University of Ghana http://ugspace.ug.edu.gh SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA KNOWLEDGE OF OCCUPATIONAL HAZARDS AND SAFETY PRACTICES AMONG HEALTHCARE PROFESSIONALS IN LEDZOKUKU KROWOR MUNICIPAL HOSPITAL, ACCRA. BY VERONICA AMPABEN-KYEREME (10333947) THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH DEGREE. MARCH, 2018 University of Ghana http://ugspace.ug.edu.gh DECLARATION I hereby declare that this work was done by me under supervision. With the exception of references made to other people’s work on the subject area which has been duly acknowledged, this work has not been submitted for award of any other degree. VERONICA AMPABEN-KYEREME ………………….… ……………….. (STUDENT) SIGNATURE DATE DR. URI SELORM MARKAKPO ……..…………… ……………….. (SUPERVISOR) SIGNATURE DATE i University of Ghana http://ugspace.ug.edu.gh DEDICATION To my husband, Mr Kwame Ampaben-Kyereme, my brother, Mr Francis Yohuno, my daughter Obaapa Ama Ampaben-Kyereme and all those who helped to obtain this success. ii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I thank the Almighty God for his divine fortification and guidance throughout the course of preparation of this dissertitation. Also, I would like to show my profound appreciation to my supervisor, Dr Uri Selorm Markakpo, for his guidance and suggestions towards successful completion of this study. Furthermore, many thanks to my husband and the entire family for their support in diverse ways during the conduct of this course of study. I am particularly grateful to the management and staff of the LEKMA hospital for giving me the permission and assisting me to conduct the study in the facility. Finally, to everyone who helped and supported me through this course, I say God richly bless you. iii University of Ghana http://ugspace.ug.edu.gh LIST OF ACRONYMS AIDs- Acquired Immune Deficiency Syndrome GDP- Gross Domestic Product GHS- Ghana Health Service HCFs- Healthcare Facilities HCV- Hepatitis C Virus HCWs- Healthcare Workers HIV- Human Immunodeficiency Virus ICD- Institutional Care Division IPC- Infection Prevention and Control MOH- Ministry of Health OSH- Occupational Safety and Health PEP- Post Exposure Prophylaxis WHO- World Health Organization iv University of Ghana http://ugspace.ug.edu.gh DEFINITION OF TERMS Occupational health hazards All activities and facilities at the workplace that have the potential to cause/increase the risk of injury or ill health. Occupational safety Control of hazards in the work place to achieve an acceptable level of risk. Workplace safety The process of protecting the health and safety of staff while on the job. Knowledge of occupational health hazards This is what the respondent say about the risk faced in their work environment. Prevalence of occupational hazards The total number of occupational hazard cases existing in the study population at the time of data collection. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS DECLARATION ..................................................................................................................... i DEDICATION ........................................................................................................................ ii ACKNOWLEDGEMENT ..................................................................................................... iii LIST OF ACRONYMS ......................................................................................................... iv DEFINITION OF TERMS ...................................................................................................... v TABLE OF CONTENTS ....................................................................................................... vi LIST OF TABLES ................................................................................................................. ix LIST OF FIGURES ................................................................................................................ x ABSTRACT ........................................................................................................................... xi CHAPTER ONE ..................................................................................................................... 1 INTRODUCTION .................................................................................................................. 1 1.1. Background .................................................................................................................. 1 1.2. Problem Statement ....................................................................................................... 2 1.3 Objectives ...................................................................................................................... 3 1.3.1 General Objective ................................................................................................... 3 1.3.2 Specific Objectives ................................................................................................. 4 1.4. Research Questions ...................................................................................................... 4 1.5 Justification ................................................................................................................... 4 CHAPTER TWO .................................................................................................................... 7 LITERATURE REVIEW........................................................................................................ 7 2.1. Occupational hazards ................................................................................................... 7 2.1.1 Biological Hazards .................................................................................................. 7 2.1.2. Mechanical hazards................................................................................................ 8 2.1.3. Chemical Hazards .................................................................................................. 8 2.1.4. Physical Hazards .................................................................................................... 9 2.1.5. Ergonomic hazards ................................................................................................ 9 2.1.6 Psychological Hazards .......................................................................................... 10 2.2. Work categories .......................................................................................................... 10 2.3. Workshop and training ............................................................................................... 11 2.4. Facility factors ............................................................................................................ 11 2.5. Socio-demographic factors ......................................................................................... 12 2.6 Conclusion ................................................................................................................... 13 vi University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE ............................................................................................................... 14 METHODS ........................................................................................................................... 14 3.1 Study design ................................................................................................................ 14 3.2 Area for the Study ....................................................................................................... 14 3.3 Variables ...................................................................................................................... 15 3.3.1 Dependent variables .............................................................................................. 15 3.3.2 Independent variables ........................................................................................... 15 3.4 Study Population ......................................................................................................... 16 3.4.1. Inclusion criteria .................................................................................................. 16 3.4.2. Exclusion criteria ................................................................................................. 16 3.5. Sampling Method ....................................................................................................... 16 3.5.1 Determination of Sample Size .............................................................................. 17 3.6. Data collection tools & techniques ............................................................................. 18 3.7. Data Processing .......................................................................................................... 19 3.8 Data Analysis .............................................................................................................. 19 3.9 Quality Control ............................................................................................................ 19 3.9.1. Training of Research Assistants .......................................................................... 19 3.9.2. Pre-Test/ Pilot Study ............................................................................................ 20 3.10 Ethical Considerations ............................................................................................... 20 3.11. Privacy and confidentiality ....................................................................................... 20 3.12 Compensation ............................................................................................................ 20 3.13 Risks and Benefits ..................................................................................................... 21 3.14 Voluntary withdrawal ................................................................................................ 21 3.15 Informed consent ....................................................................................................... 21 3.16 Data storage and usage .............................................................................................. 21 CHAPTER FOUR ................................................................................................................. 23 RESULTS OF THE STUDY ................................................................................................ 23 4.1 Socio-demographic characteristics of respondents ..................................................... 23 4.2 Knowledge of occupational hazards and safety practices ........................................... 24 4.3 Presence of safety measures and training for staff at LEKMA ................................... 25 4.4 Availability of Personal Protective Equipment ........................................................... 26 4.5 Occupational hazards associated with healthcare at LEKMA Hospital. ..................... 27 4.6 Associations between knowledge on occupational hazards, safety practices and selected characteristics of healthcare workers. .................................................................. 27 vii University of Ghana http://ugspace.ug.edu.gh 4.7 Associations between Occupational hazards, Safety Practices and socio- demographic characteristic of healthcare workers. ........................................................... 30 CHAPTER FIVE ................................................................................................................... 32 DISCUSSION ....................................................................................................................... 32 5.1 Socio-demographic characteristics of respondents ..................................................... 32 5.2 Associations between socio-demographic characteristics and knowledge of occupational hazards and safety practices. ........................................................................ 34 5.3 Limitation to the study ................................................................................................ 35 CHAPTER SIX ..................................................................................................................... 36 CONCLUSION AND RECOMMENDATION .................................................................... 36 6.1 Conclusion ................................................................................................................... 36 6.2 Recommendations ....................................................................................................... 