A user-friendly, high quality workplace assessment field guide and an accompanying worksheet are invaluable tools for recognizing hazards in the hospital environment. These tools ensure that both front line workers as well as health and safety and infection control professionals can systematically evaluate hazards and formulate recommendations. This South African example illustrates how role play and pictorial guided orientation can empower workers to use these tools in response to complex political, cultural and environmental factors.
Consistent application of infection control principles across the health care spectrum is crucial to protect patients and health workers alike. There is increasing recognition that preventing infectious disease transmission in health care must take into account the principles and state-of-the-art practices in infection control as well as occupational health. (1) In response to this recognition, audit tools have been developed to assist occupational health and infection control practitioners to assess workplaces for compliance with good practices. (2) A field guide and its companion assessment worksheet, originally from an infection control audit (2) but expanded with respect to other occupational health concerns, (3) was piloted and validated for use in low and middle income countries such as South Africa. (4) Its intent was to provide a template for consistent identification of potential workplace hazards, assessment of risk, a process for prioritization and assignment of responsibility with timelines for completion. These tools were revised based on pilot testing in a South African hospital, (4) and were intended to be introduced in clinical units within two hospitals in the Free State Province to train practitioners on their use in real settings. An unanticipated public sector strikes (5) led to the need to change the training format--as access to the health care facilities during this time was not possible. Building on studies that have shown the effectiveness of interactive training, including the use of role play, (6 7) and the extensive work conducted using role play in training in occupational health and safety, (8) we decided to rapidly develop an alternate training approach using role playing and pictorial guided orientation. The methods and results of this training exercise are detailed below.
MATERIALS AND METHODS
A case scenario using an Emergency Department was developed (see Case Study for detailed case instructions). Prior to its use, nine occupational health and infection control practitioner trainees from two target hospitals were given a presentation on basic principles of occupational health and infection control, completed an Online Basic Infection Control module and quiz (available online at www.Picnetbc.ca), participated in exercises illustrating correct hand hygiene technique, were able to practice the correct use of personal protective equipment, and oriented to the field guide and workplace assessment worksheet or checklist (available on-line at www.ghrpinnovation.com). The field guide lists 206 possible hazard codes, grouped as shown in Table 1, in a manner that enables users to quickly find the code that best corresponds with a given hazard. These codes were developed in collaboration with colleagues from South Africa, various regions of Latin America and individuals from the World Health Organization and the International Labour Organization.
After this 1.5 day orientation held at the local university, a half-day session using the newly developed case scenarios was conducted to train the practitioners on how to conduct a workplace inspection in an Emergency Department. Four distinct areas within the unit: Triage, a cubicle in Acute Treatment, the Medication Room and the X-ray suite were pictorially illustrated on large poster-sized paper (see Figure 1 photos) and designed to display specific hazards as well as deliberately omitting key safety features. …