View of IDENTIFICATION OF OCCUPATIONAL HEALTH AND SAFETY RISKS FOR CLEANING OFFICERS AT RSIA BUNDA CIPUTAT

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IDENTIFICATION OF OCCUPATIONAL HEALTH AND SAFETY RISKS FOR CLEANING OFFICERS AT RSIA BUNDA CIPUTAT

Hadis Akbari

Master of Public Health Study Program, Faculty of Public Health, Universitas Muhammadiyah Jakarta K.H. Ahmad Dahlan St., Cireundeu, Ciputat, South Jakarta, 15419

Email: hadisakry@gmail.com ABSTRACT

Occupational safety and health are important aspects in controlling and reducing the risk of hazards arising from work activities in the hospital environment, including the cleaning staff. This study aims to identify the occupational safety and health risks of janitors at RSIA Bunda Ciputat. This research is descriptive with an observational approach using the Job Safety Analysis (JSA) method and interviews.

The informants in this study were 9 janitors. Data were analyzed descriptively. The results of the identification of hazards include exposure to germs or disease viruses, needle sticks, exposure to hazardous and toxic substances, exposure to UV rays, scratches by sharp objects, and musculoskeletal disorders (pain in the waist, legs, and arms). With 28.1% the risk to the cleaning staff is at a high-risk level. 40.6% of the risk to the cleaning staff is at the moderate risk level and 31.3% has the low-risk category. The importance of management supervision and the commitment of officers in implementing occupational safety and health to create a healthy, safe and comfortable hospital environment for every worker.

Keywords: Risk management, Occupational Health, Safety, Hospital.

INTRODUCTION

Occupational safety and health are important aspects of improving the quality of health services in hospitals, especially in reducing the risk of accidents and diseases arising from work. As is known, hospitals have a high risk of danger, and a form of control is needed in the workplace so that all workers are healthy and safe. Minister of Health Regulation No. 66 years 2016 regarding hospital occupational safety and health, states that hospitals are required to implement a hospital occupational safety and health management system to create optimal health degrees and healthy, safe, and comfortable environmental conditions for workers, patients, and visitors. Therefore, in its application, hospitals are required to provide occupational health and safety for every worker to increase productivity at work and minimize the risk of work-related accidents and occupational diseases.

According to the World Health Organization (2018), at least 2.1% of all deaths worldwide are caused by the work environment. Reports from the International Labor Organization ( 2021) that around 2.3 million workers worldwide die each year due to work-related accidents and diseases. Where there are about 340 million work accidents and 160 million victims of work-related diseases every year.

Meanwhile, based on data from the Ministry of Manpower of the Republic of Indonesia (2021), the number of work accident cases in 2020 increased by 177,000 cases of work accidents from the previous year of 144,000 cases. Where, 25.19% occurred in workers in the service sector (Kemenkes, 2018). If we look at the increasing number of cases, it can be concluded that the health situation in Indonesia still needs attention, especially in providing insight into the health impacts that can be avoided through the workplace.

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Hospitals, which are health service facilities, have various potential hazards that can threaten the safety and health of workers. Cases that often occur are needle sticks, sprains, lumbago, scratches/cuts, and infectious diseases such as Tuberculosis, Hepatitis B, Hepatitis C, and even the risk of HIV/AIDS (National Institute for Occupational Safety and Health, n.d.; Widowati, 2018). The World Health Organization estimates that exposure to sharp objects in the workplace accounts for 40% of Hepatitis B and Hepatitis C infections and 2-3% of HIV infections (WHO, 2002). Where these cases are not only potentially experienced by medical officers but also non-medical officers. Because when viewed from the type of work, not only medical personnel are susceptible to disease due to direct contact with patients, but non-medical personnel also have the potential to get sick even though they do not have direct contact with patients. However, without realizing it, various infectious diseases can spread through the air, floors, walls, and other work areas (Yuantari & Nadia, 2018).

One of the non-medical personnel who works in hospitals is a janitor, whose job is to create a clean and comfortable environment for workers, patients, and hospital visitors. Cleaning workers often interact with sources of danger that can put them at risk of exposure to infectious diseases. In addition, musculoskeletal disorders are also a frequent complaint of janitors in hospitals. Menurut Kumar et al., (2011)janitors have higher rates of injury and morbidity compared to other employees in the hospital.

Where is not a bother in the lower back the most common and complained of? In line with research Bedu et al., (2013) where 49.1% of janitors had severe musculoskeletal disorders and 50.9% had mild musculoskeletal disorders. This is experienced because of the work activities they do such as taking out the trash, mopping, sweeping the floor, cleaning windows, and others. If these activities are carried out continuously with inappropriate work attitudes, it will increase the risk of musculoskeletal problems in workers (Pratama & Yuantari, 2015).