37 REFRRENCES ..................................................................................................................... 38 APPENDICES ...................................................................................................................... 47 viii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 3.1: Sample Proportions .............................................................................................. 17 Table 4.1: Socio-demographic characteristics of the respondents (n=220) .......................... 23 Table 4.2: knowledge of occupational hazards and safety practices .................................... 25 Table 4.3: Associations between knowledge on occupational hazards, safety practices and selected characteristics of healthcare workers .................................................. 29 Table 4.4: Associations between Occupational hazards, Safety Practices and socio- demographic characteristic of healthcare workers. ........................................... 31 ix University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure 1.1: Conceptual framework ......................................................................................... 6 Fiigure 3.1: Map of LEKMA Hospital. Source: Google Maps (2015). ................................ 15 Figure 4.1: Frequency of training for Healthcare workers at LEKMA................................. 26 Figure 4.2: Use of PPEs among health care workers at LEKMA ......................................... 26 Figure 4.3: Occupational hazards of respondents. ................................................................ 27 x University of Ghana http://ugspace.ug.edu.gh ABSTRACT Background: Occupational health and safety, morbidity and mortality are important issues. Health care workers are exposed to occupational hazards at their workplaces. Poor knowledge of Occupational Health and safety practices among health care workers may contribute to this situation. This study is aimed at assessing the occupational health, hazards, and safety practices among healthcare staff at Ledzokuku Krowor Municipal Hospital, popularly known and called LEKMA Hospital, in the Greater Accra Region. Methods: Cross-Sectional survey design was used. A structured, closed ended questionnaire was used to collect data. Data were entered, cleaned and analyzed using STATA. Descriptive and bivarrate analyses techniques were used to analyze, present the data and determined the level of significance. Results: All doctors, 79 % nurses and 72.4 % of other health workers had adequate /high knowledge about hazard and safety practices. Seventy- four percent (74%) of the health workers had suffered at least one form of occupational injury in the course of the study. Most of the participants comprising doctors (100%), nurses (93.9%) and others (86.2%) used appropriate personal protective equipment and safety practices. Finally, health workers working in the hospital for six years are three times more likely to have high level of knowledge of occupational hazards and safety practices. Conclusion: Health workers have high knowledge of occupational hazards and safety practices at LEKMA Hospital. Nevertheless, there was a high prevalence of occupational injuries among healthcare staff. Further studies should therefore be conducted to determine the reasons why inspite of the high level of knowledge of occupational hazards and safety practices, there was a high prevalence of occupational injuries among the healthcare staff. xi University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.1. Background Knowledge of occupational safety and health (OSH) plays an important role in the prevention of occupational injuries and diseases (Lugah et al., 2010). Knowledge of occupational safety enhances health practice and ensures safety of health workers from occupational hazards (Hamdan & Hamra, 2015). Occupational hazard refers to factors or conditions in a given work environment that can cause harm to people who work in that environment (Reddy, Bennadi, Satish, & Kura, 2015). It is also refered to as a work, material, substance, process, or situation that predisposes, or causes accidents or disease, at a work place (Fasunloro & Owotabe, 2004). Hospitals and other healthcare institutions are engaged in essential and intensive efforts to reduce healthcare associated hazards through safety practices (Quinn et al., 2015). Inspite of this, health service is a work area that can lead to important risks with regard to health and safety of employees (Ulutasdemir, Cirpan, Copur, & Tanir, 2015), especially among health professionals with limited knowledge of work related hazards (Leineweber, Chungkham, Westerlund, & Tishelman, 2014). For instance, evidence from sub-Saharan Africa indicates that healthcare workers are frequently exposed to chemical, biological, physical, and psychosocial occupational hazards (Ndejjo et al., 2015), particularly among staff with limited practice of occupational safety (Cromie, Robertson, & Best, 2001). Exposure to occupational hazards among health workers can result in psychic distress, work dissatisfaction and burnout syndrome (Oliveira, Amélia, & Dantas, 2015), musculoskeletal diseases, needlestick injuries, infectious diseases,cancer, latex allergies, violence and stress (Magboul et al., 2016). A high prevalence of occupational hazards may also impair the overall ward climate and erode the 1 University of Ghana http://ugspace.ug.edu.gh quality of patient care from healthcare workers (Lantta, Anttila, Kontio, Adams, & Välimäki, 2016). Prevention of harm from occupational hazards in healthcare environments consist of preventing work related hazards (Murray, 2003), improving health service conditions (Roger, Kayembe, & Kornblatt, 2017), provision of available emergency care to health workers at all levels (Rim & Lim, 2014) and knowledge of occupational hazards and safety practices.This not withstanding, knowledge on occupational hazards in healthcare institutions Ghana is limited (Atombo, Wu, Tetteh, Nyamuame, & Agbo, 2017); and practice of occupational safety procedures is considered challenging (Tetteh et al., 2015). . 1.2. Problem Statement All over the world, occupational deaths, diseases and illnesses account for an estimated loss of 4% of Gross Domestic Product (GDP). (Agbana et al., 2016). World Health Organization (WHO) reports that about 1.4 million people globally suffer from hospital acquired infections at any given time (WHO, 2006). Also, Lavoie et al (2010) reports of an increased susceptibility to airborne infections in the low and middle income countries, which is very detrimental to healthcare professionals. In addition, healthcare staff are exposed to hazards from needle pricks,cuts by sharp objects, muscoloskeletal injuries, violent attacks by patients and inadequacy of facilities with equipment required to enhance best practices in order to minimise or prevent occupational injuries (Aluko et al, 2016) Despite the high level of risk to occupational hazards that the healthcare environment presents, healthcare workers are usually unaware of these possible risks because they lack knowledge and training in occupational health hazards and safety practices as necessary to protect themselves (Lavoie et al., 2010; Mathewos et al., 2013). 2 University of Ghana http://ugspace.ug.edu.gh Also, health workers fail to take preventive measures on the incidence of injuries due to lack of knowledge of appropriate procedures after injury, and the notion that the source was not infectious (Solmaz & Solmaz, 2014). Data on knowledge of occupational hazards and safety practices among healthcare workers and their mitigation measures remain scarce in most of sub-Saharan Africa (Ndejjo et al., 2015). Even though several studies have examined occupational hazards among healthcare workers (Guo, Shiao, Chuang, & Huang, 1999 ; Tangvik et al., 2015 ; Klein et al., 2010), knowledge of occupational hazards among healthcare workers are rarely the focus of many studies (Alosaimi, Alghamdi, Aladwani, Kazim, & Almufleh, 2016). In Ghana, not much studies have explored the knowledge of occupational hazards among healthcare workers (Annan, Addai, & Tulashie, 2015). Most studies on occupational health and safety among HCWs focused on attitudes of healthcare workers towards occupational health and safety within the healthcare delivery system (Nyarko, Goldfrank, Ogedegbe, Soghoian, & de-Graft Aikins, 2015). Meanwhile, data on the knowledge of occupational hazards are instrumental in identifying gaps in knowledge and practice that influence the prevalence of hazards among health workers (Ocampo et al., 2017). This study therefore aims at assessing the level of knowledge of occupational hazards and safety practices among healthcare staff of the LEKMA Hospital. 1.3 Objectives 1.3.1 General Objective The general objective of this study is to assess healthcare professionals’ knowledge of occupational hazards and safety practices at the LEKMA Hospital, Accra. 3 University of Ghana http://ugspace.ug.edu.gh 1.3.2 Specific Objectives 1. To examine the level of knowledge of occupational hazards and safety practices among healthcare workers at the LEKMA Hospital. 2. To identify the occupational hazards associated with healthcare environment of the LEKMA Hospital. 3. To determine the prevalence of occupational injury occurrence among the healthcare staff. 1.4. Research Questions 1. What is the level of knowledge of occupational hazards and safety practice among healthcare workers at the LEKMA Hospital? 2. What occupational health hazards are associated with work environment of LEKMA Hospital? 3. What is the prevalence of occupational injuries among HCWs of LEKMA Hospital? 1.5 Justification High rate of occupational accidents and injuries among healthcare staff impacts negatively on healthcare delivery services carried out by healthcare staff and therefore need to be addressed. Knowledge of occupational hazards and safety practices is essential to observe safety precautionary measures necessary to minimize and prevent accidents and injuries among healthcare staff. Assessment of the level of knowledge of occupational hazards and safety practices among healthcare staff, therefore, would help devise necessary measures that must be put in place in order to minimize occupational accidents and injuries among healthcare staff. 4 University of Ghana http://ugspace.ug.edu.gh Also, even though a number of studies have been conducted on occupational hazards and safety practices,very few have been conducted among healthcare staff, and virtually none of these studies have assessed the knowledge of occupational health hazards and safety practices among healthcare staff. Therefore conduct of this study among healthcare staff would provide additional evidence-based information needed to formulate policy to minimize the occurrence of occupational accidents and injuries among healthcare staff. 1.6. Conceptual framework Figure 1.1 below, summarizes the conceptual framework of the relationship between knowledge of occupational health and safety practices among the health care staff of LEKMA and their various contributing factors. The knowledge of occupational hazards may be influenced by several other factors. Factors such as demographic characteristics are known to influence health workers knowledge of occupational health. For example, the level of education of a worker increases his/her knowledge of occupational hazards and practice of occupational safety. Again, one’s age and length of time in healthcare service may influence one’s level of knowledge of occupational hazards and safety practices. Younger aged workers are also known to have a higher knowledge of occupational hazard and safety practices through continuous learning, while older health workers are said to gain knowledge of occupational hazards through work experience and longer duration of practice. In addition, the availability of safety protocols and standards within the work environment, the use of personal protective equipment and enforcement of safety precautionary rules are also direct determinants of workers knowledge of occupational hazards and practice of safety. One other major factor that enhances workers knowledge and practice of occupational safety is in-service and induction safety trainings. Health workers who 5 University of Ghana http://ugspace.ug.edu.gh undergo safety training during service or before start of service are more knowledgeable on occupational hazards and most likely to practice occupational safety in the work environment. Independent variables Dependent variables Nurses, Work categories Doctors, Pharmacist, Laboratory staff, Orderlies Availability of safety manuals, Facility factors Enforcing rules & wearing of PPE Level of education Socio- Knowledge Age demographic on characteristics Marital status occupational hazards and Work experience safety practices In-service training Refresher courses Workshop/training Safety induction training Figure 1.1: Conceptual framework Source: Author’s conception based on review of literature, 2017. 