Introduction to Occupational Health Hazards
Subtopic:
Personal Proctective Equipment (PPE)
Personal Protective Equipment, commonly known as ‘PPE’, is worn by healthcare personnel to safeguard them during tasks where they might encounter blood or bodily fluids that could contain infectious agents (germs).
PPE serves as a barrier between the healthcare worker and germs. This barrier lessens the risk of touching, being exposed to, and spreading infectious agents. In healthcare settings, PPE is crucial in preventing the transmission of germs, protecting both patients and healthcare workers from infections.
PPE encompasses various items often recognized by the public in healthcare contexts, such as gowns, gloves, and masks. These items are generally for single-use only – meaning they must be used once and then discarded. However, some PPE items are designed for reuse after proper cleaning and reprocessing.
All personnel in healthcare facilities, including staff, patients, and visitors, should utilize PPE whenever there is a potential for contact with blood or other bodily fluids.
Types of PPE
PPE is broadly categorized into the following classes:
Masks
Eye Protection PPE
Clothing PPE
Masks
A mask is a protective covering designed to shield the face or a portion of it, specifically covering the mouth and nose.
Types of Masks Available
In Uganda, the mask market primarily features two categories:
Medical Masks
Non-Medical Masks
Medical Masks
Medical masks are intended for use by healthcare workers in medical facilities and are not designed for reuse. Two primary types of medical masks are utilized to prevent respiratory infections:
Surgical Masks (Face Masks)
Respirators (e.g., N95 and KN95)
Surgical Masks
Definition: A surgical mask is a disposable, loosely fitting device that establishes a physical barrier between the wearer’s mouth and nose and potential contaminants in the immediate vicinity. These are frequently referred to as face masks, although not all face masks are classified as surgical masks.
Important Points:
Surgical masks are manufactured in varying thicknesses and with different levels of fluid resistance.
These characteristics can influence breathability and the degree of protection against fluid exposure.
Surgical masks are intended for single use and should not be reused.
Surgical masks are not designed for sharing and may be labeled as surgical, isolation, dental, or medical procedure masks.
While effective at blocking larger droplets and splashes, surgical masks are not designed to filter or block very small airborne particles that can be transmitted through coughs, sneezes, or certain medical procedures.
Respirators
A respirator is a type of respiratory protective device engineered to achieve a tight facial seal and highly efficient filtration of airborne particles.
Crucially, respirators are designed with edges that form a seal around the nose and mouth to ensure proper fit and filtration.
Types of Respirators:
N95 (commonly used in Uganda)
KN95
General Precautions for Respirator Use:
Individuals with pre-existing respiratory conditions, cardiac issues, or other medical conditions that cause breathing difficulties should consult their healthcare provider before using an N95 respirator. N95 respirators can increase breathing resistance.
Some respirator models include exhalation valves, which can ease breathing out and reduce heat buildup inside the mask. However, respirators with exhalation valves are not suitable for use in sterile environments.
All respirators are labeled as “single-use” and disposable. If a respirator becomes damaged, soiled, or breathing becomes labored, it should be removed, properly discarded, and replaced with a new one. Safe disposal involves placing the used respirator in a plastic bag and then in the trash. Hand hygiene should be performed after handling a used respirator.
N95 respirators are not designed for children or individuals with facial hair. A proper facial seal cannot be achieved on children and people with facial hair, potentially compromising the respirator’s protective capability.
Surgical Mask vs. Respirator: Key Differences
A surgical mask is a loose-fitting, disposable barrier between the wearer’s mouth and nose and the immediate environment. In contrast, a respirator is a respiratory protection device designed for a close facial fit and high-efficiency filtration of airborne particles.
Medical Mask Usage Recommendations:
Use medical masks that have:
A snug fit over the nose and mouth to minimize air leaks.
Multiple layers of non-woven material for improved filtration.
Wide availability as disposable masks.
Avoid medical masks that are:
Wet or soiled, as this compromises their effectiveness.
