Workers' Health is involved in several projects and activities in the Region
Our role comprises different activities:
- Assisting countries to design national profiles on workers' health to identify working and employment conditions.
- Promoting workers' health protection by implementing the "healthy workplace approach."
- Building capacities to identify, measure, and register occupational injuries, diseases and fatalities at regional and country level, as well as estimating the burdens they cause.
- Supporting information dissemination, capacity building and networking.
- Promoting research for providing evidence for policy and decision-makers.
Our broad network of Collaborating Centers and partners in Workers' Health are key resources for meeting these goals. They actively network to build and share knowledge, tools, and successful experiences capable of leading workers' health, safety and wellbeing, and contributing to PAHO's Action Plan in Workers' Health.
Crystalline silica is one of the most common minerals in the earth's crust. Crystalline silica dust is released during numerous operations in which silica-containing products undergo any process that can create visible or invisible dust particles, such as the drilling of concrete. Workers may be exposed to crystalline silica in many different workplaces and processes such as mines, construction sites, and during the making of ceramicss.
Millions of workers in the Americas are exposed to crystalline silica. In Colombia alone, an estimated 1.8 million workers are at risk of developing silicosis, which is an incurable and irreversible lung disease caused by inhalation of dust containing free crystalline silica. Preventive action should be taken before workers are exposed.
The ILO/WHO International Programme on the Global Elimination of Silicosis calls for the elimination of silicosis worldwide by 2030. It includes:
- formulation of national, regional and global action plans;
- mobilization of resources for the application of primary and secondary prevention;
- epidemiological surveillance;
- monitoring and evaluation of results; and
- strengthening required national capabilities and the establishment of national programmes.
The programme will depend heavily on cooperation between international organizations and industrialized and developing countries.
In 2005, WHO, PAHO, the Chilean Ministry of Health and ILO requested that NIOSH provide capacity-building technical assistance to eliminate silicosis in the Americas. The Americas Silicosis Initiative was born as a partnership between WHO, PAHO, ILO, Chile, Brazil, and Peru. This initiative is the first regional approach to mitigate silicosis and is based upon sharing expertise to benefit workers and communities of many countries.
The Asbestos Atlas Project
PAHO has decided to compile an Asbestos Atlas which will involve gathering information on the use and regulation of asbestos in each of the PAHO countries still using asbestos. For countries that have banned asbestos, we are requesting information from those involved in the banning process.
We hope that in starting a compilation of country asbestos profiles for the Atlas, we lay the foundation for future work on development of national plans for the elimination of the asbestos disease. We also hope to produce a document that will be instructive and useful for public health workers around the world.
Influenza and Workers' Health
The transmission of infectious diseases such as influenza is a major problem that affects both patients as well as health care workers. Health care workers are especially vulnerable to influenza, as they are at the frontline against the spread of emerging and existing infections.
PAHO and its Collaborating Centers in Occupational Health are working with member states on several activities to reduce the risk of transmission of influenza in the workplace.
Some activities that had been done in 2009 include:
- For this year's Vaccination Week in the Americas, PAHO launched a regional slogan "Inmunization begins with health care workers: get vaccinated."
- Awareness activities around this theme have been organized in the region.
- Training programs for health care workers have been delivered in several countries to inform them about their occupational risk of exposure to biological agents, including influenza, and preventive measures against influenza in the workplace.*
*These resources and materials can be accessed via the Geolibrary under the special section on influenza.
Vaccination Week in the Americas 2009
Health care workers were a priority for this year's Vaccination Week in the Americas. As a fundamental part of health systems, health care workers need healthy and safe working conditions and environments to help ensure that patients receive appropriate and timely care. The occupational transmission of infectious diseases among health care workers, such as hepatitis B and influenza, account for significant illness among health care workers and are preventable by vaccination.
For this first year of the Region-wide campaign targeting health care workers, up to 16 countries aimed to vaccinate health care and other workers against diseases such as hepatitis B, measles, rubella, diphtheria, tetanus, and influenza.
Results of the 2009 Inmunization Week:
Vaccination Week coincided with World Day for Safety and Health at Work, an annual and global campaign to promote healthy and safe work for all. This year's theme was "Protecting the health and safety of health care workers".
Cochrane Systematic Review: Prevention of percutaneous injuries with risk of hepatitis B, hepatitis C, or other viral infections for health care workers
Health care workers are at risk of acquiring infectious diseases through exposure at work. Exposure to blood or bodily fluids from infected patients can lead to infection with hepatitis B, hepatitis C, or HIV viruses. These are serious infections that may cause chronic disease or initiate cancer, and eventually lead to death. Approximately two million health care workers across the world experience percutaneous exposure to infectious diseases each year. In Latin America and the Caribbean, the proportion of HBV, HCV, and HIV infections among health care workers due to occupational sharps injuries are the highest in the world at 55, 83, and 11 percent, respectively.
