INTRODUCTION

1.0 Background to the Study.

According to Opoku, Yeboah, Ampon-Wireko & Hinneh (2023) Health workers are all people
engaged in work actions whose primary intent is to improve health, including doctors, nurses,
midwives, public health professionals, laboratory technicians, health technicians, medical and
non-medical technicians, personal care workers, community health workers, healers and
traditional medicine practitioners. The term also includes health management and support
workers such as cleaners, drivers, hospital administrators, district health managers and social
workers, and other occupational groups in health-related activities as defined by the International
Standard Classification of Occupations (ISCO-08).

Health workers are the backbone of any functioning health system. While contributing to the
enjoyment of the right to health for all, health workers should also enjoy the right to healthy and
safe working conditions to maintain their own health. (Urata, Kuroda, & Tonegawa, 2023).

Health workers face a range of occupational risks associated with infections, unsafe patient
handling, hazardous chemicals, radiation, heat and noise, psychosocial hazards, violence and
harassment, injuries, inadequate provision of safe water, sanitation and hygiene. (Opoku, et al.,
2023).

The protection of health and safety of health workers should be part of the core business of the
health sector: to protect and restore health without causing harm to patients and workers.
(Suleman, Sonthalia, Webb, Tinson, Kane, Bunbury, Finch, & Bibby, 2021). Health at a Glance
(2023)Safeguarding the health, safety and well-being of health workers can prevent diseases and
injuries caused by work, while improving the quality and safety of care, human resources for
health and environmental sustainability in the health sector.

Koohang, Nord, Ooi, Tan, Al-Emran, Aw, Baabdullah, Buhalis, Cham, Dennis, Dutot, Dwivedi,
Hughes, Mogaji, Pandey, Phau, Raman, Sharma, Sigala, & Wong, (2023), narrated that the
protection of health and safety of health workers contributes to improving the productivity, job
satisfaction and retention of health workers. It also facilitates the regulatory compliance of health
facilities with national laws and regulations on occupational health and safety, bearing in mind
the specific working conditions and occupational hazards in the sector. Unsafe working
conditions resulting in occupational illness, injuries and absenteeism represent a significant
financial cost for the health sector. For instance, in 2017 the annual costs of occupational
illnesses and injuries in the health care and social services sector in Great Britain were the
highest among all sectors, estimated at the equivalent of US$ 3.38 billion (1).

According to the International Labour Organization (ILO) world statistics estimate that some 2.3
million women and men around the world succumb to work related accidents or disease yearly;
this corresponds to over 6000 deaths every single day (ILO, 2023). Worldwide, there are around
340 million occupational accidents and 160 million victims of work related illness annually
(ILO, 2023). Updates these estimates at intervals, and the updates indicate an increase of
accidents and ill health (ILO, 2023). According to the National Institute for Occupational and
Health (NIOSH, 2020) about 8 million health care workers are potentially exposed to hazardous
drugs including pharmacy and nursing personnel, physicians, operating room personnel,
environmental services workers (CDC-NIOSH, 2020). Occupational Safety and Health
Administration (OSHA) U.S department of labour urges employers to enhance workplace safety
measures, protect workers from crane hazards following fatality in Guam (OSHA, 2022).

Occupational hazard: an injury or ailment resulting from the work one does or from the
environment in which one works (Merriam, 2023). Occupational hazard is defined as the
''potential risk to the health of a person emerging from unhealthy environment '' which is a
significant public health issues. It can also be referred to as any activity, materials, processes or
situation that is likely to cause an accident or disease at work place (fasunloro, 2014)
Occupational hazard are risk associated with working in specific occupations. The Occupational
Safety and Health Administration (OSHA) describes five categories of occupational hazard
physical safety hazards, chemical hazards, biological hazards, physical hazards, and ergonomics
risk factors.

Traditionally, hospital administrators and workers considered hospitals safer than other workers
environments and recognized only infections and physical injuries as risk in the hospitals
environments (OSHA, 2020). Administrators have therefore, emphasized patients care and
allocated few resources for occupational health. However, studies have indicated that both the
incidence and risk of every category of conditions was higher in hospital workers than in all
workers (CDC-NIOSH, 2018). Although, early attempt for safety measures were to protect
patients, it was also beneficial to workers. For instance, basic sanitation measures such as open
window ventilation and fewer patients per bed which has introduced by Florence Nightingale
and hand washing by Austrian surgeon, Semmellwells, greatly reduced transmission of
infections (CDC-NIOSH). New hazards have however, emerged with the use of radiation, an
aesthetic gases, complex chemicals, new laboratory and diagnostic techniques.

The investigator observed the provision of safety box, hand gloves and Personal protective
equipment (PPE) by the Hospital management, this is as a result of interaction between the
human environments and characteristics of the job. All this factors have been observed to result
into occupational health hazards among health care workers in Hajiya Gambo Sawaba General
Hospital Kofar Gayan, Zaria.

Even though hospital safety have improved significantly in the developed countries much need
to be done in the area of research and implementation of safety measures in developing countries
as few information are available on the subject matter. This study aimed at assessing
occupational health hazards and safety awareness among health care workers in Hajiya Gambo
Sawaba General Hospital Kofar Gayan, Zaria.

1.1 Statement of Problem.

A Knowledge that man's health can be ultimately connected with his occupation must have
become apparent at an early stage of social evolution and up till now, occupational hazards are
still posing serious health problems. A hazard among health workers is quite alarming. These
hazards includes: physical, chemical, biological, mechanical and psychological hazards. The
occupational health hazards observed include; prick with sharp Instrument, cuts, falling from
lifting patients, burns and explosions.

