Occupational Safety and Health Challenges for Emergency Room Nurses

This report examines the occupational safety and health hazards encountered by emergency room nurses, with a focus on those in Saudi Arabia. It identifies chemical exposures, aesthetic gases, back injuries, stress, violence, and radiation as significant risks. The report delves into infectious diseases like Hepatitis B, A, C, Delta Hepatitis, TB, and HIV/AIDS, detailing transmission routes and preventive measures. It also highlights the Saudi Arabian government's efforts to establish and enforce occupational safety and healthcare policies. The paper concludes by suggesting further measures that can be implemented by institutions and individual health workers to enhance workplace safety.

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OCCUPATIONAL SAFETY AND HEALTH
by [Name]
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Occupational hazards can no longer be regarded as a personal issue or a mere
occasion that can be addressed through palliatives. Hofmann, Burke, and Zohar (2017)
observe that nursing and more specifically emergency caregiving is one of the most
hazardous professions in the healthcare industry. This risk concern is increasingly
transforming itself into a global distress, affecting all countries, all working environments and
all calibres of healthcare providers; emergency room nurses in Saudi Arabia not an exception.
This paper, takes a look at the various types of hazards that emergency room nurses are
exposed to, causes of those hazards, effects to the nurse, and how they can be prevented. The
discussion further narrows down to infectious disease exposure as one of the major hazards
that nurses face in the daily execution of their duties. Under this section, the author illustrates
the prevalent nature of the environment under which emergency nurses operate by looking at
the threats these diseases bear on the emergency room workforce and how they can be
prevented. The paper will also look at the efforts being made by the Saudi Arabian
government to avert this issue before suggesting further measures that can be put in place by
institutions and individual health workers to remain safe at the workplace.
Nurses are highly exposed to various chemical agents some of which may habor
detrimental effects to their health. Various clinical settings and circumstances may require
preparation and administration of antineoplastic agents. These cytotoxic drugs have been
documented as being toxic to caregivers who interact with them on regular basis (Quinn et al.
2015). These agents have been linked to carcinogenic, teratogenic and mutagenic effects not
forgetting, mild cases of eyes and skin irritations. The chemicals have also been accused of
causing allergic reactions (Aluko et al. 2016). Kermode (2019) observes that when these
agents are improperly handled say during mixing the risk of exposure increases. Several
professionals including (El-Sallamy et al. 2018) recommend safe contact in the handling of
these compounds.

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Long term exposure to aesthetic gases commonly found in recovery rooms, labor
rooms operating rooms and in some cases emergency care units may cause halothane and
methoxyflurane disorders. There is also an established correlation between these gases and
spontaneous abortions. Currently there are no published standards by the Saudi Arabian
health authorities on how to handle these gases, however, researchers recommend limited
exposure to halogens and nitrous oxide.
Glutaraldehyde is another compound that has been flagged as being harmful (Cantini
et al. 2015). The germicide has been associated with asthmatic symptoms, flu-like symptoms,
headache, and skin sensitivity. Nurses performing cold disinfection in intensive care units,
endoscopy and dialysis are more susceptible to the harmful effects of these compound.
Studies point at the practice of operating with this disinfectant in a poorly ventilated
environment as well as manual cleaning of equipment using this compound as some of the
factors increasing the risk probability. Cantini et al. (2015) found that prolonged periods of
exposure may cause severe liver complications. The existing guidelines limit the maximum
allowable exposure to glutaraldehyde to 0.2 ppm. Safe work practices and engineering
controls have been fronted as exposure minimization mechanisms.
Back injuries rank second behind infectious disease among the occupational health
hazards in Saudi Arabia (Getahun et al. 2015). In Saudi Arabia, statistics show that over
30,000 nurses and other caregivers report back-related injuries per year (Cantini et al. 2015).
Activities such as moving patients from one location to another, lifting heavy equipment, and
aiding the patients to bed are some of the most common causative activities of back-related
injuries. In Saudi Arabia, claims emanating from back injuries account for more than half of
the total recompenses paid to health workers (Getahun et al. 2015). The duties performed by
nurses at extensive care amenities place them at more serious hazard for back strains.
Emergency care nurses frequent lifts and supports patients who in general, are feeble,