The transmission of occupational blood-borne infectious diseases leads to absenteeism, morbidity, and in some cases mortality among health care workers. These ultimately lead to a reduction in workforce and consequently affect patients quality of care and safety. Health care workers may also suffer from psychological stress, which affects both work and personal life. There is also the financial burden imposed on hospitals due to occupational exposure to blood-borne diseases, which includes costs related to blood tests, treatment, outpatient visits, and lost working hours.'
Several strategies are available and widely used to prevent PEIs among health care workers. Therefore, it is important to know if these preventive interventions are effective. The objective of the Cochrane systematic review is to determine the benefits and harms of interventions for preventing percutaneous exposure incidents with risk of hepatitis B, hepatitis C, or other viral infections for health-care workers.
Road safety at work
In 2008, the inaugural international conference on road safety at work was held in Washington DC and attended by more than 220 delegates from over 40 countries. This event was organized by NIOSH and partners including WHO, PAHO, ILO, US Department of State, and National Safety Council.
Worldwide, an estimated 1.2 million people are killed in road crashes each year and as many as 50 million are injured. Fleet and road workers are included as among the many lives lost. Projections indicate that these figures will increase by about 65% over the next 20 years unless there is new commitment to prevention.
Protecting and promoting the health and safety of health care workers
PAHO, WHO, and its Collaborating Centers in Occupational Health have provided technical cooperation to several member states to protect and promote the health and safety of health care workers. Health care work has been identified as one of the most hazardous jobs. Common occupational risks include infectious diseases, heavy patient lifting, ionizing radiation, shift work, and many other chemical, biological, physical, and psycho-social factors. For example, in Latin America and the Caribbean, the proportion of HBV, HCV, and HIV infections among health care workers due to occupational sharps injuries are the highest in the world at 55, 83, and 11 percent, respectively.
The need to make health care work healthier and safer was highlighted by the Regional contribution to the WHO draft Code of Practice on the International Recruitment of Health Personnel, in which countries indicated that poor working conditions and environments found in many health care settings interact to significantly undermine the health of health workers, patients and communities. Improving work in the health care sector helps to meet the basic needs of health care workers in order for them to perform their jobs effectively, to efficiently support patient health, and to help strengthen health care systems.
For more information, tools and publications about what countries are specifically doing to improve the health and safety of health care workers, please see the country projects.
In 2005, WHO, PAHO, NIOSH, and Latin-American partners developed a model project for the region.The WHO toolkit "Protecting health care workers: preventing needlestick injuries" was culturally and linguistically adapted to Latin American audiences. Venezuela agreed to conduct the pilot project. In 2007, international, national and state partners participated in national and train-the-trainer workshops. The partners agreed to have Aragua State as a model for the country.
The model aims at transferring expertise through a research institution. This conceptual approach involves strengthening research and surveillance capabilities within a research institution, which in turn trains and supports government officials and other professionals to implement preventive interventions, and ensures sustainability of the intervention. In one year,this project has been successfully expanded to four neighbouring states and continues its expansion. About 25 hospitals and three Networks of Outpatient Care have started to implement this project. Also, 750 students from national universities and health care professional institutions were trained with the toolkit.
The WHO Global Plan of Action on Workers' Health calls for member countries to develop national occupational health and safety policies, including hepatitis B immunization policies for health care workers. The burden of diseases associated with hepatitis B is preventable; since the early 1980s, there has been a hepatitis B vaccination available which is the best defense against hepatitis B infection and is safe, efficacious and cost effective.
Peru has demonstrated strong commitment and leadership to vaccinate its health care workers by providing accessibility to the hepatitis B vaccine directly in their workplaces. As part of a massive hepatitis B vaccination campaign in Peru in 2007, over 500, 000 health care workers have been immunized with the support of WHO, PAHO and NIOSH. A national and multi-institutional occupational health and safety committee is actively involved in the planning and implementation of policies and programs supporting the vaccination campaign. In the initial phase, more than 80 public health professionals in Peru received "train-the-trainer" training based on the Protecting health care workers: preventing needlestick injuries toolkit. Each participant is responsible to train a minimum of ten health care workers in their local institution to help build local capacity. PAHO is also collaborating with the ILO to include hepatitis B vaccination coverage among health care workers as one of the key indicators of decent work.