Strategies for Enhanced Fit and Protection with Medical Masks:
Double Masking: Wear a disposable mask underneath and a cloth mask on top for increased filtration and fit.
Fitter or Brace Combination: Combine either a cloth or disposable mask with a mask fitter or brace to improve the seal around the face.
Ear Loop Knot and Tuck: Knot and tuck the ear loops of a 3-ply mask where they attach to the mask’s edge to tighten the fit.
Headband Style Masks: Opt for masks that secure behind the neck and head with elastic bands or ties instead of ear loops for a more secure fit.
Non-Medical Masks
Non-medical masks are typically made from fabric (cloth).
They are often referred to as reusable masks because they can be washed, ironed, and worn again. Public health guidance in Uganda encourages community use of non-medical masks, particularly those made from fabrics like cotton.
A well-constructed 2-layered cotton mask with a filter insert can enhance protection. Suitable filter materials include paper towels, coffee filters, or polypropylene (a material commonly used in non-plastic shopping bags). The filter is placed between the two cotton layers and can be removed before washing. Polypropylene filters are washable and reusable. Cloth masks are available in a variety of fabrics and designs.
Cloth Mask Usage Recommendations:
Use cloth masks that have:
A snug fit covering the nose and mouth to prevent air leaks.
Multiple layers of tightly woven, breathable fabric for effective filtration.
Fabric that blocks light transmission when held up to a bright light source, indicating a tighter weave.
Avoid cloth masks with:
Gaps around the sides of the face or nose, which compromise fit.
Exhalation valves, vents, or other openings that bypass filtration.
Single-layer fabric or thin fabrics that do not effectively block light, suggesting a looser weave.
Who Should Wear Masks?
All adults should wear masks in recommended settings.
Children aged 6 years and above should wear masks.
Children aged 2-6 years can wear masks but require close supervision due to their activity levels and hygiene practices.
NB: Children under 2 years old should not wear masks due to their limited lung capacity.
Where to Wear Masks During a Pandemic:
Public Places: Whenever in public settings such as workplaces, public transportation, markets, supermarkets, shops, classrooms, places of worship, healthcare facilities, etc.
Social Distancing Challenges: When maintaining adequate social distancing is not possible.
Respiratory Symptoms: If experiencing cough, cold, or sore throat symptoms, even at home.
Household Visitors: When at home and visited by individuals who are not part of the immediate household.
Congested Areas: In any area where crowding is present.
Workplaces: Especially when in proximity to colleagues.
NB: Avoid wearing a mask during strenuous physical activities like running or jogging.
While not necessary when alone in a car, it’s advisable to keep a mask readily available for situations with passengers or when exiting the vehicle.
Precautions for Wearing Masks During a Pandemic:
Proper Donning: To put on a mask, hold it by the straps or loops and position it to cover both the nose and mouth, extending down to the chin.
Minimize Touching: Avoid touching the front and inner surfaces of the mask to prevent contamination.
Continuous Wear: Keep the mask on, even while talking, to maintain consistent protection.
Safe Removal and Storage: If mask removal is necessary (e.g., for eating or drinking), remove it completely by the straps, fold it with the inner side facing inwards, and store it in a clean container like an envelope. Alternatively, it can be hung on a clean hook or nail, ensuring it does not contact any surfaces.
Hand Hygiene: Wash hands with soap and water or use a hand sanitizer each time the front or inside of the mask is touched.
Mask Care Guidelines:
Full Coverage: Ensure the mask consistently covers the nose, mouth, and chin while worn.
Clean Storage: When not in use, store the mask in a clean, dry area or a clean envelope/container.
Daily Washing of Reusable Masks: Wash reusable fabric (cotton) masks daily.
Filter Removal Before Washing: Remove any filter inserts before washing the mask.
Filter Care (if applicable): If the filter is washable (e.g., polypropylene), wash and dry it separately.
Eye Protection PPE
These PPE items primarily protect the eyes. They include:
Face Shields
Goggles
These types of PPE protect the mucous membranes of the eyes from exposure to blood and other bodily fluids. Direct contact with these fluids can allow germs to enter the body through the mucous membranes.