6 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.1. Occupational hazards The work environment is associated with work materials, substances, work processes or conditions that may result or predispose workers to accidents, injuries or diseases or death which are described as hazards (Aluko, Adebayo, Adebisi, & Ewegbemi, 2016). Occupational hazards continue to occur on daily basis (Bekele et al., 2015b), and is recorded to be 226% greater than other injuries (Malkin, Lentz, Topmiller, Hudock, & Niemeier, 2006). Occupational hazards can be defined as degree of risk posed by activities and conditions at the workplace (Aluko et al., 2016). Occupational hazards are mostly classified into six categories (infection, accidents, radiation, exposure to noxious chemicals (Volquind et al., 2013), drug addiction and psychic problems, and assault) (Magboul et al., 2016). However, occupational hazards among health professionals can further be classified into: physical (noise, vibration, radiation, extremes of temperature, ergonomic), chemical (solid, liquid, vapour), biological (bacteria, fungi, viruses), and psychosocial (psychological and social stressful factors) (Tziaferi et al., 2011). More specifically, musculoskeletal injury is more common and is highest in all employees (Orme et al., 2015). 2.1.1 Biological Hazards The occupational health hazards (OHHs) associated with healthcare delivery are on the rise (Davey et al., 2017). Within the health sector, healthcare workers are exposed to bilological occupational hazards including disease causing mico-organisms such as viruses, bacteria and parasites which lead to disease and interfere with healthcare delivery. Lack of germ-free equipment and suitable waste disposal bins expose healthcare staff to fungi like yeast (Lucio, Braz, Junior, Braz, & Braz, 2017), bacteria, parasites, or blood spread diseases such as HIV and hepatitis (Rim & Lim, 2014) as well as 7 University of Ghana http://ugspace.ug.edu.gh communicable diseases, including tuberculosis (Liautaud et al., 2017), and swine bug (Oh et al., 2017). 2.1.2. Mechanical hazards These are another type of hazards healthcare workers are exposed to. Objects like needle sticks, surgical blades, lancets, broken bottles, scissors and pointed forceps which if contaminated could introduce germs into the body in the events of an injury. In addition, needle stick injury exposes healthcare staff to Hepatitis B and HIV infections among health workers (Ansa et al., 2002). For instance, in Ethiopia, nurses have a 29% and 31% lifetime hazard of dangerous contact to needle sticks and blood, respectively (Reda, Fisseha, Mengistie, & Vandeweerd, 2010). Also, in 2000, 39 Ugandan health workers died from exposure to the Ebola virus while taking care of infected patients (Ndejjo et al., 2015). 2.1.3. Chemical Hazards Chemical hazards are the second occupational hazards that healthcare workers are exposed to. They include exposure to hazardous chemicals such as peroxide, lead, tough detergents, flammable solvents, noxious fumes, allergens and active substances which are commonly found in health facility (Mequanint, Tsegaw, Devos, Melese, & Birhan, 2017). The other chemical hazards present in healthcare facilities like, ethylene oxide (Rim, 2017) and hexachlorophene formaldehyde (Quinn et al., 2015), are known human carcinogens which significantly contributes to hazards among healthcare workers. Elements, examples of which include animal protein and antibiotics, especially the penicillin group (Mohammad, Abdel, Abd, Farghal, & Shehata, 2013) are well recognized, allergens agents which may not cause only asthma (Walters, soundly, Robertson, Burge & Ayres, 2015) but also dermatitis and conjunctivitis (Zaramba, 2018). 8 University of Ghana http://ugspace.ug.edu.gh The incidence of chemical hazards can be as high as 10.7%, and they account for up to 30% of all burn deaths caused by corrosive chemicals such as strong acids among health workers (Chou, Chiao, Wang & Tzeng, 2015; Reddy et al., 2015). Knowledge of safety measures required to protect healthcare workers against harmful exposure to such chemicals will minimize accidents and injuries among them and facilitate their core mandate of healthcare delivery services. 2.1.4. Physical Hazards Healthcare employees who work in facilities that do not satisfy safety requirements or standards and may be exposed to injuries caused by physical hazards such as slips, trips, falls, physical strains (Jilcha & Kitaw, 2017) and violence (Eriksen, 2006 ; Darkwa, Newman, Kawkab, & Chowdhury, 2015). The issue of violence against the health professionals has been widely reported in several health facilities (Shafran-tikva, Zelker, Stern, & Chinitz, 2017 ; Cheung & Yip, 2017; Fute et al., 2015). Physical hazards are common in healthcare institutions such as clinics and hospitals (Rambabu & Suneetha, 2014). Again, excessive level of sound (Przysiezny, Tironi, & Przysiezny, 2015), heat and cold temperatures (Kollie et al., 2017), rapid movement, electric and magnetic fields (Twerefoo, 2015) are also reported hazards in several health facilities. 2.1.5. Ergonomic hazards They cause injury to the musculoskeletal system as a result of exposure to repetitive movement of body joints. Lifting of heavy weights, assumption of awkward postures and stretching of the body beyond comfortable limits to lift objects. However, nearly, all establishments regard ergonomics as a pointless luxury rather than a preventive measure (Chaiklieng & Suggaravetsiri, 2015), even though other health institutions consider 9 University of Ghana http://ugspace.ug.edu.gh ergonomic injury a priority (Caraballo-arias, 2015). In Malaysia, ergonomics was the domain of OSH where health personnel showed little understanding (Lugah et al., 2010). 2.1.6 Psychological Hazards Job stress which is one of the key causes of psychological hazards are usually associated with healthcare professionals (Alosaimi et al., 2016). In most cases, problematic work relationships, frustrations due to limited resources, poor remuneration are cited causes of job stress (GHS, 2010). In addition, the work schedule and daily activities of a health worker are compounded with extended working hours which lead to stress (Ruitenburg, Frings-dresen, & Sluiter, 2016). All these factors are very important and known contributors of psychological hazards among health professionals (Kelbitsch & Kenny, 2003). Prolonged exposure to stress is associated with adverse health effects which might result in anxiety, mood swings, lethargy and depression (Nouetchognou et al., 2016). 2.2. Work categories Certain categories of health care delivery service such as doctors and nurses are more exposed to hazardous working conditions such as close contact with infectious patients which lead to infections among them (Barbara Crăciun et al., 2015). In addition, work overload, psychological stress, physical stress and mental stress are some occupational hazards that these categories of health workers are exposed to (Banovcinova, Lubica, Baskova & Martina, 2014 ; Zodwa & Elsie, 2017; Volquind et al., 2013). For instance, a study done in Malaysia indicated that 46% and 62% of medical doctors reported stress related injuries and physical weakness (Subramanian et al., 2017). Among clinical nurses in Tanzania, 56 needle stick injuries and 3 of the 7 infections among respiratory therapist due to other sharp objects, were described as occupational injuries (Lekei et al., 2014). Aside this, most occupational injuries and hospital based infections are cited in literature as an 10 University of Ghana http://ugspace.ug.edu.gh increasing trend among nurses and other clinical staff (Lee et al., 2015) due to closer contacts with infectious patients. 2.3. Workshop and training The provision of knowledge of occupational hazards is known to be a vital component of occupational hazard training (Lugah et al., 2010). It contributes significantly to the prevention of occupational injuries especially among healthcare workers and limits exposure to hospital acquired infections (Lugah et al., 2010). It is suggested that training of hospital workers should, in minimum, include a general theoretic introduction, workplace instruction, basics on quality of work, chemicals, and ergonomics (Suleiman & Svendsen, 2015). However, most occupational health training and oreintations in Ghana have focused less on the quality of work, chemical exposure and infection preventive measures in hospital certains (Boyce, Raja, Ghosh et al,. 2015 ; Nyanko, Goldfrank, Ogedegbe et al., 2015). Given the wide range of potential and/or actual undesired events associated with the myriad of work groups in Ghana, there is the need to have a comprehensive provision for OHS standards and practice in the nation with an unflinching national leadership, support, and commitment (Annan et al., 2015). This is necessary to augument the knowledge of occupational hazards and safety practices focused on the reduction of occupational injuries among health care staff. 2.4. Facility factors Globally, healthcare facilities employ over 59 million workers (Aluko et al., 2016) and are classified as the most hazardous and high risk work place (Orji, Fasubaa, Onwudiegwu, Dare, & Ogunniyi, 2002). In addition to the usual workplace related exposures, healthcare workers encounter diverse hazards due to their work related activities (Ndejjo et al., 2015).Within the hospital setting, the occurrence of occupational hazards are 11 University of Ghana http://ugspace.ug.edu.gh more rampant in some departments, compared to others (Agbana, Alabi, Joshua, Daikwa, & Metiboba, 2016), but knowledge seem to vary from department to department and facility to faclily (Anozie, Anozie, Nwali et al., 2016). More specically, research conducted in Nigeria sugest that occupational injuries were frequent in injections rooms as compared to consulting and counseling rooms (Aluko, Adebayo, Adebisi, et al., 2016). Diseases such as tuberculosis (Mrema & Ngowi, 2015), HIV and hepatitis (Adib-Hajbaghery & Lotfi, 2013) are usually transmitted via contacts with infectious fluids and droplets of aerosols from infected persons (Hu, Luk, & Smith, 2015). Also worthy of note is the recent increase in highly infectious diseases such as SARS (Nyarko et al., 2015 ; Rim & Lim, 2014) and swine-origin influenza A (H1N1) (Oh et al., 2017), which have the tendency to increase the risk of infectious diseases amongst healthcare staff (Agbana et al., 2016). 2.5. Socio-demographic factors Priliminary studies indicate that staff’s knowledge and perception of risk was influenced by hospital’s department, years of working experience and level of education (Tziaferi, Sourtzi, Kalokairinou et al., 2011). However, other studies indicate contrary association between health workers’ knowledge and their level of education (Al-meerza, Al- sayegh, Al-sayrafy et al., 2012). Again, the marital status of a health worker has also been cited as a determinant of knowledge in occupational hazards (Yim,Seo, Cho et al., 2017). This is because couples are known to easily adopt health and safety measures being practiced by their partners (Jafree, Zakar,Fischer et al., 2015), as well as take injury preventive measure that will result in less burden on their spouses (Aluko, Adebayo,Adebisi, et al., 2016). However, being married have not been consistently cited as a factor in acquiring knowledge on occupational hazards. For example, Oh and colleagues (2017), have argued that most married couples have different professions and their occupational health knowledge would be different. 12 University of Ghana http://ugspace.ug.edu.gh 2.6 Conclusion The knowledge to prevent all occupational hazards is completely insufficient. With the efforts of industry, management and individual care givers, most of the hazards are preventable. Some important safety measures and interventions have been recommended and implemented in some health facilities in both developing and developed countries. Continuous evaluation of occupational safety interventions should however be instituted in developing countries. Health care professionals are always willing to care for their patients, however, they are entitled to do so in a risk free environment that can reasonably be created. Occupational hazards can be reduced by safe working environment and mainly through intensive education, provision of adequate personal protective equipment (PPEs) and regular occupational health and safety training in order to minimize hazards in a working environment. 