Assessment of Occupational Health Hazards Among Class IV Health Workers in Dhule District- A Qualitative Study

Abstract

Introduction:

Worldwide, occupational health diseases account for 217 million cases, and evidence suggests that many of these diseases are preventable. However, the lack of adequate knowledge and training in regulating the work environment exposes many workers to occupational health hazards.

Material Methodology:

This was a qualitative study on occupational health hazards among Class IV health workers of Dhule, North Maharashtra, India. The questionnaire primarily consisted of questions regarding knowledge of class IV health workers related to occupational health hazards, types of health hazards and health-related problems experienced by them during their work, the measures taken by them and the hospital to protect themselves against these infections and hazards, their awareness regarding personal protective equipment and vaccination. Informed consent was taken by health workers before filling out questionnaires.

Result:

The awareness regarding the risk of health hazards (P = 0.000, P < 0.05) has a significant effect on the training of safe handling of biomedical waste. Due to the unavailability of this training, most of the health workers were exposed to needle prick injury and sharp blade injury, 80.7%. Only 10% of them were provided PPE (Personal Protective Equipment) for protection against communicable diseases by the hospital and 90% were shown to have unavailability of PPE; this will increase the risk of respiratory, blood-transmitted diseases.

Conclusion:

There is an awareness gap between Class IV and other healthcare workers, which increases the risk of occupational health hazards among them.

INTRODUCTION

Worldwide, occupational health diseases have 217 million cases and evidence shows that many of these diseases are preventable, but inadequate laws and policies regulating the work environment expose many workers to occupational health hazards, which may be life-threatening for them.[1] The Government of India classified Class IV employees as manual workers, like skilled, semi-skilled, and unskilled, including hospital maintenance staff, attenders, sweepers, and waste handling staff.[2,3] But knowledge of these Class IV health care workers about infection control, risk of communicable disease, precautions, while handling waste, and management of hazards is questionable and hence we need to do this study.

MATERIAL AND METHODOLOGY

Study Design: The present study was a qualitative study.

Study Setting: The study was conducted in Dhule, North Maharashtra Region, India.

Study Population: Class IV health workers, including hospital maintenance staff, attendants, sweepers, laundry and waste handling staff working at the Government hospital, private hospital, and private clinic of Dhule, north Maharashtra, India.

Ethical considerations: Ethical clearance for the study was obtained from the institutional ethical committee prior to starting the study. Written informed consent was taken from the participant for the study. Permission was also taken from the head of the hospital to conduct a study among Class IV workers.

Questionnaire: A questionnaire was formulated in a local language, Marathi and the validity of the questionnaire I-CVI, S-CVI, and UA in Marathi was 0.96, 0.95 and 0.94. The first part of the questionnaire was based on the demographic data and informed consent. The second part consisted of a total of 17 questions, with 5 open-ended and 12 closed-ended questions. The questionnaire primarily consisted of questions regarding knowledge of class IV health workers related to occupational health hazards, types of health hazards and health-related problems experienced by them during their work, the measures taken by them and the hospital to protect themselves against these infections and hazards, precautions taken by them during waste collection and disposal and their awareness regarding personal protective equipment (PPE) and vaccination.

Collection of data: The convenience sampling was conducted and a total of 300 health care workers, who were willing to participate in the study were included. A total of 300 copies of the questionnaire were distributed to health care workers. Data was collected from the questionnaire and was transferred to an Excel sheet.

Statistical Analysis: Statistical Analysis was carried out using SPSS Software version 2020.

RESULT

The present study comprised a total of 300 participants, out of which 43.7% were sweepers, 39% were attendants and 17.3% were ward boys. 71.9% were working at a private hospital, 19% at a private clinic, 4.7% at PHC and 2.7% at a government hospital. 47.8% of participants reported that their profession has a risk of health hazards and 52.2% consider that their profession has no risk of health hazards, which indicates a lack of awareness about workplace hazards among them. Most of the health workers, 46.1% identified occupational health hazards as factors posing risks to employee health, 14.6% of health workers recognized it as a workplace hazard, 13.6% viewed it as a workplace accident or illness, 12.5% believed it refers to something that can cause harm if not properly managed and 11.2% were unfamiliar with the term.

Table 1 illustrates various types of health hazards experienced by the healthcare workers. Most of the health workers were exposed to needle prick injury and sharp blade injury, 80.7% and less than 3% were exposed to electric shock. In biological hazards, bacterial and viral infections account for 66.1%. Chemical hazards, such as eye irritations, were reported in 33.2% of cases, followed closely by skin irritation and burning sensations, which affected 30.2% of individuals. In ergonomic hazards, 40.3% of workers report back pain as the main issue. For psychological hazards, fatigue is common among 35.3% of healthcare workers. After injuries, 48.1% of them get first aid, but 12.5% leave their wounds untreated and use homemade remedies instead.