Globally it is estimated that 5-7% of global fatalities are attributable to work-related illnesses and
occupational injuries (Murry & Lopez, 2020; ILO, 2023), and there are about 2.3 million
occupationally related deaths associated with work each year [6].
The world health organization (WHO) global burden of disease from occupational hazards
among health workers revealed that 37% of the hepatitis B among health workers was the result
of occupational exposure and less than 10% of HIV among health workers is the result of
exposure at work. Needle stick injuries, the cause of 95% of the HIV occupational
seroconversions, are preventable with practical, low-cost measures and have the co-benefit of
preventing exposure to other blood-borne viruses and bacteria (Louisa, Fiona, Jeff, Sarah & Lily,
2022). A national institute for occupational safety and health report indicated that an estimated
600,000 to 800,000 percutaneous injuries occur annually to healthcare workers (Ghosh, 2022).

Moreover, every year one in ten health professionals sustain a sharp material injury. These sharp
material injuries to health professionals end up with sixty-six thousand hepatitis B virus (HBV)
infections, one thousand human immunodeficiency virus (HIV) infections, and sixteen thousand
hepatitis C virus (HCV) infections. (Louisa, et al., 2022).

Among the thirty-five million health professionals that exist globally, each year around three
million are exposed to microorganisms originating from the blood through percutaneous routes
because of professional-related accidents (Cowi, 2021). In addition, occupational safety and
health administration have determined that nearly five and a half million health professionals
working in healthcare facilities are highly susceptible to microorganisms originating from blood
including hepatitis C virus, human immune virus, hepatitis B virus, and other potentially
infectious materials Centre for Diseases Control (CDC, 2020). The international labor
organization (ILO) study showed that occupation-related diseases and injury account for
economic losses as high as 4% of the global gross domestic product. Each year greater than three
hundred fifty thousand casualties and greater than two million occupational-related mortality
occur which are attributable to occupational-related hazards (Giuffrida, Lunes, & Savedoff,
2023).

In sub-Saharan Africa, the limited studies conducted have demonstrated that healthcare workers
are frequently exposed to biological, chemical, and physical occupational hazards (Nsubuga &
Jaakkola, 2021; Bekele, Gebremariam, Kaso & Ahmed, 2020). HBV, HCV and HIV prevalence
among healthcare workers who experience sharp injuries highlight the disproportionate burden
that sub-Saharan Africa bears in contrast to developed countries.
For instance, in the Africa E sub-region (including Botswana, Congo, Malawi, and South Africa
etc.), 11.8% of HBV, 2.8 of HCV, and 5.1% of HIV infections are attributable to occupational
exposure (Rapiti, Pruss-Ustun & Hutin, 2022). This is in sharp contrast with the America A sub-
region (Canada, Cuba, United States) where 0.51% of HBV, 1.6% of HCV and 0.29% of HIV
infections are attributable to occupational exposure (Rapiti et al., 2022). The higher prevalence is
partly explained by the higher prevalence of bloodborne pathogens in the general population but
can also be attributed to poor healthcare infrastructure in sub-Saharan Africa (Murry & Lopez,
2020).

There are well-established guidelines to prevent exposure to occupational hazards, including

blood and bloodborne pathogens. These include educating healthcare workers on safer use of
devices, procedures and management of exposures. Furthermore, the World Health Organization
(WHO) has instructed governments to transition to the exclusive use of safety injection devices
by 2020 (WHO, 2019). While developed countries have heeded this recommendation, the vast
majority of sub-Saharan African countries have failed to enact legislation to protect healthcare
workers. Apart from provider behaviors that increase exposure to occupational hazards, system-
level barriers increase the risk of exposure to hazards in the healthcare setting. Unsafe conditions
in the healthcare environment, lack of personal protective equipment (PPE), and high provider to
patient ratio increase the risk of exposure to bloodborne pathogens and cause preventable
infections. Healthcare workers in four African countries (Cameroon, South Africa, Uganda and
Zimbabwe), have reported that the top four reasons for migrating to developed countries include
better remuneration, safer work environment, living conditions and lack of facilities (Awases,
Gbary, Nyon & Chatora, 2021). The 2006 World Health Report Working Together for Health
drew attention to the severe healthcare worker shortages in 57 countries, most of them in Africa
and Asia (WHO, 2022). The influence of occupational hazards on healthcare worker shortages in
sub-Saharan Africa has dire implications for patient outcomes, productivity and life expectancy
in the continent.

Better understanding of the occurrence of occupational hazards among healthcare workers in

sub-Saharan Africa can inform policies to make the healthcare environment safer for healthcare
workers. Hence, the purpose of this systematic review was to examine the occurrence of
exposure to blood and bloodborne pathogens among healthcare workers in sub-Saharan Africa.
Nigeria in particular (Nsubuga & Jaakkola, 2022). Understanding the predisposing factors for
occupational hazards among healthcare workers is needed to inform occupational health and
safety policy and programs for healthcare workers Federal Ministry of Health of Nigeria
(FMOH, 2017). For the most part, injuries and occupational health hazards are not well studied
and recorded for communication with other healthcare workers.

Healthcare workers provide patient care in one of the most dangerous occupational settings
(Tinubu, Mbada, Oyeyemi and Fabunmi, 2020). Biological, chemical, physical, ergonomic,
psychosocial, fire and explosion, and electrical hazards all threaten the lives, safety, and well-
being of healthcare workers (Lockley, Barger, Ayas, Rothschild and Cziesler, 2019). Every year,
it is estimated that one out of every ten healthcare workers suffers a sharp injury (Moore &
Kaczmarek, 2022). Sharps injuries to healthcare workers resulted in 16,000 cases of hepatitis C
virus (HCV), 66,000 cases of hepatitis B virus (HBV), and 1000 cases of human
immunodeficiency virus (HIV) infection in 2010 (Dembe, Erickson, Delbos and Banks, 2021).
These infections are thought to have a significant impact. Between 2010 and 2030, these
infections are expected to result in 145 HCV-related deaths, 261 HBV-related deaths, and 736
HIV-related deaths (Trinkoff, Giegeer-Brown, Brady Lipscomb and Muntaner (2022).