13 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODS 3.1 Study design Cross-sectional study design was used in carrying out the study. Quantitative data collection methods were involved in the study. Data gathered was used to describe the knowledge of occupational hazards and safety practices among healthcare staff. 3.2 Area for the Study The Ledzokuku Krowor District Hospital was the area where the study was conducted. The LEKMA Hospital was established on 1st November, 2007 with an inauguration held on 29th February 2008 under the Legislative Instrument (LI 1865) as merger of the Teshie and Nungua Sub Metros. It was one of the sixteen (16) districts of the Greater Accra Region. LEKMA covers an estimated land area of 47.6 square kilometers. The South it is bounded of the Gulf of Guinea, that is from the Kpeshie Lagoon to the Mukwe Lagoon. LEKMA consists of 82 communities. The estimated population as at 2010 was 320, 000. It is a Ghana Health Service facility classified as a district hospital, with a total workforce of 460 HCW. The facility was constructed by the Chinese Government to strengthen the relationship of the two countries as China-Ghana Friendship Hospital in 2010. The Hospital serves as the District hospital for the Ledzokuku Krowor Municipality and its environs. As a district hospital it offers various services, including specialist health services. The LEKMA Hospital is situated in Teshie north in the municipality. The hospital sees about 450 out patients a day, 3,200 patients per week and more than 12,000 patients a month. 14 University of Ghana http://ugspace.ug.edu.gh Fiigure 3.1: Map of LEKMA Hospital. Source: Google Maps (2015). 3.3 Variables 3.3.1 Dependent variables Knowledge of occupational hazards and safety practices. 3.3.2 Independent variables 1. Number of years of work 2. Training in safety and occupational health hazards. 3. Data availability on occupational safety practices and health hazards 4. Level of education 5. Management factors 6. Health seeking behavior 15 University of Ghana http://ugspace.ug.edu.gh 3.4 Study Population The study population was selected from the healthcare workers who were at post at the time of the data collection. Healthcare workers recruited in this study included nurses (Nurses, Midwives and Healthcare assistants), Doctors (Doctors and Physician assistants), Laboratory staff (Biomedical scientists and laboratory technicians), Pharmacists (Pharmacists and dispensary technicians), Radiologists, Physiotherapists, Orderlies, Mortuary staff and management members of the hospital. 3.4.1. Inclusion criteria All healthcare workers who were at post in the LEKMA Hospital at the time of the data collection and were willing to take part in the study were recruited. 3.4.2. Exclusion criteria A staff who is too ill to talk to me or who refuses to get involved in the study. 3.5. Sampling Method The study used a multi-stage sampling technique to recruit a total of 220 health workers. First, stratified sampling was used to divide the hospital into strata (existing departments were labeled as the strata). At each strata (department), a proportionate sample was picked. In each department, a list of the healthcare workers was requested and numbers were assigned to each worker on the list. “YES or NO” was written on pieces of paper numbering the total population of workers of that department were written on pieces of papers and mixed up, put in a box. Respondents were asked to randomly pick a piece of paper from a box containing a mixture of YES and NO. Respondents who picked YES were orally invited and interviewed. Also any respondent who picked YES and was not willing to participate in the study was 16 University of Ghana http://ugspace.ug.edu.gh replaced with the next eligible person. This process was used to sample individuals calculated for each category of healthcare workers as shown in Table 3.1. Table 3.1: Sample Proportions Category of healthcare workers Number Sample Sample Size Proportion % Nurses 380 82.6 181 Doctors 22 4.7 10 Laboratory Staff 18 3.9 9 Pharmacists 16 3.5 8 Radiology 4 0.9 2 Physiotherapist 2 0.4 1 Orderlies 18 3.9 9 Total 4 6 0 100(100) 220 3.5.1 Determination of Sample Size Fisher’s formula for estimating single proportion was used to determine the sample size and the formula for estimating the minimum sample size when the total sample is below 10,000 people. The standard normal deviation was set at a 95 % confidence level, prevalence at 25 % with the allowable margin of error of 5 %.The study sed the Fisher’s formula (n = Z2 (pq)/d2) for the calculation of the sample size. In the two formulae: n = z2 (pq) / d2, z = 1.96, q=1-p n = minimum required sample size in population greater than 10,000 ns = minimum required sample size in population less than 10,000 Z = reliability coefficient for 95 % confidence level, (Z = 1.96) p = prevalence of the attribute (25 %) 17 University of Ghana http://ugspace.ug.edu.gh d = acceptable difference; using 5 % (d = 0.05) q = 1 − p N = population size. The sample size was calculated as; n = 1.962 (0.25 x 0.75)/ 0.052 =288 where n = Sample size, z = 1.96, p =1-Q Since the total eligible respondents is 460 and thus less than 10,000, applying the formula (ns = n/ (1+ n/N) gavens = 288/ (1+ 288/460) = 186. The sample size was increased to 220 by 10 % because ofnon-responses. 3.6. Data collection tools & techniques Structured interviewer administered questionnaires were used for data collection through a a face-to-face interview. Data was collected on socio-demographic characteristics such as age, sex, marital status, the level of education and occupation. Questions were asked on occupational hazards pertaining to the healthcare environment. In addition, data were collected on respondents’ knowledge and awareness of the occupational health policy for the health sector in Ghana. Knowledge on occupational hazards and safety practices was determined using 5 question-items, and scored “Yes” or “No”. The response “Yes” was given a score of “1” and “No” was given a score of “0”. The scores were added up to give the total mark scored by the respondents on the knowledge in occupational hazards and safety practices. Respondents who scored 4-5 were classified as having an adequate / high knowledge of occupational safety and health practices and those with scores 0-3 were classified as having inadequate / low knowledge of occupational hazards and safety practices. The questionnaire had been interviewer administered with assistance of two trained research assistants. Items 18 University of Ghana http://ugspace.ug.edu.gh on the questionnaire were read and explained to individual respondents who chose the options as they deemed fit. 3.7. Data Processing The administered questionnaires were coded and entered into Microsoft Excel 2010. The data were cleaned, validated and exported to STATA (statistical analysis software) Version13. 3.8 Data Analysis Other Unilabiate variables including socio demographic characteristics were presented by summary statistics using median, mean, standard deviation for continuous variables and frequency / percentages for categorical variables. Bivariate analysis was conducted to test the association between individual variables and the outcome of interest at a significance level of p<0.05. 3.9 Quality Control Two research assistants were recruited and trained. They were supervised to assist the principal investigator to administer questionnaire. They were monitored appropriately throughout the data collection process.The principal investigator collected, checked and cleaned the data to ensure completeness and accuracy of data. 3.9.1 Training of Research Assistants Prior to the start of field work, two research assistants were recruited and taken through three days training to equip them with the required skills needed to assist in the study. The training helped to clearly spell out their roles in the study. 19 University of Ghana http://ugspace.ug.edu.gh 3.9.2. Pre-Test/ Pilot Study The questionnaires for the study was pre-tested in the Tema General Hospital, which is also under Ghana Health Service and has similar characteristics and caliber of staff as the LEKMA Hospital in which the study was carried out. This was to enable the identification of errors and complex questions sequencing and correction prior to the field data collection. 3.10 Ethical Considerations In order to ensure that the research meets ethical standards, an approval was sought from the Ethical Review Committee of the Ghana Health Service (GHS), before the beginning of the study. Approval was also obtained from the management of the LEKMA Hospital and the directorate of the Ledzokuku Krowor Municipal Assembly before conduct of the study. 3.11 Privacy and confidentiality In order to ensure privacy and confidentiality, the questionnaires were coded with respondents IDs instead of names. Also participants names were not mentioned in the report of the study and information gathered on participants were kept strictly confidential by the principal investigator. 3.12 Compensation Study participants were not given any compensation for participating in the study. This was made known to them before they chose to take part in the study. However, participants given snacks after administering the questionnaires. 20 University of Ghana http://ugspace.ug.edu.gh 3.13 Risks and Benefits Apart from the time lost by study subjects in answering the questionnaires, there was no risk or cost associated in participating in the study. Participants would not gain any direct benefits. However, it is the expectation that the results of the study would contribute towards policy decisions about occupational health hazards and safety of healthcare workers which would be beneficial to both the study participants and the investigator in the future. 3.14 Voluntary withdrawal Getting involved or participating in the in the study was entirely voluntary and participants could choose not to answer any or all of the questions. Also participants were free to withdraw from the study at any point in time which would not have any adverse consequences on any rights or privileges that were due them. However, participants were admonished and encouraged to fully participate to ensure that findings from the study would be a true reflection of the knowledge of healthcare workers of occupational hazards and safety in the LEKMA hospital. In the event of any withdrawal by a participant, all data gathered on the participant were deleted. 3.15 Informed consent Consent was also obtained from participants before commencement of the study. Also the objectives of the study was explained to the participants and only those who consented were recruited into the study. In addition, each respondent was made to sign a written consent form before participating in the study. 3.16 Data storage and usage Data collected in this study were strictly for research purposes. The data were stored with passwords on electronic media and safely in locked boxes. Anonymity was ensured in 21 University of Ghana http://ugspace.ug.edu.gh dissemination of findings from this study since participants were not identified by their names. 