Guyana has made significant progress in the standardization of the immediate disposal of sharps at medical facilities, as previously this was characterized as ad hoc and inefficient. This improvement is attributed to the training of staff at district hospitals, health centers and health posts across the country on the safe disposal of needles immediately after use. Proper kits for the storage and disposal of needles after use were also provided. This process is ongoing to ensure training and provision of sharps disposal equipment to all of the approximately four hundred facilities providing medical care in Guyana.
However, the situation related to final disposal of sharps is bleak and is one of the major challenges with regard to medical waste disposal in Guyana. Most of the sharp storage kits, including those of the main hospitals in Georgetown, are disposed at dump sites. Two of the district hospitals are equipped with incinerators, which burn sharps not only from their facility, but from nearby health centers and health posts. However, these incinerators are in urgent need of repair and do not function effectively. This inefficient final disposal of sharps may lead to injury and exposure to blood-borne pathogens by waste handlers at medical facilities, and people who collect refuse at dumpsites. Inappropriate medical waste disposal may also pollute the environment, directly affecting the community members.
To minimize the problems associated with the final disposal of sharps, the Pan American Health Organization in Guyana (PAHO-GUY) in collaboration with the Ministry of Health in Guyana is in the process of constructing De Montfort prototype incinerators at key small-medium health care facilities. These incinerators will also accommodate sharp disposals from nearby facilities. Training will be provided to medical waste handlers to ensure efficient operation of these incinerators.
The transmission of nosocomial infections is a major global public health concern affecting both healthcare workers and patients. The WHO estimates that over 1.4 million people worldwide are suffering from infections acquired in hospitals.
The Healthy Hospitals Project, financed by the Canadian Government, aims to strengthen Ecuador's capacity to promote healthier and safer hospitals by reducing occupational transmission of infectious diseases.
The main activities of this project include:
1. Identifying primary disease hazards and health risks;
2. Strengthening existing occupational health and safety committees;
3. Conducting OHS workshops for healthcare workers and managers; and,
4. Promoting the development of micro projects to address priority hazards
The needs assessment revealed several good occupational health and infection control practices such as the establishment of a medical waste disposal program and widespread dissemination of health information. Challenges included a high frequency of recapping needles, limited resources and training available to enable workers to apply consistent infection control measures. There was also a high percentage of under-reporting of exposure to blood and bodily fluid, and limited occupational health and safety training. These findings guided the design and content of a training program. Following the workshop, existing occupational health and safety committees implemented micro projects and participated in delivering standard precautions. The knowledge and experience gained throughout the project formed a basis for the implementation of other occupational health and safety projects across the country.
Occupational Health and Infection Control: Preparing for Biological and Bioterrorism Events Preventing the spread of highly infectious biological agents is a global safety and security priority worldwide. The willingness of healthcare workers to work during a disaster is significantly influenced by their perceptions of the risk, as well as their knowledge and ability to provide the care required in a catastrophic situation. This situation is preventable as health workers are more likely to respond comfortably and effectively to natural and intentional disasters if they understand the risks involved, and are trained in risk reduction strategies. Conversely, without proper training and infrastructure capacity prior to the onset of such events the health and safety of first responders and other health workers can be severely comprised. This risk is then directly transferred to patients and families of healthcare staff.
This project, financed by the Canadian Government, was therefore conceived and designed to strengthen the capacity of the health workforce to protect itself, patients and the public to respond to biological events.
The main activities include conducting a situational analysis of existing infection control and occupational health practices, developing and delivering training materials and programs, and providing technical support to build capacity to counter biological threats.
The project focuses on four main areas of work:
1. Infection control and occupational health practices;
3. Laboratory safety; and,
4. Risk management and communication
Tools for Health-care Workers
PAHO Health, Safety and Well-being Committee
In 2008, the first Health, Safety, and Well-being Committee was formed at PAHO as a response to the organization's commitment to the welfare of its staff, promoting personal health and a safe working environment.
The Committee plays a normative role in:
- Identifying the health and well-being issues existing in PAHO's work environment or with PAHO employees;
- Making recommendations on specific actions to improve the working environment of all staff to promote the involvement of all staff in health and safety issues;
- Providing technical expertise on well-being related policies directed at employee well-being or safety; and,
- Reporting to management on identified problems and progress on improving workplace health and safety.
The Committee is comprised of representatives from all levels and types of work at PAHO and has achieved several major milestones. These include raising awareness of workplace health, safety and well-being by hosting an annual PAHO Wellness Day, promoting traveler's health and immunization, and providing information to PAHO cleaning service workers on the prevention of influenza at the workplace.
Inmunization for PAHO workers
"Traveler's health and immunization for PAHO workers"
Make Kindness contagious