Few studies have shown that healthcare workers are frequently exposed to biological, chemical,
and physical occupational hazards (Adib-Hajbaghery & Lotfi, 2023). Despite the efforts of a
number of health-care organizations and ministries, occupational hazards continue to be a threat
to workers’ public health. The dangers associated with the healthcare setting are sometimes
overlooked by health-care organizations and providers who have prompted public health and
safety campaigns. Data on the safety of health-care workers is limited, and possible exposure to a
variety of occupational hazards and challenges remains a major concern that prompted the
researcher to conduct this research. It is through this that the researchers examined the common
occupational hazards associated with health care workers at Hajiya Gambo Sawaba General
Hospital Kofar Gayan, Zaria.

The researchers observation of some these hazards among health care workers in Hajiya Gambo
Sawaba General Hospital Kofar Gayan, Zaria was quite traumatic, this making my interest to
have a better understanding of occupational health hazards among health workers and the
common types of health hazards and the prevention among the study population.

1.2 Objectives of the Study.

(1) To assess the knowledge of occupational health hazards among health care workers in Hajiya
Gambo Sawaba General Hospital Kofar Gayan, Zaria.

(2) To determine the prevalence of occupational health hazards among health care workers in
Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria.

(3) To identify the types of occupational health hazards among health care workers in Hajiya
Gambo Sawaba General Hospital Kofar Gayan, Zaria

(4) To assess the availability of safety measures in averting occupational health hazards among
health care workers in Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria.

1.3 Research Questions

What are the level of knowledge of occupational health hazards among health care
workers in Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria?

What is the prevalence of occupational health hazards among health care workers in
Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria?

What are the types of occupational health hazards among health care workers in Hajiya
Gambo Sawaba General Hospital Kofar Gayan Zaria?

What are the availability of safety measures in averting occupational health hazards
among health care workers in Hajiya Gambo Sawaba General Hospital Kofar Gayan,
Zaria?

What do you recommend to the government and health care workers on health safety
measures?
1.4 Significance of the Study.

This study will provide information about the knowledge, attitude and practice of safety
measures related to occupational hazards in Hajiya Gambo Sawaba General Hospital Kofar
Gayan, Zaria. The result from study will be great significance to the hospital management, the
federal ministry of health and public health personals. It is hoped that the findings from this
research will assist the hospital management in gaining more information about the occupational
hazards that hospital staff are exposed to, and also on the itemization of safety measures. The
information from this research will guide the hospital management, state ministry of health,
federal ministry of health and various public health organization in designing intervention
strategies or policies that will help to promote and uphold better health and safety occupational
standards for the health workers in Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria
and Nigeria at large.

`1.5 Scope of the Study

The study cover only Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria. In order to
describe the occupational health hazards and safety awareness among health care workers in
Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria.

1.6 Operational definition of terms.

Occupation: a person's usual or principal work or business, especially as a means of earnings a

living; vocation.

Hazards: is anything which can harm.

Health: Is a state of complete physical, mentally, socially well-being and not merely absence of
disease or infirmity.

Safety: state of being safe; freedom from the occurrence or risk of injury, danger or loss.

Awareness: The state or condition of being aware; having knowledge; consciousness.

 CHAPTER TWO

LITERATURE REVIEW

Preamble: This chapter will be discussed under conceptual review, empirical review,
theoretical framework and summary.

2.1Conceptual Review

2.1.1 Overview of Occupational Health Hazards in Healthcare

Occupational hazards are defined as the potential source of injury or poor health effect on a
person or individuals arising from any unsafe working environment due to insufficient
occupational health and safety (OHS) implementation Health and Safety (HAS, 2022).
Occupational health is a branch of public health that works to promote and maintain the best
level of physical, mental, and social well-being among workers in all jobs World Health
Organization (WHO, 2022). On the other hands, Occupational safety refers to the goal of
reducing the risk of dangers that may arise as a result of events connected to the tasks that
workers undertake in the workplaces, particularly when equipment are utilized (WHO, 2022).

Now-a-day assessing occupational hazard exposures (OHE) is crucial because currently result in
a growing amount of financial loss as well as intangible damage within businesses globally
(Dabbagh, & Yousefi, 2019). Despite it is not well identified among SWs, those are providing a
service for large community across the world by cleaning health facilities and other work setup
(Gomathi & Kamala, 2020; WHO, 2022). They frequently cited aspects of working
circumstances that are common not just in low-income countries, such as hazardous working
environments, machine safety, unsanitary workplaces, high temperatures, excessive noise, and
poor indoor air quality (Robertson, Brown, and Dehejia, 2023). Moreover, they are exposed to
chemical, biological, ergonomically, mechanical, electrical, psychological hazards European-
Occupational Safety and Health Association and National Institute for Occupational Safety and
Health (EO-OSHA, 2022; NIOSH, 2022). Despite of fact that different workplaces may have
hazards and their frequency varied according to workplace or settings—with their attitude levels
and practice levels (Tolera & Mengistu, 2021).
2.1.2 Importance of Assessing and Managing of Occupational Health Hazards

Occupational Health and Safety (OHS) focuses primarily on protecting employees in the
workplace from accidents, injuries, and exposure to harmful substances. While accidents can
happen at any time, it is still the employer’s responsibility to ensure that they take steps to reduce
the risk of incidents and maintain a safe working environment. Prioritizing OHS at your business
has several key benefits, including:

1. Reduced risk or accidents or injuries by identifying and mitigating hazards

2. Improved efficiency and productivity due to fewer employees missing work from illness
or injury

3. Improved employee relations and morale (a safer work environment is a less stressful
work environment)

4. Reduced costs associated with accidents or injuries (healthcare and rehabilitative costs,
losses in productivity, impact on employees’ well-being)

5. Lower insurance premiums resulting from fewer workplace incidents and workers’
compensation claims

It’s no secret that all industries have safety hazards of some sort. The most important aspect of a
good Occupational Health and Safety policy is identifying these hazards and ensuring that
employees have the training, safety equipment, and other resources needed to work safely.
Failure to implement effective policies and precautions can lead to injuries, reduced productivity
due to the absence or loss of skilled labor, workers’ compensation claims, and possible penalties
from the Occupational Safety and Health Administration (OSHA).