22 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR RESULTS OF THE STUDY 4.1 Socio-demographic characteristics of respondents Table 4.1 below summarizes the socio-demographic characteristics of the respondentsOverall, 220 respondents were recruited for the study with a response rate of 100%. Majority (77.7%) of the respondents were nurses 6.8% were medical doctors (and more than half were females (64.1%). The mean age and standard deviation of respondents was 32 ±1.6years and majority were aged between 30-39 years old (44.1%). Again, nearly all (92.7%) respondents had tertiary education and a little over half (62.7%) had served at the hospital for a period of between 6-10years. Table 4.1: Socio-demographic characteristics of the respondents (n=220) Characteristics Frequency Percent Age 20-29 55 25.0 30-39 97 44.1 >39 68 30.9 Sex Male 79 35.9 Female 141 64.1 Religion Christianity 204 92.7 Islam 16 7.3 Education level Some formal education** 19 8.6 Tertiary 201 91.4 Profession Nurse 181 82.3 Laboratory staff 9 4.2 Pharmacist/Radiologist 10 4.5 Orderlies/Physiotherapy 10 4.5 Doctor 10 4.5 Duration of work >1 year 10 4.6 1-5 years 70 31.8 >6 years 140 63.6 **Attained Primary, JHS & SHS 23 University of Ghana http://ugspace.ug.edu.gh 4.2 Knowledge of occupational hazards and safety practices Table 4.2 below, summarizes the assessment of the respondent knowledge of occupational hazards and safety practices, based on job categories/stratification. The results show that all the 10 doctors, 82.9 % of the nurses and 75.9 % of other working categories (radiologist, pharmacist, laboratory staff and orderlies) had high level of knowledge about occupational health and safety and indicated correctly that occupational safety covers both employers’ and employees’ welfare. With regards to knowledge on occupational hazards, all the doctors, 79% of nurses and 72.4 % of the other working categories had high knowledge of the subject. Also, all the 10 doctors, 93.8 % of nurses and 86.2 % of the others had knowledge on the use of protective equipment (PPEs) before performing duties. In addition, majority of the respondents (Doctors and Nurses) had high level of knowledge about work place safety representing 100% and 82.3 % respectively, whilst 82.8% of the other working categories had high knowledge on work place safety. Furthermore, all the doctors and 79.6 % of nurses accepted that employers and employees have responsibilities and rights for effective occupational health and safety whilst only 58.6 % of other working categories accepted this safety standard requirement. 24 University of Ghana http://ugspace.ug.edu.gh Table 4.2: knowledge of occupational hazards and safety practices Statement Working category(n=220) Doctors (n=10) Nurses (N=181) Others(n=29) Yes(%) Yes(%) Yes(%) Knowledge that occupational safety cover 10 (100) 150 (82.9) 22 (75.9) both employers’ and employees’ welfare Knowledge of occupational hazards 10 (100) 143 (79.0) 21 (72.4) Knowledge of work place safety 10 (100) 149 (82.3) 24 (82.8) Knowledge of use of protective equipment 10 (100) 170 (93.9) 25 (86.2) (PPEs) before performing duties Knowledge that both employees and 10 (100) 144 (79.6) 17 (58.6) employers are responsible for effective occupational safety *Others (laboratory staff, pharmacist, radiologist,physiotherapist and orderlies) 4.3 Presence of safety measures and training for staff at LEKMA Most respondents (72.0%) indicated the presence of safety measures at the work place (not indicated on the figure). Most of the respondents (76.0%) answered they have had training on occupational safety and hazards in their respective departments (not indicated on the figure). With regard to how regular they are trained, most respondents asserted that there was no definite time fixed for training (54.5%), while others indicated annually (22.7%), quarterly (13.8%) and biannually (9%). 25 University of Ghana http://ugspace.ug.edu.gh 13.80% 9% Quarterly 54.50% Biannually 22.70% Annually No definite time fixed Figure 4.1: Frequency of training for Health care workers at LEKMA 4.4 Availability of Personal Protective Equipment Figure 4.2 summarises the availability of personal personal protective equipment for staff use at LEKMA Hospital. The PPEs reported to be available included; hand gloves (86%), nose mask (75%), overalls (78%), safety boots (65%) and protective goggles (56%). 100% 86% 78% 80% 75% 65% 60% 56% 40% 20% 0% Hand Overalls gloves Nose mask Safety boots Goggles Protective equipment Figure 4.2: Use of PPEs among health care workers at LEKMA 26 Percentage(%) University of Ghana http://ugspace.ug.edu.gh 4.5 Occupational hazards associated with healthcare at LEKMA Hospital. Figure 4.3 summarises the occupational hazards associated with health care at LEKMA Hospital. A high proportion of the respondents (95.5%) indicated there were hazards associated with their work. With respect to this, about 74% of them reported to have suffered at least one occupational hazards in the course of duty. Hazards and injuries suffered by the respondents included blood and bodily fluid spills (27.8%), needle prick (55.6%), liquor splash during deliveries (11.1%), and physical assault by patients (4.9%). 4.90% 11.10% Needle pricks 27.80% 55.60% Blood and bodily fluid spills Liquor splash Physical assault Figure 4.3: Occupational hazards of respondents. 4.6 Associations between knowledge on occupational hazards, safety practices and selected characteristics of healthcare workers. A bivariate analysis was performed to examine the relationship between socio- demographic variables and knowledge on occupational hazards and safety practices among healthcare workers. The results revealed there was an association between religious affiliation and knowledge in occupational hazards and safety practices p<0.0001). Additionally, there was a significant association between level of education and knowledge on occupational hazards and safety practices (p<0.0001). The profession of a health worker 27 University of Ghana http://ugspace.ug.edu.gh (p<0.0001), and his or her duration of work (P<0.004), were also significantly associated with knowledge on occupational hazards and safety practices of healthcare workers. Other variables that were significantly associated with knowledge of healthcare workers include wearing of personal protective equipment (P<0.0001), and frequency of training on occupational safety (P<0.0001). However, the age of a healthcare worker (P<0.061), his or her gender (P<0.929), and whether he or she was trained on occupational health and safety (P<0.151) were all not associated with their knowledge on occupational hazards and practice of occupational safety. See Table 4.3. 28 University of Ghana http://ugspace.ug.edu.gh Table 4.3: Associations between knowledge on occupational hazards, safety practices and selected characteristics of healthcare workers Attribute Knowledge level, n (%) Chi-square High Low P-value Age 20-29 47(85.4) 8(14.6) 0.061 30-39 86(88.7) 11(11.3) 40-49 62(98.4) 1(1.6) 50-59 5(100.0) 0(0.0) Sex Male 72(91.1) 7(8.7) 0.929 Female 128(90.8) 13(9.2) Religion Christianity 190(93.1) 14(6.9) 0.0001* Islam 10(62.5) 6(37.5) Educational level Some formal education** 8(42.1) 11(57.9) 0.0001* Tertiary education 192(95.5) 9(4.5) Profession Doctor 15(100.0) 0(0.0) 0.0001* Laboratory staff 9(90.0) 1(10.0) Pharmacist/ Radiologist 10(9.9) 1(9.1) Orderlies/physiotherapy 2(18.2) 9(81.8) Nurse 163(95.3) 8(4.7) Duration of work Less than 1 year 8(80.0) 2(20.0) 0.004* 1-5 years 58(82.9) 12(17.1) 6 years and more 134(95.7) 6(4.3) Trained on OHS Trained 158(92.4) 13(7.6) 0.151 Not Trained 42(85.7) 7(14.3) Wear protective equipment PPE 13(86.7) 2(13.3) 0.0001* No PPE 32(15.6) 173(84.4) Frequency of training Annually 1(5) 19(95) 0.0001* No definite time fixed 41(62.1) 25(37.9) Quarterly 3(12.5) 21(87.5) *p<0.05 **Attained Primary, JHS & SHS OHS=Occupational Health and Safety 29 University of Ghana http://ugspace.ug.edu.gh 4.7 Associations between Occupational hazards, Safety Practices and socio- demographic characteristic of healthcare workers. A multiple logistic regression model was built to test the strength and direction of the association between significant variables. All variables that were significant at P<0.05 at the simple logistic regression were added to the model. The results suggest that as compared to Christians, Muslim healthcare workers were less likely to have knowledge on occupational hazards (OR 0.15, Cl: 0.02-1.15). Again, healthcare workers with tertiary education as compared to those with some level of formal education (primary, JHS, SHS), were four times more likely to have knowledge on occupational hazards and significantly practiced occupational safety (OR 3.50, Cl: 0.18- 0.82). On assessing knowledge on occupational hazards among various professions in the LEKMA hospital, as compared to Nurses, Laboratory staff (OR 0.57, Cl:0.04-8.86), pharmacist (OR 0.31, Cl: 0.02-4.46), Radiologist (OR 0.82, Cl: 0.35-2.51), and Orderlies/physiotherapist (OR 0.23, Cl: 0.29-3.24), were all less likely to have knowledge on occupational hazards and less likely to adopt occupational safety practices. Contrary, doctors as compare to all other professions were twice more likely to have knowledge on occupational hazards (OR 1.61, Cl: 0.81-4.41). Workers who had worked in the hospital for a period of five years (OR 0.54, Cl: 0.54-0.92) had lesser odds of occupational knowledge as compared to those who had been working for less than a year as compared to working for less than a year. On the use of PPE during work, respondents who did not use PPE were less likely to have knowledge on occupational hazards (OR 0.31, Cl: 0.53-2.10) as compared to workers who used PPE. In addition, both intermittent safety training (OR 2.06, Cl: 1.12- 1.23), and safety training on quarterly bases (OR 2.61, 0.20-0.37) as compared to annual trainings, were twice and three times respectively more likely to determine workers knowledge on occupational hazards. 30 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Associations between Occupational hazards, Safety Practices and socio- demographic characteristic of healthcare workers. Attribute Occupational Hazards Adjusted OR 95% CI Religion Christianity Ref Islam 0.15 (0.02-1.15) Educational level Some formal education Ref Tertiary education 3.50 (0.18-0.82) Profession Nurse Ref Laboratory staff 0.57 (0.04-8.86) Pharmacist 0.31 (0.02-4.46) Radiologist 0.82 (0.35–2.51) Orderly/physiotherapist 0.23 (0.29-3.24) Doctor 1.61 (0.81-4.41) Duration of work Less than 1 year Ref. 1-5 years 0.54 (0.64-0.92) 6 years and more 2.62 (1.72-2.15) Frequency of Training Annually Ref. No definite time fixed 2.06 (1.12-1.23) Quarterly 2.61 (0.20-0.37) OR: Odd Ratio, Cl: Confidence interval, Ref: Reference variable 31 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE DISCUSSION 5.1 Socio-demographic characteristics of respondents A number of researchers have studied occupational hazards in different parts of Ghana and in different institutions. For instance, studies conducted by Dijk, Bubas, & Smits, (2015) suggest female majority among workers as compared to male majority in other studies (Mattessich & Shea, 2017). These findings are similar to the findings of this study where majority of the workers at the LEKMA hospital were made up of the female population. Again, systematic reviews suggest similarity with findings of this study, indicating that majority of healthcare workers are mostly married (Manyisa & Aswegen, 2017). Contrary, this study showed that most (44%) of the respondents were aged between 30-39 years old as compared to 29% of respondents between ages 30-39 (Franz, Zeh, Schablon, Kuhnert, & Nienhaus, 2010) and 37% of healthcare workers less than 30 years (Henrotin et al., 2017) as reported in different studies. With respect to education, majority of the workers at LEKMA hospital had tertiary level education. This finding agrees with findings from other parts of Ghana where close to all workers sampled in the hospital had attained tertiary education (Tetteh et al., 2015). Knowledge on occupational hazards,prevalence of occupational injuries and selected characteristics of health care staff Results of this study indicated that health care workers have adequate knowledge of occupational hazards and safety practices. This finding is supported by cross-sectional studies which found high level of knowledge of occupational hazards among healthcare workers (Henrotin et al., 2017). However, contrary findings indicate that healthcare workers, especially nurses were found to have low levels of knowledge of occupational hazards (Santos et al., 2013) which was in agreement with reports from other studies (Viraji 32 University of Ghana http://ugspace.ug.edu.gh et al, 2013; Chopra and Pandey, 2007). Considering the high level of knowledge of occupational hazards among health workers in this study, it was expected that there would be low prevalence of occupational injuries among them. However, on the contrary a high (74%) prevalence of occupational injuries was recorded among healthcare staff. This finding is supported by studies conducted elsewhere in Ghana which also recorded high prevalence of occupational injuries among healthcare staff (Twerefoo, 2015). Knowledge of occupational hazards and safety practices under normal circumstances should lead to a reduction in occupational injuries. However, the fact that tis was not the case in this study suggests that sustenance of occupational injury may not be due to only one factor but a multiplicity of factors working together. Level of knowledge of respondents The results of the study show that majority (95.5%) of the respondents who have attained tertiary level of education also have a high level of knowledge of occupational hazards while the majority (58%) of those with lower than tertiary level of