The critical role of healthcare workers

The critical role played by health workers in protecting patients, particularly during the COVID-19 pandemic – and action to better support this essential workforce – is brought to the fore on World Patient Safety Day.

The COVID-19 pandemic has put healthcare systems globally under pressure on a scale and severity that is unprecedented in living memory, stretching some beyond breaking point.

As the international OSH community marks World Patient Safety Day (WPSD) on 17 September, it’s both fortuitous and timely that the World Health Organization (WHO) had chosen ‘Health worker safety: a priority for patient safety’ as the theme for 2020 before the pandemic struck.

First established in May 2019, the WPSD’s overall objectives are ‘to enhance global understanding of patient safety, increase public engagement in the safety of healthcare and promote global actions to enhance patient safety and reduce patient harm’.

This year’s event takes a more holistic approach and calls on stakeholders to invest in the safety of health workers as a priority for patient safety.

‘Health and social care workers are an invaluable resource, doing demanding and potentially hazardous work for the public good,’ says Richard Jones, head of policy and regulatory engagement at IOSH, one of WPSD’s signatories.

‘Occupational injury and illness can deplete this resource, impacting the remaining workforce and the ability to deliver quality care to patients, so it’s vital that we care for the carers, so that they can care for us,’ Richard says.

Tragically, health workers have not escaped the indiscriminate devastation wreaked by COVID-19 and the high level of infections and death among the workforce underlines the urgency of more stringent measures to enhance their protection (see Frontline exposure, below).

As the WHO notes in its policy briefing (see Resources, below): ‘Health workers who feel psychologically and physically safe and have a secure working environment are more likely to be able to provide safe and high-quality patient care.’ This has always been the case, but what the pandemic has done is highlight the vital role these individuals play and the many risks they face delivering this essential public service.

Workers are exposed to a diverse range of biological, chemical and physical hazards related to their interactions with patients, the public and the work environment. These vary significantly from country to country, depending on how the healthcare system is organised and resourced.

Trouble on the frontline

Maintaining effective protection from airborne and blood-borne pathogens is one of the most significant challenges facing all frontline staff. According to the WHO, needlestick injuries are one of the top causes of injuries and infection globally.  

Violence against health workers, through both verbal threats and physical assault, is another significant issue that is prevalent globally and on the rise. The threat of aggression and physical attack also has an immeasurable impact on mental health.

Workers’ psychological safety is further compounded by other contributory factors. These include fatigue caused by long shifts and demanding, heavy workloads; the emotional stress that arises when workers are poorly paid, have low morale and feel unsupported by ineffective managers; and concerns over the work environment due to the lack of basic hygiene facilities, the shortage of essential equipment and ineffective OSH procedures.

The WHO has called upon governments, employers and trade unions to take bold measures to improve working conditions in the health sector and to develop programmes for occupational health for health workers at the national levels and in all healthcare facilities. This requires strong collaboration between OSH professionals and their colleagues responsible for infection prevention and control, patient safety and health workforce planning and management.

Dr Ivan Ivanov, team leader of the WHO Global Occupational Health Programme, argues: ‘Paradoxically, the health sector, which is supposed to restore, protect and promote health, is among the sectors most hazardous for health and safety of workers together with agriculture, construction and mining. In many low-income countries, healthcare services are not covered by the national OSH legislation, and health workers have no protection from occupational risks. This is unacceptable.

'All health workers, including doctors, nurses, midwives, community health workers, cleaners and drivers, have the right to decent working conditions and it is a duty of care of their employers to provide adequate levels of occupational safety and health protections.’

As Dr Gwen Brachman, chair of the Scientific Committee on Occupational Health for Health Workers at the International Commission on Occupational Health, points out, the challenges, risks and stressors that health workers have faced since COVID-19 struck were already issues. What the virus has done is magnify them significantly.

‘What’s really exacerbated the situation is the fatigue, the work hours, the patient loads, the shift work and the stress of watching people be very sick and die,’ she says.

One particularly sensitive issue has been the role of health workers in some countries who have inadvertently spread the virus.

‘If an individual has COVID-19, and it may be a hospital-related or acquired illness, or from the community, in some countries workers might not get paid if they are off sick, so sometimes they will go to work because if they don’t, they won’t get paid,’ says Fiona Potter, deputy chair of IOSH’s Health and Social Care Group.

‘Certain countries are not swabbing and testing staff, and this has a potential impact on spreading the virus.’

Safety and health workers

What the crisis created by the pandemic has underscored is the important role that OSH professionals play in supporting health workers across the world.

‘It really takes somebody who can look at the whole picture and how you improve the health and safety of any worker by decreasing the risks,’ explains Gwen. ‘But also, when you can’t decrease the risks, protecting them from the risks.’

IOSH has issued a policy statement on COVID-19 that emphasises the importance of providing health workers and other workers on the frontline with adequate staffing levels, training and PPE, together with appropriate health evaluations, mental health support and return-to-work processes.

The professional body has also rolled out a series of webinars (see Webinars, below), which includes one with IOSH’s Health and Social Care Group on practical measures to better protect health workers responding to COVID-19.

‘This [pandemic] has highlighted the trauma staff have gone through. Whereas they deal with death on a regular basis, the number of deaths that they have dealt with has been significantly higher than what they would normally,’ says Mark Parsons, the group’s chair.

‘This is why we’re doing something on mental health in the webinar to support our members and others through the psychological impact. The big concern has been about the challenges around PPE and the anxiety levels of staff.’

Fiona concurs. ‘If you’ve got to wear a lot of PPE, there is an impact on an individual’s dexterity, visual clarity – glasses steam up – and it has a significant impact on heat stress,’ she says.

‘People talk about post-traumatic stress. The volume of people who are acutely ill and then dying has a massive impact, but because workers are having to do things wearing additional PPE, the only protection against transmission of the virus, mental fatigue and exhaustion occurs.’

On the research side, IOSH is funding a UK study that will assess hospital-acquired infection risks to health workers from patients infected from aerosol-transmitted pathogens. The study findings are currently at report stage.

Through IOSH’s Health and Social Care Group, Fiona is part of a WHO ad hoc study group of occupational health and healthcare workers in COVID-19. Set up in April, the special working group aims to raise the profile of issues like staff safety, violence levels and aggression.

As part of this, the WHO has developed an occupational health for health workers COVID-19 course. Available from mid-September, the resource will be freely available online for health workers to access and covers key areas such as infection, protection and control, violence and bullying, stigma, discrimination and fatigue.

The WHO is also developing a national occupational health programme targeted specifically at health workers. This will include a policy brief and technical guide so countries can set up their own system if they don’t have a single national programme already in place.

For this year’s WPSD, the international health body is planning a global virtual event. The WHO will be launching technical products and is encouraging health workers and patients to tell their stories. In particular, it would like to hear from professionals who have responded successfully to COVID-19 and can share any practical measures that could be replicated across other countries.

IOSH would like to hear from members who can share initiatives they have introduced to protect health workers. Tweet @IOSH_tweets