Hospital Administration

Definition of Occupational Health

Adopted by the Joint ILO/WHO Committee on Occupational Health (1950),
Occupational health should aim at the promotion and maintenance of the highest degree of
physical, mental and social well-being of workers in all occupations; the prevention among
workers of departures from health caused by their working conditions; the protection of
workers in their employment from risks resulting from factors adverse to health; the placing
and maintenance of the worker in an occupational environment adapted to his physiological
and psychological capabilities and; to summarize: the adaptation of work to man and of each
man to his job. The main focus in occupational health is on three different objectives: (i) the
maintenance and promotion of workers health and working capacity; (ii) the improvement of
working environment and work to become conducive to safety and health and (iii)
development of work organizations and working cultures in a direction which supports health
and safety at work and in doing so also promotes a positive social climate and smooth
operation and may enhance productivity of the undertakings. The concept of working culture
is intended in this context to mean a reflection of the essential value systems adopted by the
undertaking concerned. Such a culture is reflected in practice in the managerial systems,
personnel policy, Aaaccordi
principles for participation, training policies and quality management of the
undertaking.
ng to
Based on Undang-Undang No. 23 Tahun 2003 Tentang Kesehatan pasal 23 stated that
efforts Occupational Health and Safety must be held in all workplaces, especially workplaces
that have health hazards, easily contract the disease or have at least 10 employees. So it
becomes clear that the Hospital is including the criteria to work with a variety of hazards that
can cause health effects, not only against the direct perpetrators who work in hospitals, but
also to the patients and hospital visitors. So it should be the manager of the hospital
implement measures the Occupational Health and Safety in hospitals.
Potential hazards in hospitals, in addition to infectious diseases, there are also other
potential hazards that affect the situation in the hospitals, for examples, accidents
(explosions, fires, accidents related to electrical installations, and other sources of injury),
radiation, chemicals materials-hazardous, anesthetic gases, psychosocial disorders and
ergonomics. All potential hazards mentioned above are clear as the life-threatening for
employees at the hospital, the patients and the visitors were there in the hospital
environment.
Shift Working
According to the ILO (1990), working in shifts is a method of organization of working time
in which workers succeed one another at the workplace so that the establishment can
operate longer than the hours of work of individual workers at different daily and night hours.
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Occupational Health and Safety on the Hospital Night-Shift Worker

Within the broad category of shift work, we can make a distinction between a fixed shift
system and a rotating one. Under a fixed shift system, working time can be organized in two
or three shifts: the early, late and/or night shifts. This means that one group of workers might
work during the morning and early afternoon; another group will work during the late
afternoon and evening; and the third group (in a three-shift system) will work during the night.
Under a rotating shift system, workers might be assigned to work shifts that vary regularly
over time; these are called rotating shifts because they rotate around the clock (e.g. from a
shift in the morning, to one in the afternoon, to one at night). If the firms equipment is
running non-stop the whole week, we can speak of continuous shift work with 24 hours of
work, seven days a week (i.e. 168 hours of firm operating time). There is a virtually unlimited
number of potential shift work patterns.
Potential Effects that May Occur to the Hospital Night Workers
There is a considerable body of research evidence regarding the negative effects of
night and shift work. The effects obviously do not happen to all night shift workers and with
proper management the risks can be minimised. Fatigue is the main issue which needs to be
addressed. These effects include:
Disruption of the internal body clock (circadian rhythms)
Biological clocks
A master clock in the brain coordinates the various body biological clocks so that
they are in synch. The biological clocks in turn drive our circadian rhythms. The
master clock consists of a group of nerve endings called the suprachiasmatic nucleus
(SCN), which is located in the hypothalamus area of the brain close to the optic
nerves.
Circadian rhythms
Circadian rhythms are physical, mental and behavioural changes that follow
roughly a whole day or twenty four hour cycle. Circadian rhythms are produced by
natural factors in the body such as genetic activity and the release of the hormone
melatonin, but they are also affected by signals from the environment, especially light.
Light is the main cue influencing circadian rhythms, turning on and off genes that
control the internal clocks. Circadian rhythms can change sleep-wake cycles,
hormone release, body temperature and other important bodily functions. Circadian
rhythms are important in determining human sleep patterns.
The bodys master clock or SCN controls the production of melatonin that makes
us sleepy. As it is located just above the optic nerves, which relay information from
the eyes (external environment) to the brain, the SCN receives information about
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incoming light. When, there is less light, such as at night or in darkness, the SCN
directs the brain to produce more melatonin, so you get drowsy or sleepy. Melatonin,
which is vital to the suppression of tumours, is released at night. Light shuts down
melatonin production, so being exposed to artificial light at night could lead to a
melatonin deficiency.
Disruption of the circadian rhythm is linked to various sleep disorders such as
insomnia, disrupted sleep-wake cycles and insufficient hours of sleep. Disrupted
circadian rhythms are also associated with depression, bipolar disorder and seasonal
affective disorder. Night shift work can cause disruption to the circadian rhythms.
Basically the night workers are working at night, and they are not sleeping when their
body tells they should be. Conversely when we try to go to sleep during the day it is
not easy as the circadian rhythm is telling us that we should be awake and this is
supported by cues such as daylight and normal daytime external environmental
activities such as traffic and noise, which make it more difficult to sleep. Our internal
body clocks can change gradually but are resistant to abrupt changes brought on by
night and shift work. Nor will they ever fully adjust, even for those workers on
permanent night shifts. Such workers may sleep during the day when they are on
their rest period between shifts but on days off their body clocks will attempt to reset
to normal circadian rhythms. The end result of disruption of the circadian rhythms is
loss of sleep and disturbed sleep, which both lead to fatigue.
Sleeping difficulties
We all need proper sleep in order to wake up refreshed and energised for the days
activities. Sleeping is restorative both physically and mentally. It allows the body to
recover from the days exertions, be they physical or cognitive activities. People who have
problems sleeping can become anxious and worried when they lie awake. They may get
some broken periods of sleep but when they get up they are still tired and lack energy.
Insufficient sleep is associated with tiredness leading to accidents and errors as the body
and mind are out of tune with their environment. Because of our circadian rhythms and
external cues such as sunlight, temperature, voices, traffic, family and domestic
responsibilities, it is much more difficult to get a proper sleep of sufficient duration without
interruptions during daylight hours.
This lack of sleep leads to sleep debt whereby the body knows it has had insufficient
sleep and although we can cope with this temporarily, eventually when working at night,
we will feel a deep need of sleep and may fall asleep on the job despite other external
cues. Sleep deprivation affects our ability to think and concentrate and can lead to