2.1.3 Types of Occupational Health Hazards

There are several types of hazards employees may be exposed to depending on their industry

1. Physical hazards: are environmental factors that can lead to injuries. These include
exposed electrical wiring, falling objects, wet floors, and other conditions that can cause
 slips, falls, cuts, or other injuries. Some physical hazards don’t necessarily need to make
physical contact to cause harm, such as excessive noise levels, heat, and pressure.

2. Biological hazards: can lead to diseases, infections, and other serious health conditions.
Mold and fungi, blood and other bodily fluids, bacteria, viruses, sewage, and vermin are
all examples of biological hazards. Using Personal Protective Equipment (PPE) is vital to
preventing exposure to biological hazards and protecting your health.

3. Chemical hazards: can be inhaled as gases or vapors, or come in contact with skin as a
liquid or solid. They can cause skin irritation, burns, respiratory problems, blindness, or
other serious health complications. Chemicals such as cleaning products, acids,
pesticides, and petroleum products need to be handled responsibly with proper PPE to
prevent exposure.

4. Ergonomic hazards: put strain on muscles, tendons, and other connective tissues of the
body. They can result from bad posture, not using dollies other mechanical assistance,
and repetitive or awkward lifting/movement. They can lead to musculoskeletal injuries
such as muscle sprains, ruptured or herniated discs, and carpal tunnel.

5. Psychological hazards: can lead to depression, concentration problems, inattention, or

negligence. This type of hazard includes work-related stress, fatigue, harassment, and
violence. These conditions can, in turn, lead to morale issues, reduced productivity and
quality of work, and increased risk of injury

2.1.4 Methods of Assessing Occupational Health Hazards

One of the root causes of workplace injuries, illnesses, and incidents is the failure to identify or
recognize hazards that are present, or that could have been anticipated. A critical element of any
effective safety and health program is a proactive, ongoing process to identify and assess such
hazards.

To identify and assess hazards, employers and workers the following items need to be followed:

1. Collect and review information about the hazards present or likely to be present in the
workplace.
 2. Conduct initial and periodic workplace inspections of the workplace to identify new or
recurring hazards.

3. Investigate injuries, illnesses, incidents, and close calls/near misses to determine the
underlying hazards, their causes, and safety and health program shortcomings.

4. Group similar incidents and identify trends in injuries, illnesses, and hazards reported.

5. Consider hazards associated with emergency or non routine situations.

6. Determine the severity and likelihood of incidents that could result for each hazard
identified, and use this information to prioritize corrective actions.

Action item 1: Collect existing information about workplace hazards

Information on workplace hazards may already be available to employers and workers, from
both internal and external sources.

How to accomplish it

Collect, organize, and review information with workers to determine what types of hazards may
be present and which workers may be exposed or potentially exposed. Information available in
the workplace may include:

i. Equipment and machinery operating manuals.

ii. Safety Data Sheets (SDS) provided by chemical manufacturers.

iii. Self-inspection reports and inspection reports from insurance carriers, government
agencies, and consultants.

iv. Records of previous injuries and illnesses, such as OSHA 300 and 301 logs and reports of
incident investigations.

v. Workers' compensation records and reports.

vi. Patterns of frequently-occurring injuries and illnesses.

vii. Exposure monitoring results, industrial hygiene assessments, and medical records
(appropriately redacted to ensure patient/worker privacy).

viii. Existing safety and health programs (lockout/tagout, confined spaces, process safety
management, personal protective equipment, etc.).

ix. Input from workers, including surveys or minutes from safety and health committee
meetings.

x. Results of job hazard analyses, also known as job safety analyses.

Action item 2: Inspect the workplace for safety hazards

Hazards can be introduced over time as workstations and processes change, equipment or tools
become worn, maintenance is neglected, or housekeeping practices decline. Setting aside time to
regularly inspect the workplace for hazards can help identify shortcomings so that they can be
addressed before an incident occurs.

How to accomplish it

i. Conduct regular inspections of all operations, equipment, work areas and facilities. Have
workers participate on the inspection team and talk to them about hazards that they see or
report.

ii. Be sure to document inspections so you can later verify that hazardous conditions are
corrected. Take photos or video of problem areas to facilitate later discussion and
brainstorming about how to control them, and for use as learning aids.

iii. Include all areas and activities in these inspections, such as storage and warehousing,
facility and equipment maintenance, purchasing and office functions, and the activities of
on-site contractors, subcontractors, and temporary employees.

iv. Regularly inspect both plant vehicles (e.g., forklifts, powered industrial trucks) and
transportation vehicles (e.g., cars, trucks).

v. Use checklists that highlight things to look for. Typical hazards fall into several major
categories, such as those listed below; each workplace will have its own list: General
 housekeeping and Slip, trip, and fall hazards, Electrical hazards and Equipment
operation, Equipment maintenance and Fire protection.

vi. Before changing operations, workstations, or workflow; making major organizational

changes; or introducing new equipment, materials, or processes, seek the input of
workers and evaluate the planned changes for potential hazards and related risks.

Note: Many hazards can be identified using common knowledge and available tools. For
example, you can easily identify and correct hazards associated with broken stair rails and frayed
electrical cords. Workers can be a very useful internal resource, especially if they are trained in
how to identify and assess risks.

