Located in the Songkhla province in the south of Thailand, Bangkok Hospital Hatyai (BHH) is still grappling with a serious COVID-19 situation. As of September 2021, Songkhla is classified as a Red zone under the government’s colour-coded system – signalling that COVID-19 caseload and spread in Songkhla remains high.
The hospital has had to ramp up and adapt its Infection Control and Hygiene Policy as the situation evolved, said Ms Satita Tantiyapong, infection control nurse.
For one, an Acute Respiratory Infection (ARI) clinic was set up, to serve only patients with ARI symptoms, or close contacts of COVID-positive cases.
Inpatients were arranged to stay in a “Buffer Ward”, or a temporary holding room, to wait for their swab test results before they are admitted. As for the critically ill patients who are COVID-positive, they were admitted promptly to airborne infection isolation rooms (AIIR), which are designed specifically to prevent the spread of airborne diseases.
An increase in cleaning tasks
These measures meant an increase in hospital cleaning work to be done around the clock, as strict infection control and disinfection is required at these high-risk areas.
“All medical equipment in ARI Clinic must be cleaned with a proper cleaning material, for instance, disinfection wipes approved by FDA Thailand,” said Ms Tantiyapong, as there is a higher risk of infection exposure in the area.
If a patient in the Buffer Ward receives a positive COVID result, deep cleaning will be conducted before the ward can receive new patients. In addition, the cleaning of common areas such as lifts and escalators has been stepped up.
While cleaning tasks have increased, Ms Tantiyapong revealed that the number of cleaning staff at BHH did not increase. Instead, the hospital redesigned work procedures, such as streamlining routine cleaning tasks in the COVID wards, and redeploying staff in areas that needed more manpower. There are some limitations to this, though, as staff assigned to certain high-risk areas such as the ARI clinic cannot be redeployed elsewhere to prevent cross-infections.
BHH is also exploring the adoption of UVC light for sanitising and disinfection purposes. However, though this solution would complement manual cleaning and safeguard staff safety, “the most significant disadvantages of applying this method are complicated process and high cost,” said Ms Tantiyapong. In the meantime, the hospital has invested in antiviral air conditioner filters, and antiviral or antibacterial coatings on medical equipment.
Mitigating risk of workplace injuries
As workload increases, hospitals will have to be conscious of the higher risk of workplace injuries in cleaning staff as well.
One potential cause is the cleaning chemicals and substances used, which could cause burns and injury when exposed to the eyes or skin. To mitigate this, Ms Juthamas Jantawilai, Safety, Occupational Health, and Environment coordinator at BHH, emphasised that the proper use of PPE, as well as thorough training in chemical safety, would be key.
On the other hand, a 2021 survey of hospital cleaners found a high prevalence of musculoskeletal disorders, particularly in the lower back and shoulder. “Major cleaning tasks heavily involve the lower back and shoulders, for example, mopping and wiping,” said the authors. “Mopping tasks require a bending forward posture, which can put a strain on the back muscles… while wiping requires repetitive and strenuous shoulder and arm movement.” Extended working hours or insufficient rest could exacerbate the problem.
Ms Jantawilai pointed to improper cleaning posture as a common issue. “The muscle pain experienced during or after lifting heavy objects, for instance, table, chairs, and cabinet, is usually caused by improper lifting technique. Over-bending during the cleaning process is also a potential cause of muscle pain,” she said.
To protect its staff, BHH holds mandatory training on lifting techniques, as well as the proper use of lifting machines for all cleaning staff. It also ensures that appropriate resting time and shift rotation is scheduled.
One other area that hospitals can look at, to boost occupational safety, is the adoption of ergonomic cleaning equipment or those designed with user safety in mind. An example is microfibre mops, which can cut movement risk by 20% as users spend less time outside the preferred range of movement. The microfibre mopping action is completed closer to the body’s core than wet mopping, and lower muscle activity is observed in the lower back and shoulder.
These mops also dry faster, reducing the risk of slips or falls by both staff and patients. Moreover, a mop handle that is designed bent minimises the force and leverage required while mopping, as workers stay in a more natural upright position, while a swivel grip reduces wrist strain. Thus, the selection of the right cleaning equipment goes a long way in reducing costly workplace injuries in cleaning staff.
Building a safe workplace
To promote a safe work environment, BHH set up a Safety, Occupational Health and Environment Committee, which is tasked to design a proper safety training programme for cleaning staff, learning from past occurrences of workplace injury to improve its guidelines and measures.
“If a workplace injury occurs, the staff must report to their supervisor as well as record in the hospital occurrence report system,” said Ms Jantawilai. “All statistics and data related to workplace injuries will be analysed and reported to Safety, Occupational Health and Environment Committee to monitor, review, as well as design proactive root cause analysis and prevention. The main aim of the committee is to prevent recurrence of an injury.”
With hospital cleaning and disinfection now a high priority, especially in the wake of a pandemic, hospitals would do well by encouraging a culture of continuous safety monitoring and review, coupled with the adoption of improved processes or innovations that can uplift safety for both its staff and patients.