Occupational Health and Safety on the Hospital Night-Shift Worker

cognitive errors in tasks requiring concentration, fast reaction times, good memory
function, vigilance, awareness and decision making.
Fatigue
Fatigue is the decline in mental and/or physical performance that results from
prolonged exertion, lack of quality sleep or disruption to the circadian rhythms. It is a
feeling of tiredness and being unable to work effectively. A fatigued person will be less
alert and perceptive, less able to process information and have slower reaction times
than someone who is not fatigued. A person who is fatigued may fall asleep momentarily
while at work or driving home, which can be extremely dangerous. Fatigue results from
an imbalance between work demands and rest and recovery periods. Poorly designed
shift work patterns and long working hours are likely to result in fatigue. Fatigue is the
most common adverse effect of shift and night work. Fatigue can also lead to errors and
accidents, while chronic fatigue is associated with a number of adverse health effects and
illnesses outlined below.
Health effects
There are a number of well documented illnesses associated with night and shift
workers, while other emerging risks are presently undergoing evaluation and research.
Night and shift work are also known to exacerbate a number of pre-existing illnesses. The
majority of illnesses are due to disruption of the circadian rhythms resulting in hormone
imbalance (melatonin suppression), sleeping difficulties and fatigue. Chronic fatigue
resulting from night and shift work is strongly associated with gastrointestinal illnesses
such as abdominal pain, chronic gastritis, peptic ulcers and cardiovascular illnesses such
as hypertension and coronary heart disease.
Shift work is also known to exacerbate pre-existing illnesses for night and shift
workers. These include asthma, diabetes, epilepsy and psychiatric illness. This is why
night workers have been given an entitlement to a health assessment under the Night
Work and Shift Work Regulations to assess their suitability for such work before
commencing work and then at regular intervals thereafter.
Individual factors
Individuals react differently to the effects of night shift work. Workers who do the
same shifts and same tasks can experience different health effects. Some will remain
perfectly healthy while others may develop health problems. This reflects a combination
of factors including: age, gender, lifestyle, attitude and behaviour. Individuals tolerance of
shift work varies according to their:
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Hospital Administration
a. Ability to sleep (some people are good sleepers regardless while others find it difficult
b.
c.
d.
e.

to fall asleep and even when they do, they wake up a number of times).
Ability to adapt to changes in shift pattern
Ability to adapt to shift work (which decreases with age anyway)
Different life style behaviours (e.g. alcohol consumption, diet, levels of fitness)
Different coping mechanisms

Social and family factors

Social and family factors can have a big impact on a shift workers mental and
physical health. Workers who dont have sufficient time to interact with their families and
friends because of shift working and the need to rest in between may feel deprived and
isolated, leading to moodiness and negativity. This can affect their relationships both at
home and at work. On the other hand, some workers will try to maintain a normal family
and social life, but as a result not sleep sufficiently and end up fatigued. Thus there is a
fine balance to be struck between these competing demands. The design of shift patterns
can have a major impact in this area (e.g. 8 hour versus 12 hour, 2 daytime shifts not
involving a night shift, no shift working at weekends, etc).
Errors and accidents
The risk of errors and accidents has been found to:
a.
b.
c.
d.

