University of Ghana http://ugspace.ug.edu.gh SCHOOL OF PUBLIC HEALTH COLLEGE OF HEALTH SCIENCES UNIVERSITY OF GHANA ASSESSMENT OF THE KNOWLEDGE OF OCCUPATIONAL HAZARDS AND SAFETY PRACTICES AMONG HEALTHCARE WORKERS IN POLICE HOSPITAL, ACCRA, GHANA BY FRANK DUODU 10637319 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 JULY, 2018 i University of Ghana http://ugspace.ug.edu.gh Declaration I declare that, apart from references made to works done by other authors which have been duly acknowledged, this work was independently done by me under supervision. I further declare that this work has not been submitted for the award of any degree in this university or elsewhere. FRANK DUODU ………………………… ………………. (STUDENT) SIGNATURE DATE DR URI MARKAKPO ………………………. ..…………….. (SUPERVISOR) SIGNATURE DATE ii University of Ghana http://ugspace.ug.edu.gh Dedication This dissertation is dedicated to the following dear ones: The loving memory of my late father Mr Charles K. Duodu; to my beloved wife Mrs Delna E. Duodu and our precious daughters Janice and Lauren; my brothers and sisters, in-laws and friends and loved ones whose contributions were invaluable to the success of this work. I also dedicate it to the lovely members of my study group of the 2018 regular MPH class who assisted in diverse ways to make this work and my studies in general successful. Finally, to the deacons and members of Dansoman Baptist Church, for their spiritual support and guidance. iii University of Ghana http://ugspace.ug.edu.gh Acknowledgements To God Almighty give I praise for His grace and mercy to have brought me this far in this project. If it were not for Him by my side I would not have made it. To my supervisor, Dr Uri Markakpo, I extend my sincerest gratitude for his depth of knowledge in my research topic, attention to precision and timely constructive criticism throughout the period of the study. My thanks also go to the head of department of BEOH, the Dean of the School of Public Health and the staff and management of the Police Hospital for their immense assistance towards the success of this study. iv University of Ghana http://ugspace.ug.edu.gh Table of Contents Declaration .................................................................................................................................... ii Dedication .................................................................................................................................... iii Acknowledgements ...................................................................................................................... iv Table of Contents .......................................................................................................................... v List of Tables ................................................................................................................................ x Definition of Acronyms .............................................................................................................. xii Abstract ...................................................................................................................................... xiii Definition of Terms..................................................................................................................... xv CHAPTER ONE ........................................................................................................................... 1 INTRODUCTION ........................................................................................................................ 1 1.0 Background ............................................................................................................................ 1 1.1 Problem Statement ................................................................................................................. 2 1.2 Conceptual Framework .......................................................................................................... 3 1.3 Justification ............................................................................................................................ 5 1.4 Research Questions ................................................................................................................ 5 1.5 Objectives of the Study .......................................................................................................... 6 1.5.1 General Objective ............................................................................................................... 6 1.5.2 Specific Objectives ............................................................................................................. 6 CHAPTER TWO .......................................................................................................................... 7 LITERATURE REVIEW ............................................................................................................. 7 v University of Ghana http://ugspace.ug.edu.gh 2.0 Introduction ............................................................................................................................. 7 2.1 Prevalence of Occupational Hazards and Injuries in different Hospital Settings ................... 7 2.6 Knowledge of Occupational Hazards and Safety Practices among Healthcare Workers ..... 12 2.7 Socio-demographic factors and Knowledge of Occupational Hazards and Safety .............. 14 2.8 Summary .............................................................................................................................. 15 CHAPTER THREE .................................................................................................................... 16 METHODOLOGY ..................................................................................................................... 16 3.0 Introduction .......................................................................................................................... 16 3.1 Study Design ........................................................................................................................ 16 3.2 Study Area ............................................................................................................................ 16 3.3 Inclusion Criteria .................................................................................................................. 17 3.4 Exclusion Criteria ................................................................................................................. 17 3.5 Sample Size Determination ................................................................................................... 17 3.6 Sampling Method .................................................................................................................. 18 3.7 Data Collection Tool ............................................................................................................. 19 3.8 Limitation of the Study ......................................................................................................... 19 3.9 Definition of Variables of the Study ..................................................................................... 20 3.10 Knowledge of occupational hazards and safety practices ................................................... 21 3.11 Data Management and Analysis ......................................................................................... 22 3.12 Quality control .................................................................................................................... 22 vi University of Ghana http://ugspace.ug.edu.gh 3.13 Training of research assistants ............................................................................................ 23 3.14 Ethical Consideration .......................................................................................................... 23 3.15 Access to study area ............................................................................................................ 24 3.16 Privacy, confidentiality and anonymity .............................................................................. 24 3.17 Compensation ..................................................................................................................... 25 3.18 Risk and benefits ................................................................................................................. 25 3.19 Voluntary withdrawal ......................................................................................................... 25 3.20 Consenting process ............................................................................................................. 26 3.21 Data storage and usage ........................................................................................................ 26 3.22 Declaration of conflict of interest ....................................................................................... 26 3.23 Funding of the study ........................................................................................................... 26 CHAPTER FOUR ....................................................................................................................... 27 RESULTS ................................................................................................................................... 27 4.1 Introduction .......................................................................................................................... 27 4.2 Socio-demographic Profile of Participants ........................................................................... 27 4.3 Level of knowledge of Occupational Hazards of HCWs ..................................................... 29 4.3.1 Knowledge of Biological Hazards .................................................................................... 29 4.3.2 Knowledge of Physical Hazards ....................................................................................... 30 4.3.3 Knowledge of Ergonomic Hazards ................................................................................... 31 4.3.4 Knowledge of Chemical Hazards ..................................................................................... 32 4.3.5 Knowledge of Psychosocial Hazards ................................................................................ 33 vii University of Ghana http://ugspace.ug.edu.gh 4.3.6 Comparing Various Domains of Occupational Hazards ................................................... 33 4.3.7 Knowledge of Occupational Hazards by Strata ................................................................ 35 4.4 Factors Influencing Level of Awareness of OHSP .............................................................. 36 4.4.1 Demographic Factors Affecting Level of Awareness of Occupational Hazards and Safety Practices (OHSP) .............................................................................................................. 36 4.4.2 Institutional Factors affecting Knowledge of Occupational Hazards and Safety Practices39 4.4.3 Knowledge of Safety Practices Available ........................................................................ 41 4.4.4 Knowledge of control practices provided by employers .................................................. 42 4.4.5 Knowledge of Individual Protective Practices.................................................................. 43 4.4.6 Knowledge of Institutional Culture and Practice .............................................................. 43 4.4.7 Comparison of Knowledge of Safety Practices ................................................................ 44 4.5 Socio-demographic Factors Affecting Knowledge of Safety Practices .............................. 45 4.6 Effect of safety measures on knowledge of Occupational Hazards ..................................... 47 4.2 Summary of Findings ........................................................................................................... 48 CHAPTER FIVE ........................................................................................................................ 50 DISCUSSION ............................................................................................................................. 50 5.0 Introduction .......................................................................................................................... 50 5.1 Level of Knowledge of Occupational Hazards among HCWs ............................................. 50 5.2 Factors Influencing Level of Knowledge of OHSP ............................................................. 52 CHAPTER SIX ........................................................................................................................... 56 SUMMARY, CONCLUSION AND RECOMMENDATIONS ................................................. 56 viii University of Ghana http://ugspace.ug.edu.gh 6.0 Introduction .......................................................................................................................... 56 6.1 Summary .............................................................................................................................. 56 6.2 Conclusion ............................................................................................................................ 56 6.3 Recommendations ................................................................................................................ 57 6.3.1 Recommendations for Practice and Policy ....................................................................... 57 6.3.2 Recommendations for Theory and Research .................................................................... 58 REFERENCES ........................................................................................................................... 