RSIA Bunda Ciputat is a type C hospital that provides health services in the city of South Tangerang. In supporting its services, RSIA Bunda Ciputat has 102 workers who help provide optimal services. However, in the process, it is undeniable, that RSIA Bunda Ciputat also has risks that may occur for the occurrence of Occupational Diseases and Occupational Accidents for workers, both patients, and hospital visitors. In the results of the initial survey conducted in May 2022, some information was obtained regarding the occurrence of occupational accidents among cleaning staff, such as exposure to UV light, cuts or scratches by sharp objects, and slipping while doing work. As for complaints such as aches or pains in the arms and back pain due to working too long. Seeing this phenomenon, researchers are interested in conducting this study which aims to identify occupational safety and health risks for janitors at RSIA Bunda Ciputat.

METHOD

This research is descriptive. This research was conducted in June. The samples of this study were all 9 people who were cleaning staff at RSIA Bunda Ciputat. Data collection was obtained from

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interviews with informants and observations using risk assessment methods based on guidance from the Australian Standard/New Zealand Standard for Risk Management (AS/NZS 4360:2004)with several stages including identifying the occupational safety and health risks of janitors using JSA ( Job Safety Analysis ), providing an assessment of occupational safety and health risks from the work process of janitors, analyzing the level of risk and recommending how to control them to be applied at RSIA Bunda Ciputat using a hierarchical control approach (elimination, substitution, engineering, administration, and PPE). Data were analyzed descriptively.

RESULTS AND DISCUSSION

RSIA Bunda Ciputat has 9 cleaners who work in all areas of the hospital. Where, all officers are recruited directly by the hospital, not from cleaning service providers. Thus, work procedures and processes must be carried out with special training and socialization to minimize various kinds of exposure to potential hazards in hospitals. Job descriptions carried out by cleaning staff include the following: 1) Cleaning toilets or bathrooms throughout the room in the work area; 2) Disposing of medical and non-medical waste in every room in their working environment. Where the garbage is taken 2 times a day (morning and evening) from the trash and collected for storage at the TPS at RSIA Bunda Ciputat; 3) Clean all furniture such as tables, chairs, windows, door handling, and others from dust, germs or viruses throughout the work area; 4) Cleaning the OK room after performing medical procedures; 5) Sweeping and mopping the floor of every room, corridor or hospital lobby periodically;

6) Cleaning the yard and garden in the hospital environment. This work is carried out starting by watering the plants, sweeping the yard, and cleaning the weeds in the garden; 7) Decontaminate the room after use with a disinfectant solution.

In minimizing the risk of this work, RSIA Bunda Ciputat obliges and provides personal protective equipment for cleaning staff when they are on duty. During the COVID-19 pandemic, personal protective equipment that is required to be used during work includes masks, gloves, and shoes.

However, sometimes some officers do not comply with the use of complete personal protective equipment such as gloves and masks.

It is known that the cleaners of RSIA Bunda Ciputat are placed in each area of the hospital, including 3 people on the 1st-floor area, 4 people on the 2nd floor, and 1 person on the 3rd and 4th floors each with different work shifts. So, the type of work they do varies depending on the area where they work. From the results of risk identification using the Job Safety Analysis (JSA) method, a list of risks in every job that can potentially cause harm to the cleaning staff in the hospital is obtained. From the results of the risk identification, an assessment of the probability of occurrence and the consequence of each risk is carried out. From the risk assessment in table 1, it is found that 28.1% risk has a high- risk category in the form of workers' risk of exposure to germs and viruses in their work, 40.6% has a moderate risk category in the form of the risk of workers being pricked by needles or sharp objects and

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musculoskeletal disorders. such as pain in the arms, stiffness, and waist, and 31.3% have a low-risk category such as the risk of falling because the floor is slippery and exposed to cleaning/disinfectant fluids at work.

Table 1. Results of the Hazard Identification Assessment for Cleaning Workers No. Job details Risk Likelihood Severity Risk Level Control

1

Collecting medical and non-medical waste

Exposure to viruses or germs

3 4 12 High Use masks and

gloves and ensure staff washes their hands before and after carrying out activities.

Punctured by needles or sharp objects.

3 2 6 Moderate Make Standard Operating Procedures regarding handling sharps waste and provide socialization for a maximum of waste that cannot be filled more than 3/4 of the container.