Action item 3: Identify health hazards

Identifying workers' exposure to health hazards is typically more complex than identifying
physical safety hazards. For example, gases and vapors may be invisible, often have no odor, and
may not have an immediately noticeable harmful health effect. Health hazards include chemical
hazards (solvents, adhesives, paints, toxic dusts, etc.), physical hazards (noise, radiation, heat,
etc.), biological hazards (infectious diseases), and ergonomic risk factors (heavy lifting,
repetitive motions, vibration). Reviewing workers' medical records (appropriately redacted to
ensure patient/worker privacy) can be useful in identifying health hazards associated with
workplace exposures.

How to accomplish it

i. Identify chemical hazards –review SDS and product labels to identify chemicals in your
workplace that have low exposure limits, are highly volatile, or are used in large
quantities or in unventilated spaces. Identify activities that may result in skin exposure to
chemicals.

ii. Identify physical hazards –identify any exposures to excessive noise (areas where you
must raise your voice to be heard by others), elevated heat (indoor and outdoor), or
sources of radiation (radioactive materials, X-rays, or radiofrequency radiation).
 iii. Identify biological hazards –determine whether workers may be exposed to sources of
infectious diseases, molds, toxic or poisonous plants, or animal materials (fur or scat)
capable of causing allergic reactions or occupational asthma.

iv. Identify ergonomic risk factors –examine work activities that require heavy lifting, work
above shoulder height, repetitive motions, or tasks with significant vibration.

v. Conduct quantitative exposure assessments –when possible, using air sampling or direct
reading instruments.

vi. Review medical records –to identify cases of musculoskeletal injuries, skin irritation or
dermatitis, hearing loss, or lung disease that may be related to workplace exposures.

Note: Identifying and assessing health hazards may require specialized knowledge. Small
businesses can obtain free and confidential occupational safety and health advice services,
including help identifying and assessing workplace hazards, through OSHA's On-site
Consultation Program.

Action item 4: Conduct incident investigations

Workplace incidents –including injuries, illnesses, close calls/near misses, and reports of other
concerns– provide a clear indication of where hazards exist. By thoroughly investigating
incidents and reports, you will identify hazards that are likely to cause future harm. The purpose
of an investigation must always be to identify the root causes (and there is often more than one)
of the incident or concern, in order to prevent future occurrences.

How to accomplish it

i. Develop a clear plan and procedure for conducting incident investigations, so that an
investigation can begin immediately when an incident occurs. The plan should cover
items such as: Who will be involved, Lines of communication, Materials, equipment, and
supplies needed and Reporting forms and templates

ii. Train investigative teams on incident investigation techniques, emphasizing objectivity

and open-mindedness throughout the investigation process.
 iii. Conduct investigations with a trained team that includes representatives of both
management and workers.

iv. Investigate close calls/near misses.

v. Identify and analyze root causes to address underlying program shortcomings that
allowed the incidents to happen.

vi. Communicate the results of the investigation to managers, supervisors, and workers to
prevent recurrence.

Effective incident investigations do not stop at identifying a single factor that triggered an
incident. They ask the questions "Why?" and "What led to the failure?" For example, if a piece
of equipment fails, a good investigation asks: "Why did it fail?""Was it maintained
properly?""Was it beyond its service life?" and "How could this failure have been prevented?"
Similarly, a good incident investigation does not stop when it concludes that a worker made an
error. It asks such questions as: "Was the worker provided with appropriate tools and time to do
the work?""Was the worker adequately trained?" and "Was the worker properly supervised?"

Note: OSHA has special reporting requirements for work-related incidents that lead to serious
injury or a fatality (29 CFR 1904.39). OSHA must be notified within 8 hours of a work-related
fatality, and within 24 hours of an amputation, loss of an eye, or inpatient hospitalization.

Action item 5: Identify hazards associated with emergency and non-routine situations

Emergencies present hazards that need to be recognized and understood. Non-routine or

infrequent tasks, including maintenance and startup/shutdown activities, also present potential
hazards. Plans and procedures need to be developed for responding appropriately and safely to
hazards associated with foreseeable emergency scenarios and non-routine situations.

How to accomplish it

i. Identify foreseeable emergency scenarios and non-routine tasks, taking into account the
types of material and equipment in use and the location within the facility. Scenarios such
as the following may be foreseeable: Fires and explosions, Chemical releases, Hazardous
material spills, Startups after planned or unplanned equipment shutdowns, Non-routine
 tasks, such as infrequently performed maintenance activities, Structural collapse, Disease
outbreaks, Weather emergencies and natural disasters, Medical emergencies and
Workplace violence

Action item 6: Characterize the nature of identified hazards, identify interim control
measures, and prioritize the hazards for control

The next step is to assess and understand the hazards identified and the types of incidents that
could result from worker exposure to those hazards. This information can be used to develop
interim controls and to prioritize hazards for permanent control.

How to accomplish it

i. Evaluate each hazard by considering the severity of potential outcomes, the likelihood
that an event or exposure will occur, and the number of workers who might be exposed.

ii. Use interim control measures to protect workers until more permanent solutions can be
implemented.

iii. Prioritize the hazards so that those presenting the greatest risk are addressed first. Note,
however, that employers have an ongoing obligation to control all serious recognized
hazards and to protect workers.

2.1.5 Prevention and Control Strategies for Occupational Health Hazards

Control measures include actions that can be taken to reduce the potential of exposure to the
hazard, or the control measure could be to remove the hazard or to reduce the likelihood of the
risk of the exposure to that hazard being realised. A simple control measure would be the secure
guarding of moving parts of machinery eliminating the potential for contact. When we look at
control measures we often refer to the hierarchy of control measures.
Fig2.1.5.1 Control Measures of Occupational Health Hazards

1. Eliminate the hazard: Elimination of the hazard is not always achievable though it does
totally remove the hazard and thereby eliminates the risk of exposure. An example of this
would be that petrol station attendants in Ireland are no longer exposed to the risk of
chronic lead poisoning following the removal of lead from petrol products sold at
forecourts.