59 APPENDICES ............................................................................................................................ 66 Appendix A: Participants‟ informed consent form ..................................................................... 66 Appendix B: Questionnaire ......................................................................................................... 68 ix University of Ghana http://ugspace.ug.edu.gh List of Tables Table 4. 1: Socio-demographic Profile of Participants ..................................................... 28 Table 4. 2: Participants' Knowledge of Biological Hazards ............................................. 30 Table 4. 3: Participants' knowledge of Physical Hazards ................................................. 31 Table 4. 4: Participants' Knowledge of Ergonomic Hazards ............................................ 32 Table 4. 5: Participants' Knowledge of Chemical Hazards .............................................. 32 Table 4. 6: Participants' Knowledge of Psychosocial Hazards ......................................... 33 Table 4. 7: Comparison of Awareness of Various Occupational Hazards ....................... 34 Table 4. 8: Knowledge Levels Stratified by Professions .................................................. 35 Table 4. 9: Multivariate Analysis of Demographic Factors & Knowledge of Occupational hazards ........................................................................................................... 37 Table 4. 10: Multivariate Analysis of Socioeconomic Factors & Knowledge of Occupational hazards ................................................................................... 38 Table 4. 11: Factors Contributing to Knowledge of Occupational Hazards and Safety Practices ....................................................................................................... 40 Table 4. 12: Periods for training and monitoring .............................................................. 41 Table 4. 13: Control practices provided by employers ..................................................... 42 Table 4. 14: Individual protective measures ..................................................................... 43 Table 4. 15: Institutional culture and practice .................................................................. 44 Table 4. 16: Comparison of Safety Practices .................................................................... 45 Table 4. 17: Multivariate Analysis of Demographic Factors Affecting Knowledge of Safety Practices ............................................................................................ 46 Table 4. 18: Safety Measures as predictors of knowledge of occupational hazards ......... 48 x University of Ghana http://ugspace.ug.edu.gh List of Figures Figure 1: Conceptual framework of factors influencing knowledge of occupational hazards and safety measures ................................................................................4 Figure 2: Bar Graph showing Knowledge of Occupational Hazards ................................34 xi University of Ghana http://ugspace.ug.edu.gh Definition of Acronyms GHS Ghana Health Service GPH Ghana Police Hospital HCWs Health care workers HCFs Health care facilities HSE Health and Safety Executive of the UK ILO International Labour Organization OHS Occupational Health and Safety OHSP Occupational Hazards and Safety Practices PPE Personal Protective Equipment SOPs Standard Operating Procedures WHO World Health Organization xii University of Ghana http://ugspace.ug.edu.gh Abstract Background Healthcare staff work in an environment considered to be one of the most hazardous occupational settings. This is especially true in developing countries where health service delivery is fraught with inadequate protection against exposures to numerous fomites and pathogens. Studies have shown that inadequate knowledge of occupational hazards and unavailability of safety measures contribute greatly to the increased incidence of occupational accidents and injuries among healthcare workers (HCWs). However, there is limited research on knowledge of occupational hazards and safety measures among HCWs of the Ghana Police. Objective This study examined knowledge of occupational hazards and safety practices among healthcare workers of Ghana Police Hospital, Accra. Methods A descriptive cross-sectional survey involving 216 randomly sampled HCWs was conducted. Data was collected using validated standardized questionnaire and analysed using descriptive statistics and multivariate analysis of covariance (MANCOVA) and linear regression with the help of STATA version 15. Results Findings of the study showed that the participants recorded high level of knowledge of biological (93.5%), moderate level of knowledge of psychosocial hazards (84%) and ergonomic hazards (82%) and low level of physical (72%) and chemical hazards (66.5%). Control measures provided by employers recorded highest (96%) level of knowledge, xiii University of Ghana http://ugspace.ug.edu.gh followed by individual protective practices (82.5%) and then institutional culture and practices (79.2%). Age, educational level, income level and profession had significant effect (P < 0.05) on knowledge of psychosocial, chemical and ergonomic hazards. Conclusion Even though control measures had been instilled to minimize occupational hazards, accidents, injury and death, some institutional lapses were identified that need to be addressed to strengthen safety practices and improve occupational health. The findings of the study are expected to help improve awareness on occupational hazards among healthcare workers and promote safety practices at the work environment. xiv University of Ghana http://ugspace.ug.edu.gh Definition of Terms Health care facilities (HCFs): these are institutions that provide health care services, including counselling, clinical, surgical, and/or psychiatric consultations and treatment for the healthy, sick and the injured. Hazards: they are situations, conditions or substances such as agents, sources of energy, particles or organisms that have the potential of causing harm or damage to the environment, life and property. Risk: the probability that damage to „life, health, and or the environment‟ may be cause by a hazard. Occupational hazards: workplace activities, occurrences, conditions, materials or humans that have the potential to cause/ increase the risk of injury or ill health. Occupational injury: any physical trauma sustained by a worker while performing his or her work. Occupational safety: the protection of workers against hazards in the work environment or associated with their work. Workplace safety: the process of protecting the health and safety of staff while on the job, irrespective of vocation xv University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.0 Background Workers spend not less than one third of a day at work and this has a strong effect on their health and safety due to work-related hazards, accidents and injuries (Aderaw, Engdaw, & Tadesse, 2011). Also occupational injuries pose major public health and developmental problems which result in serious health, social, and economic consequences on workers and their employers (Aderaw et al., 2011). In 2005, an estimated 250 million occupational injuries and 5.4 million deaths due to injuries were recorded worldwide, with over 90% of these deaths occurring in low- and middle-income countries where the greatest concentration of the world‟s workforce and poorly resourced factories are found (Owie & Apanga, 2016). This problem contributes a global cost of roughly 4% of the gross national product, and in spite of this, only 5 to 10% of the workforce in low income countries has access to some kind of occupational health and safety services (Portell, Gil, Losilla & Vives, 2014). The International Labour Organization (2001) estimated that about 2.3 million workers in developing countries die each year from unintentional work related accidents and diseases. By profession, healthcare workers (HCWs) attend to clients and patients through a variety of preventive and curative services and over 59 million workers representing 12% of the working population are employed into healthcare facilities (HCFs) worldwide 1 University of Ghana http://ugspace.ug.edu.gh (WHO, 2006). Healthcare staff work in an environment that is considered to be one of the most hazardous occupational settings (WHO, 2006). However, while their attention is focused on healthcare delivery, they become vulnerable to hazards that could be detrimental to their health and well-being. This is especially true in developing countries where health service delivery is fraught with inadequate or no protection against exposures to fomites and infectious agents (WHO, 2006). Assessment of the knowledge of occupational hazards and safety practices among HCWs therefore, would help improve their protection against occupational hazards that have deleterious effects on their health. 1.1 Problem Statement Unsafe working conditions cause occupational accidents, injuries and diseases which contribute to healthcare worker attrition in many countries (Ndejjo et al., 2015a). The WHO report on Human Resources (2006), published a global shortage of health personnel which had reached crisis level in 57 countries mostly due to incapacitation from occupational diseases and called for the support and protection of the health workforce. Evidence from sub-Saharan Africa indicates that healthcare workers are frequently exposed to chemical, biological, physical and psychosocial occupational hazards owing to inadequate knowledge of occupational hazards and safety practices (Directorate- General for Employment Social Affairs and Inclusion, 2011). 2 University of Ghana http://ugspace.ug.edu.gh High rates of occupational accident and injury as well as incidence of occupational disease have been observed among healthcare staff of the Ghana Police Hospital (GPH). However, there are no data on the incidence or occurrence of these events. To help minimize the rate of occurrence of occupational accident, injury, disease and death in this healthcare facility therefore, this study was carried out to assess the knowledge of occupational hazards and safety practices among healthcare workers of the GPH. 1.2 Conceptual Framework This section discusses the factors known to contribute to the knowledge of occupational hazards and safety practices among workers. In a study to determine the relationship between individual characteristics and occupational hazards, variables such as age group, sex and work experience were reported to be associated with knowledge of occupational hazards. Also, lack of adequate information on occupational safety and health was said to contribute to the poor knowledge of healthcare workers about the subject (Ndejjo et al., 2015b). Again, according to ILO (2001), the availability of guidelines/ protocols of occupational health and safety and the institution of quality assurance through training, monitoring and evaluation contribute a lot in increasing the knowledge of workers in occupational health and safety at the workplace. 3 University of Ghana http://ugspace.ug.edu.gh In addition, availability and use of personal protective equipment at the workplace contribute to workers interest in the concept of occupational health and tend to raise awareness concerning occupational hazards and safety. Finally, a study conducted in Malaysia on knowledge of healthcare workers about occupational hazards and safety practices revealed that health professionals who have access to PPEs are more likely to use them and thereby engender interest among colleague workers (Lugah et al., 2010) Socio-demographic Sex, number of years at work, level of education, profession, income level, Availability Access to of health Occupational safety info health dept Knowledge of occupational hazards and Availability of safety measures Availability, occupational health accessibility and safety and use of guidelines/protocols PPEs Training on Quality assurance in occupational occupational health health and through monitoring safety and evaluation Figure 1: Conceptual framework of factors influencing knowledge of occupational hazards and safety measures 4 University of Ghana http://ugspace.ug.edu.gh 1.3 Justification This study would generate evidence-based data on the level of awareness of occupational health and safety among healthcare workers of the Ghana Police Hospital, Accra. The data would also provide additional information required to formulate policy measures necessary to minimize accidents and injuries during healthcare delivery services at the Ghana Police Hospital. In addition, results of this study would serve as a useful baseline for further research on factors that contribute to occupational injuries among healthcare workers. Finally, results of the study would guide management on the need to understand and minimize stigmatization and victimization of personnel when occupational accidents and injuries occur at the hospital. 1.4 Research Questions Based on the specific objectives, the following research questions were raised to guide the conduct of the study: i. What is the level of knowledge of HCWs of the Ghana Police Hospital on occupational hazards associated with their work and the safety precautionary practices adopted? ii. What are the factors that influence the knowledge of occupational hazards and safety practices among the staff of Police Hospital? iii. What safety measures are available to protect HCWs of Police Hospital against health hazards in the work environment? 5 University of Ghana http://ugspace.ug.edu.gh 1.5 Objectives of the Study 1.5.1 General Objective To assess the knowledge of occupational hazards and safety practices available to mitigate the occurrence of injury and disease among healthcare workers of the Ghana Police Hospital. 