Be higher on night shifts

Rise with increasing shift length over an 8 hour threshold
Increase over successive shifts (especially night shifts)
Increase when there are insufficient breaks
The main cause is poorly designed shift schedules resulting in fatigue, which in turn

leads to poor performance resulting in errors and accidents. These can be a mixture of
minor and major incidents. Fatigue is a major contributory factor in road traffic accidents.
Who has not experienced the feeling of nodding off while driving but luckily regaining
alertness just in time? Fatigue, night work and shift work arrangements have been found
to be contributory factors to such incidents.
Discussionnya
Hazardnya apa solusinya apa. Berarti yg di tinjauan pustaka tulis pengertian, jenis hazard yg
di temuinya. Poacnya masukin discussion aja. Ditambahin bawahnya hazard apa
rekomendasinya apa, selesai deh
Occupational Health and Safety Management
Health and safety in hospitals is an effort to provide health insurance and improve the
health of the workers or workers on how to prevent accidents and occupational diseases,
control of hazards in the workplace, health promotion, treatment and rehabilitation.

Occupational Health and Safety on the Hospital Night-Shift Worker

Occupational health and safety management in hospitals is a process that begins with
activity planning, organizing, implementing and controlling aiming to empower health and
safety in hospitals. Management is the achievement of predetermined goals, with the
assistance of others. It is expected to reduce the impact of errors or omissions (malpractice)
as well as the direct impact of reducing the spread of faulty work.
To achieve these objectives, proficiency level of management functions can be classified:
Planning
Planning function is an attempt to determine the activities to be conducted in the
future in order to achieve those objectives. In this case, are include safety and
healthy aspects in hospitals and other health institutions. Planning is carried out to
meet the standards of health care. In this plan, the prescribed activities include, are:
a.
b.
c.
d.
e.
f.
g.

What kind of terms that should be done. How do I do it.

How should we do it.
Why it should be done.
Who should be worked on.
What time it should be done.
Where these activities can be done.
reciprocal relationships (cause and effect).
Health activities is now no longer just in the areas of service, but it includes

activities in the areas of education and research, as well as the methods used more
and more variety. All that activities can lead to increase risk level of danger in the
hospital. Therefore, safety working at the hospital should be taken seriously by safety
organizations hospital.
Organizing
Organization's safety and health of hospitals can be formed in several levels,
ranging from area (region) level to the central or national hospital level. Government
involvement in the organization, either directly or indirectly is needed. The
government can put individual officials within the organization at the central level
(national) and regional level (region), in addition to imposing Undang-Undang
Keselamatan Kerja. At the local level (region) and central (national) need to be
established the Employment Security Commission hospital or institution whose on
duties and responsibilities are may include:
a. Formulating guidelines outline job security hospital.
b. Providing guidance, counseling, training executor's job security hospital.
c. Monitoring the implementation of occupational safety guidelines for hospitals.
d. Providing recommendations for consideration for the issuance of permits
e.

hospitals.
Preventing the spread of the dangers arising from a hospital, and many others.
The members of professional organizations or with similar interest activities are

related to hospital/health institution be appointed as member of the commission at the

Hospital Administration
local level (region) and the central (national). In addition, that professional
organizations can also set up an independent body that serves as an advisory body
or a committee of Trustees Occupational Health and Hospitals.
Actuating
Implementation or actuating functions is encouraging morale activities, exerting
activity, coordinating the various activities that will be compact activity (synchronous),
so that all activities in accordance with a predetermined plan. Implementation of
health and safety programs hospitals/health institutions target the workplace is safe
and healthy. For that every individual who works in the hospital and community/health
agencies must know and understand all the things that are expected to be a source of
occupational injuries in the hospital, as well as have the ability and knowledge to
implement prevention and control of occupational accidents are. Then comply with
the various rules or regulations in handling specimens and reagents tools. If the
implementation of the actuating function raised the question, doubt or disagreement,
then it is the duty of all to take the settlement decision.
Controlling
Oversight function is the activities that try to get the jobs done in accordance with
established plans or desired results. To be able to exercise oversight, to note two
fundamental principles, are namely:
a. There are planning activities.
b. There are instructions and granting authority to subordinates.
In the supervisory function is not less important is the need for socialization of
discipline, comply with all safety regulations for hospitals or the health agencies.
Socialization needs to be done continuously, due to prevention efforts that however
well the danger would be in vain if the rules are ignored. In the hospital, should be
established surveillance hospitals or health institutions whose duties include:
a.

Monitoring and periodically briefed about the appropriate and safe activities that

b.

carried out in hospital.

Ensure that all hospital personnel can understand the ways how to avoid hazards

c.
d.
e.

that may arise in the hospital.

Investigate an adverse event or accident that occurred in the hospital.
Develop the recording and reporting system about safety level of the activities.
Undertake the emergency steps in order to overcoming the hazard events and
prevent the spread of these hazards.

Therefore, the enforcement of Occupational Health and Safety in hospitals needs to be

managed properly, so that can be more effective, efficient and integrated.
Program yang mengimplementasikan poac dalam kasus kejadian night shift worker. Missal
kasus
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