education also have low level of knowledge of occupational health and safety. This suggest that the ability to acquire knowledge of occupational hazards may depend on the ability to read and understand as well as one’s level of education. A study carried out by Aluko (Aluko, 2016) revealed that the respondents with high level of education demonstrated high level of knowledge of occupational hazards and safety practices. Availability of personal protective equipment (PPEs) at LEKMA Hospital According to findings of this study, all respondents had personal protective equipment (PPEs) available for use at the hospital, which should have led to the reduction in the prevalence of occupational injuries, however this was not the case. Contrary findings from Ugandan health worker population suggest that the absence of PPE contributed significantly to the occurrence (Ndejjo et al., 2015). It is therefore possible to conclude that 33 University of Ghana http://ugspace.ug.edu.gh other factors such as national occupational health policies as well as facility-based regulations play a role in the findings from the two studies. PPEs that were available and used by healthcare workers at the LEKMA Hospital include; hand gloves, nose mask, overalls, safety boots and protective goggles. This finding is similar to what has been reported (Awodele et al., 2014). These findings are similar and confirmed the fact that the type of PPEs used in the health sector are generally universal among healthcare workers worldwide. However,it is worthy of note that the rather high prevalence of occupational injuries recorded among these healthcare staff suggest that either the PPE were not being used or were not effective. The observation therefore confirms the fact that additional studies are required to ascertain all the causes of high prevalence of occupational injuries among the the health care staff. Similarly, the findings also emphasize the importance of constant training of health care workers on measures that must be taken in order to prevent occupational injuries among them. 5.2 Associations between socio-demographic characteristics and knowledge of occupational hazards and safety practices. The study results suggest that health worker’s age, lenghth of time in the health care service or a health worker’s profession and religious affiliation were determinants of knowledge of occupational health hazards and safety practices. In similar studies, the worker’s age (Rambabu & Suneetha, 2014), duration of service (Joshi, Reingold, Menzies, & Pai, 2006), one’s profession (Reddy et al., 2015), and religion were also cited as associated with knowledge on occupational injury (Mthewos et al., 2013). However, considering the fact that knowledge of occupational hazards and safety practices did not transcend into prevention of occupational injuries among the healthcare staff, it can be 34 University of Ghana http://ugspace.ug.edu.gh concluded that socio-demographic factors alone cannot ensure the occupational health and safety of health care workers. Rather, additional factors such as incentives, training and other working conditions are relevant to ensure the occupational health and safety of the staff. 5.3 Limitation to the study The results of this study are limited to an extent. As a cross sectional study, no causal relationship was established among study variables. Respondents’ bias could have limited the study findings as information given could not be verified. The data collection was limited to a single centre and therefore the findings are limited to the study area. 35 University of Ghana http://ugspace.ug.edu.gh CHAPTER SIX CONCLUSION AND RECOMMENDATION 6.1 Conclusion In conclusion, the study results show that healthcare workers have a high level of knowledge about occupational hazards and safety practices, work place safety and the rights for effective occupational health and safety for employers and employees.. Similarly, the study has shown that there was a high level of knowledge about the use of personal protective equipment (PPE) among the workers. In addition, the study has shown that the practice of occupational safety among the health staff at LEKMA was associated with the religion, the profession of a respondent, educational level and duration of work. However, in spite of the high level of knowledge of occupational hazards and safety among the staff, there was high prevalence of occupational hazards among health workers at LEKMA. Occupational injuries recorded by healthcare workers at the LEKMA hospital were needle prick, blood and bodily fluid spills, liquor splash during deliveries, and physical assault by patients. Available PPEs included; hand gloves, nose mask, overalls, safety boots and protective goggles. Furthermore, socio-demographic charateristics such as age, religious affiliation, profession and duration of service were significant determinants of worker’s knowledge of occupational hazards and safety practices. Additionally, the hospital instituted in-service trainings on occupational hazards and safety, eventhough this was periodic, yearly or intermittent. Again, knowledge of safety measures was high and workers were aware about the rights and duties to ensure occupational safety by both the employer and the employee.The rathers high level of occupational injuries among the staff was indicative 36 University of Ghana http://ugspace.ug.edu.gh that other factors could have been involved which was not detected by this study. Further studies are therefore required to ascertain this fact. 6.2 Recommendations Recommendation for management and policy Considering the the high prevalence of occupational injuries recorded, the Management of LEKMA occupational health and safety unit, should investigate the factors that contribute to this in order to institute measures to minimize the prevalence of injuries among the staff. Recommendation for research The study recommends that future research should use qualitative methods to better understand and the views and challenges of healthcare workers concering occupational hazards. The management of LEKMA (Occupational health and safety unit) should organize regular and indept training on occupational health hazards and safety practices for the health workers.The training should target profession, educational level and duration of work of the various health workers at the hospital. 37 University of Ghana http://ugspace.ug.edu.gh REFRRENCES Adeyemo, O., & Smallwood, J. (2017). Impact of Occupational Health and Safety Legislation on Performance Improvement in the Nigerian Construction Industry. Procedia Engineering, 196(June), 785–791. http://doi.org/10.1016/j.proeng.2017.08.008. Adib-Hajbaghery, M., & Lotfi, M. S. (2013). Behavior of healthcare workers after injuries from sharp instruments. Trauma Monthly, 18(2), 75–80. http://doi.org/10.5812/traumamon.12779. Agbana, B. E., Joshua, A., Daikwo, M., & Metiboba, L. (2016). Knowledge of occupational hazards among sawmill workers in Kwara state, Nigeria. Nigerian Postgraduate Medical Journal, 23(1), 25. http://doi.org/10.4103/1117-1936.180176. Alosaimi, F. D., Alghamdi, A. H., Aladwani, B. S., Kazim, S. N., & Almufleh, A. S. (2016). Work-related stress and stress-coping strategies in residents and administrative employees working in a tertiary care hospital in KSA. Journal of Taibah University Medical Sciences, 11(1), 32–40. http://doi.org/10.1016/j.jtumed.2015.08.009. Aluko, O. O., Adebayo, A. E., Adebisi, T. F., & Ewegbemi, M. K. (2016). Knowledge , attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers Knowledge , attitudes and perceptions of occupational hazards and safety practices in Nigerian healthcare workers. BMC Research Notes. http://doi.org/10.1186/s13104-016-1880-2. Amiry, A. Al. (2015). Methicillin-resistant Staphylococcus aureus: An occupational health hazard in the prehospital setting. Journal of Acute Disease, 4(4), 274–276. http://doi.org/10.1016/j.joad.2015.06.003. Amponsah-tawiah, K., & Mensah, J. (2016). Occupational Health and Safety and Organizational Commitment : Evidence from the Ghanaian Mining Industry. Safety and Health at Work, 7(3), 225–230. http://doi.org/10.1016/j.shaw.2016.01.002. Annan, J., Addai, E. K., & Tulashie, S. K. (2015). A Call for Action to Improve Occupational Health and Safety in Ghana and a Critical Look at the Existing Legal Requirement and Legislation. Safety and Health at Work, 6(2), 146–150. http://doi.org/10.1016/j.shaw.2014.12.002. Annan, J. S., Addai, E. K., & Tulashie, S. K. (2015). A Call for Action to Improve Occupational Health and Safety in Ghana and a Critical Look at the Existing Legal Requirement and Legislation. Safety and Health at Work, 6(2), 146–150. http://doi.org/10.1016/j.shaw.2014.12.002. Ansa, V. O., Udoma, E. J., Umoh, M. S., & Anah, M. U. (2002). Occupational risk of infection by human immunodeficiency and hepatitis B viruses among health workers in south-eastern Nigeria. East African Medical Journal. http://doi.org/10.4314/eamj.v79i5.8863. Atombo, C., Wu, C., Tetteh, E. O., Nyamuame, G. Y., & Agbo, A. A. (2017). Safety and Health Perceptions in Work-related Transport Activities in Ghanaian Industries. Safety 38 University of Ghana http://ugspace.ug.edu.gh and Health at Work, 8. http://doi.org/10.1016/j.shaw.2016.10.002. Awodele, O., Popoola, T. D., Ogbudu, B. S., Akinyede, A., Coker, H. A. B., & Akintonwa, A. (2014). Occupational Hazards and Safety Measures Amongst the Paint Factory Workers in Lagos , Nigeria. Safety and Health at Work, 5(2), 106–111. http://doi.org/10.1016/j.shaw.2014.02.001 Bekele, T., Gebremariam, A., Kaso, M., & Ahmed, K. (2015a). Attitude , reporting behavour and management practice of occupational needle stick and sharps injuries among hospital healthcare workers in Bale zone , Southeast Ethiopia : a cross-sectional study. Journal of Occupational Medicine and Toxicology, 10(42), 1–7. http://doi.org/10.1186/s12995-015-0085-2. Bekele, T., Gebremariam, A., Kaso, M., & Ahmed, K. (2015b). Factors associated with occupational needle stick and sharps injuries among hospital healthcare workers in bale zone, Southeast Ethiopia. PLoS ONE, 10(10). http://doi.org/10.1371/journal.pone.0140382. Caraballo-arias, Y. (2015). Occupational Safety and Health in Venezuela. Annals of Global Health, 81(4), 512–521. http://doi.org/10.1016/j.aogh.2015.08.022. Chaiklieng, S., & Suggaravetsiri, P. (2015). Ergonomics risk and neck shoulder back pain among dental professionals. Procedia Manufacturing, 3(Ahfe), 4900–4905. http://doi.org/10.1016/j.promfg.2015.07.620. Cheung, T., & Yip, P. S. F. (2017). Workplace violence towards nurses in Hong Kong : prevalence and correlates. BMC Public Health, 17(196), 1–10. http://doi.org/10.1186/s12889-017-4112-3. Chou, C., Chiao, H., Wang, C., & Tzeng, Y. (2015). Major chemical burn injury combined with a penetrating injury of the abdomen leading to hypovolemic shock. Formosan Journal of Surgery, 48(1), 26–29. http://doi.org/10.1016/j.fjs.2014.06.006. Cromie, J. E., Robertson, V. J., & Best, M. O. (2001). Occupational health and safety in physiotherapy : Guidelines for practice. Australian Journal of Physiotherapy, 47(1), 43–51. http://doi.org/10.1016/S0004-9514(14)60297-X. Darkwa, E. K., Newman, M. S., Kawkab, M., & Chowdhury, M. E. (2015). A qualitative study of factors influencing retention of doctors and nurses at rural healthcare facilities in Bangladesh. BMC Health Services Research, 1–12. http://doi.org/10.1186/s12913- 015-1012-z. Davey, S., Maheshwari, C., Raghav, S. K., Singh, J. V., Singh, N., & Davey, A. (2017). Impact of Occupational Health Hazards Prevention Messages on Perceptions among Rural Clients in India : The Outcomes of a Panel Study. International Journal of Health System and Disaster Management, 11–17. http://doi.org/10.4103/ijhsdm.ijhsdm. Dijk, F. J. Van, Bubas, M., & Smits, P. B. (2015). Evaluation Studies on Education in Occupational Safety and Health : Inspiration for Developing Economies. Annals of Global Health, 81(4), 548–560. http://doi.org/10.1016/j.aogh.2015.08.023 39 University of Ghana http://ugspace.ug.edu.gh Eo, Y., Kim, Y., & Lee, N. (2014). Path Analysis of Empowerment and Work Effectiveness among Staff Nurses. Asian Nursing Research, 8(1), 42–48. http://doi.org/10.1016/j.anr.2014.02.001. Eriksen, W. (2006). Practice area and work demands in nurses’ aides: a cross-sectional study. BMC Public Health, 97, 1–9. http://doi.org/10.1186/1471-2458-6-97. Fasunloro, A., & Owotabe, F. J. (2004). Occupational hazards among clinical dental staff. Journal of Contemporary Dental Practice, 5(2), 134–152. Franz, S., Zeh, A., Schablon, A., Kuhnert, S., & Nienhaus, A. (2010). Aggression and violence against