1.5.2 Specific Objectives The following objectives were examined: i. To determine the level of knowledge of occupational hazards and safety practices among healthcare workers (HCWs) at the Police Hospital. ii. To assess the socio-demographic factors that contribute to knowledge of occupational hazards and safety practices among HCWs of the Hospital. iii. To assess specific safety practices available to reduce exposure to occupational hazards among HCWs at the Police Hospital. 6 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.0 Introduction This chapter reviews existing literature on the prevalence of occupational hazards in the work environment of healthcare workers and the determinants of knowledge of these hazards and safety practices available to mitigate their occurrence. The chapter is presented as follows: The prevalence of occupational hazards and injuries in different health care settings. This is followed by knowledge of occupational hazards and safety practices among healthcare workers. Lastly, socio-demographic factors that influence knowledge of occupational hazards are discussed. 2.1 Prevalence of Occupational Hazards and Injuries in different Hospital Settings This section discusses the prevalence of occupational injuries and hazards among healthcare workers across different contexts. The section discusses the prevalence within the broader contexts of different occupational hazards that characterize healthcare settings. The literature broadly shows that occupational hazards and injuries that compromise the health and safety of healthcare workers are prevalent in the health care setting (Tipayamongkholgul, Luksamijarulkul, Mawn, Kongtip, & Woskie, 2016). Studies report that the prevalence of occupational hazards and injuries is highest in developing countries compared to high income countries (Aluko et al., 2016; Gershon, Karkashian, Grosch, Murphy, Escamilla-Cejudo, Flanagan & Martin, 2000; Puplampu & Quartey, 2012). 7 University of Ghana http://ugspace.ug.edu.gh A cross-country study commissioned by the World Health Organization (WHO) in 2006 on occupational hazards in healthcare settings reported extremely high levels of different sets of hazards in hospitals. The report indicated that HCWs are exposed to a complex variety of health and safety hazards everyday which include:  Biological Hazards which may include disease causing micro-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 8 spread diseases such as HIV and hepatitis (Rim & Lim, 2014) as well as communicable diseases, including tuberculosis (Liautaud et al., 2017), and swine bug (Oh et al., 2017).  Chemical Hazards which 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). 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 contribute to hazards among healthcare workers.  Physical Hazards, as slips, trips, falls, physical strains (Jilcha & Kitaw, 2017) and violence (Eriksen, 2006; Darkwa, Newman, Kawkab, & Chowdhury, 2015). The issue of violence against health professionals has been widely reported in several health facilities (Shafran-tikva, Zelker, Stern, & Chinitz, 2017; Cheung & Yip, 2017; Fute et al., 2015). Again, excessive level of sound (Przysiezny, Tironi, 8 University of Ghana http://ugspace.ug.edu.gh & Przysiezny, 2015), heat and cold temperatures, rapid movement, heavy lifting, electric and magnetic fields are also reported hazards in several health facilities (Twerefoo & Portia, 2015).  Psychosocial Hazards, such as shift work, violence and stress. Job stress which is one of the key causes of psychological hazards is usually associated with healthcare professionals (Alosaimi et al., 2016)  Ergonomic Hazards 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. According to Twerefoo & Portia (2015), back injuries and back pain are common disorders reported among health workers According to WHO (2006), health-care workers (HCWs) need protection from these workplace hazards yet, because their job is to care for the sick and injured, they are often considered as “immune” to injury or illness. Their patients come first. They are often expected to sacrifice their own well-being for the sake of their patients. Indeed protecting health-care workers has the added benefit to contributing to quality patient care and health system strengthening (WHO, 2006). 2.2 Proportion of Healthcare Workers exposed to occupational hazards Some studies have been conducted into the proportion of healthcare workers who are exposed to different kinds of injuries and occupational hazards in their everyday practices. These studies also report significant proportions of healthcare workers 9 University of Ghana http://ugspace.ug.edu.gh experiencing various forms of injury or hazards (Ndejjo et. al., 2015a). For instance, a study conducted by Portell, Gil, Lossilla & Vives (2014) among Spanish healthcare workers reported that about 47% of them had experienced occupational hazard or injury in the last one year preceding their study. Similar findings have been reported in low income countries, albeit, with higher rates. For instance, a study conducted by Aluko et al. (2016) reported very high rates of occupational hazards and injuries among healthcare workers. Majority of the respondents (89% of 290) indicated that the hospitals where they work exposed them to different kinds of hazardous substances and injuries. 2.3 Category of work or profession In a study by Aderaw (2013), it was reported that certain groups of individuals are at greater risk of exposure to occupational hazards than others because of the nature of their work. Medical, dental, nursing and midwifery workers are at higher risk of occupational exposure to blood borne pathogens via sharp injuries (Aderaw, 2013). Medical assistants faced the highest risk of needle stick injury followed by nurses, doctors and clinical care attendants (Aderaw, 2013). According to the same study, univariate statistical analysis showed no significant difference between exposure group and non-exposure group in terms of age, gender, education and marital status (Aderaw, 2013). Other studies reviewed also showed that the prevalence of occupational exposures are generally highest among house officers, medical officers and nurses, and lowest among consultants and laboratory scientists (Owie & Apanga, 2016; Suarez, Agbonifo, Hittle, Davis & Freeman, 2017). 10 University of Ghana http://ugspace.ug.edu.gh 2.4 Training on Occupational Safety and Health The provision of knowledge of occupational hazards is known to contribute significantly to the prevention of occupational injuries especially among healthcare workers and also limit exposure to hospital acquired infections (Lugah et al., 2010). It is suggested that training of hospital workers should, at least, include a general introduction, workplace instruction, and basics on quality of work, chemicals, and ergonomics (Gestal, J. J., 1987). However, most occupational health training and orientations in Ghana have focused less on the quality of work, chemical exposure and infection preventive measures in hospital settings (Nyarko et al., 2015). According to Annan et al., (2015) there is the need to have a comprehensive manual for OSH standards and practice in the Country with all stakeholders on board. 2.5 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 the hospital setting, the incidence of occupational hazards differ from one department to another (Agbana, Alabi, Joshua, Daikwa, & Metiboba, 2016). A research conducted in Nigeria suggested that occupational injuries were frequent in injections rooms as compared to consulting and counseling rooms (Aluko et al., 2016). 11 University of Ghana http://ugspace.ug.edu.gh 2.6 Knowledge of Occupational Hazards and Safety Practices among Healthcare Workers Plethora of studies has focused on examining knowledge and awareness of occupational hazards and safety measures among healthcare workers (Puplampu & Quartey, 2012). The underlying reason for these groups of studies has been that awareness of occupational hazards and safety measures is fundamental to promoting occupational health and safety among any group of workers (Mitchual, Donkoh & Bih, 2015). This is because for workers to protect themselves, especially against any avoidable injuries and accidents in the workplace, they need to know the causes, risk factors and preventive mechanisms for avoiding these occupational injuries and accidents (Okafoagu, Oche, Awosan, Abdulmulmuni, Gana, Ango & Raji, 2017). The studies report various degrees of awareness among different health workers from different contexts. Some studies have reported high knowledge (Amponsah-Tawiah & Dartey-Baah, 2011), while other studies report low knowledge of occupational hazards and safety measures (Akagbo, Nortey, & Ackumey, 2017). Some systematic reviews of occupational health hazards conducted among studies published on developing countries indicate that knowledge and awareness levels of occupational hazards and safety measures are low compared to those recorded in advanced countries (Akagbo et al., 2017; Nyame-Annan, 2017; Suarez et al., 2017). For instance, a systematic review by Owie and Apanga (2016) among developing countries indicates the need to prioritize knowledge of occupational health in low income countries. They found that the proportion of workers with good knowledge of occupational hazards among the reported studies were low, averaging around 67 – 82% 12 University of Ghana http://ugspace.ug.edu.gh compared to the average of 88 – 95% reported among healthcare workers in developed countries. In Ghana for instance, a review of critical issues in occupational health shows problematic safety practices among workers. Puplampu and Quartey (2012) argued that the concern for the health of workers is lagging behind due to issues of occupational health that are often overlooked. They reviewed different studies on occupational health and safety in Ghana to synthesize evidence from different work contexts in Ghana. They found that inadequate attention has been paid to occupational health and safety practices in Ghana. Their findings indicated that, although some attempts have been made by some institutions, occupational injuries, accidents and occupation-related diseases were still high which calls for more research and policy attention. With regards to health in Ghana, the Ghana Health Service (GHS) commissioned a study by the Occupational and Environmental Health Programme unit in 2010 into issues relating to occupational health and safety among health workers in Ghana. The study reported that healthcare workers work under hazardous conditions detrimental to their health but the staff are not adequately trained in Occupational Health and Safety (OHS) issues. In the Ablekuma sub-metro of Accra namely, Korle Bu Teaching Hospital and Mamprobi Polyclinic one of these studies was carried out among female nurses to determine the occurrence of musculoskeletal diseases. The study revealed that nurses suggest the spine as the body part mostly affected by their work. In order of predominance the specific parts mentioned are lower back (65.4%), neck (63%) and upper back (37%). The interviewed nurses identified lifting of patients (79%); poor working postures (77.2%); stress (68.5%); slips and falls (48.0%); haulage and transport 13 University of Ghana http://ugspace.ug.edu.gh (45.7%) as situations or activities that constitute to hazards in their work place. The study found that 78% of nurses were overweight attributable probably to the sedentary nature associated with their work, and poor eating habits that may be aggravated by shift work. Whilst 43.1% of the respondents were not aware of measures in place to control occupational hazards, as low as between 0.8% to 5.9% of respondents were aware of the measures in place (Ghana Health Service, 2010). In a recent study by Nyame-Annan (2017) among healthcare workers at the Accra Regional Hospital, the author reported positive attitudes of the workers towards occupational health and safety practices. The study involved 246 conveniently selected health workers and data collected through questionnaire. The findings showed that there were high occupational injuries and illness among the workers, despite high knowledge of and positive attitudes towards occupational health and safety practices. These call for the need for further studies to understand the complexities of occupational health and safety within the health contexts in Ghana. 2.7 Socio-demographic factors and Knowledge of Occupational Hazards and Safety A study conducted in South Africa by Osungbemiro et al., (2016) indicated that in relation to socio-demographic determinants that contribute to injuries at a work facility, variables such as age group, sex and work experience showed statistically significant association with occupational injury in the bivariate analysis. However, socio- demographic variables like religion, ethnicity, marital status, educational level, employment condition, and monthly salary did not show any significant association with occupational injury. Only sex and age remained significant in a multivariate model. 14 University of Ghana http://ugspace.ug.edu.gh Bekele, Gebremariam, Kaso, & Ahmedalso, (2015) showed that the distribution of undergraduate nursing students according to their socio-demographic characteristics indicated the following; with regard to age, it was recorded that the highest percentage of the nursing students (60.6%) were in the age group (20-21) years old. In relation to year of training, it was noticed that (54.54%) of the sample were third year applied medical science students whereas (45.45%) were from second and third year at faculty of health science. In addition, it was also observed that all students (100%) did not have training about occupational hazards, 54.4 % of them did not have any training about infection control measures, while more than three quarters of them did not have any needle stick and sharp injuries previously. Other important causes of occupational injuries are high workload, working hastily, fatigue and a crowded work environment, performing some activities as two-handed recapping, unsafe sample collection, disposal of sharps waste and washing contaminated instruments (El-hay, 2015). 