Musculoskeletal disorders/ Pain in the arm.

4 1 4 Moderate Training on the attitude of a safe garbage collection position

2

Sweeping the floor in every room

Exposure to dust

2 2 4 Moderate Using PPE (mask) Musculoskeletal

disorders/ Arm pain

3 2 6 Moderate Training on the attitude of a safe garbage collection position

3

Mopping the floor in every room

3 4 12 High Use non-slip

footwear and always put a wet floor sign when the floor is still wet.

Slip and fall 3 1 3 Low Use non-slip

footwear.

Musculoskeletal disorders/ Arm pain

4 2 8 Moderate Training in a safe and comfortable position and relaxation after doing activities Skin irritation

due to contact with Hazardous and Toxic Materials

3 1 3 Low Use gloves (Always

see hazard labels and MSDS before using Hazardous and Toxic Materials)

4

Cleaning the bathroom

Slip and fall 3 1 3 Low Using boots/safety

shoes

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No. Job details Risk Likelihood Severity Risk Level Control

Skin irritation due to contact with Hazardous and Toxic Materials

Musculoskeletal disorders/back pain

3 2 6 Moderate Education about a safe and comfortable position and

relaxation after doing activities

5

Cleaning the blood in the OK room (if any action is taken)

3 4 12 High Using PPE (masks

and gloves) and ensuring staff washes their hands before and after carrying out activities.

Exposure to cleaning fluids/

Hazardous and Toxic Materials

2 2 4 Moderate Use gloves (Always see hazard labels and MSDS before using Hazardous and Toxic Materials)

6 Cleaning the garden (sweeping, watering, and pulling weeds)

Musculoskeletal disorders/back pain

7

Cleaning the elevator

Exposure to disinfectant liquids/Hazardo us and Toxic Materials

8

Wipe glass, door handles, desks, and computers from dust,

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No. Job details Risk Likelihood Severity Risk Level Control viruses, or

germs

Exposure to dust

3 1 3 Low Using PPE (mask)

Scratched by a sharp object

3 1 3 Low Using gloves

9

Decontamin ate the room with disinfectant

Skin irritation due to contact with Hazardous and Toxic Materials

3 2 6 Moderate Use gloves (Always see hazard labels and MSDS before using Hazardous and Toxic Materials)

Fall or slip 2 1 2 Low Use non-slip

footwear.

10 Decontamin ate the room with UV rays

Exposure to UV rays

3 4 12 High Socialization and

education on the use of UV tools.

11

Cleaning the Grasetrap

3 4 12 High Education about a

safe and comfortable position and

Itchy skin due to exposure to wastewater

2 1 2 Low Using PPE (masks

Slip and fall 3 1 3 Low Use non-slip

footwear.

Musculoskeletal disorders / Pain in the arms and waist

Note :

Likelihood : 1 (Rare), 2 (Unlikely), 3 (Possible), 4 (Likely), 5 (Almost Certain).

Severity : 1 (Insignificant), 2 (Minor), 3 (Moderate), 4 (Major), 5 (Catastropic).

Risk Level : 1-3 (Low), 4-9 (Moderate), 10-16 (High), 17-25 (Extreme).

Risk analysis was also carried out by interviewing 9 cleaners, to find out more about work accidents and health complaints among workers. Based on the results of interviews that have been conducted, it is known that 9 workers have experienced Occupational Accidents (KAK) such as falling,

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being stabbed by a needle, being slashed by a sharp object, being hit by a blunt object, exposed to UV rays and exposed to Hazardous and Toxic Materials.

Table 2. Cases of Occupational Accidents for Cleaning Officers Work Accident Cases Number of Cases Interview result

Fall 2 2 out of 9 respondents stated that they had fallen

while mopping the floor because they did not use footwear.

Needled 1 1 out of 9 respondents stated that when disposing

of medical waste was done in a hurry and did not use PPE such as gloves.

Cut by a sharp object 1 1 out of 9 respondents stated that when they were cutting the paper they were not focused.

Hit with a blunt object 1 1 out of 9 respondents stated that the pick-up location was narrow and limited when cleaning the Grasetrap and the officers did not use PPE (Safety Helmets).

Exposure to

chemicals/disinfectants

6 6 out of 9 respondents stated that they had been exposed to hazardous and toxic substances because they did not wear gloves and footwear when coating vinyl or when decontaminating the room.

Exposure to UV Rays 1 1 out of 9 respondents stated that they did not know the Standard Operating Procedures and had never attended training related to the use of these tools because they were new.