Table 1.

Types of health hazards among health care worker

Hazard Type	Category	Exposed (%)
Physical hazards	Needle prick	62.4%
	Sharp blade injury	18.3%
	Slips, trip, fall	22.4%
	Burn and wound	3.4%
	Electric shock	3%
Biological hazards	Bacterial infection	34.6%
	Viral infection	31.5%
	Fungal infection	9.8%
	Respiratory infection	5.8%
	Blood-borne diseases	12.5%
Chemical hazards	Skin irritation and burning	30.2%
	Eye irritation and burning	33.2%
	Inhalation of poisonous gas	15.3%
	Contact with carcinogens	2%
	Other	3%
Ergonomics hazards	Back pain	40.3%
	Strain or sprain	22.4%
	Musculoskeletal injury	21%
	Standing long hour	21.4%
	Other	3%
Psychological hazards	Loss of sleep	29.5%
	Fatigue	35.3%
	Persistent tiredness	29.5%
	Loss of social relationships	2.7%
	Other	3%

All values are in percentage %

As 96% of health workers were educated up to 12^th and only 4% of them were trained by the hospital regarding waste management, self-protection against biomedical and occupational hazards, so 18.3% of health workers are only aware of the protocols of biomedical waste management and 81.7% were not aware. As hospitals fail to give training, only 27.5% of them received training regarding the safe handling of hospital-generated biomedical waste and 72.5% did not receive training regarding and were unaware. Due to the unavailability of this training, most of the health workers were exposed to needle prick injury and sharp blade injury, 80.7%.

As the workload of healthcare workers increases daily, there is an increase in their exhaustion at work. 51.1% were very often exhausted, and this increased ergonomic hazards like back pain and sprains up to 62.7% in them. 18.3% were exhausted sometimes, and 24.1% were exhausted rarely.

61% of health workers were aware of communicable diseases; hence, 93.2% of healthcare workers use face masks for protection, and 89.8% use aprons as personal protective equipment. But use of gloves and head caps is 30.2% and 24.7%, respectively, and it is less as compared because only 10% of them were provided PPE for protection against communicable diseases by the hospital and 90% showed unavailability of PPE; this will increase the risk of respiratory, blood-transmitted diseases.

Due to a lack of awareness regarding vaccination, only 27.1% of health workers were vaccinated for tetanus and 22.4% for the Hepatitis B vaccine. A total of 26.1% of participants reported being unaware of the specific vaccine they had received and its intended purpose.

Table 2 illustrates the comparison of the work experience of health workers and their use of PPE when handling infectious materials and waste. So, chi-square test results show that work experience (P = 0.007, P < 0.05) has a significant effect on PPE use by health care workers, indicating that recently appointed health workers have more awareness regarding the use of PPE.

Table 2.

Cross-tabulation for work experience of health workers and use of PPE, while handling infectious material and waste

Use of PPE for handling infectious material and waste	Experience				P
	0 to 5 year	5 to 10 year	10 to 15 year	More than 15 year
YES	108	71	48	42	0.007
NO	3	9	3	0	0.001
If it is provided	0	4	3	4	0.027

P<0.05-significant, P<0.001-Highly significant. PPE=Personal Protective Equipment

Table 3 shows awareness of the risk of health hazards and training of safely handling of biomedical waste. Chi-square test results show that the awareness regarding the risk of health hazard (P = 0.000, P < 0.05) has got significant effect on the training of safe handling of biomedical waste.

Table 3.

Cross-tabulation for awareness of risk of health hazards and training of safely handling of biomedical waste

Risk of health hazards	Training received for the safe handling of waste		P
	YES	NO
Yes	116	25	0.001
No	98	56

P<0.05-significant, P<0.001-Highly significant

DISCUSSION

The health care hazards are classified by WHO[4] into physical, biological, mechanical, ergonomic, chemical, and psycho-social. Health care workers are providers of important health services and social care. In physical hazards most of the health workers in current study were exposed to needle prick injury and sharp blade injury that is 80.7% due to improper handling and lack of biomedical waste management protocols, similar result was obtained in another study by Aluko et al.[5] on Nigerian healthcare workers which had 94.5% exposure to needle prick injury this increase may be due to the improper disposal of sharp needles and this type of injury increase the chance of cross infection among health care worker.

