Discussions about health sector reform have been intense lately. With experts from diverse backgrounds opining on what needs to be fixed, little is on the table about healthcare workers' health, safety, and well-being. Without taking care of the workers who provide patient care services directly and indirectly, fixing the overall system may not produce the desired level of patient care.
While sad events like violence against medical doctors by patients' attendants, and harassment of female nurses by their male colleagues or supervisors bring occupational health and safety at the health facilities to the forefront of Bangladeshi news media, this fades quickly and conveniently unless the aggrieved associations of doctors or nurses stop working as the last resort to protect themselves. Alas! the government and the common public usually do not take it constructively when such work abstentions occur.
Doctors, direct patient care providers, and other healthcare support workers face a myriad of occupational health and safety issues. A frequent hazard is slips, trips, and falls which may not result in severe enough injuries but may affect patient care service delivery greatly.
The unplanned, untidy, overcrowded, and ever-busy hospitals or other healthcare facilities in Bangladesh, particularly the government-run ones and low-cost private ones put the healthcare professionals who work there at constant risk for slips, trips, and falls. There are numerous anecdotes of healthcare professionals-including doctors, nurses, therapists, and technologists falling on the job while providing patient care. The support staff like ayas, ward boys, zammadar, cleaners, electricians, mechanics, cooks, gate-keepers, storekeepers, guards, gardeners, domes, and clerks in the hospitals while providing patient care or offering maintenance, operational and auxiliary services also sustain slips, trips and falls. The risk is also shared by the patients, their companions, and visitors.
Nevertheless, no epidemiological or preventive research has been conducted on fall-related injuries in Bangladeshi healthcare settings. Completed and published research studies on workplace health and safety in this country mostly concentrated on identifying and managing work-related stress, anxiety, depression, workplace violence and harassment, needlestick and sharp incidents, and chemical or radiation exposure.
Monitoring and reporting of occupational falls in healthcare facilities is critical to enhance the knowledge of health and safety professionals and facility administrators to facilitate and plan the designing and implementing of effective preventative initiatives. The steps include assessing risk factors, characterising trends, and assessing the associated economic consequences, such as lost work wages and productivity. By looking further into these, ergonomists, health and safety experts, safety engineers, and epidemiologists will be better prepared to act.
The epidemiology of occupational falls in Bangladesh is little understood, even though these have been extensively investigated and studied in many other countries. Studies on falls in the construction, mining, and transportation sectors are abundant there. Research studies are much needed in Bangladesh to find out how and why these injuries occur to determine the different levels of susceptibility of health workers and to help develop appropriate injury remedies.
According to one research report published before, environmental hazards like clutter, uneven or slippery surfaces, inadequate lighting, and obstacles were identified as major risk factors for occupational falls. In the construction sector, weather, terrain, and surface conditions were reported to be the main causes of falls. One previous research study in Canada identified that slippery or uneven surface was the main cause of falls in acute care sectors, followed by the work environment (office design, small workstation, inadequate lighting). Trying to move a patient, running to an emergency room, falling down stairs, tripping over objects, and slipping on wet flooring were the risk factors among medical staff in Sweden.
On the other hand, electrical cords, stairs, ice/snow, obstructions, uneven flooring, and liquid pollution were shown to be among the environmental risk factors for falls in another research study on US hospitals.
According to this author's own prior research in Canadian healthcare settings, a lot of falls were reported to be caused by liquid contamination in the absence of any suitable cautionary/wet floor signs. Other major causes of indoor falls were medical equipment and patient cords interfering. The most common activities that led to falls were walking and running, then reaching for objects and pushing or pulling medical equipment.
Because of the poor maintenance of healthcare facilities and the high work stress that health professionals experience from caring for a large number of patients with diverse health issues, healthcare staff in Bangladesh are much more likely to be prone to falls. Due to social norms, patients in Bangladesh are also accompanied by a large number of friends and relatives who stay with them throughout their entire treatment period making the workplace crowded and chaotic. Health facilities' structural layouts and working environments are rarely planned with occupational health and safety in mind. Many healthcare facilities are cluttered and dimly lit.
According to earlier research, incorporating new technologies and making adjustments to the work environment lowers the risk factors for occupational injuries. Interventions as simple as putting non-slippery floor materials, warning signs, doing timely and regular housekeeping, and wearing slip-resistant shoes can have an immediate impact on the health and safety of hospital professionals and workers.
Planning and implementing successful fall prevention programmes requires examining the causes of falls and identifying susceptible worker groups. The job tasks, occupation, and socio-demographics such as age, gender, education, income, and experience of the workers should be taken into account.
Bangladesh needs to better care for its healthcare personnel to provide better patient care.
Dr. Hasnat M Alamgir is Professor and Director of Research at Southeast University Dhaka. [email protected]
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