Clothing PPE
Clothing PPE is frequently used in surgical settings to protect both healthcare workers and patients.
It is also used in routine patient care when there is a risk of exposure to bodily fluids. Visitors may be required to wear gowns when visiting patients in isolation due to easily transmissible illnesses. Clothing PPE includes:
Gowns
Aprons
Head Coverings
Shoe Covers
Aprons/Disposable Aprons
Aprons must be changed after completing care activities for each individual patient.
Aprons are not required for many routine aspects of daily patient care, such as assisting with short walks. However, aprons are necessary in situations such as:
Performing or assisting with procedures that may involve splashing of bodily fluids.
Providing or assisting patients with personal hygiene tasks.
Performing cleaning and tidying within the patient’s living space, including bed making.
Hand hygiene must always be performed both before putting on a disposable apron and after removing it and disposing of it in the correct clinical waste bin.
Note that apron color-coding may vary between organizations for different tasks. Always refer to your workplace’s local policy.
Donning an Apron:
Pull the apron over your head.
Fasten the ties at the back of your waist.
Doffing an Apron:
Unfasten or break the waist ties.
Pull the apron away from your neck and shoulders, lifting it over your head, being careful to touch only the inside and avoid the contaminated outer surface.
Fold or roll the apron into a bundle, with the inner side facing outwards.
Dispose of the apron in the clinical waste bin.
Perform hand hygiene.
Gloves/Disposable Gloves
Gloves are a type of PPE that covers the hands, preventing the spread of infection via hand contact.
Disposable gloves should only be worn when performing or assisting with procedures that carry a risk of contact with bodily fluids, broken skin, contaminated instruments, or hazardous substances like chemicals and disinfectants.
Types of Gloves:
Examination Gloves: Used by healthcare workers during patient examinations or non-invasive procedures, such as general physical assessments and taking vital signs.
Surgical Gloves: Used during surgical procedures, wound dressing changes, and any invasive procedures.
Gloves should not be used routinely or preemptively “just in case.” This practice is potentially harmful as it reduces opportunities for hand hygiene while wearing gloves.
Gloves are necessary only in specific circumstances involving procedures with:
Risk of splashes from bodily fluids (blood, saliva, sputum, vomit, urine, or feces).
Contact with the patient’s eyes, nose, ears, lips, mouth, or genital area, or instruments that have contacted these areas.
Contact with open wounds or cuts.
Handling potentially hazardous substances, such as disinfectants.
Note: Disposable gloves are generally NOT needed for routine daily care tasks like assisting a patient with washing and dressing or bed making.
Glove Requirements:
Gloves should fit comfortably, neither too tight nor too loose.
Gloves must be changed between patients and between different tasks performed on the same patient.
Gloves are single-use and should never be washed or reused.
After completing a procedure, gloves should be removed carefully, avoiding contact with the outer surfaces (which are likely contaminated). Dispose of used gloves in the designated waste disposal system and immediately perform hand hygiene.
Donning Gloves:
Select the correct glove size and type for the task.
Perform hand hygiene.
Pull gloves on, ensuring they cover the wrists.
Doffing Gloves:
Grasp the outside of one glove with the opposite gloved hand and peel it off.
Hold the removed glove in the gloved hand.
Slide a finger under the lip of the remaining glove and peel it off, being careful not to touch the contaminated outer surface.
Dispose of gloves in the clinical waste bin.
Perform hand hygiene.
Warnings:
Latex Allergy: Some gloves contain latex, which can cause severe allergic reactions in sensitized individuals. If you have a latex allergy, inform your employer to ensure latex-free gloves are provided.
Hand Dermatitis: Healthcare staff may experience hand soreness due to a combination of factors including wet work (bathing, washing patients), frequent use of wipes and alcohol-based hand sanitizers, and glove use without proper hand drying.
Report Hand Issues: If you develop hand soreness, inform your manager and report it to occupational health or your designated lead.
Benefits of PPE Usage in Healthcare Settings:
PPE effectively prevents the transmission of infections:
From patient to patient.