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incapacitated, and older, increasing the risk propensity of back pains. Registered emergency
nurses, nurse aides, and licensed practical assistants are among the social insurance
employees often affected by back pains and injuries.
Nurses working with terminally ill patients, intensive care units, operation theatres,
burn unit and emergency rooms are more likely to suffer stress (Chand et al. 2016). Patient
care gets compromised in a clinical setting where nurses are stressed since their concentration
levels begin dwindle. Symptoms of stress include, but not limited to sleep disturbances,
emotional unrest, irritability, migraine headaches, loss of appetite, and ulcers (Chand et al.
2016). Managing hazardous sicknesses and wounds, fatigue, understaffing, rigorous
schedules, the chain of command of power, and patient deaths are some of the factors
attributed to high levels of stress among health caregivers in Saudi Arabia (Viliani et al.
2017). In many healthcare amenities, the nurse may develop a feeling of isolation, anger,
fatigue, and helpless due to the sense of depersonalization developed by complex
bureaucratic systems. Individuals suffering from stress are likely to find themselves in
excessive consumption of alcohol, cigarettes and substance abuse. The employees' attitude
towards work may also be seriously affected leading to decreased productivity and rise in
absenteeism. Strategies for adapting to pressure incorporate frequent staff meetings,
development of flexible working routines and engaging in pastime activities when it is due.
Emergency care centres and casualty departments are home to almost all types of
patients including mental patients. Violence from patients to nurses is not uncommon in these
workstations. Other areas prone to violence risks include mental health departments, surgical
units, and paediatric units. Incidences of patients yielding weapons on caregivers are frequent
in emergency rooms and psychiatric facilities. The factors related to an attack of emergency
room nurses are, staffing plans, time of day, age and gender of the caregiver, and security of
the facility. Studies demonstrate that inexperienced nurses and student nurses are an

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increased risk of ambush than their senior counterparts. Most of the wounds are sustained
during the time spent containing violent patients. Preventive measures incorporate
deployment of security personnel in high hazard areas, composed methods for controlling
fierce patients, and utilization of lawful activity against the assaultive party.
Radiation is one of the oldest healthcare concerns among the professional coming into
contact with it. It is responsible for stillbirth, miscarriages and other adversative reproductive
consequences. Teratogenic and mutagenic tendencies have also been linked to contact with
ionizing radiation. Perhaps the most significant effect of radiation is its linkage to various
types of malignancies including blood, skin and bone cancer. Nurses come into contact with
radiations while supporting patients in radiography rooms, and also when giving care to
patients in nuclear medicine test labs (Hassankhani et al. 2018). Healthcare professionals in
emergency quarters, surgical areas, and intensive care divisions where x-rays are often done
are more accidentally susceptible to radiation than the personnel in other sections. Scholars
do however differ on the quantifiable proportions of radiations enough to cause the said
effects. However, they seem to be in agreement that even very low quantities of radiation
have harmful outcomes on individuals exposed to them (Hassankhani et al. 2018).
Exposure to infectious diseases tops the list of healthcare environmental hazards
among employees across the globe. Medical personnel in numerous settings might be
presented to transmissible illnesses, for example, measles, rubella, mumps, and flu. Although
the risk of exposure to infectious diseases is more prevalent in other external settings outside
the hospital, health care environments bear more infection risks than any other setup. Nurses
working in penitentiary facilities, institutions for the mentally challenged, home-based care
nurses and those working in outpatient stations such as community health clinics, workplace
health amenities, and dialysis canters are highly susceptible to infection by transmittable