If seen from Table 2, most of these work accidents were experienced due to unsafe actions carried out by cleaners such as not using PPE, not knowing standard operating procedures, and lack of knowledge and skills while working. This is under research Umniyyah, dkk (2020) which states that unsafe actions and knowledge of workers can affect the incidence of work accidents. As Heinrich stated that 80% of work accidents are triggered by unsafe actions (unsafe actions) from workers and 20% from unsafe environmental conditions (unsafe conditions) (H. W. Heinrich, 1941).

Table 3. Cases of Diseases Due to Occupational for Cleaning Officers Occupational Disease Cases Number of Cases Interview result Musculoskeletal disorders

(Pain in joints and muscles)

9 All respondents stated that they had

experienced pain in the joints and muscles in the arms, waist, and legs.

Visual disturbance 1 1 out of 9 respondents stated that they had experienced visual disturbances for 3 days due to UV exposure.

Irritation to skin 3 3 out of 9 respondents stated that they have experienced itching after contact with disinfectant liquids and Hazardous and Toxic Materials

Covid-19 2 2 out of 9 respondents stated that they had

experienced exposure to the COVID-19 virus.

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Every job has a health risk to workers, this is also felt by the cleaning staff in doing their job.

Where cases of occupational diseases that are often experienced by janitors are musculoskeletal disorders, namely muscle and joint pain in the arms, hands, and waist.

Musculoskeletal disorders that are often experienced by janitors are mostly caused by inappropriate work attitudes that are carried out repeatedly or statically. This causes pain or aches in the muscles and joints because there is no opportunity for officers to relax (Hopsu et al., n.d.; Tarwaka, 2008). This is in line with research by Agistha Novta Auliya et al., (2021) which states that musculoskeletal disorders in janitors at the Islamic University of Bandung are caused by workers often performing repetitive and monotonous movements without changing positions when doing their work such as mopping and sweeping, lifting weights, and bending over. Where the body parts that most workers complain about are the waist (65%) and the back area (63%). Therefore, relaxation or stretching to flex or relax stiff muscles is very important for workers to reduce the risk of musculoskeletal injuries and work fatigue. As, according to Harahap et al., (2021), program implementation of workplace stretching exercises that are carried out by workers for at least ± 5 minutes 2 to 3 times a week can help reduce musculoskeletal risk.

Based on the results of interviews, it is known that 88% of the cleaners have participated in socialization and training on occupational safety and health. However, in its application, it is often still not optimal, because most of the cleaning workers who experience work accidents are caused by the officers not using personal protective equipment while working. Supervision in the use of personal protective equipment is one of the success factors in suppressing work accidents. As, the results of the study Budiarti (2019), showed that work accidents caused by lack of K3 supervision had a 4.5 times risk compared to those who had good Occupational Health and Safety supervision. Supported by research Maramis et al., (2019), state that good supervision affects the use of personal protective equipment for every worker.

In improving the safety and health of workers, RSIA Bunda Ciputat already has work guidelines that have been designed and adapted to the conditions of the hospital environment. Where later these guidelines are used as work procedures and safety technical guidelines that will be applied by officers in the field during work. In addition, the hospital has also provided personal protective equipment for each worker, so that workers feel safe in the hospital environment. According to Kasman (2016), the use of personal protective equipment influences the high number of work-related accidents caused by the low level of use of personal protective equipment. Therefore, it is important to use the right personal protective equipment so that all workers who work can be protected from the risks of danger in their work environment. Thus, the risks of danger can be reduced to a minimum.

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Cleaning workers at RSIA Bunda Ciputat have risks including exposure to germs or viral diseases, needle sticks, exposure to hazardous and toxic substances, exposure to UV rays, scratches by sharp objects, and musculoskeletal disorders (pain in the waist, legs, and arms). Work accidents that occur by cleaning staff at RSIA Bunda Ciputat are known to be mostly caused by unsafe acts and occupational diseases experienced by workers mostly in the form of musculoskeletal disorders, namely pain in the waist, legs, and arms due to static and repetitive activities without relaxation or muscle stretching. based on the results of the known risk assessment 28.1% of the risk to the janitor is at the high-risk level. 40.6% of the risk to the cleaning staff is at the moderate risk level and 31.3% have a low-risk category.

In controlling and reducing hazard risk, management supervision is needed and the commitment of officers in carrying out work procedures that have been determined. In addition, the program workplace stretching exercises need to be implemented to help reduce the risk of musculoskeletal disorders in workers. Thus, occupational safety and health at RSIA Bunda Ciputat can be realized properly and the risks of danger in every worker's activity can be minimized.

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