From healthcare worker to patient and vice versa.
From healthcare worker to healthcare worker.
Ultimately, PPE provides healthcare workers with confidence and motivation to deliver care to patients, even those with infectious diseases, comfortably and safely.
FIRE EXTINGUISHERS
A fire extinguisher is a portable device used for active fire protection. Its purpose is to put out or manage small fires, typically in urgent situations.
The Components of Fire
While commonly referred to as a triangle, fire actually requires four elements to exist, forming a tetrahedron:
Oxygen: This is necessary to support combustion, acting as the oxidizer in the fire process.
Heat: Sufficient heat is required to raise the fuel source to its ignition point, initiating combustion.
Fuel: A combustible material is essential to sustain the fire and provide substance for the burning process.
Chemical Chain Reaction: A self-sustaining chemical reaction must occur between oxygen, heat, and fuel to maintain the fire. This interplay of elements is often visually represented as the “fire tetrahedron” (previously known as the fire triangle).
NB: Eliminating Any Fire Element Stops the Fire.
Types of Fire
Fires are generally categorized into the following classes based on the burning materials:
Class A: Ordinary Solid Materials: These fires involve everyday combustible solids. Examples include materials like wood, paper products, fabrics, rubber, and many types of plastics.
Class B: Flammable Liquids and Gases: This category covers fires involving liquids that easily ignite, such as gasoline, petroleum-based greases, tars, oils, paints that use oil as a base, solvents, and alcohols. Class B also includes fires fueled by flammable gases like propane and butane. It’s important to note that fires involving cooking oils and kitchen grease are not classified as Class B.
Class C: Energized Electrical Fires: These are fires that involve electrical equipment that is currently powered or “live.” Examples include computers, servers, electric motors, transformers, and various appliances. Once the electrical power is shut off, a Class C fire transitions into another fire class depending on the burning material (typically Class A or Class B).
Class D: Combustible Metal Fires: Class D fires are those involving flammable metals. Examples of these metals include magnesium, titanium, zirconium, sodium, lithium, and potassium. These fires require specialized extinguishing agents to be safely controlled.
Class K: Cooking Media Fires: These fires are specific to cooking oils and greases, commonly found in kitchens. Examples include fires involving animal fats and vegetable oils.
NB: Some fire extinguishing agents are designed to be effective on multiple classes of fire, offering versatility. However, some agents are class-specific, and using them on an incorrect fire type can be ineffective or even dangerous for the user. Always refer to the extinguisher label for proper application.
Classification of Fire Extinguishers
Fire extinguishers are categorized in two primary ways:
1. Classification by Fire Type Suitability:
Extinguishers are grouped into classes (A, B, C, D, K) to indicate the types of fires they are designed to put out:
Class A Extinguishers: These are designed to extinguish Class A fires, which involve ordinary solid combustibles like wood and paper.
Class B Extinguishers: These are intended for use on Class B fires, such as those involving flammable liquids like grease, gasoline, and oil.
Class C Extinguishers: These extinguishers are specifically designed for Class C fires, which are fires involving energized electrical equipment. They contain non-conductive extinguishing agents.
Class D Extinguishers: These are specialized extinguishers designed for use on Class D fires, which involve flammable metals.
2. Classification by Extinguishing Agent Composition:
Fire extinguishers are also classified based on the type of chemical agent they contain, which determines their method of fire suppression:
Water and Foam Fire Extinguishers: These extinguishers primarily work by removing the heat component from the fire tetrahedron.
(a) Foam Agents: In addition to cooling, foam agents also create a barrier that separates the oxygen supply from the fire’s fuel source.
(b) Water Extinguishers: Water extinguishers are designed solely for Class A fires. They are unsafe and ineffective on Class B or Class C fires. Using water on a Class B fire can spread the flammable liquid, and on a Class C fire, it creates a serious risk of electric shock.