health care workers in Germany--a cross sectional retrospective survey. BMC Health Services Research, 10, 51. http://doi.org/10.1186/1472-6963-10- 51 Fute, M., Mengesha, Z. B., Wakgari, N., & Tessema, G. A. (2015). High prevalence of workplace violence among nurses working at public health facilities in Southern Ethiopia. BMC Nursing, 14(9), 1–5. http://doi.org/10.1186/s12912-015-0062-1. Ghana Health Service. (2010). Occupational Health and Safety Policy and Guidelines for the health sector. Policy. Giurgiu, D. I., Jeoffrion, C., Roland-lévy, C., Grasset, B., Dessomme, B. K., Moret, L., … Tripodi, D. (2016). Wellbeing and occupational risk perception among health care workers : a multicenter study in Morocco and France. Journal of Occupational Medicine and Toxicology, 11(20), 1–12. http://doi.org/10.1186/s12995-016-0110-0. Guo, Y. L., Shiao, J., Chuang, Y. C., & Huang, K. Y. (1999). Needlestick and sharps injuries among health-care workers in Taiwan. Epidemiology and Infection, 122, 259– 265. http://doi.org/10.1017/S0950268899002186. Hamdan, M., & Hamra, A. (2015). Workplace violence towards workers in the emergency departments of Palestinian hospitals : a cross-sectional study. Human Resources for Health, 13(28), 1–9. http://doi.org/10.1186/s12960-015-0018-2. Henrotin, J., Vaissière, M., Etaix, M., Dziurla, M., Malard, S., & Lafon, D. (2017). Exposure to occupational hazards for pregnancy and sick leave in pregnant workers : a cross-sectional study. Annals of Occupational and Environmental Medicine, 1–11. http://doi.org/10.1186/s40557-017-0170-3. Hu, S. X., Luk, A. L., & Smith, G. D. (2015). The effects of hazardous working conditions on burnout in Macau nurses. International Journal of Nursing Sciences, 2(1), 86–92. http://doi.org/10.1016/j.ijnss.2015.01.006. Jahangiri, M., Rostamabadi, A., Yekzamani, P., Abadi, B. M., Behbood, F., Ahmadi, S. F., & Momeni, Z. (2016). A Descriptive Study of Occupational Health Services in Self- employed Enterprises ( Nanoscale Enterprises ), Shiraz , Iran. Safety and Health at Work, 7(4), 317–321. http://doi.org/10.1016/j.shaw.2016.05.004. Jilcha, K., & Kitaw, D. (2017). Industrial occupational safety and health innovation for sustainable development. Engineering Science and Technology, an International 40 University of Ghana http://ugspace.ug.edu.gh Journal, 20(1), 372–380. http://doi.org/10.1016/j.jestch.2016.10.011. Joob, B., & Wiwanitkit, V. (2017). Occupational hazards due to exposure to waste anesthetic gases. Brazilian Journal of Anesthesiology (English Edition), (xx), 74129. http://doi.org/10.1016/j.bjane.2017.09.003. Joshi, R., Reingold, A. L., Menzies, D., & Pai, M. (2006). Tuberculosis among Health-Care Workers in Low- and Middle-Income Countries : A Systematic Review. PLoS Medicine, 3(12). http://doi.org/10.1371/journal.pmed.0030494. Kelbitsch, N., & Kenny, P. (2003). Developing an Occupational Health and Safety Plan for Small Bussinesses and Organisations. Kim, Y., Park, J., & Park, M. (2016). Creating a Culture of Prevention in Occupational Safety and Health Practice. Safety and Health at Work, 7(2), 89–96. http://doi.org/10.1016/j.shaw.2016.02.002. Klein, L. W., Miller, D. L., Balter, S., Laskey, W., Haines, D., Norbash, A., … Goldstein, J. A. (2010). Occupational health hazards in the interventional laboratory: Time for a safer environment. Journal of Radiology Nursing, 29(3), 75–82. http://doi.org/10.1016/j.jradnu.2010.06.003. Kollie, E. S., Winslow, B. J., Pothier, P., & Gaede, D. (2017). Deciding to work during the Ebola outbreak : The voices and experiences of nurses and midwives in Liberia. International Journal of Africa Nursing Sciences, 7(October), 75–81. http://doi.org/10.1016/j.ijans.2017.09.002. Krieger, N., Chen, J. T., Waterman, P. D., Hartman, C., Stoddard, A. M., Quinn, M. M., … Barbeau, E. M. (2008). The inverse hazard law: Blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers. Social Science and Medicine, 67(12), 1970–1981. http://doi.org/10.1016/j.socscimed.2008.09.039. Lantta, T., Anttila, M., Kontio, R., Adams, C. E., & Välimäki, M. (2016). Violent events , ward climate and ideas for violence prevention among nurses in psychiatric wards : a focus group study. International Journal of Mental Health Systems, 10(27), 1–10. http://doi.org/10.1186/s13033-016-0059-5. Lavoie, M.-C., Yassi, A., Bryce, E., Fujii, R., Logronio, M., & Tennassee, M. (2010). International collaboration to protect health workers from infectious diseases in Ecuador. Pan American Journal of Public Health, 27(5), 396–402. http://doi.org/10.1590/S1020-49892010000500010. Leineweber, C., Chungkham, H. S., Westerlund, H., & Tishelman, C. (2014). Hospital organizational factors influence work – family conflict in registered nurses : Multilevel modeling of a nation-wide cross-sectional survey in Sweden. International Journal of Nursing Studies, 51(5), 744–751. http://doi.org/10.1016/j.ijnurstu.2013.09.010. Liautaud, A., Adu, P. A., Yassi, A., Zungu, M., Spiegel, J. M., Rawat, A., … Engelbrecht, M. C. (2017). Strengthening Human Immunode fi ciency Virus and Tuberculosis Prevention Capacity among South African Healthcare Workers : A Mixed Methods 41 University of Ghana http://ugspace.ug.edu.gh Study of a Collaborative Occupational Health Program. Safety and Health at Work, 1– 8. http://doi.org/10.1016/j.shaw.2017.08.004. Lucio, L. M. C., Braz, M. G., Junior, N., Braz, J. R. C., & Braz, L. G. (2017). Occupational hazards , DNA damage , and oxidative stress on exposure to waste anesthetic gases. Brazilian Journal of Anesthesiology (English Edition), (xx). http://doi.org/10.1016/j.bjane.2017.07.002. Lugah, V., Ganesh, B., Darus, a, Retneswari, M., Rosnawati, M. R., & Sujatha, D. (2010). Training of occupational safety and health: knowledge among healthcare professionals in Malaysia. Singapore Medical Journal, 51(7), 586–592. Magboul, N. A., Madkhali, O. A., Alhazmi, A. M., Basehi, M. F., Basehi, A. F., Albaraa, A., & Abdulhameed, A. (2016). Measurement Knowledge, Attitude and Practice of Medical Students and applied medicine toward occupational health hazard in Jazan region,KSA. International Journal of Scientific & Engineering Research, 7(10). Malkin, R., Lentz, T. J., Topmiller, J., Hudock, S. D., & Niemeier, R. W. (2006). The Characterization of Airborne Occupational Safety and Health Hazards in Selected Small Businesses ; Manufacturing Wood Pallets. Industrial Health, (2000), 58–63. Manyisa, Z. M., & Aswegen, E. J. Van. (2017). Factors affecting working conditions in public hospitals : A literature review. International Journal of Africa Nursing Sciences, 6, 28–38. http://doi.org/10.1016/j.ijans.2017.02.002. Mattessich, S., & Shea, K. (2017). Parenting and female dermatologists ’ perceptions of work-life balance. International Journal of Women’s Dermatology, 3(3), 127–130. http://doi.org/10.1016/j.ijwd.2017.04.001 Mequanint, G., Tsegaw, A., Devos, E. L., Melese, E., & Birhan, M. (2017). Poisoning cases and their management in emergency centres of government hospitals in northwest Ethiopia Les cas d ’ intoxication et leur traitement dans les services d ’ urgence des hôpitaux d ’ urgence dans le nord-ouest de l ’ Ethiopie. African Journal of Emergency Medicine, 7(2), 74–78. http://doi.org/10.1016/j.afjem.2017.04.005. Mohammad, M., Abdel, A. M., Abd, A., Farghaly, A., & Shehata, H. M. (2013). Pattern of community and hospital acquired pneumonia in Egyptian military hospitals. Egyptian Journal of Chest Diseases and Tuberculosis, 62(1), 9–16. http://doi.org/10.1016/j.ejcdt.2013.01.003. Montano, D. (2014). Chemical and biological work-related risks across occupations in Europe : a review. Journal ofOccupational Medicine and Toxicology, 28(9). Mrema, E. J., & Ngowi, A. V. (2015). Status of Occupational Health and Safety and Related Challenges in Expanding Economy of Tanzania. Annals of Global Health, 81(4), 538–547. http://doi.org/10.1016/j.aogh.2015.08.021. Mthewos, B., Birhan, W., Kinfe, S., Boru, M., Tiruneh, G., & Addis, Z. (2013). Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care workers in Gondar, North West Ethiopia. BMC Public Health, 13(4). http://doi.org/10.4172/2329-6879.1000208. 42 University of Ghana http://ugspace.ug.edu.gh Murray, L. R. (2003). Sick and tired of being sick and tired: Scientific evidence, methods, and research implications for racial and ethnic disparities in occupational health. American Journal of Public Health, 93(2), 221–226. http://doi.org/10.2105/AJPH.93.2.221 Ndejjo, R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J. S., … Ssempebwa, J. (2015). Occupational Health Hazards among Healthcare Workers in Kampala, Uganda. Journal of Environmental and Public Health, 2015, 1–16. http://doi.org/10.1155/2015/913741. Nerbass, F. B., Pecoits-filho, R., Clark, W. F., Sontrop, J. M., Mcintyre, C. W., & Moist, L. (2017). Occupational Heat Stress and Kidney Health : From Farms to Factories. Kidney International Reports, 1–11. http://doi.org/10.1016/j.ekir.2017.08.012. Nouetchognou, J. S., Ateudjieu, J., Jemea, B., & Mbanya, D. (2016). Accidental exposures to blood and body fluids among health care workers in a Referral Hospital of Cameroon. BMC Research Notes, 9(94), 1–6. http://doi.org/10.1186/s13104-016-1923- 8. Nyarko, Y., Goldfrank, L., Ogedegbe, G., Soghoian, S., & de-Graft Aikins, A. (2015). Preparing for Ebola Virus Disease in West African countries not yet affected: perspectives from Ghanaian health professionals. Globalization and Health, 11(1), 7. http://doi.org/10.1186/s12992-015-0094-z. Ocampo, W., Geransar, R., Emt-p, N. C., Jones, J., Grood, J. De, Joffe, M., … Ghali, W. (2017). Infection Control Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. AJIC: American Journal of Infection Control, 45(10), 1116–1126. http://doi.org/10.1016/j.ajic.2017.05.014. Oh, N., Hong, N., Ph, M. D. D., Ryu, D. H., Ph, M. D. D., Bae, S. G., … Ph, M. D. D. (2017). Exploring Nursing Intention , Stress , and Professionalism in Response to Infectious Disease Emergencies : The Experience of Local Public Hospital Nurses During the 2015 MERS Outbreak in South Korea. Asian Nursing Research, 11(3), 230–236. http://doi.org/10.1016/j.anr.2017.08.005. Oliveira, G., Amélia, R., & Dantas, A. (2015). Work-related mental and behaviour disorders in anesthesiologists. Brazilian Journal of Anesthesiology (English Edition), 65(6), 504–510. http://doi.org/10.1016/j.bjane.2013.03.021. Orji, E. O., Fasubaa, O. B., Onwudiegwu, U., Dare, F. O., & Ogunniyi, S. O. (2002). Occupational health hazards among health care workers in an obstetrics and gynaecology unit of a Nigerian teaching hospital. Journal of Obstetrics and Gynaecology, 22(1), 75–78. http://doi.org/10.1080/01443610120101781. Orme, N. M., Rihal, C. S., Gulati, R., Holmes, D. R., Lennon, R. J., Lewis, B. R., … Singh, M. (2015). Occupational health hazards of working in the interventional laboratory: A multisite case control study of physicians and allied staff. Journal of the American College of Cardiology, 65(8), 820–826. http://doi.org/10.1016/j.jacc.2014.11.056. 43 University of Ghana http://ugspace.ug.edu.gh Przysiezny, P. E., Tironi, L., & Przysiezny, S. (2015). Work-related voice disorder. Brazilian Journal of Otorhinolaryngology, 81(2), 202–211. http://doi.org/10.1016/j.bjorl.2014.03.003. Quinn, M. M., Henneberger, P. K., Braun, B., Delclos, G. L., Fagan, K., Pharmd, V. H., … Zock, J. (2015). Cleaning and disinfecting environmental surfaces in health care : Toward an integrated framework for infection and occupational illness prevention. American Journal of Infection Control, 43(5), 424–434. http://doi.org/10.1016/j.ajic.2015.01.029. Rambabu, T., & Suneetha, K. (2014). Prevalence of work related musculoskeletal disorders among physicians, surgeons and dentists: A comparative study. Annals of Medical and Health Sciences Research, 4(4), 578. http://doi.org/10.4103/2141-9248.139327. Reda, A. A., Fisseha, S., Mengistie, B., & Vandeweerd, J. M. (2010). Standard precautions: Occupational exposure and behavior of health care workers in Ethiopia. PLoS ONE, 5(12), 1–6. http://doi.org/10.1371/journal.pone.0014420. Reddy, V., Bennadi, D., Satish, G., & Kura, U. (2015). Occupational Hazards among Dentists: A Descriptive Study. Journal of Oral Hygiene & Health, 3(5), 3–6. http://doi.org/10.4172/2332-0702.1000185. Rim, K. (2017). Reproductive Toxic Chemicals at Work and Efforts to Protect Workers ’ Health : A Literature Review. Safety and Health at Work, 8(2), 143–150. http://doi.org/10.1016/j.shaw.2017.04.003. Rim, K., & Lim, C. (2014). Biologically Hazardous Agents at Work and Efforts to Protect Workers ’ Health : A Review of Recent Reports. Safety and Health at Work, 5(2), 43– 52. http://doi.org/10.1016/j.shaw.2014.03.006. Roger, N., Kayembe, N. J., & Kornblatt, E. (2017). Epidemiology of ebolavirus disease ( EVD ) and occupational EVD in health care workers in Sub-Saharan Africa : Need for strengthened public health preparedness. Journal of Epidemiology, 1–7. http://doi.org/10.1016/j.je.2016.09.010. Roja, Z., Kalkis, H., & Roja, I. (2015). Measuring muscle fatigue in relation to the workload of health care workers. Procedia Manufacturing, 3(Ahfe), 4189–4196. http://doi.org/10.1016/j.promfg.2015.07.394. Ruitenburg, M. M., Frings-dresen, M. H. W., & Sluiter, J. K. (2016). How to De fi ne the Content of a Job-Speci fi c Worker ’ s Health Surveillance for Hospital Physicians ? Safety and Health at Work, 7. http://doi.org/10.1016/j.shaw.2015.08.004 Santos, P. B., Moraes, M. S., Oliveira, A., Scotá, S., Gomes, A. S., Moura, S. R., & Martins, R. S. (2013). P287 : Adherence to biosafety practices by nursing staff in the face of situations of occupational risk. Antimicrobial Resistance and Infection Control, 2(Suppl 1), 2994. http://doi.org/10.1186/2047-2994-2-S1-P287. Shafran-tikva, S., Zelker, R., Stern, Z., & Chinitz, D. (2017). Workplace violence in a tertiary care Israeli hospital - a systematic analysis of the types of violence , the perpetrators and hospital departments. Israel Journal of Health Policy Research, 1–11. 