2.8 Summary The studies reviewed show that occupational health and safety research in developing countries in general is pretty low. The healthcare setting has been shown to be characterised by high levels of occupational hazards that compromise health and safety of health workers. Research on knowledge and awareness of occupational hazards and safety measures has produced inconsistent findings. Even among studies that report high knowledge, they also report high occupation-related injuries and sickness among health workers. 15 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 3.0 Introduction This chapter describes the study design, the study population, the sampling method, the sample size, variables of the study, data collection tool, data management and analysis and ethical considerations that were used for the study. 3.1 Study Design A descriptive cross-sectional study was conducted and data collected on the determinants of awareness of occupational hazards and safety practices among staff of the Ghana Police Hospital, Accra. 3.2 Study Area The study was conducted at the Ghana Police Hospital (GPH), within the La- 0 Dadekotopon district of the Greater Accra Region of Ghana. It is located on 5 35‟10”N, 0 0 10‟ 35“W at the intersection of the Ring Road East and Osu-Re road at the Danquah Circle. The Hospital was established in 1976 with the primary function of providing quality health care to the members of the Ghana Police Service and their families but currently its services are open to the general public. The staff strength is 416, comprising clinical and non-clinical professionals. The clinical professionals include medical doctors, nurses, pharmacists, laboratory scientists and 16 University of Ghana http://ugspace.ug.edu.gh health assistants. The non-clinical professionals include administrators, cleaners/ orderlies and engineers/ technicians. The GPH has several departments including the Central Administration, Surgical, Medical, Paediatrics, Obstetrics and Gynaecology, Anaesthesia, Records, Pharmacy, Accident and Emergency, Public Health, Laboratory, Radiology, Pathology, and Security. 3.3 Inclusion Criteria All clinical care workers and non-clinical workers whose task in the hospital brings them into direct contact with patients who are on admission. They comprised medical doctors, nurses, laboratory scientists, health assistants and pharmacists on the one hand, and cleaners/ orderlies, administrative and technical workers on the other. 3.4 Exclusion Criteria Auxiliary workers who are on contract, whose day to day activities do not bring them into direct contact with patients on admission at the hospital but are called in on adhoc basis were exempted from the study. 3.5 Sample Size Determination For a Descriptive Study whose outcome variable is a measurement/ continuous variable (mean score of level of knowledge) the sample size was estimated using the following formula: 2 2 2 2 2 n = {4 x (z1-a/2) x S } / W = {4x1.96 x0.36}/0.1 where: 17 University of Ghana http://ugspace.ug.edu.gh n – sample size Z1-a/2 – standard normal variate at 5% type 1 error S – the standard deviation of the outcome variable based on previous study W – the width of the confidence interval (equal to twice the “margin of error”) It was computed based on a percentage mean score of 50 with a standard deviation of 0.36 prevalence of average awareness level of occupational hazards among healthcare workers as reported in a similar study by Akagbo et al., 2017. This gave an approximation of 199 clinical care workers and a 10% allowance for non-responsive participants as was reported in a similar study by Aderaw et al. (2011). 3.6 Sampling Method A Stratified Random Sampling (Proportionate Stratified Sampling) technique was used for the study. A sample frame (N) of 416 workers was identified and categorized into various strata using profession as the select criterion. These strata of HCWs included; the Medical Doctors, Nurses/ Midwives, Laboratory Scientists, Pharmacists, Administrators, Nurse Assistants and Orderlies. Using the staff list each member of the various strata was serially numbered. With a sample size (n) of 216, each stratum was multiplied by a sampling fraction (n/N) of 216/416 to determine, by proportionate to size, the number of respondents from each stratum. By simple random sampling technique and with the aid of a random number generator respondents were selected from each stratum. 18 University of Ghana http://ugspace.ug.edu.gh 3.7 Data Collection Tool A structured questionnaire was used to collect the data since the participants can read and write on their own. This instrument was constructed in English language using close ended questions. The questions were constructed to reflect the variables under study. The questionnaire was a 63- item questionnaire divided into four sections: Section I consisted of 7 questions which elicited information on the socio-demographic characteristics of the participants. Section II consisted of 28 questions that elicited information on knowledge of hazards in the workplace. Section III comprised 16 questions which elicited information on awareness of the various health and safety measures available in the work environment. Section IV consisted of 12 questions on factors that contributed to knowledge of OHSP. The reliability assessment of the developed survey in this study was implemented by calculating the value of the internal consistency reliability coefficient (Cronbach‟s alpha reliability coefficient). A conventional benchmark value of Cronbach‟s α value of ≥0.7 which is commonly used to indicate that relatively most of the items measure the same construct was scored with likert scale and composite variables were identified and defined. 3.8 Limitation of the Study Perhaps, the most important limitation of this study was the self-reported nature of the data that was collected. This study is a facility-based study and only relied on report by the participants. This may lead to reporting bias because of the possibility of reporting behaviours that are socially desirable. To help reduce the occurrence of this bias, participants were assured of strict confidentiality to the data collected and that their 19 University of Ghana http://ugspace.ug.edu.gh anonymity were guaranteed and there were no names on the questionnaire and therefore participants should be open in their responses. Participants were also informed that the research is a pure academic exercise intended to contribute towards improvement of healthcare delivery services, and to minimize occupational injury, accident and disease among workers but not to indict on individual shortcomings. Lastly, to minimize bias each participant spent a maximum of 30 minutes in answering the questionnaire. 3.9 Definition of Variables of the Study This section discusses the variables in the study; mainly the dependent variable and the independent variables. Dependent Variable The dependent variable for the study is Knowledge of Occupational Hazards and Safety Practices among Health workers. Occupational hazard was operationalized in five domains; biological hazards, chemical hazards, physical hazards, psychosocial hazards and ergonomic hazards. Safety measures were operationalized in three domains; employer control measures, individual protective measures and institutional culture and practices. 20 University of Ghana http://ugspace.ug.edu.gh Independent Variables The independent variables in the study were factors that influence knowledge of occupational hazards and safety measures. These were mainly socio-demographic factors and institutional factors. The socio-demographic factors were sex, age, marital status, educational level, income level and profession. The institutional factors included hospital‟s provision of personal protective equipment (PPEs), presence of occupational health and safety department, occupational health policy, standards of operations or guidelines, training and retraining schedules in occupational health trainings, monitoring, inspection and evaluation, sources of occupational health information, use of protocols at work. 3.10 Knowledge of occupational hazards and safety practices The comparative mean scores of the five occupational hazards were determined to measure the level of knowledge and based on that, high awareness is decided using a percentage cut off of ≥ 90% (owing to the educational background of the respondents and the dangers and incidence associated with occupational hazards, especially in the health sector). Their responses within each of the hazards are analysed. After that, the awareness levels of all the five kinds of hazards are compared. 21 University of Ghana http://ugspace.ug.edu.gh 3.11 Data Management and Analysis The data collected was edited manually to correct any duplications and wrong entries. The edited data was then coded and statistically analyzed using Stata software version 15. Basic descriptive statistics were run and the results were presented using Tables depicting frequencies, percentages, and proportions. The relationship between variables was further analysed using multivariate analysis of co-variance (MANCOVA). Socio-demographic characteristics of the participants were described using descriptive statistics of mean, standard deviation and percentages. Level of exposure of Occupational risks and hazards, knowledge of occupational health and safety practice and safety precautionary measures as well as use of personal protective equipment among workers are summarized as frequencies and percentages. MANCOVA was used to test the differences in level of awareness of occupational hazards based on different socio- demographic characteristics. Statistical level of significance was set at p ≤ 0.05. 3.12 Quality control The questionnaire used was made brief to ensure easy understanding. Two Research Assistants (two of them) were recruited, and upon training, were supervised to administer the questionnaire effectively. The questionnaire was pretested at the La General Hospital due to its proximate characteristics with that of the Police Hospital in order to check for consistency of variables. Errors in the questionnaire were identified and corrected. Daily cross checking of data collected on each respondent was done to ensure complete and appropriate filling of questionnaires and accurate capturing of all information. 22 University of Ghana http://ugspace.ug.edu.gh 3.13 Training of research assistants Prior to the start of field work, a day training session for the two research assistants was organized by the principal investigator in order to equip them with the required skills needed to assist in the study. The responsibilities of these research assistants were spelt out to them during the training sessions, including a discussion of the purpose of the study, ethical issues and administration of questionnaires. 3.14 Ethical Consideration Ethical approval was sought from the Ghana Health Service Ethics Review Committee before the commencement of the study. Permission was sought from the Medical Director, the departmental heads as well as the officers‟ in-charge of the various units of the Ghana Police Hospital. Informed consent was sought from the participants after the objectives of the study were explained to them. Participants who consented to participate in the study were made to sign the consent form before they responded to the items on the questionnaire. The questionnaire was administered to respondents in an environment that was devoid of intimidation and ensured privacy. Participants were also made to understand that participation in the study was voluntary and that they had the right to withdraw at any time during the study at no cost. Confidentiality of data collected was ensured by using identifiers rather than names of participants and the participants were assured that the data collected would be used for academic purposes only. The information collected was stored in an electronic format on different personal computers and as hard copies which were kept under lock and key in fire-proof cabinets. 23 University of Ghana http://ugspace.ug.edu.gh Apart from those involved in this study such as the research assistants and supervisors, no other party was given access to the data collected from participants without the consent of the participants. The study involved only the administration of questionnaire with minimal risks to the participants. These minimal risks included the time spent in answering the questions and some personal questions such as „how old they are‟ which they may feel uncomfortable in answering. There was no compensation package to the participants. The questionnaire was self-administered and did not last for more than 30 minutes. Participants in the study did not receive any material benefits from the study and this was communicated to them before the commencement of the study. 3.15 Access to study area Permission was sought from the Management of the Ghana Police Hospital before commencement of the study. Copies of the ethical clearance letter from the Ghana Health Service Ethical Review Committee were also sent to the authorities of the hospital. A copy of the proposal and final dissertation would be submitted to the Hospital Management to enable them disseminate information about the study. 3.16 Privacy, confidentiality and anonymity Coding for the questionnaires was done and respondents names were excluded from the filling of each of the questionnaires. Privacy was ensured during the interview of individual respondents. Participants‟ names were also excluded from the report of the 24 University of Ghana http://ugspace.ug.edu.gh study and information gathered on participants was kept strictly confidential between the study participants and the researcher. This was achieved by storing data in a password secured format known only to the researcher and the questionnaire under lock and key. 3.17 Compensation Study participants were duly informed that there would be no compensation for participating in the study before they offered themselves to take part in the study. 