The study by Thirunavukkarasu et al.[6] which focused on occupational hazards among health staff of Northern Saudi Arabia finding indicates most of the respondents reported their exposure to bacteria with a percentage of (31.1%), while current study indicates (34.6%) exposure rate for biological exposures especially among untrained staff and was increased by the limited use of personal protective equipment’s like mask and gloves. Ergonomic hazards, especially back pain, affected 40.3% of HCWs in this study. Other research, including a study by Sun et al.,[7] supports the association between high physical demands in healthcare work and musculoskeletal issues. Psychological fatigue reported by 35.3% of participants in this study highlights the impact of high workload on HCWs, with similar findings from Costa,[8] who documented how high workload and stress levels contribute to mental and physical exhaustion. High demands in healthcare roles due to increased disease load in developing countries, long shifts, and the cumulative impact on healthcare workers’ physical and mental health.

This study found that only 27.5% of HCWs received training on safe biomedical waste handling, and 81.7% were unaware of proper biomedical waste management protocols. These gaps in training expose workers to significant risks, consistent with findings by other researchers, including Kalpana et al.,[9] who reported that poor waste management knowledge increases the likelihood of injuries. Before COVID-19, mask use among healthcare workers was generally limited. A study conducted by Lakshmi et al.[10] indicated that mask use in healthcare was often limited to high-risk departments such as surgery, emergency care, and infectious disease wards and similarly, gloves were widely used, but mainly in departments with a high risk of blood-borne pathogen exposure. The pandemic greatly expanded mask use beyond high-risk areas. A study by Wang et al.[11] found that mask compliance in hospitals increased from under 30% pre-pandemic to nearly 100% during COVID-19. Post COVID-19 pandemic, due to increased awareness about airborne pathogens, many healthcare workers retained universal masking protocols¹⁷. The current study shows 91.2% use of PPEs like gloves 30.2% and mask 93.2%, similarly survey by Griswold et al.[12] revealed that around 70% of healthcare facilities continued some level of mandatory masking policy and Soleman et al.,[13] showing that healthcare professionals are now more consistent in wearing gloves even for low-risk interactions, compared to pre-pandemic behaviors. Similarly, the use of aprons or gowns remains consistent, especially for activities involving direct patient contact or fluid exposure. Limited availability of PPE is reported by 90% of workers in this study, which increases the risk of disease transmission and this may be due to the financial burden on hospitals due to the increase in demand for personal protective equipment. These finding parallels those in studies like that of Galanis et al.,[14] who found a strong link between personal protective equipment shortages and increased rates of occupational infection among HCWs, especially in low-resource settings. So, personal protective equipment should be available to them at a low cost to reduce cross-infection and communicable diseases, which helps to reduce the workload on healthcare workers. As they work in high-risk zones and under heavy workloads, there is a need and suggestion to increase their salary.

Aluko et al.[5] study evidence show that most respondents were aware of immunization but in current survey only 27.1% of health workers were vaccinated for Tetanus, 22.4% for Hepatitis B vaccine, this show gap in knowledge of other health worker and class IV health worker and reveal an urgent need for immunization campaigns, awareness among healthcare workers and need to make vaccination compulsory among them.

18.3% health workers in the current study are only aware of safety protocols of biomedical waste management, compared to the previous study by Aluko et al.[5] concluded that most of them (99 %) were aware about preventive safety precautions because of the difference that previous study was done on doctors, nurses having more education and training than class IV health workers. The standardized precautions that must be taken are good hand hygiene practice, facial protection (e.g., masks and goggles), disposal of sharp objects, and management of biomedical waste.[15] But lack of information and knowledge about waste collection, segregation and its disposal, lack of risk awareness and limited financial resources are the main factors that cause the mismanagement of biomedical waste from the health sector.[16]

The findings from this study reveal the occupational health risks and gaps in safety practices among healthcare workers, especially regarding exposure to physical, biological, chemical, ergonomic, and psychological hazards. Limitations of this study are differences in hospital facilities available, staff education levels, diverse services, and locations of hospitals where healthcare workers are employed. Additionally, the severity of working conditions and overall workload may influence the extent of hazard exposure among healthcare workers. Some healthcare workers may not have reported injuries, needle stick incidents, or infections, leading to underreporting and an incomplete assessment of physical and biological hazard exposure and there may be differences in the availability or enforcement of safety training and policies between institutions that were not fully controlled, which might affect the uniformity of responses. So, the current study concluded that there is still a notable disparity in awareness between Class IV and other healthcare workers, increasing the risk of occupational health hazards among them. So, efforts should focus on providing comprehensive, frequent training on biomedical waste management, increasing PPE availability, and promoting vaccination programs for high-risk diseases. Regular monitoring and evaluation of workplace safety protocols, as well as mental health support to address psychological and ergonomic stresses, would further enhance the occupational health of healthcare workers.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.