Integrated Governance Report 2008 - Nuffield Health

46 INTEGRATED GOVERNANCE REPORT 2008
47
08
STAFF & PUBLIC HEALTH
Occupational Health
Occupational Health (OH) is concerned with protecting
and promoting the health of staff at work and aims to
balance the needs of individuals whilst supporting
managers in meeting their obligations under Health and
Safety Law, Employment Law and the requirements of the
Care Standards Act 23
OH services are provided to all divisions within Nuffield
Health and are also extended to other business partners.
Currently 24 hospitals and all HSSU units receive services
from Nuffield Health OH nurses. Where internal services
are not a viable option, these are obtained from third
party providers. These include two independent OH
practitioners and four NHS Trusts. There is scope to
provide an internal service to two more hospitals during
2009. We seek external guidance from a Consultant in
Occupational Medicine to provide additional specialist
support to the team.
Service Provision
OH activity is driven by occupational demands and hazards.
Clinical settings generally require greater OH input and all
hospitals and HSSU units have regular OH nurse site visits.
Staff not based within a hospital who need an OH
appointment are usually seen at the Nuffield Health hospital
nearest to where they work or live.
The range of services provided are described in the OH
Operational Plan and include pre-employment screening,
immunisation programmes, statutory health surveillance and
sickness absence management.
Blood Borne Viruses & Inoculation Injuries
The risk of blood borne virus transmission is a significant
occupational hazard for those exposed to blood and body
fluids in the course of their work. Exposure occurs through
needle stick injuries, cuts sustained whilst using or cleaning
surgical equipment or through blood splashes to mucous
membranes. There is a robust hepatitis B vaccination
programme in place and this remains a key focus for local
OH nurses. There are currently no vaccines available
against Hepatitis C or HIV: the prompt management of
needle stick injuries is therefore essential to minimise the
risks of transmission.
Table 18:
Total number of inoculation injuries reported - 2007 & 2008
Year Inoculation Splash Hospitals Total
Injuries Injuries Reporting Incidents
2008 144 10 30 154
2007 109 3 36 112
Table 19:
Top ten causes of inoculation injuries
Cause
Number
Suturing 23
Other 19
Cutting 15
Intramuscular injections 11
Unknown 8
Cannulation 5
Venepuncture 4
Finger/heel stick 3
Elecrocautery 2
Drilling 2
Blood Borne Viruses
– Infected Health Care Workers
Patients may be put at risk if a health care worker (HCW) is
infected with a blood borne virus and carries out exposure
prone procedures (EPP). Staff classified as EPP workers
include surgeons, first assistants, scrub nurses, operating
department practitioners, dentists and dental hygienists.
In 2007 a Nuffield Health healthcare worker reported to
OH when they were diagnosed as HIV positive. The Health
Protection Agency (HPA) was informed and detailed risk
assessments were completed with no cases of transmission
identified. We worked openly with the Department of Health
UK Advisory Panel for Blood Borne Viruses to allow an
independent assessment to be made.
This is the third time such an incident has occurred in
Nuffield Health over the last eight years. In view of the small
but significant risk to patients from such incidents, the blood
borne virus screening policy has been revised. From March
2009 all EPP staff applying to work within Nuffield Health
for the first time will be required to provide evidence of their
HIV, Hepatitis B and Hepatitis C status.
Stress Management
- Employee Assistance Programme
In June 2008, in support of the stress management policy
and in order to provide access to timely, reliable and
confidential support for staff an employee assistance
programme (EAP) was introduced. The EAP service is
available 24 hours a day, seven days a week and is open
to staff and their immediate family.
The following telephone services are now available:
• Counselling – emotional/psychological
• Legal
• Financial/debt
• Citizens Advice Bureau style information services
Driving at Work
Driving at work is an occupational hazard which is being
giving increasing prominence and companies are expected
to assess the risks associated with driving at work and
provide suitable control measures to reduce risks.
For the last three years the Hospitals Division has worked in
partnership with DriveTech a driving at work, risk
management and driver training company. All staff in receipt
of a car allowance or company car who drive regularly on
company business are included in the risk assessment
process. This involves completing an on line risk assessment
with follow up control measures such as on-road training or
attending a safe driving workshop, depending on the risk
rating. No further follow up is required for low risk drivers.
Most drivers within the Hospital Division have now been
through the programme and the programme is at the
‘maintenance’ stage with activity focused around new drivers
joining the company. The process is now managed by
Human Resources as part of the induction for new company
car drivers. Whilst some staff are initially sceptical about the
driving at work programme, all those who have completed
a workshop or on road training have rated it highly and
found it useful.
Drivers for HSSU and mobile diagnostic services have a
different driver programme in place to meet the specific
needs of lorry drivers.
Policy Development and Renewal
During 2008 the following policies and procedures have
been reviewed and re-issued:
• Health Surveillance
• Stress Management
• Stressful and Traumatic Incidents
• Inoculation Injury Management
• Violence and Aggression
• Testing Patients for Blood Borne Viruses
• Sickness Absence Management
Training staff in the prevention and management of needle
stick injuries, to include the process for testing patients for
blood borne viruses has been a key focus in 2008 with
101 staff from 20 hospitals attending training. Further
courses are planned for 2009.
The Group Infection Prevention & Control Committee has
recommended that all Wellbeing Advisors performing
health assessments on clients that involve finger prick
blood sampling must be offered a course of Hepatitis B
vaccination, followed up by testing to assess immunity
response.
In addition to the telephone services, staff can view a wide
range of information using the on line service.