3.18 Risk and benefits Study respondents used between fifteen (15) and twenty (20) minutes of their time in answering the questionnaires. Apart from that, there was neither liability nor direct benefit for the study participation. However, the outcome of the study was expected to contribute to the formulation of policies intended to improve upon health services delivery which would in turn benefit them in the future. 3.19 Voluntary withdrawal Participants were informed of the option of voluntary withdrawal from the study at any point in time without the risk of real or potential problem between the researcher and the participant. If a participant withdrew, his/ her data collected by then would immediately be deleted. Participants reserved the unfettered right not to answer any individual or all the questions. 25 University of Ghana http://ugspace.ug.edu.gh 3.20 Consenting process After explaining the objectives of the study to each respondent separately, each one was then required to indicate their desire to participate in the study. This was ratified by making each one to sign a written consent form before they participated in the study. 3.21 Data storage and usage Electronic media secured with passwords and kept in safely locked boxes was used to store the data and was used strictly for the purpose of research. Anonymity was ensured in dissemination of findings from this study since participants were not identified by their names. 3.22 Declaration of conflict of interest As the principal investigator, the researcher declares no conflict of interest in this study. 3.23 Funding of the study This study is in partial fulfilment of requirements for the award of a Master of Public Health (MPH) degree at the School of Public Health, College of Health Sciences, University of Ghana, Legon and was solely funded by the researcher. 26 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR RESULTS 4.1 Introduction The current study examined knowledge of occupational hazards and safety practices available for mitigating the occurrence of occupational accidents, injury and disease among healthcare workers at the Ghana Police Hospital. This chapter presents analysis of the results and findings. For the purposes of clarity, the chapter is presented as follows. The socio-demographic characteristics of the participants are presented first. This is followed by knowledge of occupational hazards that participants were exposed to in the course of work. After that, factors that contributed to their level of knowledge are presented. Lastly, the health and safety practices that participants adopted to reduce exposure to occupational hazards are then presented. 4.2 Socio-demographic Profile of Participants Table 4.1 below summarizes the socio-demographic profile of the 216 individuals who participated in the study. The age range of the participants was between 20 and 50+ years with majority (44.9%) falling within the age of 30 – 39 years. Majority (63%) of them were females and most (69.9%) reported their marital status as married, 29.2% of them were single and never married, with the rest (0.9%) being divorced. Their educational level ranged from secondary education to first degree. 27 University of Ghana http://ugspace.ug.edu.gh Relative to the level of education, the majority of the participants (42.2%) had university degree while diploma in education attracted the least (19%) number of participants. Furthermore, more than half (52.8%) were non-police personnel. Table 4. 1: Socio-demographic Profile of Participants Characteristics Frequency(N) Percentage (%) Age 20 - 29 years 45 20.8 30 - 39 years 97 44.9 40 - 49 years 36 16.7 50+ years 38 17.6 Sex Male 80 37.0 Female 136 63.0 Marital Status Married 151 69.9 Single, never married 63 29.2 Divorced 2 0.9 Level of Education Secondary 73 33.8 Diploma 41 19.0 Degree 102 42.2 Employment Category Police Personnel 102 47.2 Non-Police Personnel 114 52.8 Income Level below 1000ghc 83 38.4 1000 - 3000ghc 58 26.9 3000 - 5000ghc 69 31.9 above 5000ghc 6 2.8 Profession Administrative Staff 14 6.5 Medical Doctors 18 8.3 Medical Lab Scientists 10 4.6 Nurses/Midwives 71 32.9 Pharmacists 14 6.5 Orderlies 40 18.5 Ward Assistants 49 22.7 28 University of Ghana http://ugspace.ug.edu.gh On income levels, the majority (38.4%) of the participants earn below GH¢1000 per month, 31.9% earn between GH¢3000 – GH¢5000 while the minority (2.8%) earn above GH¢50000 per month. Finally, in terms of job category (professional) the majority (32.9%) were nurses/midwives and the minority (4.6%) were the medical laboratory scientists. 4.3 Level of knowledge of Occupational Hazards of HCWs 4.3.1 Knowledge of Biological Hazards Table 4.2 summarizes the level of knowledge of biological hazards among the participants. The findings showed that participants generally had high knowledge of biological hazards. Nonetheless, their levels of knowledge of different biological hazards were varied. For instance, all of them were aware of infection from patients (100%), followed by knowledge of airborne diseases (97.2%) and cuts and wounds/ injuries (91.2%). Their levels of knowledge of other biological hazards, although were below 90% were high. They include blood borne pathogens (84.7%) and direct contact with contaminated specimen (73.1%). 29 University of Ghana http://ugspace.ug.edu.gh Table 4. 2: Participants' Knowledge of Biological Hazards Biological Hazards Yes Not Sure No n(%) n(%) n(%) Infection from patients 216 (100.0) - - Cuts and wound/ injuries 197 (91.2) 19 (8.8) - Airborne disease 210 (97.2) 6 (2.8) - Direct contact with contaminated 158 (73.1) 35 (16.2) 23 (10.6) specimen Others (Blood borne pathogens) 183 (84.7) 33 (15.3) - 4.3.2 Knowledge of Physical Hazards Table 4.3 below, summarizes the level of knowledge of physical hazards among the participants. The findings showed that the participants had very low awareness of physical hazards. Using the 90% cut off point, even the two indicators of physical hazards that participants had highest knowledge of were below 90%; broken bottles injuries (83.8%) and faulty electrical wiring (75%). All the other indicators recorded very low percentage of awareness; ranging from 46.8% (extreme temperature) to poor ventilation (71.3%). 30 University of Ghana http://ugspace.ug.edu.gh Table 4. 3: Participants' knowledge of Physical Hazards Physical Hazards Yes Not Sure No n(%) n(%) n(%) Extremes of temperature, (cold/heat) 101 (46.8) 71 (32.9) 44 (20.4) Poor lighting affecting vision, 113 (52.3) 65 (30.1) 38 (17.6) Poor ventilation 154 (71.3) 29 (13.4) 33 (15.3) Radiation, 105 (48.6) 80 (37.0) 31 (14.4) Faulty electrical wiring 164 (75.0) 25 (11.6) 29 (13.4) Noise, 111 (51.4) 69 (31.9) 36 (16.7) Explosions from pressurized containers 105 (48.6) 52 (24.1) 59 (27.3) Wet floors 143 (66.2) 25 (11.6) 48 (22.2) Lancets, broken bottles injuries 181 (83.8) 27 (12.5) 8 (3.7) 4.3.3 Knowledge of Ergonomic Hazards The levels of knowledge of ergonomic hazards are provided in Table 4.4 below. Findings showed that knowledge of ergonomic hazards was relatively low among the participants. None of the indicators of ergonomic hazards crossed the 90% cut off mark. The highest level of indicator was standing for prolonged periods (83.3%), followed by manual lifting of patients (81.5%), poor work posture (77.8%) and the lowest was repetitive or monotonous work (42.6%). 31 University of Ghana http://ugspace.ug.edu.gh Table 4. 4: Participants' Knowledge of Ergonomic Hazards Ergonomic Hazards Yes Not Sure No n(%) n (%) n(%) Manual lifting of patients 176 (81.5) 37 (17.1) 3 (1.4) poor work posture 168 (77.8) 25 (11.6) 23 (10.6) Repetitive or monotonous work 92 (42.6) 62 (28.7) 54 (25.0) Standing for prolonged periods. 181 (83.8) 35 (16.2) - 4.3.4 Knowledge of Chemical Hazards Table 4.5 below, summarizes the level of knowledge of chemical hazards among the participants. Findings showed that participants‟ knowledge of chemical hazards is extremely low. Awareness of chemical hazards was cleaning detergents (61.1%), followed by drugs (52.3%), alcohols (51.4%), corrosive chemical such as acids (49.1%) and reagents (46.8%). Table 4. 5: Participants' Knowledge of Chemical Hazards Chemical Hazards Yes Not Sure No n(%) n(%) n(%) Cleaning detergents, 132 (61.1) 56 (25.9) 28 (13.0) Reagents (used in laboratory and other 101 (46.8) 75 (34.7) 40 (18.5) areas) Anaesthetic gases, Alcohols 111 (51.4) 58 (26.9) 47 (21.8) Corrosive chemicals such as acids 106 (49.1) 70 (32.4) 40 (18.5) Drugs 113 (52.3) 51 (23.6) 52 (24.1) 32 University of Ghana http://ugspace.ug.edu.gh 4.3.5 Knowledge of Psychosocial Hazards Knowledge of psychosocial hazards by the participants is provided in Table 4.6. Knowledge levels among the participants were also relatively low. Nonetheless, there was a high knowledge of stress as a psychosocial hazard (96.3%) among the participants. All the rest of the indicators recorded awareness levels less than the 90% cut off point; verbal and physical harassment (80.1%), excessive workload (79.6%), organizational lapses (64.8%) and poor interpersonal relationships (61.6%). Table 4. 6: Participants' Knowledge of Psychosocial Hazards Psychosocial Hazards Yes Not Sure No N (%) N (%) N (%) Stress 208 (96.3) 8 (3.7) - Excessive workload 172 (79.6) 29 (13.4) 15 (6.9) Verbal and physical harassment 173 (80.1) 28 (13.0) 15 (6.9) Work organization lapses such as 140 (64.8) 33 (15.3) 43 (19.9) overlapping roles and procedures, Poor interpersonal relationships 133 (61.6) 64 (29.6) 19 (8.8) 4.3.6 Comparing Various Domains of Occupational Hazards After assessing the indicators of each of the occupational hazards, all the five occupational hazards were then compared among the participants. The comparison was done using the mean scores of each of the hazards, mean scores closer to 2 indicating higher knowledge. The results are provided in Table 4.7. 33 University of Ghana http://ugspace.ug.edu.gh The findings showed that biological hazards recorded the highest mean score (M = 1.87, SD = 0.22) crossing the cut off percentage mean score of 90%, followed by psychosocial hazards (M = 1.68, SD = 0.44), ergonomic hazards (M = 1.64, SD = 0.36), physical hazards (M = 1.44, SD = 0.45) and then chemical hazards (M = 1.33, SD = 0.45). Table 4. 7: Comparison of Awareness of Various Occupational Hazards Occupational Hazards N Min. Max. Mean SD mean score (%) Biological Hazard 216 1.20 2.00 1.87 .22 93.5 Psychosocial Hazard 216 .40 2.00 1.68 .44 84 Ergonomic Hazard 216 .75 2.00 1.64 .36 82 Physical Hazard 216 .56 2.00 1.44 .45 72 Chemical Hazard 216 .20 2.00 1.33 .45 66.5 Mean Score of knowledge of various Domains of Occupational Hazards 1.87 1.68 1.64 1.44 1.33 Biological Psychosocial Ergonomic Physical Hazard Chemical Hazard Hazard Hazard Hazard Occupational Hazards Figure 2: Bar Graph showing Knowledge of Occupational Hazards 34 University of Ghana http://ugspace.ug.edu.gh 4.3.7 Knowledge of Occupational Hazards by Strata The sample frame was a heterogeneous one and so knowledge of occupational hazards was estimated by stratification based on profession. Table 4.8 summarizes the level of knowledge of occupational hazards according to profession. The findings show that high levels of knowledge of occupational hazards were recorded by majority (90%) of medical lab scientists, medical doctors (88.9%) and pharmacists (85.7%). Majority (90.1%) of Nurses/midwives, orderlies (75%) and ward assistants (63.3%) recorded average levels of knowledge. Lastly, majority (57.1%) of administrative staff recorded low levels of knowledge of occupational hazards. Table 4. 8: Knowledge Levels Stratified by Professions Knowledge of Occupational Hazards Low Knowledge Average Knowledge High Knowledge Profession n(%) n(%) n(%) Administrative Staff 8 (57.1) 6(42.9) - Medical Doctors - 2(11.1) 14 (88.9) Medical Lab Scientists - 1(10.0) 9(90.0) Nurses/Midwives 7(9.9) 64 (90.1) - Pharmacists - 2(14.3) 12 (85.7) Orderlies 10 (25.0) 30 (75.0) - Ward Assistants 18 (36.7) 31 (63.3) - Total 43 (19.9) 136 (63.0) 37 (17.1) 35 University of Ghana http://ugspace.ug.edu.gh 4.4 Factors Influencing Level of Awareness of OHSP The second objective of the study assessed the factors that influence level of knowledge and awareness of occupational hazards and safety practices. The factors are divided into two. The first group of factors looks at how individual-level demographic factors affect knowledge and awareness of occupational hazards. The next group looks at how institutional-level factors affect awareness of occupational hazards and safety practices. 4.4.1 Demographic Factors Affecting Level of Awareness of Occupational Hazards and Safety Practices (OHSP) Table 4.9 below summarizes the association of demographic characteristics of participants with knowledge of occupational hazards as determined by Multivariate Analysis of Variance (MANOVA) The demographic characteristics that had significant effect on knowledge of occupational hazards were sex, age, education, income and profession. Sex had significant effect on knowledge of ergonomic hazards (F = 19.414, p < .001) and chemical hazards (F = 6.180, p < .05). Specifically, male workers had higher knowledge of both ergonomic and chemical hazards than female workers. Profession also had significant effect on knowledge of chemical hazards (F = 11.348, p < .001), ergonomic hazards (F = 4.00, p < .01) and psychosocial hazards (F = 2.041, p < .05). Specifically, medical lab scientists, pharmacists and medical doctors had higher knowledge of the three hazards than the others. Educational level affected knowledge of biological hazards (F = 5.406, p < .01), chemical hazards (F = 45.14, p < .001) and psychosocial hazards (5.699, p < .01). Specifically, 36 University of Ghana http://ugspace.ug.edu.gh participants with higher education (degree) recorded higher awareness of both chemical hazards and psychosocial hazards. Table 4. 