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ailments. In Health amenities, high-risk zones consist of ambulatory care facilities, paediatric
areas, emergency rooms, and infectious disease wards.
Hepatitis B (HBV) is arguably the most ubiquitous work-related contagious disease in
Saudi Arabia. Although the disease virus is hosted in blood, the virus may also find its way in
body fluids such as semen and saliva as well as faecal waste. Transmission may happen from
a percutaneous stick from a debased needle or other sharp instruments. Statistics place the
risk of this kind of transmission at 6-30 percent worldwide (Wei et al 2016). Infection
mechanisms include a contaminated stick breaking through the skin of a caregiver, ingestion
or a contaminated body fluid splattering onto mucous membranes of a medical caregiver.
Global standards outline Hepatitis B infection prevention mechanisms for healthcare workers
such as education, Hepatitis B inoculation, customary procedures for disinfection and
sterilization, and use of protective attire. Moreover, there are recommendations for safety
practices during an outbreak.
Another infectious disease that poses a risk to emergency room healthcare providers is
Hepatitis A. the risk is even higher for personnel handling patients whose personal asepticism
is poor. Guidelines recommend good, thorough and frequent hand washing techniques as the
ultimate infection prevention methodology (Wei et al 2016).
Al-Turki, Afify, and AlAteeq (2016) write that Delta Hepatitis occurs only in
individuals infected with Hepatitis B. The infection is, more prevalent among hemophiliacs
and intravenous drug abusers. Patients undergoing hemodialysis they inadvertently be
infected. In the Saudi Kingdom, however, there are limited sources documenting disease
prevention measures for healthcare workers. The few known preventive measures should be
established to edge spread of Delta Hepatitis.
Most Hepatitis C incidents are idiopathic in nature or linked to the use of IV drugs.
The disease is rarely transmitted to emergency care nurses through percutaneous exposure

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except under unique circumstances. This paper recommends more investigations to
determine the extent to which this ailment is considered an occupational hazard to emergency
care nurses in the Saudi Arabia Kingdom.
Saudi Arabia experienced a re-emergence of TB in the early 2000s. This is attributed
to the HIV/AIDS pandemic, homelessness, increase in the number of immigrants mostly from
Africa and the emergence of unique strains of the disease that were drug-resistant (Al Jarallah
& Ahmed, 2016). Healthcare attendants working in public and private medical facilities
particularly in HIV units, pulmonary departments and emergency stations are more
susceptible to TB infection. Other personnel likely to be infected are nurses operating in
prisons, outpatient clinics and long term care amenities (Sharma 2017). In most
circumstances, emergency room attendants come into contact with undiagnosed patients
making it difficult for the nurses to take extra caution when interacting and handling TB
infected patients. The Arabian health authorities anticipate issuing TB standard prevention
procedures in the near future (Alsaleem et al. 2018).
HIV/AIDS is the most dreaded infectious disease on the planet. The virus might be
procured by the introduction to contaminated blood or body liquids. The danger of
contracting HIV after percutaneous introduction with a defiled needle is 0.3– 0.4 percent (Lee
et al. 2016). Statistics show that out of the 42 recorded seroconversion in human workforce,
13 were medical attendants (World Health Organization [WHO] 2015). The Arabian
Bloodborne Pathogens Standard's distributed rules are intended to avoid occupation based
exposure to HIV. The Health Department suggests that blood and body liquids of all patients
are considered conceivably irresistible and, subsequently, all-inclusive precautionary
measures ought to be clung to with every patient contact.
The government of Saudi Arabia like most arab countries has been making efforts
steady efforts to develop, implement and enforce occupational safety and healthcare policy