Carbon Dioxide (CO2) Fire Extinguishers: CO2 extinguishers suppress fire by removing the oxygen element, displacing it from the fire area. They also cool the fire due to the very cold temperature of the discharged CO2, thus removing heat. Carbon dioxide extinguishers are suitable for Class B and Class C fires. However, they are generally not very effective on Class A fires because the CO2 gas dissipates quickly and may not penetrate deeply enough to extinguish embers within solid materials.
Dry Chemical Fire Extinguishers: These extinguishers primarily work by disrupting the chemical chain reaction, one of the four elements of fire. Multipurpose dry chemical extinguishers are the most commonly used type today because of their versatility. They are effective on Class A, B, and C fires. For Class A fires, the dry chemical also forms a barrier, separating the oxygen from the fuel source.
Wet Chemical Fire Extinguishers: Wet chemical extinguishers utilize a specialized agent that works by removing heat from the fire tetrahedron. Importantly, they also prevent the fire from reigniting by creating a barrier between the oxygen and the fuel. Class K wet chemical extinguishers are specifically formulated for modern, high-efficiency deep fat fryers commonly found in commercial kitchens (Class K fires). Some Class K extinguishers are also rated for use on Class A fires, particularly in kitchen environments.
Halogenated (Clean Agent) Fire Extinguishers: This category includes both older halon agents and newer, more environmentally friendly halocarbon agents. They extinguish fire by interrupting the chemical reaction and/or removing heat. Clean agent extinguishers are effective on Class A, B, and C fires. They are often favored for protecting sensitive electronic equipment and areas where residue from other types of extinguishers would be problematic, as they leave minimal to no residue after use.
Dry Powder Fire Extinguishers: While their name is similar to dry chemical extinguishers, dry powder extinguishers are different in application. They work by either separating the fuel from the oxygen supply or by removing heat. However, dry powder extinguishers are exclusively designed for Class D fires (combustible metal fires). They are not effective on any other fire classes.
Water Mist Fire Extinguishers: A more recent innovation, water mist extinguishers extinguish fires by removing the heat element. They serve as an alternative to clean agent extinguishers when concerns about contamination are present. Water mist extinguishers are primarily intended for Class A fires, but they are also safe for use on Class C fires because the de-ionized water used is non-conductive, reducing electrical hazards.
Rules for Safe Fire Fighting: The 3 A’s
In the event of a fire, remember the “3 A’s” to guide your response in a safe and effective manner:
ACTIVATE the building’s fire alarm system without delay, and immediately notify the fire department by calling emergency services (e.g., 911 or your local emergency number). If you are dealing with the fire directly, ensure someone else is assigned to activate the alarm and call for professional help.
ASSIST anyone in immediate danger from the fire, especially those who are unable to evacuate independently. Help them to exit the building quickly and safely, but only if you can do so without putting yourself at significant risk. Your safety should be the priority.
ATTEMPT to extinguish the fire only after the first two steps (activating the alarm and assisting others) have been completed, and only if it is safe to do so.
Only Attempt to Fight a Fire If:
The Fire is Small and Contained: The fire should be in its initial stages and limited to a small area. If it is rapidly spreading or already large, evacuation is the priority.
You are Safe from Smoke: Ensure you are not in immediate danger from toxic smoke. Smoke inhalation is a major fire-related hazard. If smoke is thick or overwhelming, evacuate.
You Have an Escape Route: Confirm that you have a clear and unobstructed path to exit the area in case the fire becomes uncontrollable or escalates rapidly.
Your Instincts Say It’s Manageable: Trust your judgment. If you feel unsafe or unsure, do not attempt to fight the fire. Evacuate and leave firefighting to trained professionals.
Fire Extinguisher Operation (PASS Method)
It is critical to know the locations of fire extinguishers and the types available in your workplace before a fire emergency occurs.
Familiarize yourself with the weight and feel of fire extinguishers. They can be heavy, so practice picking one up and holding it to understand its weight and balance.
Carefully read and understand the operating instructions and any warning labels printed on the fire extinguisher. Extinguishers may have different designs and operating mechanisms.
