BATCH 10 AIMST: Occupational health KPAS

Occupational and environmental health (KPAS)

History – the department is initially known as unit kesihatan am. Few years back, it was changes to kesihan pekerjaan alam sekitar (KPAS) and department of occupational safety and health (DOSH).

KPAS mainly deals with the safety of government health care workers in the district health office and the clinics under the DHO. DOSH deals with the safety of workers in other sectors including private health care settings.

Employees – 1 PPKP (En. Hasbullah) 1 staff nurse (Azahul)

Qualifications

- Encik Hasbullah has a diploma in environmental health

- staffnurse has a diploma in nursing and is also a qualified occupational health nurse

Activities

KPAS deals with occupational and environmental health. The steps in occupational safety are as follows:

- Notification

- Investigation

- Submit the relevant documents to the ministry of health

- Inform DOSH of the incident

- Auditing facilities

- Health promotion activities

- Vaccinations

Notification

Any disease that the doctor suspects has being caused by the work environment (DHO, KK) must be notified to KPAS.

The notification is done with the aid of several forms listed below: (sample is available)

- WEHU A1 (occupational accidents and dangerous occurance)

- WEHU D1 (occupational poisoning / disease)

- WEHU E1 (occupational induced hearing loss)

- WEHU L1 (occupational lung disease)

- WEHU S1 (occupational skin disease)

In addition to these forms, there are 4 separate forms (OHU/SIS1, OHU/SIS2a, OHU/SIS2b, OHU/SIS3) specifically for needle prick injury.

Each form has 3 copies, of which 2 are submitted to the Ministry and State health office and the remaining copy is kept by KPAS for reference.

The WEHU form’s layout is as shown below.

The OHU/SIS form’s layout is as shown below

Investigation

After a notification form has being filled up, staff nurse Azahul will visit the affected person and conduct an interview which will include among other things:

- Biodata

- Work experience

- Education level

- Knowledge about safety at the work place

- How the incident happened

She will then compile a report to be attached together with the notification form which will later to be sent to the state health office.

KPAS deals with finding the cause of the incident and not placing blame on anyone.

Needle prick injury – KPAS’ aim is to have no needle prick injury within the district. However it still continues to occur among students and lab workers due to recapping of the needle. So far, there have been two cases this year, which is an increase from last year where there were none.

Needle prick injury can be of two types:

a) used/contaminated needles

b) New/ unused needles

Proper handling of needles is necessary to prevent needle-prick injury

After a needle prick injury, it is the treating doctor’s responsibility to fill up the correct OHU/SIS form. After this, the staff nurse from KPAS will interview the affected person as detailed above.

After a needle prick injury, the immediate action to be taken is summarized below:

Step 1 – for percutaneous injuries, blood should be expressed out by squeezing the tissues adjacent to the wound and immediately washing it thoroughly with soap and water. For mucosal exposure, e.g. spillage into the eyes, wash immediately with water.

Step 2 – after the relevant notification has been performed, a risk assessment must be carry out in order to evaluate the potential of and exposure to; HIV, HBV, and HCV.

Step 3 – the HIV,HBV, and HCV status of the source should be obtained.

Step 4 – the health care worker should have baseline testing for HIV, HBV and HCV

Step 5 – if indicated, post exposure prophylaxis can be commenced.

If a doctor is infected due to a needle prick injury, he/she can still continue working but will be transferred to an area with less risk (administration).

The correct OHU/SIS form should be updated regularly with the affected health care worker’s status. A guideline is provided by the MOH Malaysia on the correct practices and documentation.

(PIC OF BOOK)

Auditing facilities

KPAS is in-charge of auditing all the government health facilities within its district at least once a year.

KPAS also helps government workers who are disabled due to an injury occurring in the work place obtain compensation from Exgratia. The compensation amount will be determined by the severity of the disability.

Health promotion activities

These can be performed after an incident has occurred. E.g. if a needle prick injury has occurred due to the lack of knowledge on needle safety, an occupational health promotion campaign can be conducted in that clinic.

In addition to this, the unit also organizes courses such as clinical waste handling and talks about safety to employees. An example about the health promotion activity carried out in Kota Setar is for the foggers in the vector unit. The foggers are taught about safety and how to wear their protective clothing in a correct manner. They are also taught about their equipment and the chemicals they use and the effects that these chemicals can have on their health. This is done due to the increased incidence of skin and lung diseases among the foggers who do not follow the proper procedures.

In addition to the above, every month, the occupational health specialist from the state health office visits the out patient department at the Klinik Kesihatan Bandar. High risk cases (government as well as non-government workers) selected by the doctors in the OPD are reviewed by the specialist, who initiates early treatment and if need be will request the KPAS unit to visit the patient’s work place in order to assess it as well as request that the patient be transferred to an environment more suitable to his health.

Vaccination

Influenza vaccinations for front liners (police, firemen, custom’s agents, health care workers, and marine department workers) are administered by KPAS.

They also administer hepatitis B vaccinations as well as vaccination for meningitis for those going for Haji. This was formerly under Unit Kesihatan AM, but since its dissolution, the activity has being take up by KPAS.

Budget – the annual budget is RM 8000 solely for the purpose of running programs. The supply of personal protective equipments (PPE) is from the CDC budget.

For 2009, there have been:

- 2 needle prick injury cases

- 1 fall at work

- 4 skin disease cases (foggers)

Below are some Personal Protective Equipment provided by KPAS to the health care workers