9: Multivariate Analysis of Demographic Factors & Knowledge of Occupational hazards Occupational Type III Source df MS F p Hazards SS Biological Hazard .143 3 .048 1.053 .371 Physical Hazard .126 3 .042 .341 .796 Ergonomic Age 2.827 3 .942 16.691 .000 Hazard*** Chemical Hazard .207 3 .069 1.054 .370 Psychosocial 1.872 3 .624 5.260 .002 Hazard** Biological Hazard .007 1 .007 .165 .685 Physical Hazard .019 1 .019 .156 .693 Sex Ergonomic Hazard .001 1 .001 .017 .897 Chemical Hazard .216 1 .216 3.299 .071 Psychosocial Hazard .005 1 .005 .041 .840 Biological Hazard .017 1 .017 .371 .543 Physical Hazard .242 1 .242 1.969 .162 Marital Ergonomic Hazard .208 1 .208 3.692 .056 Chemical Hazard .005 1 .005 .072 .789 Psychosocial Hazard .010 1 .010 .088 .767 37 University of Ghana http://ugspace.ug.edu.gh Table 4. 10: Multivariate Analysis of Socioeconomic Factors & Knowledge of Occupational hazards Source Occupational Hazards Type III SS df MS F p Biological Hazard** .488 2 .244 5.406 .005 Physical Hazard .113 2 .056 .459 .633 Education Ergonomic Hazard .116 2 .058 1.027 .360 Chemical Hazard*** 5.898 2 2.949 45.140 .000 Psychosocial Hazard** 1.352 2 .676 5.699 .004 Biological Hazard .019 1 .019 .156 .693 Physical Hazard .001 1 .001 .017 .897 Employment Ergonomic Hazard .242 1 .242 1.969 .162 Chemical Hazard .208 1 .208 3.692 .056 Psychosocial Hazard .207 3 .069 1.054 .370 Biological Hazard .008 1 .008 .179 .673 Physical Hazard .358 1 .358 2.912 .090 Income Ergonomic Hazard .129 1 .129 2.286 .132 Chemical Hazard .069 1 .069 1.062 .304 Psychosocial Hazard* .743 1 .743 6.265 .013 Biological Hazard .261 4 .065 1.445 .221 Physical Hazard .810 4 .202 1.645 .165 Profession Ergonomic Hazard .543 4 .136 2.404 .052 Chemical Hazard*** 6.500 4 1.625 24.873 .000 Psychosocial Hazard .951 4 .238 2.005 .096 38 University of Ghana http://ugspace.ug.edu.gh Age affected knowledge of ergonomic hazards (F = 16.691, p < .001) and psychosocial hazards (F = 5.26, p < .01). Specifically, older workers reported higher awareness of ergonomic and psychosocial hazards compared to younger workers. Income level also affected psychosocial hazards (F = 6.265, p < .05). Specifically, participants with higher income levels had higher awareness of psychosocial hazards compared to low income earners. 4.4.2 Institutional Factors affecting Knowledge of Occupational Hazards and Safety Practices This section presents findings on how institutional factors influence knowledge of occupational hazards and safety practices. Participants were asked to indicate the extent to which institutional factors within the hospital where they work affect the occupational hazards and safety practices within which they work. The findings are provided on Tables 4.11 to 4.13. As shown in the Table majority of the participants indicated that they are required by the hospital to put on protective clothes (82.4%). However, more than half of the participants (50.9%) indicated that the hospital does not provide personal protective equipment. Majority of them (68.5%) indicated the hospital does not have a safety department or committee. Only a little over half of them (58.8%) indicated that the unit where they work has a copy of the written policies on occupational health and safety policy of the hospital. Almost all the participants are either not sure (10.2%) or said that there are no available SOPs for their work (89.8%). Majority of them also were either not sure 39 University of Ghana http://ugspace.ug.edu.gh (34.7%) or said their professional associations do not organize training sessions on occupational health (29.6%). Table 4. 11: Factors Contributing to Knowledge of Occupational Hazards and Safety Practices Characteristics Yes n (%) Not Sure No n (%) n (%) Does the hospital provide PPEs for your tasks? 106 (49.1) - 110 (50.9) If yes, is it easily accessible? 57 (26.4) - 159 (73.6) Are staff required to put on protective clothing 178 (82.4) - 38 (17.6) in the performance of their duties? Does the hospital have a safety 68 (31.5) - 148 (68.5) dept./unit/committee? If yes, is the unit run by trained personnel in 51 (23.6) 50 (23.1) 115 (53.2) occupational health and safety? Do you or your department or unit have a 127 (58.8) 34 (15.7) 55 (25.5) written copy of occupational health and safety policy of the hospital? Are there available SOPs/guidelines for your - 22 (10.2) 194 (89.8) work? Does your professional association organize 77 (35.6) 75 (34.7) 64 (29.6) continuous professional development sessions on occupational safety and health 40 University of Ghana http://ugspace.ug.edu.gh Their responses to training and monitoring are provided on Table 4.12. The participants indicated that there are no definite or fixed time for training staff on occupational health and safety practices (68.5%) and monitoring, inspection and evaluation (71.8%). Table 4. 12: Periods for training and monitoring None No definite Annually Biannually Quarterly n (%) time fixed n (%) n (%) n (%) n (%) How regular is training 35 (16.2) 148 (68.5) 33 (15.3%) - - organized for staff on occupational health and safety? How often is 23 (10.6) 155 (71.8) - 8 (3.7) 30 (13.9) monitoring, inspection and evaluation conducted? 4.4.3 Knowledge of Safety Practices Available The final objective of the study examined the level of knowledge of the participants concerning safety practices adopted to reduce exposure to occupational hazards and improving occupational health and safety. The safety practices were examined at three levels; employer-provided control practices, individual-level protective practices and institutional culture and practices. 41 University of Ghana http://ugspace.ug.edu.gh 4.4.4 Knowledge of control practices provided by employers This section presents findings on the knowledge of control practices provided by the employers to ensuring occupational health and safety in their work contexts. The responses are provided on Table 4.13. The findings show that there is relatively higher knowledge of control practices provided by the employer. For instance, majority of the participants indicated their awareness that there is safety and training on all universal precautions (90.7%), training on how to wash hands (90.7%), separate areas of containers for disposing waste (86.1%) personal protective equipment (83.3%). Table 4. 13: Control practices provided by employers Control practices provided by employers Yes n (%) Not Sure No n (%) n (%) Safety education and training on all universal 196 (90.7) 8 (3.7) 4 (1.9) precautions Training on all machinery and equipment used 150 (69.4) 41 (19.0) 25 (11.6) Training on how to wash hands 196 (90.7) 6 (2.8) 14 (6.5) Personal set of personal protective equipment 180 (83.3) 13 (6.0) 23 (106) Separate areas and containers to dispose 186 (86.1) 17 (7.9) 13 (6.0) medical waste 42 University of Ghana http://ugspace.ug.edu.gh 4.4.5 Knowledge of Individual Protective Practices The findings on the knowledge of Individual Protective practices for preventing occupational injuries and hazards are provided on Table 4.14 The findings showed that knowledge of individual protective practices was high. For instance, majority of the participants have had Hepatitis B vaccination (88.4%), Hepatitis A vaccination (79.6%), BCG vaccination (76.9%) and few having provision of post- exposure prophylaxis (67.6%). Table 4. 14: Individual protective measures Individual protective measures Yes n (%) Not Sure No n (%) n (%) BCG vaccination 166 (76.9) 9 (4.2) 41 (19.0) Hepatitis A vaccination 172 (79.6) 12 (5.6) 32 (14.8) Hepatitis B vaccination 191 (88.4) 5 (2.3) 20 (9.3) Provision of post-exposure prophylaxis 146 (67.6) 50 (23.1) 20 (9.3) 4.4.6 Knowledge of Institutional Culture and Practice This section presents results of the participants‟ knowledge of institutional culture and practices regarding occupational health and safety within the hospital. The knowledge of institutional culture and practices are provided in Table 4.15. Findings show that the participants had limited knowledge of institutional culture and practices on occupational health. The few domains where participants recorded high 43 University of Ghana http://ugspace.ug.edu.gh knowledge were: pre-employment medical screening (82.9%), use of protocols (81.1%) and clinical care and safety training (80.1%). All the other domains recorded lower level of knowledge; presence of safety guidelines on walls (74.5%), accessible dustbins (73.1%), avenues for reporting injuries (57.4%) and training on management of injuries (51.4%). Table 4. 15: Institutional culture and practice Institutional culture and practice Yes Not Sure No n (%) n (%) n (%) Training on Management of injuries 111 (51.4) 74 (34.3) 31 (14.4) Avenue for reporting of injuries 124 (57.4) 37 (17.1) 55 (25.5) Use of protocols 175 (81.0) 21 (9.7) 20 (9.3) Availability and accessibility of dustbins 158 (73.1) 17 (7.9) 41 (19.0) Presence of safety guidelines on walls of 161 (74.5) 34 (15.7) 21 (9.7) the wards Clinical care and safety training 173 (80.1) 30 (13.9) 13 (6.0) Pre-employment medical screening 179 (82.9) 29 (13.4) - 4.4.7 Comparison of Knowledge of Safety Practices Knowledge of the three levels (i.e. employer-provided control practices, individual-level protective practices and institutional culture and practices) were compared to assess their relative standing. The results are provided on Table 4.16 44 University of Ghana http://ugspace.ug.edu.gh Knowledge of employer control practices had higher mean scores (M = 1.92, SD = 0.89), followed by knowledge of individual protective practices (M = 1.65, SD = 0.59) and then knowledge of institutional culture and practices (M = 1.59, SD = 0.39). Table 4. 16: Comparison of Safety Practices Knowledge of: N Min. Max. Mean SD %mean score Employer Control Practices 216 .60 2.00 1.92 .89 96 Individual Protective Practices 216 .00 2.00 1.65 .59 82.5 Institutional Culture and Practices 216 .57 2.00 1.59 .39 79.2 4.5 Socio-demographic Factors Affecting Knowledge of Safety Practices This section presents results on the socio-demographic factors that affect knowledge of the three different safety practices among the participants. The socio-demographic factors examined here also included age, sex, educational level, marital status, income level and profession. A multivariate Analysis of Variance (MANOVA) was run to assess how demographic factors influence knowledge of safety measures. The findings are provided on Table 4.17. The findings showed that socio-demographic factors that had significant effect on knowledge of safety measures included age, sex, education, income and profession. The factors that had effect on knowledge of individual protective practices were age (F = 8.692, p < .001), sex (F = 5.26, p < .01), education (F = 18.232, p < .001) and profession (F = 24.873, p < .001). 45 University of Ghana http://ugspace.ug.edu.gh Table 4. 17: Multivariate Analysis of Demographic Factors Affecting Knowledge of Safety Practices Type Source Knowledge of Safety Measures III df MS F p SS Employer Provided Safety .207 3 .069 1.054 .370 Measures Age Individual Protective Practices** .208 1 .208 8.692 .006 Institutional Culture and Practices .207 3 .069 1.054 .370 Employer Provided Safety .007 1 .007 .165 .685 Measures Sex Individual Protective Practices** 1.872 3 .624 5.260 .002 Institutional Culture and Practices .001 1 .001 .017 .897 Employer Provided Safety .017 1 .017 .371 .543 Marital Measures status Individual Protective Practices .242 1 .242 1.969 .162 Institutional Culture and Practices .208 1 .208 3.692 .056 Employer Provided Safety .488 2 .244 5.406 .005 Measures Education Individual Protective Practices*** 5.112 2 4.232 18.232 .000 level Institutional Culture and 1.456 2 .546 7.982 .006 Practices** Employer Provided Safety .019 1 .019 .156 .693 Employment Measures category Individual Protective Practices .001 1 .001 .017 .897 Institutional Culture and Practices .242 1 .242 1.969 .162 Employer Provided Safety .008 1 .008 .179 .673 Income Measures level Individual Protective Practices .358 1 .358 2.912 .090 Institutional Culture and Practices .129 1 .129 2.286 .132 Employer Provided Safety .261 4 .065 1.445 .221 Measures Profession Individual Protective Practices*** 6.500 4 1.625 24.873 .000 Institutional Culture and Practices .543 4 .136 2.404 .052 46 University of Ghana http://ugspace.ug.edu.gh The factors that had effect on knowledge of institutional culture and practices were sex (F = 43.165, p < .001), education (F = 5.406, p < .01) and profession (F = 5.445, p < .01). The only factor that had effect on knowledge of employee provided safety measures was education (F = 7.982, p < .001). 4.6 Effect of safety measures on knowledge of Occupational Hazards The effect of the three safety measures (employer control practices, individual protective practices and institutional cultural practices) on knowledge of occupational hazards was examined. A linear score was computed for the five occupational hazards (biological, chemical, physical, psychosocial and ergonomic) to obtain knowledge of occupational hazards variable, which was used as a criterion or dependent variable. The three safety measures were used as predictors. Multiple linear regressions were used to estimate the effect of the three safety measures on knowledge of occupational hazards. The results are summarized on Table 4.18. Findings showed that the model was significant F (3,212) = 65.089, p < .001). The three 2 safety measures together accounted for 47.9% variance (R = .479) in knowledge of occupational hazards. Each of the three safety measures were then examined for their unique effect on knowledge of occupational hazards. All the three safety measures had significant unique effect on knowledge of occupational hazards. Specifically, individual protective measures had the highest effect (β = .561, t = 7.933, p < .001), such that a unit increase in individual protective measure is associated with .561 standard deviation increase in knowledge of occupational hazards. This was followed by institutional culture and practices (β = .190, t = 2.759, p < .01), such that a unit increase 47 University of Ghana http://ugspace.ug.edu.gh in institutional culture practices is associated with .190 standard deviation increase in knowledge of occupational hazards. Employer control measure however had negative effect (β = -.113, t = 2.147, p < .05), such that a unit increase employer control measures is associated with .113 standard deviation decrease in knowledge of occupational hazards. Table 4. 