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Worker wellness: Summer 101 in the clinic


June 1, 2019


As summertime arrives in the U.S., there’s a good chance you’re not thinking about the dangers of the season. After all, it’s the season of sunshine and the beach, and most healthcare workers in medical clinics aren’t spending their workdays toiling in the heat.

Still, warmer weather can take a toll on indoor workers. According to OSHA, when the human body is unable to maintain a normal temperature, heat illnesses can occur and may even result in death.

While most of us don’t equate indoor healthcare work with dangerous heat-related conditions, it’s important to consider that hot work environments may exist indoors. Each person has a different tolerance to hotter temperatures, and in places like laboratories, heavier clothing such as lab coats can quickly make a worker heat up. Individuals’ personal lives can affect their ability to cool down (for example, if they work out before work and don’t drink enough water). Age, physical fitness, and other factors can affect how heat will strike the workers in your facility. It’s your job to mitigate the factors you can. Here are some good places to start:

Chill out. It seems like common sense that when the temperatures rise, the air conditioners and fans should turn on. But it’s not that simple in the healthcare environment. Personal fans, for instance, are not hygienic. They can spread airborne bacteria and contaminants throughout the facility. Dehumidifiers aren’t any better, as people don’t often clean them and bacteria collects in the stagnant water. There’s a reason that healthcare facilities have intricate HVAC systems that can control the temperature, levels of humidity, and even the amount of “wind” blowing through a facility. The best thing to do is to work with facility management to maintain a comfortable temperature and humidity level for most employees.

Heat illness can strike fast. Unlike traumatic injuries, heat illness works on a sliding scale and can go from uncomfortable to life-threatening in a matter of minutes. It’s important to know the stages of heat illness and how to quickly react should it strike your workers.

According to OSHA, heat rash is the most common problem in hot work environments. Heat rash is caused by sweating and looks like a red cluster of pimples or small blisters. Heat rash may appear on the neck, upper chest, or groin; under the breasts; and in elbow creases. The best treatment for heat rash is to provide a cooler, less humid work environment. The rash area should be kept dry, as anything that makes the skin warm or moist may make the rash worse.

Next on the scale are heat cramps, muscle pains usually caused by the loss of body salts and fluid during sweating. Workers with heat cramps should replace fluid loss by drinking water and/or carbohydrate-electrolyte replacement liquids (e.g., sports drinks like Gatorade) every 15–20 minutes.
If left untreated, heat cramps can quickly deteriorate into heat exhaustion, another common heat-related health problem. The signs and symptoms of heat exhaustion are headache, nausea, dizziness, weakness, irritability, confusion, thirst, heavy sweating, and a body temperature greater than 100.4°F.

Workers with heat exhaustion should be removed from the hot area and given liquids to drink. Have workers wash their head, face, and neck with cold water, or help cool them with cold compresses to the head, neck, and face. Encourage frequent sips of cool water. Workers with signs or symptoms of heat exhaustion should be taken to a clinic or emergency room for medical evaluation and treatment. Make sure that someone stays with them until help arrives. If symptoms worsen, call 911 and get help immediately.

The most serious heat-related health problem is heat stroke, a life-threatening medical emergency that occurs when the body’s ability to cool itself is overwhelmed and shuts down. This is a definite call to 911, as the condition can lead to death.

Heat stroke occurs when the body’s temperature regulating system fails and body temperature rises to critical levels (greater than 104°F). The signs of heat stroke are confusion, loss of consciousness, and seizures. Workers experiencing heat stroke have a very high body temperature and may stop sweating. Until medical help arrives, move the worker to a shady, cool area and remove as much clothing as possible. Wet the worker with cool water and circulate the air to speed cooling. Place cold wet cloths, wet towels, or ice all over the body, or soak the worker’s clothing with cold water.

Drink your faces off. No, this isn’t an excuse for happy hour. But one of the major health concerns for workers, especially those who work outside or in warm indoor conditions, is that they don’t drink enough water. OSHA says to make sure that cool drinking water is available and easily accessible. Note that beverages containing caffeine and alcohol are not included, as they both can lead to dehydration.

Workers should be encouraged to drink a liter of water over one hour, which is about one cup every 15 minutes. The Institute of Medicine (IOM) says an adequate daily intake is about 13 cups (3 liters) for men and 9 cups (2.2 liters) for women.

That means it’s your responsibility as a safety officer to make sure drinking coolers or fountains are available throughout the facility, with replacement jugs available. Unlike other jobs, healthcare employees are discouraged from bringing water bottles into the medical environment because they can pose a sanitation and infection control hazard, so it’s extremely important to make water available.

Proper water intake is another of those sliding scale issues, as most people don’t realize they’re dehydrated until they get symptoms. Symptoms of mild dehydration include sleepiness, dizziness, and headaches.

Cover up for safety. Many workers will try to cool off at work by wearing lighter clothes, but shorter, lighter clothes can also pose a serious infection control risk. Open-toed shoes or sandals in the clinic or lab are a definite no-no, because feet need to be protected from germs as well as from chemical spills and dropped items.

Capri pants or shorts that don’t completely cover workers’ legs, for the same reasons, should never be part of the dress code in healthcare. Make sure employees get the message that for safety reasons, the dress code is the same for summertime as in winter. There are lightweight lab coats and scrubs, made from cooling materials such as copper, which can be purchased for the summer months.

Keep those doors closed. Regardless of how nice the weather is outside, resist the temptation to keep outside doors open. The outside air will fluctuate the inside air temperature and humidity instead of keeping them consistent.

Having open doors can invite insects and vermin to infest your facility, hardly a good idea from a sanitary and infection control perspective. An open door is also a breach in your security wall and invites intruders inside. At night, it becomes more of a safety concern because intruders could use the darkness as a way to hide themselves from detection.

Even if intruders from the outdoors aren’t a problem, a propped-open door is also a break in the indoor barriers designed to keep your facility clean and safe, such as in areas of negative pressure.

Additionally, many doors in healthcare facilities are rated as fire doors, and therefore keeping them open can break fire codes.

Even better, lock the doors. Your registration and triage staff are your frontline workers, and unlocked and open doors leave them vulnerable. Violence in healthcare facilities is a perennial and worsening problem, and there needs to be more protection between workers and visitors. OSHA says that there should be a way for everyone in the office to know when danger lurks. A panic button, a code word, or a PA announcement system can let people in the back know when things are getting ugly and give them a chance to help or escape.

The front door shouldn’t be the only way out, especially if an armed person is blocking it. Your office should have at least two exits, and most rooms should have two exit routes as well. Workers should be aware of them, and exits should be easily identified and clear of obstructions.

Consider giving your workers a barrier. Gone are (or should be) the days when the receptionist sits behind an open desk, ready to greet customers—that can invite an intruder to jump over and overwhelm desk staff. A better solution is to install bulletproof glass, deep counters, and a receptionist area with lockable doors to create more of a barrier.

Do some outdoor landscaping. Take a good look around the outside of your facility and see how inviting it is to a would-be intruder. There should be no dark areas outside your facility where people can lurk in the shadows. Walkways, parking areas, bus stops, and areas near doorways should have plenty of lighting, as should the actual building itself, to remove deep shadows that intruders could hide in.

Next, invest in some cameras. Closed-circuit video systems have become so affordable that it makes sense to spend some money on a system that can not only record activity around your perimeter, but also broadcast to front desk folks who can monitor the feeds via television screens or smartphones.
Lastly, trim your hedges and trees. Overgrown shrubbery in warmer weather makes ideal places for troublemakers to hide. Instruct your maintenance department to keep vegetation to a minimum.

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