Since nursing is one of the most hazardous occupations, nurses should protect themselves from contact with occupational hazards by using knowledge of the infectious process and appropriate personal protective equipment (PPE). The potential environmental or occupational hazards that have been recognised include infectious disease, toxic substance and radiation.

Infectious disease

 

When a patient has a suspected or known infection, nurses get alerted and follow infection prevention and control practices. In fact, diseases such as hepatitis B and C, human immunodeficiency virus (HIV), tuberculosis (TB), and multidrug-resistant organisms require a greater emphasis on infection prevention and control techniques (CDC, 2001). It has been recognised that body substances such as feces, saliva, mucus and wound drainage always contain potentially infectious organisms.

Hand hygiene

 

A major component consists of maintaining a good hand hygiene standard as contaminated hands of healthcare workers are the primary source of infection transmission in the health care setting. For example, you are performing a dressing change, and the patient’s roommate asks for assistance with a blocked IV line. If you fail to perform hand hygiene before handling the IV line, organisms from the patient’s wound could be transferred to the roommate’s IV site (Boyce, 2001). The use of alcohol-based hand rubs is recommended by the Centers for Disease Control and Prevention (CDC) to improve hand hygiene practices, protect health care worker’s hands, and reduce the transmission of pathogens to clients and personnel in health care settings (CDC, 2001). 

As a nurse, you will at times obtain specimens from drainage tubes or IV tubing ports. Disinfect tubes and ports by wiping the surface outward with alcohol or a Chlorhexidine solution before entering the system. Hence, a proper technique for wound cleansing is the final step towards reducing the entry of microorganism. To prevent entry of microorganism into the wound, always clean outward from a wound site. When applying an antiseptic or cleaning with soap or water, wipe around the wound edge first and then clean outward away from the wound.

Contaminated needles

 

Patients and nurses are also at a high risk for acquiring infections from accidental needle sticks. Hepatitis B and Hepatitis C are the infections most commonly transmitted by contaminated needles. Nurses need to ensure that after administering an injection or inserting IV catheter, they place the used needle safety device in a puncture-resistant box (OSHA, 2001). To prevent transmission of microorganisms through indirect contact, soiled items and equipment must be kept from touching your clothing. A common error is to carry dirty linen in the arms against the uniform. You should use fluid-resistant linen bags, or otherwise, carry soiled linen with hands held out from the body.

Another cause for entrance of microorganisms into a host is improper handling and management of urinary catheters and drainage sets. The first thing a nurse needs to ensure is the point of connection between a catheter and drainage tube remains closed and intact so the contents are considered sterile. Then, minimise the movement of the catheter at the urethra by stabilizing the catheter with tape to reduce the chances of microorganisms ascending the urethra into the bladder.

Besides taking precautions, the CDC has published a list of recommended immunizations and vaccinations for healthcare workers, and the Occupational Safety and Health Administration (OSHA) is enforcing them. These include, hepatitis B vaccine, TB testing, annual influenza vaccine, measles, mumps, rubella (MMR), chicken pox vaccine, and tetanus, diphtheria and pertussis.

Toxic substances

 

Some of the hazardous drugs that have been identified in healthcare facilities are antineoplastic drugs, ethylene oxide and anesthetic drugs (OHSA, 2016). Antineoplastic agents are drugs used to treat malignancies. The handling and administration of antineoplastic drugs is very controversial, because the nurse mixing and giving the drug may experience negative consequences. These agents can cause carcinogenic effects as well as adverse effects such as irritation of the skin, eyes, and mucous membranes (Polovich, 2004). Many facilities recommend taking precautions during the care of patient who is receiving chemotherapy. This includes using personal protective equipment (gloves, gown, protective eyewear, closed footwear) and double flushing the patient’s bodily secretions in the commode and using special hampers for the disposal of all items that come into contact with the patient.

In most institutions, special spill kits are employed to clean up even the smallest chemotherapy spills. Additionally, having an updated knowledge about these drugs is important to ensure safe and appropriate nursing care. All nurses must be certified to administer chemotherapy and must remain current in their level of practice and competencies. All equipment and containers should be handled appropriately once the infusion is completed, and the hands and any exposed area must be washed to ensure the safety of the healthcare provider.

Radiation

 

At times, radiation and radioactive materials are used in the diagnosis and treatment of patients. Exposure to ionizing radiation is associated with mutagenic and teratogenic properties leading to an increased risk of miscarriage, stillbirth, and other adverse reproductive outcomes. To reduce exposure to radiation, nurses should limit the time spent near the source, make the distance from the source as great as possible, and use the shielding devices such as lead aprons. Staff working near radiation would also be required to wear devices that track the accumulative exposure to radiation (Potter & Perry, 2009).

A safe environment is essential to promoting, maintaining, and restoring health. As nurses, although caring for your patients is your main concern, you are also responsible for your own health and safety. Thus, recognise the hazardous exposure in your clinical settings and take the necessary precautions. MIMS

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Sources:
Boyce, J.M. (2001). Hand hygiene task force and CDC healthcare control practices advisory committee draft guidelines for hand hygiene in healthcare setting.
Centers for Disease Control and Prevention (CDC). (2001). Guidelines for the prevention and transmission of hepatitis B, hepatitis C and human immunodeficiency virus in health care personnel. Washington DC.
Occupational Safety and Health Administration (OSHA). (2016). Retrieved from, https://www.osha.gov/SLTC/hazardousdrugs/
Occupational Safety and Health Administration (OSHA). (2001). Needlestick safety and prevention act. Public law. 106-430.
Polovich, M. (2004). Safe Handling of Hazardous Drugs. Online Journal of Issues in Nursing. Vol. 9 No. 3, Manuscript 5
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing 7th ed. MOSBY Elsevier.