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frameworks over years. Saudi Arabia came up with the OSH regulatory framework of 2009,
legislation whose most content is detailed in the labor code. Furthermore, there are other
enactments that contain some word related security and wellbeing arrangements, for example,
the Rules of Implementation for the Control and Regulation of Labour Inspection Activities
of 1970 and all the more as of late the Minister's Labour Decree No. 159 of 2009, building up
an outline of Occupational Diseases in Saudi Arabia. Under this framework, occupational
transmittable diseases are considered work injuries. The policy acknowledges a wide range of
infectious diseases as being health workplace hazards, some of which have been discussed in
this paper. The framework outlines the part of the employer, and the employee medical
practitioner in the event of infection by a transmittable disease at work including reporting
procedure, employee and employer obligations. In addition, the Ministry of labor, in 2009
issued a decree establishing a ledger directory for defining industrial debilities in the
Kingdom of Saudi Arabia. Although the diktat doesn’t agree with infectious health infections,
it does contemplate on various determinations of what amounts to occupational disabilities
including a back injury and subsequent disability that an emergency healthcare provider is
subject to.
In 2018, the government, through the ministry of labor and social development also
launched a countrywide health and safety inspection campaign targeting companies and
health facilities to enforce acquiescence. The operation aims at ensuring all constructing and
healthcare facilities fully comply with existing occupational safety policies. Any organization
found violating any of the requirements faces a penalty of SR10, 000.
Memish et al. (2015) estimate that organizations across Saudi Arabia spend close to
SR1000, 000 in compensations for work-related injuries to employees. While safety
responsibility has culminated into a blame game especially when an injury incident occurs,
every party has a role to play in employee safety. Healthcare facilities must conform to all the

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laid down safety requirements not only to ensure the safety of their manpower but also to
ensure that patient care is not compromised. Samargandy et al. (2016) suggest that
organizations should encourage medical attendants to report injuries, offer security to their
staff, comply with the statutory requirements on health and occupation safety, develop
flexible schedules for their employees, employ enough workforce to avoid straining their
manpower, and follow up on safety reports so dangers can be tended to and avoidance steps
are taken. Ahmad et al. (2016) also advises organizations to develop and implements internal
safety policies and regulations. Such frameworks will compel employees to observe safety
procedures in the line of their duty as they will be required to prove evidence of compliance
to these rules when making claims for compensation due to workplace injury.
Whereas the Saudi Arabian Government through the relevant authorities is making
some milestones at ensuring that its workforce remains safe and free from occupational
hazards, the citizenry is called upon to be responsible for their own personal safety while at
work (Alsabaani et al. 2017). All individuals working both in the public or private sector are
required to exercise safety practices at all times to prevent unnecessary injuries. Ahmad et al.
(2017) lays 30 percent of the blame on individual nurses who overlook standard safety
procedures and end up causing harm to themselves. He cites the case of mixing chemicals in
a poorly ventilated room despite there being a specialized facility for this purpose. Memish et
al. (2015) propose simple guidelines that could help emergency care nurses remain safe at
workstations. These practices include ergonomic activities, for example, training on
equipment intended to support patient exchanges from bed to seat or vice versa, ergonomic
activities, wearing protective clothing and adhereing to all safety procedures however
insignificant they may seem.
Emergency nurses are liable to exposure to occupational risks through their contact
with patients, medical equipment’s, drugs, and various chemicals. These health hazards

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include exposure to harmful substances such as chemicals, harmful radiations, violence,
stress, back injuries and more significant exposure to infectious diseases. Safety and
occupational health authorities in the Saudi Arabia Kingdom continue to grapple with the
issue of life-threatening infectious ailments such as tuberculosis, hepatitis B just to mention
but a few. This calls for an all-out responsibility on the part of every healthcare stakeholder to
make the nursing environment safe and conducive for everyone including emergency care
nurses. The government on its part should come up with proper legislation and occupational
safety frameworks to ensure safety for its citizenry. Moreover, the government should be
relentless in its war against non-compliance of set safety standards to both public and private
health care organizations. Healthcare management should come up with tailor-made policies
that fit their own internal safety requirements while conforming to the national set standards.
Organizations should also train their employees on safety practices and use of equipment that
make the employees work much safer such as the application that aids movement of patients
from one facility to another. Lastly, emergency care nurses have a wider role to play on their
part to ensure their own personal safety. They should always engage in safe practices, report
injuries, and their cause, and follow all the safety procedures required of them in the
execution of their duties.

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