Learning from staff claims relating to exposure of substances hazardous to health

Situation: A member of cleaning staff works across multiple wards within a busy trust. They had previously worked within an agency, but more recently was recruited to work full time within an NHS trust.

Background: As part of their role, it was the expectation within the service that cleaning chemicals would be mixed and then added to water. Due to the pressures within the organisation, the cleaner felt rushed to prepare these chemicals. In addition, they were expected to mix these chemicals within a small and poorly ventilated room. They outlined that there had been an extractor fan, however that had broken. Despite multiple complaints by staff members, there was no follow up maintenance for the ventilation system. The staff member was advised to hold the door open while they mixed cleaning chemicals.

Assessment: The organisation did not attempt to eliminate substances hazardous to health, nor did they attempt to limit, or risk assess the exposure. There was inadequate ventilation, due to the broken mechanical ventilation system. PPE was provided to the staff member. However, this was deemed to be inappropriate due to there being no specific respiratory PPE. They were not fully compliant with their training, however there was no organisational follow up to ensure this training was completed. As such the claimant was unaware of the risks of exposure. They experienced breathing difficulties, inflammation, and chest pain.

Recommendations:

• While it might not be possible to eliminate the use of cleaning chemicals, consider whether you can use less hazardous chemical or a lower concentration (pre-diluted may not be practical due to weights and volumes).
• Consider reducing the number of people who do the dilution and consider preparing diluted containers in a more appropriate space (remember this may introduce additional manual handling risks so processes would have to be in place to control these).
• If it is necessary to use the chemical and perform the dilution on the ward, then ensure that the room is suitable with working ventilation and that staff have sufficient time to do this safety.
• Have an alternative suitable space and plan, as it is foreseeable that the ventilation could break occasionally even with regular maintenance (remember that additional time will need to be allocated if the back-up is carrying out the task on another ward).
• Ensure staff have access to the correct PPE, remembering this should be a last line of defence. It is unlikely that providing a properly selected and fit tested mask would be considered as the only appropriate control in this situation.
• Raise as an incident on internal risk register.
• Ensure that staff have adequate training, supervision and support to ensure that all the appropriate controls are working and followed.

Situation: An experienced theatre nurse was working in a busy theatre suite that is often short staffed. When the nurse started on the afternoon shift, the theatre list was discussed.

Background: High operational demand led to a detailed clinical history not being provided about a patient who was known to have a blood borne virus. The nurse was called into the operating room and whilst in there, was splashed with blood as an instrument was passed to a colleague.

Assessment: The nurse was not aware of the patient’s diagnosis. When entering the operating theatre, the nurse did not wear protective eyewear as this was not available. Following the incident, the nurse followed the protocol for the management of blood and body fluid exposure. Though the nurse did not contract the blood borne virus, the staff member experienced psychological injury and raised a claim.

Recommendations:

• We may not always know the infection risks from patients, but the appropriate PPE should always be available within clinical settings.
• Where there is a risk of splashes from bodily fluids, eye projection must be worn (not just for patients where their status is known).
• PPE should be readily available at point of use, and checking types and sizes are available should be part of a start of the day theatre checklist.
• All staff should be trained in immediate first aid for bodily fluid splashes, and how to contact Occupational Health (OH) for follow up (or your local arrangements).
• Managers should follow up straight away with staff to support and ensure that OH has been attended if appropriate.
• Procedures should be straightforward and ensure staff are reviewed in a timely manner.
• Systems must be in place for psychological support of staff following incidents.

Situation: A paramedic spent extended periods at the ambulance station (similar to a garage environment) and inside the ambulance vehicle during her shifts while waiting to transfer patients to emergency services. Due to operational demand, the ambulance was overdue in its repair, resulting in delays in identifying emissions of exhaust fumes.

Background: Despite smelling exhaust fumes, the paramedic continued with their duties as operational demand was high. Over time, they started experiencing symptoms such as nausea, headaches, fatigue, and occasional chest discomfort. They presented at the Emergency Department. The prolonged exposure further raised concerns about the increased risk of developing lung cancer.

Assessment: The organisation had failed to prevent the exposure of the claimant to substances which were hazardous to her health and failed adequately to control such exposure. The organisation failed to ensure that substances were contained and/or properly extracted. There was a failure to adequately monitor exposure, and a failure to ensure the adequate maintenance of ambulances. As such, there were failures to ensure a safe system and place of work. The claimant experienced sickness, injury to internal organs and subsequently psychological injury. Incidentally there was no local guidance in place for harm associated with running a vehicle while stationary.

Recommendations:

• Follow internal processes to raise any concerns regarding fumes within your organisation.
• Consider decommissioning older vehicles which may have poor emission levels.
• Ensure vehicles are properly maintained, consider pre-use checks of vehicles by drivers and, if issues are found, remove from use until repaired. Keep records of maintenance regimes and monitor trends in faults.
• Ensure vehicles are switched off when stationary. Where it is necessary to keep the engine running ensure there is sufficient ventilation.
• Ensure staff are aware of actions to take when responding to and reporting faults.

Situation: A staff member was working as an administrator within a clinical setting on a ward, in a small office that was poorly ventilated. The hospital was undergoing maintenance works, occurring in the courtyard below the office. During the works, large amounts of dust particles travelled through the ventilation into the room making it difficult to breathe.

Background: Managerial staff were advised of the disruptions and persistence of dust within the office and communal spaces. When the staff spoke to managerial staff, they were advised that there were no alternative places to decamp to complete these duties. They were provided with a small fan to assist with ventilation, but staff found the fan increased dust circulation. Due to the clinical setting the office door could not be held open. The staff member felt obliged to complete their work despite these conditions.

Assessment: There were poor ventilation systems, and despite the provision of the fan, the dust persisted. The organisation failed to make suitable and sufficient assessment of the risks created by the work in question to the health of the staff member. There was a failure to prevent the exposure of the claimant to substances which were hazardous to their health. They further failed to ensure that dust suppression measures were put in place to ensure that the dust levels were kept to a minimum or staff were moved to areas where they would not be exposed to dust at levels which may cause irritation. The staff member experienced exacerbation of an existing respiratory condition.

Recommendations:

• Review causes of dust and what can be done to eliminate or reduce this (building works, extract ducts etc.) by ensuring dust suppression is in place.
• Ensure any engineering works carefully consider how risk from environmental dust is controlled and mitigated at the onset of project.
• Review the frequency of cleaning to keep dust levels under control, and ensure the cleaning equipment is working properly.
• Installation of filtered air intake/extract may help reduce the levels if levels still remain high.
• Remove staff from the area until dust levels have been reduced. Where possible, consider hybrid working, hot desking etc.
• Monitoring of dust levels to ensure that they are controlled to low levels.
• PPE would rarely be a suitable control for office workers. However, a mask may be considered for short term work that needs to be carried out in areas where there is dust or where dust is generated (though if you can, local exhaust ventilation (LEV) to remove the dust should be considered).