18: Safety Measures as predictors of knowledge of occupational hazards Model B SE β t p Constant 5.003 0.331 15.115 0.000 Employer Control Practices 0.178 0.083 -.113 -2.147 0.033 Individual Protective Practices 1.347 0.170 .561 7.933 0.000 Institutional Culture Practices 0.674 0.244 0.190 2.759 0.006 4.2 Summary of Findings The findings from the study are summarized in this section. Putting them together, the findings showed that: i. The participants recorded relatively high awareness of biological and psychosocial hazards, rated moderately low awareness of ergonomic hazards and poorly on physical and chemical hazards. ii. Different factors were identified to affect knowledge and awareness of organizational health and safety practices; 48 University of Ghana http://ugspace.ug.edu.gh a. In terms of demographic factors, the multivariate analysis showed that age, educational level, income level and profession had effect on knowledge of psychosocial, chemical and ergonomic hazards. b. In terms of institutional factors, findings showed institutional lapses on occupational health. While the hospital required participants to put on protective clothes, there were several lapses including; low provision of PPEs, not safety department, no SOPs and training lapses on occupational health iii. When it comes to available safety measures, control measures provided by employees rated highest, followed by individual protective practices and then institutional culture and practices. 49 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE DISCUSSION 5.0 Introduction The current study assessed the knowledge of occupational hazards and safety practices adopted to mitigate the occurrence of injury and disease among healthcare workers of the Ghana Police Hospital. Three main objectives were examined. First, the level of knowledge of occupational hazards that HCWs were exposed to at the Police Hospital was assessed. Second, the factors that contribute to the level of knowledge of OHSP among HCWs were examined. Lastly, health and safety practices adopted to reduce exposure to occupational hazards among HCWs at the Police Hospital were assessed. This chapter presents the discussion of the findings with reference to relevant literature on the subject. 5.1 Level of Knowledge of Occupational Hazards among HCWs Participants were examined on their level of knowledge of different (5) classes of occupational hazards namely: biological hazards, physical hazards, chemical hazards, psychosocial hazards and ergonomic hazards. Each of these hazards could lead to accidents, injury, disease and sometimes death among healthcare workers and therefore it is imperative for HCWs to have adequate knowledge of them. Findings of the study showed that the participants recorded high level of knowledge of biological (93.5%), moderate level of knowledge of psychosocial hazards (84%) and ergonomic hazards (82%) and low level of physical (72%) and chemical hazards (66.5%). 50 University of Ghana http://ugspace.ug.edu.gh These findings meant that, understanding the knowledge and awareness of the different domains of occupational health serves as an entry point into understanding safety behaviours and practices of workers in the hospital. The findings show that while workers can be aware of some occupational hazards; their knowledge of other hazards may be low. This has implications on their safety practices at work. They would be seen to be simultaneously engaging in practices that protect them from certain hazards while at the same time fail to protect themselves from other hazards, because of their low knowledge on the latter. In the current study for instance, while the healthcare workers may protect themselves from biological hazards because of high awareness, they might expose themselves to the harms of chemical hazards due to their low awareness. In addition, some related earlier studies have reported that healthcare workers report higher awareness and knowledge of occupational hazards within the context of their practice (Aluko et al. 2016; Portel et al. 2014; Suarz et al. 2017). However, most of these studies failed to assess their levels of knowledge of different types of occupational hazards. Furthermore, consistent with previous studies (Gershon et al, 2000), is the observation that healthcare workers record high levels of awareness of biological and psychosocial hazards. Contrary to such studies, however, the participants of this present study recorded low levels of knowledge of chemical, ergonomic and physical hazards. Paying attention to the dimensions reveals the nuances of workers‟ awareness and knowledge of occupational hazards, which is required to provide a way of deeply understanding different domains of their safety practices and applications. Perhaps, further training on these hazards would improve the level of knowledge of these hazards among the staff and 51 University of Ghana http://ugspace.ug.edu.gh measures put in place in the event of an emergency situation resulting from their exposures. Knowledge of occupational hazards is essential to determine appropriate protective measures needed to prevent accidents, diseases and / or injury among participants (Aderaw et al., 2011). Adequate knowledge of hazards is also essential for determining the appropriate measures required to prevent complication and death after exposure to occupational hazards (Aderaw et al., 2011). therefore the moderate or low levels of knowledge of occupational hazards recorded among the participants suggests that they may have low ability to carry out practices necessary to prevent accident, injury and/ or disease. Chemical and Physical hazards are known to be among the most common type of hazards that confront workers of developing countries (WHO, 2006). The fact that participants recorded low levels of these indicates that further training should be given to the staff affected in order to prevent or minimize the exposure to accidents and disease occurring from these hazards. 5.2 Factors Influencing Level of Knowledge of OHSP The second objective of the study examined the factors that influenced level of knowledge of occupational hazards. Different factors were identified to affect knowledge and awareness of organizational health and safety practices among the participants. Multivariate analysis of the results showed that age, educational and income levels, as well as profession had effect on knowledge of psychosocial, chemical and ergonomic 52 University of Ghana http://ugspace.ug.edu.gh hazards. Sex and marital status did not have significant effect on awareness of occupational hazards. Other studies have also examines the influence of demographic factors on knowledge of occupational hazards with similar results. For instance, Osungbemiro et al. (2016) in a study in South African reported that demographic factors such as age group, sex and work experience showed statistically significant association with occupational injury. However, socio-demographic factors like religion, ethnicity, marital status, educational level, employment condition, and income did not show any significant association with occupational injury. Only sex and age remained significant in a multivariate model, while years with job became non-significant. Aderaw et al. (2011) also reported among undergraduate nursing students that age and level of studies had significant effect on their knowledge and awareness of occupational hazards. In terms of institutional factors, the findings showed some institutional lapses on occupational health. While the hospital required participants to put on protective clothimg some health workers do not comply. In addition several lapses were observed which include low provision of PPE, no safety department, no SOPs and training lapses on occupational health. These findings mean that institutional factors also play important role in the awareness levels of occupational hazards among the workers. Apart from individual responsibility for protecting themselves, institutions are responsible for instituting occupational safety culture in order to solidify individuals‟ safety practices. Therefore, when there are lapses in occupational health and safety practices at the institutional level, individual workers depend on their own discretion for their safety practices and behaviours, some of which may not be healthy. 53 University of Ghana http://ugspace.ug.edu.gh 5.3 Safety Practices adopted by participants The final objective assessed safety practices adopted at the Ghana Police Hospital for guarding against occupational injuries and accidents. Safety practices assessed included individual protective practices, employers‟ control practices and institutional culture and practices. The individual level focused on the individual workers in terms of what they do to protect themselves. The institutional culture and practices focused at the level of the hospital, to implement safety practices in the hospital. The employers‟ control measures focuses on the Ghana Police Service and its policies on occupational health within its medical set up. Findings of this study showed that adoption of control practices provided by employees rated highest, followed by individual productive practices and then institutional culture and practices. These findings suggest that the workers appreciate the policies put in place by the employers at the broader level of health sector in general. However, at the institutional level, there were lapses in the occupational practices at the Ghana Police Hospital. This creates a situation where the broader policy level provisions of occupational health and safety practice does not translate into safety institutional culture and cultural practices. The healthcare workers also identified several lapses in occupational health in the institution where they work. This reflected in their personal safety practices which also recorded some lapses, such as their low levels of awareness of certain critical occupational hazards. The situation was suggestive of a policy-practice disconnect where policies at the structural level of the health sector fails to translate into practice at the 54 University of Ghana http://ugspace.ug.edu.gh institutional level and then at the individual practice levels. These are consistent with findings from some previous studies. There is enough evidence of the difficulties of hospitals when it comes to resources for providing personal protective equipment (Mitchual et al. 2015; Owie & Apanga, 2016; Puplampu & Quartey, 2012). This is especially prevalent among health institutions in developing countries. The resulting effect is that well designed occupational health policies do not translate into practice due to resource constraints. It is, therefore, recommended that the health sector invest in resources for providing safety materials to enhance occupational health in the hospital settings. 55 University of Ghana http://ugspace.ug.edu.gh CHAPTER SIX SUMMARY, CONCLUSION AND RECOMMENDATIONS 6.0 Introduction This chapter discusses the conclusions from the study and makes recommendations for improving occupational health and safety practices among the healthcare workers. 6.1 Summary The study examined the knowledge of occupational hazards and safety practices among healthcare workers of the Ghana Police hospital. Factors that influence knowledge of occupational hazards and the safety practices adopted to minimize the exposure and effects of these hazards were also assessed. Data were collected with a standardized questionnaire from a cross-section of conveniently sampled 216 participants and analysed using Stata version 15. 6.2 Conclusion Findings showed relatively high level of knowledge of biological hazards, moderate level of knowledge psychosocial hazards and ergonomic hazards and low level of knowledge of physical and chemical hazards. Age, educational level, income level and profession had significant effect on awareness of psychosocial, chemical and ergonomic hazards. While the hospital required participants to put on protective clothes, there were low provision of PPEs, no safety department, no SOPs and training lapses on occupational health. Control practices adopted by employers rated highest among safety practices, 56 University of Ghana http://ugspace.ug.edu.gh followed by individual protective practices and then institutional culture and practices. The study thus concludes that awareness level of occupational hazards is relatively low among the healthcare workers of GPH. While there existed control measures provided by employers, some institutional lapses were identified that need to be addressed to strengthen safety practices and improve occupational health. 6.3 Recommendations The recommendations from the study are presented in two parts. First, recommendations for practice and policy are made. Next, recommendations for theory and research are also discuss. 