2. Substitute the hazard with a lesser risk: Substituting the hazard may not remove all of
the hazards associated with the process or activity and may introduce different hazards
but the overall harm or health effects will be lessened. In laboratory research, toluene is
now often used as a substitute for benzene. The solvent-properties of the two are similar
but toluene is less toxic and is not categorised as a carcinogen although toluene can cause
severe neurological harm.
 3. Isolate the hazard: Isolating the hazard is achieved by restricting access to plant and
equipment or in the case of substances locking them away under strict controls. When
using certain chemicals then a fume cupboard can isolate the hazard from the person,
similarly placing noisy equipment in a non-accessible enclosure or room isolates the
hazard from the person(s).

4. Use engineering controls: Engineering Controls involve redesigning a process to place a

barrier between the person and the hazard or remove the hazard from the person, such as
ventilation system, machinery guarding, proximity guarding, extraction systems or
removing the operator to a remote location away from the hazard.

5. Use administrative controls: Administrative controls include adopting standard

operating procedures or safe work practices or providing appropriate training, instruction
or information to reduce the potential for harm and/or adverse health effects to person(s).
Isolation and permit to work procedures are examples of administrative controls.

6. Use personal protective equipment: Personal protective equipment (PPE) include

gloves, glasses, earmuffs, aprons, safety footwear, dust masks which are designed to
reduce exposure to the hazard. PPE is usually seen as the last line of defence and is
usually used in conjunction with one or more of the other control measures. An example
of the weakness of this control measure is that it is widely recognised that single-use dust
masks cannot consistently achieve and maintain an effective facepiece-to-face seal, and
cannot be adequately fit-tested and do not offer much, if any real protection against small
particulates and may lead to a false sense of security and increase risk. In such instances
an extraction system with fitted respirators may be preferable where the hazard may have
significant health effects from low levels of exposure such as using isocyante containing
chemicals.

2.2 Empirical Review

2.2.1 Knowledge of Occupational Health Hazards

Moonu S. & Srijana K., (2019) investigated on the Knowledge Regarding Occupational Health
Hazards among Nurses in a Hospital, Rupandehi, Nepal. A descriptive cross-sectional study was
conducted to find out the knowledge regarding occupational health hazards among nurses. Sixty
one (61) respondents were selected as the study sample by using enumerative sampling method.
Self- administered structured questionnaire was used to collect the data and collected data were
analyzed by using descriptive and inferential statistics with SPSS software version 16. The
findings of the study revealed that 70.5% of respondents had knowledge on meaning of
occupational health hazards. Forty six percent had knowledge regarding meaning of biological
hazards, 86.9% and 65.6% had knowledge on high risk person and immediate management for
blood and body fluids exposure respectively. The finding of the study was also showed that
52.5% had high knowledge and 47.5% had low knowledge regarding occupational health
hazards. Based on findings of the study, it is concluded that more than half of the respondents
have high knowledge regarding occupational health hazards. Besides this, respondents have high
knowledge on meaning of occupational health hazards, causative agents of biological hazards,
diseases that can occur after exposure to infected body fluids, preventive measures and low
knowledge on meaning of biological hazards, virus having chance of transmission and first
person to report after exposure to blood and body fluids.

2.2.2 Another Study Conducted on Knowledge and Awareness

Amal, A. M., Fatima, M. A., Aya, A. A., Aya, J. R. A., and Amira, A. A., (2023). Conducted a
research study on assessing the occupational health and safety awareness and practices among
the healthcare workers in the pediatric hospital in Benghazi city, Libya. The study adopted
descriptive survey research in the Benghazi pediatric hospital. The study randomly selected 246
healthcare workers and the response rate was 96%. A questionnaire was used as the main data
collection instrument. The data were coded and analyzed using descriptive statistics; frequencies
and percentages and inferential analysis of correlation. The study showed that around 50% of the
participants reported a lower level of awareness regarding occupational health and safety (OHS).
The study proposes that the ministry of health should conduct specialist training in occupational
health and safety for their staff, they also should confirm provisions of this policy and technical
guidelines apply to all health institutions and administrative units within the health sector.
Further hospital risk management should put in place a regular monitoring team who will certify
that workers notice in firm terms safety measures put in place to avoid any accidents/injuries.
Lastly, the study recommends that further research on the factors determining the
implementation of occupational health and safety awareness and practices at public health care
facilities in Libya.

2.2.3 Prevalence of Occupational Health Hazards

According to Duaa S. A., & Ibrahim R. N. E., (2023) carried out research on Prevalence and
Determinant of Work-Related Injuries (WRIs) Among Healthcare Workers in Jeddah, Saudi
Arabia. The study design was an analytic cross-sectional study conducted at secondary hospitals
of the Ministry of Health (MOH) in Jeddah by using a self-administered questionnaire to
measure the prevalence of WRIs and their related factors. The Chi-squared test was used to
compare variables. A p-value <0.05 was considered statistically significant. The study involved
387 participants, of whom 283 (73.1%) were female. Most of the participants (n=226, 58.4%)
agreed that personal protective equipment (PPE) was always available at their hospitals.
Approximately two-thirds (n=251, 64.9%) agreed that they always used PPE. The overall
prevalence of WRIs was 52%, with back injuries (32.6%), eye/mouth splashes (20.4%), and
needle stick injuries (19.9%) being the most common. The study revealed a high prevalence of
WRIs among HCWs in Jeddah, Saudi Arabia, with back injuries, eye/mouth splashes, and needle
stick injuries being the most common types. The study also found that the injuries were
significantly associated with the type of profession, experience, work hours, and shifts as well as
the availability of safety management and equipment such as sharp containers and PPE.

