliminary training programmes on employee radiation protection;
- in three hospitals (25%) irregularities were identified in terms of categorising locations at workplaces into controlled areas (with exposure to radiation doses specified for category A employees) and supervised areas (with exposure to radiation doses specified for category B employees);
- in 6 hospitals (50%) emergency exercises - aimed to review and update the hospital emergency action plans - were ceased in some cases.
Safety and health at work regulations not always observed
The NIK auditors pointed out that the audited hospitals were only partly prepared to identify and minimise occupational risk related to injuries and radiation while providing healthcare services.
In the audited period, all the hospitals covered by the audit hired over 100 persons and, in line with the Labour Code, an occupational safety and health (OSH) service was appointed there. In one hospital, tasks in this area were outsourced, which was against the law. In two hospitals, the OSH service did not directly report to the employer, which was also a breach of applicable law.
In one hospital, compliance with radiation protection requirements was not properly supervised. The NIK auditors established that for over seven months the radiation protection inspector was not hired there and for the following three months that function was performed by a non-eligible person. That was a breach of the Atomic Law.
Other irregularities:
- in three hospitals (25%) risk assessments referred only to some hazardous biological agents defined in the ordinance of the Minister of Health of 2005;
- in six hospitals (60% of 10, where OSH commissions were appointed) meetings were not organised as often as needed. In one case, not a single meeting was held in the audited period, which was against the Labour Code;
- in half of the audited hospitals, assessments of occupational risk related to injuries were not updated after two years from their preparation, which was a breach of the OSH ordinance on work with exposure to injuries;
- in seven hospitals (58%) employees were not provided with suitable training programmes – because their scope was limited, they were not organised frequently enough or they covered only some employees;
- in three hospitals (25%) the minimum number of OSH service employees was too small.