6.3.1 Recommendations for Practice and Policy The study finds some lapses in occupational health at the institutional level. First, it is recommended that the hospital creates institutional culture that places serious emphasis on occupational health. Setting up an Occupational Health Unit (OHU) in the hospital, making the hospital‟s policy on occupational health available to all workers in the hospital and enforcing safety practices among the workers will go a long way to creating safety culture in the hospital. Also individual workers in the hospital must be encouraged to embrace the importance of observation of high standards of occupational health and safety at the workplace. This can be achieved through routine schedule of training, provision and enforcement of PPE and the establishment of a reward system for compliant staff. 57 University of Ghana http://ugspace.ug.edu.gh 6.3.2 Recommendations for Theory and Research The study finds that the healthcare workers have high level of knowledge on some occupational hazards than others. This means that the domain of occupational hazards assessed during research is important to broadening the theoretical understanding of occupational health in health settings. It is recommended that future studies should examine how knowledge of occupational hazards influence occupational injuries suffered. By far, most studies have focussed on assessing awareness and knowledge of occupational hazards. Future studies should also focus on researching how knowledge and awareness influence safety participation and occupational injuries in the health settings. 58 University of Ghana http://ugspace.ug.edu.gh REFERENCES Aderaw, Z. (2013). Assessment on magnitude of needle stick and sharp injuries and associated factors among Health Care Workers in East Gojjam Zone Health institutions, Amahara Regional State, Ethiopia. Global journal of medical researh, 2013 Aderaw, Z., Engdaw, D., & Tadesse, T. (2011). Determinants of Occupational Injury : A Case Control Study among Textile Factory Workers in Amhara Regional State , Ethiopia. Journal of tropical medicine 2011. https://doi.org/10.1155/2011/657275 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. Akagbo, S. E., Nortey, P., & Ackumey, M. M. (2017). Knowledge of standard precautions and barriers to compliance among healthcare workers in the Lower Manya Krobo District, Ghana. BMC research notes, 10(1), 432. 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. 59 University of Ghana http://ugspace.ug.edu.gh https://doi.org/10.1186/s13104-016-1880-2 Amponsah-Tawiah, K., & Dartey-Baah, K. (2011). Occupational health and safety: Key issues and concerns in Ghana. International Journal of Business and Social Science, 2(14). 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. 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. 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. 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. Directorate-General for Employment Social Affars and Inclusion. (2011). Occupational health and safety risks in the healthcare sector Guide to prevention and good practice. https://doi.org/10.2767/27263 El-hay, S. A. A. (2015). Prevention of Needle Stick and Sharp Injuries during Clinical 60 University of Ghana http://ugspace.ug.edu.gh Training among Undergraduate Nursing Students : Effect of Educational Program, International Journal Occupational Environ Health 2004;10:451–4564(4), 19–32. https://doi.org/10.9790/1959-04471932 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. 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. Gershon, R. R., Karkashian, C. D., Grosch, J. W., Murphy, L. R., Escamilla-Cejudo, A., Flanagan, P. A., ... & Martin, L. (2000). Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. American journal of infection control, 28(3), 211-221. Gestal, J. J. (1987). Occupational hazards in hospitals: accidents, radiation, exposure to noxious chemicals, drug addiction and psychic problems, and assault. British Journal of Industrial Medicine, 44(8), 510–520. https://doi.org/10.1136/oem.44.8.510 Ghana Health Service. (2010). Occupational Health and Safety Policy and Guidelines. Policy, 1–68. ILO (2001). Guidelines on occupational safety and health management systems, International Labour Organization, Geneva, Switzerland Jilcha, K., & Kitaw, D. (2017). Industrial occupational safety and health innovation for sustainable development. Engineering Science and Technology, an International 61 University of Ghana http://ugspace.ug.edu.gh Journal, 20(1), 372–380. http://doi.org/10.1016/j.jestch.2016.10.011. 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 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. 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 Mitchual, S. J., Donkoh, M., & Bih, F. (2015). Assessment of safety practices and injuries associated with wood processing in a timber company in Ghana. Open Journal of Safety Science and Technology, 5(1), 10. Ndejjo, R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J. S., … Ssempebwa, J. (2015b). Occupational Health Hazards among Healthcare Workers in 62 University of Ghana http://ugspace.ug.edu.gh Kampala, Uganda. Journal of Environmental and Public Health, 2015. https://doi.org/10.1155/2015/913741 Ndejjo, R., Musinguzi, G., Yu, X., Buregyeya, E., Musoke, D., Wang, J., … Ssempebwa, J. (2015a). Occupational Health Hazards among Healthcare Workers in Kampala , Uganda, 2015. Nyame-Annan, E. K. P. (2017). Occupational Hazards And Safety Practices Among Hospital Workers At Greater Accra Regional Hospital, Ridge (Doctoral dissertation, University of Ghana). 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. Oh, N., Hong, N., Ryu, D. H., Bae, S. G., Kam S., & Kim K. (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. Okafoagu, N. C., Oche, M., Awosan, K. J., Abdulmulmuni, H. B., Gana, G. J., Ango, J. T., & Raji, I. (2017). Determinants of knowledge and safety practices of occupational hazards of textile dye workers in Sokoto, Nigeria: a descriptive analytic study. Journal of public health in Africa, 8(1). 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 63 University of Ghana http://ugspace.ug.edu.gh gynaecology unit of a Nigerian teaching hospital. Journal of Obstetrics and Gynaecology, 22(1), 75–78. http://doi.org/10.1080/01443610120101781. Osungbemiro, B. W., Adejumo, O. A., Akinbodewa, A. A., & Adelosoye, A. A. (2016). Assessment of Occupational Health Safety and Hazard among Government Health Workers in Ondo City , Southwest Nigeria, British Journal of Medicine & Medical Research 13(8): 1-8, 13(October 2015), 1–8. https://doi.org/10.9734/BJMMR/2016/23620 Owie, H. O., & Apanga, P. A. (2016). Occupational health hazards prevailing among healthcare workers in developing countries. Journal of AIDS and Clinical Research, 7(8). Portell, M., Gil, R. M., Losilla, J. M., & Vives, J. (2014). Characterizing occupational risk perception: the case of biological, ergonomic and organizational hazards in Spanish healthcare workers. The Spanish journal of psychology, 17. 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. Puplampu, B. B., & Quartey, S. H. (2012). Key issues on occupational health and safety practices in Ghana: A review. International journal of business and social science, 3(19). 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 64 University of Ghana http://ugspace.ug.edu.gh prevention. American Journal of Infection Control, 43(5), 424–434. http://doi.org/10.1016/j.ajic.2015.01.029. 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. 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. http://doi.org/10.1186/s13584-017-0168-x. Suarez, R., Agbonifo, N., Hittle, B., Davis, K., & Freeman, A. (2017). Frequency and Risk of Occupational Health and Safety Hazards for Home Healthcare Workers. Home Health Care Management & Practice, 29(4), 207-215. Tipayamongkholgul, M., Luksamijarulkul, P., Mawn, B., Kongtip, P., & Woskie, S. (2016). Occupational Hazards in the Thai Healthcare Sector. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 26(1), 83-102. Twerefoo, O., Portia (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. WHO. (2006) The World Health Report Working Together for Health, World Health Organization, Geneva, Switzerland. 65 University of Ghana http://ugspace.ug.edu.gh APPENDICES Appendix A: Participants’ informed consent form School of Public Health College of Health Sciences University of Ghana Assessment of the Knowledge of Occupational Hazards and Safety Practices among Healthcare Workers in Ghana Police Hospital, Accra Introduction I am FRANK DUODU, a student pursuing Masters in Public Health in the School of Public Health, University of Ghana. I am the principal investigator in this study and together with my research assistants we are conducting a study on the above subject. You are warmly invited to take part in the study. But before you make a decision to take part in the study or not, I 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. The only cost you will incur will be the time taken to answer the questionnaire. 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 66 University of Ghana http://ugspace.ug.edu.gh 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 will be reviewed and approved by the Ghana Health Service Ethical Review Committee (GHS-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. Signature/thumbprint of participant: ____________________________________ In case of any concern you can contact the Ethics Administrator, Miss Hannah Frimpong, GHS/ERC on: 0243235225 / 0507041223. 67 University of Ghana http://ugspace.ug.edu.gh Appendix B: Questionnaire QUESTIONNAIRE ON ASSESSMENT OF THE KNOWLEDGE OF OCCUPATIONAL HAZARDS AND SAFETY PRACTICES AMONG HEALTHCARE WORKERS IN POLICE HOSPITAL, GHANA. No QUESTIONS ANSWER (Please write in the blank spaces provided or indicate with a tick () the option that best applies to you and your job) SOCIO-DEMOGRAPHIC CHARACTERISTICS 1. Age at last birthday (year1s.) 20 – 29 2.  30– 39 3.  40 – 49 4.  50 and above 2. Sex 1.  Male 2.  Female 3. Marital 1.  Married Status 2.  Single, never married 3.  Divorced 4.  Widow/Widower 4. Level of education 1.  primary 2.  secondary 3.  diploma 4.  degree 68 University of Ghana http://ugspace.ug.edu.gh 5. Category of 1.  Police Personnel employment 2.  Non-Police Personnel 6. Level of income 1.  below 1000ghc 2.  1000-3000ghc 3.  3000-5000ghc 4.  5000ghc 7. Profession ---------------------------------------------------------- SECTION II – AWARENESS OF HAZARDS IN THE WORKPLACE Do you consider the following to be hazardous agents in your line of duty? (Please check √ the appropriate box) Biological hazards Yes Not No 2 Sure 0 1 8. Infection from patients 9. Cuts and wound/ injuries 10. Airborne disease 11. Direct contact with contaminated specimen 12. Others (Blood borne pathogens) Physical hazards 69 University of Ghana http://ugspace.ug.edu.gh 13. extremes of temperature, (cold/heat) 14. poor lighting affecting vision, 15. poor ventilation 16. radiation, 17. faulty electrical wiring 18. noise, 19. explosions from pressurized containers 20. wet floors 21. lancets, broken bottles injuries Ergonomic Hazards 22. Manual lifting of patients 23. poor work posture 24. Repetitive or monotonous work 25. Standing for prolonged periods. Chemical Hazards 26. Cleaning detergents, 27. Reagents (used in laboratory and other areas) Anaesthetic 28. Alcohols gases, 29. Corrosive chemicals such as acids 30. Drugs Psychosocial Hazards 31. Stress 32. Excessive workload 33. Verbal and physical harassment 34. Work organization lapses such as overlapping roles and 35. poor interpersonal relationships procedures, 70 University of Ghana http://ugspace.ug.edu.gh SECTION III – AWARENESS OF SAFETY PRECAUTIONARY MEASURES Do you consider the following as useful safety precautionary measures in case of exposure to an occupational hazard? (Please check √ the appropriate box) Control measures provided by employers Yes Not No Sure 36. Safety education & training on all universal precautions 37. Training on all machinery and equipment used 38. Training on how to wash hands 39. Personal set of personal protective equipment 40. Separate areas and containers to dispose medical waste Individual protective measures 41. BCG vaccination 42. Hepatitis A vaccination 43. Hepatitis B vaccination 44. Provision of post exposure prophylaxis Institutional culture and practice 45. Training on Management of injuries? 46. Avenue for reporting of injuries? 47. Use of protocols? 48. Availability and accessibility of dustbins? 49. Presence of safety guidelines on walls of the wards? 50. Clinical care and safety training? 51. Pre-employment medical screening? 71 University of Ghana http://ugspace.ug.edu.gh Section IV: Factors that Contribute to Knowledge of Occupational Hazards and Safety Practices 52. Does the hospital provide PPEs 1.  Yes for your tasks? 0.  No 53. If yes, is it easily accessible? 1.  yes 0.  no 54. Are staff required to put on 1.  Yes protective clothing in the 0.  No performance of their duties? 55. Does the hospital have a safety dept/unit/committee? 1.  Yes 0.  No 56. If yes, is the unit run by trained personnel in 2.  Yes occupational health and safety? 1.  not sure 0.  No 57. How regular is training organized for staff on 4.  Quarterly occupational health and safety? 3.  Biannually 2.  once Annually 1.  No definite time fixed for training 0.  None 58. How often is monitoring, inspection and evaluation 4.  monthly conducted? 3.  Quarterly 72 University of Ghana http://ugspace.ug.edu.gh 2.  Biannually 1.  No definite time fixed for training 0.  None 59. Do you or your department or unit have a written copy 1.  Yes of occupational health and safety policy of the hospital? 0.  No 60. Are there available SOPs/guidelines for your work? 2.  Yes 1.  not sure 0.  No 61. Does your professional association organize continuous 2.  Yes professional development sessions on occupational 1.  not sure safety and health 0.  No 62. Which of the following is/are regular source(s) of health 0.  library information? 1.  social media 2.  electronic media 3.  print media 4.  internet 5.  others 73