2.2.4 The Availability of Safety Measures in Averting Occupation Health Hazards

According to Kumar, A., Kumar, A., & Panigrahi, O. P. (2022) Investigated on assessment of
knowledge, attitude and practice towards occupational health hazards and safety measures
among healthcare personnel working in public health facilities of Bhubaneswar Block, India.
Descriptive cross-sectional study was adopted for the study which was undertaken in public
health facilities of Bhubaneswar Block, Odisha. The study was conducted for a period of one
year. One hundred seventy two health care providers (both medical and paramedical with a
minimum experience of six months) were included. Descriptive statistics were used and Pearson
chi-square test as the test of significance; taking a p value of< 0.05 as statistically significant.
The findings of the study revealed the mean age of the respondents is 38.44 years with a standard
deviation of 12.8. Majority of the participants had good knowledge (69%), positive attitude
(61%) and good level of practice (67%) towards occupational hazards and safety measures at
their workplaces. Education and occupation were significantly associated with both knowledge
and practice whereas age and occupation were associated with attitude. Conclusions: The overall
level of knowledge, attitude and practice was quite satisfactory. However, still wider gaps exist
that can be filled by implementing new policies relating to workplace hazards and safety.

2.3 Theoretical Framework

This study was informed by the hierarchy of controls framework which was developed by
Hazpak in 1996. The framework systematically identifies hazards and prioritizes intervention
strategies. It is based on the premise that the best was to control hazards is to remove them from
the workplace rather than rely on employees to reduce exposure. Additional means can also be
used, but these offer less protection. The framework further states that elimination substitution,
engineering controls, administration control and personal protective clothing equipment can also
be used as control measures (Hazpak, 1996).

The hierarchy of controls as outlined by Hazpak (1996) as shown in figure 2.1 is a useful tool for
outlining the preferred options for occupational health and safety risk control in any work
environment including in hospitals like Hajiya Gambo Sawaba General Hospital, Zaria city.
Figure 2.3.1 : Hierarchy of Controls framework (Adapted from Hazpak (1996)

Based on the work and theory by Hazpak (1996) and from figure 2.1, the different aspects of the
theory can be summarized as follows;

2.3.4 Elimination

Elimination of hazards refers to complete removal of the hazards from the workplace (Butch de
Castro, 2003). In the case of Hajiya Gambo Sawaba General Hospital Zaria city, elimination
suggests that latex-free gloves should be purchased for daily use to remove the risk that the
health workers will develop allergic reactions to latex materials.

2.3.3 Substitution

Substitution involved replacing a hazard with one that represents a lower risk (Hazpak, 1996). At
Hajiya Gambo Sawaba General Hospital, substitution may refer to removal of some disinfectants
that contain hazardous chemicals which can cause poisoning and even death and substituting
them with less harmful disinfectants.

2.3.4 Engineering controls

Engineering controls refers to removing or isolating a hazard through technology (Butch de

Castro, 2003), focusing on the source of the hazard or the pathway of transmission. In this study,
the use of a ceiling-mounted system for lifting patients out of bed and into a chair would
constitute an engineering control to prevent the nurse or doctor from the risk inherent to heavy
lifting.

2.3.5 Administrative control

According to Butch de Castro (2003), administrative control refers to policies aimed at limiting
workers exposure to a hazard, typically accomplished through work assignments. In this study, to
prevent a worker from occupational stress, more staff can be allocated to a ward or clinic, this
will reduce the workload. Administrative controls such as training, education, job rotation, safe
work procedure, checklists and a reward system for good safety and health suggestions should be
employed to reduce the risk of hazards (Hazpak, 1996).
2.3.6 Personal protective equipment

Hazpak (1996) argues that personal protective equipment is necessary in a work environment.
The success of this control is dependent on the equipment being chosen and fitted correctly,
worn at all times and maintained properly. For example, gloves, gowns, mask, goggles should be
worn when caring for a patient diagnosed with severe acute respiratory syndrome. Personal
protective equipment tries to reduce worker’s exposure but does not control hazards themselves.

The hierarchy of controls framework can be useful in a study like this one because it can prevent
or minimize exposure to occupational hazard. It is critical to strive for the most effective
measures possible and, when selecting control measures, the combination of methods is vital.
Health workers should be familiar with hazard control measures within their workplace (Hazpak,
1996). As shown in figure 1, the elimination of the risk is the primary form of occupational
health and safety risk control, however, the legislation and standards tends to lean more towards
the minimization of the risk, particularly where it is not reasonably practical to eliminate the risk.
In this study, the hierarchy of controls framework was useful as it helped to identify occupational
hazards at Hajiya Gambo Sawaba General Hospital, Zaria city. These hazards were classified
into: biological, chemical, psychosocial, physical, ergonomic hazards, electrical hazards and fire
hazards.

The theory also informed the study on the measures that are necessary for addressing
occupational hazards before can cause harm in the workplace. The measures or controls that
need to be implemented are linked to administration and personal protective measures.

2.4 Summary
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

This chapter discussed the method employed for this study.it includes research design, area of
study, the study population, sample size and sampling technique, method of data collection,
validity of instrument, instrument for data collection and method of data analysis, ethical
consideration.

3.1Research Design

The study is a descriptive cross sectional design. Is a survey research design, as stated by Uranus
(2005) survey is very effective in seeking the view of people about a particular issue that concern
them. Therefore, the design was deemed appropriate in assessing of occupational health hazards
and safety awareness among health care workers in Hajiya Gambo Sawaba General Hospital
Kofar Gayan, Zaria.