Practice releasing the discharge hose or nozzle and aiming it at the base of a hypothetical fire. Do not pull the pin or squeeze the lever during practice, as this will break the safety seal and cause the extinguisher to lose pressure.
When you need to use a fire extinguisher on an actual fire, remember the acronym PASS:
(a). P – Pull the Pin: Pull out the safety pin. This breaks the tamper seal and allows the extinguisher to operate.
(b). A – Aim at the Base of the Fire: Aim the extinguisher nozzle or hose low, directing it at the base of the flames. This is where the fuel source is burning.
(c). S – Squeeze the Lever: Squeeze the operating lever or handle to discharge the extinguishing agent. Maintain a firm, consistent squeeze.
(d). S – Sweep Side to Side: Starting from a safe distance, sweep the nozzle or hose from side to side in a controlled motion, covering the base of the fire. Continue sweeping until the fire appears to be extinguished. As the fire diminishes, move closer to the burning area. After extinguishing the flames, carefully watch the area for any signs of reignition.
Fire Extinguisher Maintenance
To ensure fire extinguishers will function correctly when needed, they require regular maintenance.
Annual maintenance by a qualified fire equipment professional is essential and should be performed according to local, regional, and national fire safety codes and regulations. Annual maintenance is a thorough inspection that includes examination of the extinguisher’s mechanical components, the extinguishing agent itself, and the expellant gas pressure.
A trained fire equipment professional is best suited to perform this annual maintenance because they possess the necessary servicing manuals, specialized tools, recharge materials, replacement parts, lubricants, and the required training and experience.
Fire Extinguisher Inspection
Like any mechanical device, fire extinguishers need regular inspection to ensure they are ready for operation. As the property owner or occupant, you are responsible for arranging and ensuring routine fire extinguisher maintenance.
In addition to annual professional maintenance, fire extinguishers should be visually inspected or given a “quick check” every 30 days.
For most extinguishers, this routine 30-day inspection can be easily performed by you. Locate the extinguishers in your workplace and check the following three points:
Correct Location: Verify that each extinguisher is in its designated and correct location as per fire safety plans and regulations.
Visible and Accessible: Ensure that each extinguisher is clearly visible, unobstructed, and easily accessible in case of an emergency. Nothing should be blocking or hiding it.
Pressure Gauge Check: Check the pressure gauge or indicator on each extinguisher. It should be in the “green” or “operable” range, indicating proper pressure. If the gauge is in the “red” or shows overpressure, the extinguisher may require servicing.
Fire Extinguisher Precautions
Understand the Instructions: Never ignore the operating instructions provided with your fire extinguisher. Carefully read and understand them. Ensure that all capable members of your household or workplace also read and understand these instructions. Review the instructions periodically, especially during fire drills and when reviewing your fire evacuation plan.
Use the Correct Extinguisher Type: Always use the correct type of fire extinguisher for the class of fire you are facing. Never use an extinguisher on a fire class for which it is not rated, as indicated on its label. It is especially critical to remember that extinguishers labeled only for Class A fires should never be used on electrical fires (Class C) or cooking grease fires (Class K). However, it is generally safe to use a multipurpose extinguisher labeled for Class B and C fires on a Class A fire. While Class K fires are technically a subset of Class B fires (involving flammable liquids), using a standard Class B extinguisher on a Class K fire can actually worsen the situation. For cooking oil and grease fires, it is always best to use a dedicated Class K extinguisher.
Check Expiration Dates: Fire extinguishers have expiration dates. After this date, the extinguishing agent may no longer be effective. Regularly check the expiration dates on your extinguishers and replace them as needed to ensure they will function in an emergency.
Consider Exit Routes: When deciding where to place a fire extinguisher, choose a location that is easily accessible and near exit doors. Also, think about common areas where fires are likely to occur in your home or workplace (e.g., kitchen, electrical panels).
Share Location Knowledge: Make sure everyone in your home or workplace knows where fire extinguishers are located. Communicate the location of extinguishers, along with your complete fire escape plan, to babysitters, house sitters, and any long-term visitors so they are also prepared in case of a fire emergency.