44 University of Ghana http://ugspace.ug.edu.gh http://doi.org/10.1186/s13584-017-0168-x. Shieh, S., Sung, F., Su, C., Tsai, Y., & Hsieh, V. C. (2016). Increased low back pain risk in nurses with high workload for patient care : A questionnaire survey. Taiwanese Journal of Obstetrics & Gynecology, 55(4), 525–529. http://doi.org/10.1016/j.tjog.2016.06.013. Solmaz, M., & Solmaz, T. (2014). Experiences with Needle-Stick and Sharp Object Injuries for Healthcare Workers in a State Hospital in Tokat Province , Turkey. Subramanian, G. C., Arip, M., & Saraswathy Subramaniam, T. S. (2016). Knowledge and Risk Perceptions of Occupational Infections Among Health-care Workers in Malaysia. Safety and Health at Work, 8(3), 246–249. http://doi.org/10.1016/j.shaw.2016.12.007. Tangvik, R. J., Tell, G. S., Berit, A., Eisman, J. A., Henriksen, A., Miodini, R., & Hylen, A. (2015). Nutritional risk pro fi le in a university hospital population. Clinical Nutrition, 34(4), 705–711. http://doi.org/10.1016/j.clnu.2014.08.001. Tetteh, R. A., Nartey, E. T., Lartey, M., Mantel-teeuwisse, A. K., Leufkens, H. G. M., Nortey, P. A., & Dodoo, A. N. O. (2015). Adverse events and adherence to HIV post- exposure prophylaxis : a cohort study at the Korle-Bu Teaching Hospital in Accra , Ghana. BMC Public Health, 15(573), 1–13. http://doi.org/10.1186/s12889-015-1928-6. Twerefoo, O. (2015). What about my health ? An assessment of how the health and safety issues of health workers are addressed. Research on Humanities and Social Sciences, 5(2), 182–193. Tziaferi, S. G., Sourtzi, P., Kalokairinou, A., Sgourou, E., Koumoulas, E., & Velonakis, E. (2011). Risk Assessment of Physical Hazards in Greek Hospitals Combining Staff’s Perception, Experts’ Evaluation and Objective Measurements. Safety and Health at Work, 2(3), 260–272. http://doi.org/10.5491/SHAW.2011.2.3.260. Ulutasdemir, N., Cirpan, M., Copur, E. O., & Tanir, F. (2015). Occupational Risks of Health Professionals in Turkey as an Emerging Economy. Annals of Global Health, 81(4), 522–529. http://doi.org/10.1016/j.aogh.2015.08.019. Volquind, D., Bagatini, A., Massaro, G., Monteiro, C., Londero, J. R., & Benvenutti, G. D. (2013). Occupational Hazards and Diseases Related to the Practice of Anesthesiology. Brazilian Journal of Anesthesiology, 63(2), 227–232. http://doi.org/10.1016/S0034- 7094(13)70221-6. Walters, G. I., Soundy, A., Robertson, A. S., Burge, P. S., & Ayres, J. G. (2015). ScienceDirect Understanding health beliefs and behaviour in workers with suspected occupational asthma. Respiratory Medicine, 109(3), 379–388. http://doi.org/10.1016/j.rmed.2015.01.003. WHO. (2006). Taking stock: Health worker shortages and the response to AIDS. Geneva: WHO, (August), 1–16. Retrieved from http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Taking+stock+:+He alth+worker+shortages+and+the+response+to+AIDS#0%5Cnhttp://scholar.google.co m/scholar?hl=en&btnG=Search&q=intitle:Taking+stock:+Health+worker+shortages+a 45 University of Ghana http://ugspace.ug.edu.gh nd+the+response+to+AIDS. Wilburn, S., & Eijkemans, G. (2004). Preventing needlestick injuries among healthcare workers. International Journal of Occupational and Environmental Health, 10(4), 451–456. http://doi.org/10.1179/oeh.2004.10.4.451. Zaramba, S. (2008). Guidelines for Occupational Safety and Health , Including HIV in the Health Services Sector. 46 University of Ghana http://ugspace.ug.edu.gh APPENDICES Appendix A: Participant’s Consent Form School of Public Health College of Health Sciences University of Ghana Research Topic: Assessment of Knowledge of Occupational Health Hazards and Safety practices among Healthcare workers in LedzokukuKrowor Municipal Hospital, Accra. Introduction My name is Veronica Ampaben-Kyereme and I am a student pursuing Master in Public Health in the School of Public Health, University of Ghana. I am the principal investigator and together with my research assistants we are conducting a study on Knowledge of Occupational Hazards and Safety Practices among Healthcare workers in Ledzokuku Krowor Municipal Hospital, Accra. You are warmly invited to take part in the study. But before you make a decision to take part in the study or not, we would like you to read this consent or let someone read it to you to guide you in making your decision. There will be no costs for participating in this research and there will be no payments awarded for participating in this research. However, your response will help in coming out with the true picture of the knowledge of healthcare workers of the LEKMA hospital on occupational hazards and safety The only cost you will incur will be the time taken to answer the questionnaire. 47 University of Ghana http://ugspace.ug.edu.gh Confidentiality Every single information you provide will be held in absolute confidence and data collected in this study are strictly for research purposes and will be stored with passwords on electronic media and in safely locked boxes. Access to the data will be limited strictly to the researcher and supervisor. Anonymity will be ensured in dissemination of findings from this study since participants will not be identified by their names. Ethical Approval The study has been reviewed and approved by the Ghana Health Service Ethical Review Committee (GH-ERC). This committee is there to ensure that participants in researches are protected from harm and their rights are respected. Participant’s Consent Form I have read the foregoing information/ the foregoing information has been read to me or translated to me in a language that I understand and I have fully understood it. I consent voluntarily to participate in this study. (Name and signature of a witness should be provided in a case where the participant cannot speak or read English) Signature/thumbprint: ____________________________________ Name of witness: __________________________________________________ Signature/thumbprint of witness: ____________________________________ 48 University of Ghana http://ugspace.ug.edu.gh Interviewer's Statement I, the undersigned (your name), have explained this consent form to the participant in simple language that she/he understands, clarified the purpose of the study, procedures to be followed as well as the risks and benefits involved. The participant has freely agreed to participate in the study. Signature of interviewer ………………………………………….. Date …………. / ………….. / ……………. Address Korle-Bu Teaching Hospital PMB Korle-Bu. Telephone number: 0243801771 Email address: gmens265@gmail. In case of any concern you can contact the Ethics Administrator, Miss Hannah Frimpong, GHS/ERC on: 0243235225 / 0507041223. 49 University of Ghana http://ugspace.ug.edu.gh Appendix B: Questionnaire TOPIC: ASSESSMENT OF KNOWLEDGE OF OCCUPATIONAL HEALTH HAZARDS AND SAFETY PRACTICES AMONG HEALTHCARE PROFESSIONALS IN LEDZOKUKU KROWOR MUNICIPAL HOSPITAL, ACCRA. I am VERONICA AMPABEN-KYEREME, a student of the School of Public Health, University of Ghana, Legon. I amconducting a study on knowledge of occupational health hazards and safety among healthcare workers of LedzokukuKrowor Municipal Assembly (LEKMA) hospital of the Greater Accra Region. All the information obtained is strictly for academic purposes and will be highly treated with the greatest level of confidentiality. Thank you. Participants consent: Yes[ ] No[ ], If No, end of interview Section 1: Demographic characteristics of respondents 1 Gender Male…………………………… GENDER Female…………………………. 2 Age of 15-19………………………… AGE respondents(yrs) 20-29……………………....... 30-39………………………… 40-49………………………… 50- 59………………………… Educational No formal education…………… EDUCATION_LEVEL 3 level of Primary……………………....... respondents JSS……………………………… Secondary……………............... Vocational……………………… Tertiary…….…………………… 4 What is your Nurse………………………….. PROFESSION profession? Doctor……………………....... Laboratory staff………………… Pharmacist……………............... Radiologist……………………… Physiotherapist…….…………… Others…………………………999 5 Religion Christianity……………………… RELIGION Islam…………………………..... Traditionalist…………………..... Others(specify)…………………… 999 6 How long have <1yrs……………………………… DURATION you being 1-5 yrs…………………………….. working in the 6-10yrs……………………………. hospital? 11-15yrs………………………….. >15yrs……………………………. 50 University of Ghana http://ugspace.ug.edu.gh SECTION 2: KNOWLEDGE OF OCCUPATIONAL HEALTH HAZARDS AND SAFETY 7 Occupational health and safety Yes cover both employers’ ad No employees welfare? 8 Staff are required to put on Yes protective clothing in the No performance of their duties 9 Both employers and Yes employees have NO responsibilities and rights for effective occupational health and safety 10 Occupational hazards refer to Yes all workplace activities that No have the potential to cause/increase the risk of injury or ill health. 11 Workplace safety generally Yes refers to the process of No protecting the health and safety of staff while on the job, irrespective of vocation SECTION 3: PREVALENCE OF OCCUPATIONAL HEALTH HAZARDS 12 Are there any risks and hazards Yes……............................. . associated with the work you No…………………………. do? 13 Have you suffered from any Yes……............................. . If yes go to work related accidents or injury No…………………………. Q16 in the hospital since you were engaged? 14 What are the causes of the Lack of adequate training on accidents? health and safety……………. Non provision of adequat e protective equipment………… Ignorance of health and safet y matters……………………… Not sure……………………. SECTION 4: AVAILABILITY SAFETY MEASURES 15 Are there safety measures in Yes……............................. . your work environment? No…………………………. 16 Have you ever been trained on Yes……............................. . If yes go to occupational health hazards and No…………………………. Q19 safety in your workplace? 51 University of Ghana http://ugspace.ug.edu.gh 17 How regular is the training Quartely…………………….. organized for staff on Biannually…………………… occupational health and safety Annually……………………. No definite time fixed for training………………………. 19 Do you have protective Yes……............................. . If Yes go to equipment to use in your work No…………………………. Q21 environment?? Which of the following PPE are Respirator……………………. 19 available for your use (Tick as Hand gloves…………………. applied)? Nose/Mouth mask…………….. . Overalls………………………. Boots……………………….. Protective Goggles…………. Helmet……………………… 20 Are you compensated when you Yes……............................. .. experience hazards in your No…………………………….. workplace? 21 Indicate how satisfied you are Very satisfied……………….. with the current occupational Satisfied……………………. health and safety measures put Dissatisfied…………………. in place Very dissatisfied……………. 22 How will you describe your Safe………………………….. work environment? Very safe……………………. Not safe………………………. SECTION 5: AVAILABILTY OF OCCUPATIONAL HEALTH HAZARDS AND SAFETY POLICY 23 Are you aware of the Yes……...................... ……… occupational health hazards and No…………………………… safety policy for the health sector? 24 Do you think effective Yes……...................... ……….. occupational heath and safety No……………………………. policies have any impacts on job Not sure……………………… performance in the hospital? 25 Do you or your department or Yes……...................... ……… unit have a written copy of No…………………………… occupational health and safety policy of the hospital END OF INTERVIEW Thank you 52