3.2 Area of Study

Hajiya Gambo Sawaba General Hospital, Kofar-Gayan, Zaria complex is located at the south
west of Zaria City just less than 4km from the wall of the city. As a secondary health institution,
the general hospital was established in 1974 as a Health Care Centre and later upgraded to
general hospital in 1976.

In 1994, the hospital was renovated by the administration of Colonel Lawal, then Military
Administrator of Kaduna State and commissioned on the 4 th November, 1994 and renamed as
Hajiya Gambo Sawaba General Hospital, Kofar Gayan, Zaria City, to operate semi-autonomous
as a public enterprise to generate revenue and provide and provide services at a reduced cost.
The hospital operates various medical services such as Ante-natal clinic, laboratory services,
surgical operation (minor or major), eye services, child welfare, and general medical services.
It also undertakes training of traditional birth attendance (TBA) and Volunteers village health
workers (VVHW) for some weeks or some modern methods and techniques of birth, delivery so
that they can assists in delivery in rural communities areas.

3.3 Population of the Study

The target population of the study are 215 Health Workers. These includes doctors, nurses, and
the laboratories workers in Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria.(Admin.
Office of Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria)

3.4 Sample Size Determination: Refers to the number of participation or observations included
in a study. This number usually represented by ''n''.

A. The sample size (n) was determined using ''Taro Yamane formula of sample extraction''
(1967)

Where:

n = N / 1 + N (e)2
n= Sample size

N= Total population

e= Number of precision (5 %)

Therefore, sample size (n)

n = 215 / 1+ 215 (0.05)2

n = 215 / 1+ (215*0.0025)
n = 215 / 1+ 0.53
n = 215 / 1.53
n = 139.83
n ≈ 140 (rounded)
After calculated the sample size by substituting the numbers into the Yamane formula, the
numbers of sample is 139.83 persons. In order to obtain reliable of data, researcher has increased
sample size to 140 persons.

B. Sampling Technique: Is a technique of selecting individual members or a subset of the

population to make statistical inference from them and estimate the characteristics of the whole
population.

A Multi stage sampling technique was used, as follows:

Stage I: clustering based on existing wards as follows:

1. Cluster I Surgical wards

i. Female Surgical Ward
ii. Female Medical ward
iii. Male Medical ward
iv. Male Surgical Ward
2. Cluster II Maternity Ward
i. Gynae Ward
ii. Labor Ward
3. Cluster III Pediatric wards
i. Pediatric Surgical Ward
ii. Pediatric Medical Ward
4. Cluster IV Clinics
i. Ear, Nose and Throat (ENT clinic)
ii. Eye clinic
iii. GOPD
iv. Laboratory unit
v. Dental unit
vi. Theater
STAGE II: Randomly selecting wards using paper balloting method to represent a ward. These
include:

WARDS NUMBER OF HEALTH WORRKERS

Doctors Nurses

Female Surgical Ward 6 16

Female Medical Ward 7 18

Male Medical Ward 6 14

Male Surgical Ward 5 12

Gynae Ward 6 12

Labour Ward 8 16

Pediatric Surgical Ward 4 10

Pediatric Medical Ward 8 13

GOPD 9 14

Laboratory Unit Laboratory Workers = 31

Doctors 59

Nurses 125

Laboratory Workers 31

Grand Total 215

STAGE III: Stratification of health workers in the selected wards.

Strata I= Doctors

Strata II= Nurses

Strata III=Laboratory workers

C. Sampling unit allocation: the method of collection of sample unit by proportional allocations
based on numbers of existing health workers by using the formular

X = A/B

Where X = Sample to be Allocated to each ward

A = Total population of health workers in a given ward

B = Total number of health workers in a selected ward

n = sample size

Therefore, the calculation is shown in the table below:

WARDS NUMBER OF HEALTH WORRKERS

Doctors Nurses

Female Surgical Ward 6/215*140 = 4 16/215*140 = 10

Female Medical Ward 4 12

Male Medical Ward 4 9

Male Surgical Ward 3 8

Gynae Ward 4 8

Labour Ward 5 10

Pediatric Surgical Ward 3 7

Pediatric Medical Ward 5 9

GOPD 6 9

Laboratory Unit 20
 Doctors 38

Nurses 82

Laboratory Workers 20

Grand Total 140

3.5 Instrument for Data Collection

The data will be collected by using a self administered questionnaire designed by the researcher
to the respondents. The questionnaire contain five sections as A, B, C, D and E.

Section A: contain socio -demographic characteristics of the respondents.

Section B: Level of knowledge of the respondents of the respondents.

Section C: Types of occupational health hazard.

Section D: Prevalence of occupational health hazard.

Section E: Measures by the respondents in averting occupational health hazard.

3.6 Validity of instrument

In order to ensure the validity of an instrument, The questionnaire was design from the research
questions and content validity was ensured. The questionnaire was assessed by the supervisor
and every item was in relation with research questions focusing on the study.

3.7 Method of data collection.

Data for the study will be collected by using self administered questionnaire to the respondents.
Questionnaire will be distributed among the respondents and collected back after being
successful filled by the respondents.

3.8 Ethical consideration

The ethical consideration were ensured and put in place; an introduction of the researcher to the
management of Hajiya Gambo Sawaba General Hospital Kofar Gayan, Zaria was done by the
researcher for this study.

3.9 Data Analysis

The main statistical method used for the analysis of data in the study is the descriptive statistics.
The frequency and percentage of each section was and the results were analyzed.

For the purpose of this study a rating scale will be used to analyze level of knowledge.

That is

Respondent who score 0 – 49 have poor knowledge on occupational health hazard an safety
awareness.

Respondent who score 50 – 69 have good knowledge on occupational health hazard an safety
awareness.

Respondent who score 70 – 100 have excellent knowledge on occupational health hazard an
safety awareness