Occupational Health and Safety Administration (OSHA) in the Morgues: Management and Practice of the Universal Precautions in Morgues in Kenya

Abstract

Background: Morgues provide a risky work environment that requires universal safety precaution since it presents a variety of Occupational Health and Safety (OHS) challenges. Although OHS is a top priority internationally, in sub-Saharan Africa, health institutions are perceived to be ‘safe’ given that ‘health’ is their core mandate thus creating numerous hazards like the health worker Ebola related fatalities in Africa. Despite high global OHS-related mortality, there is lack of information on the potential of OHS exposures among mortuary workers in government health facilities in Kenya. As such, the current study investigated the OHS management practices, focusing on the implementation of Universal Safety Precautions (USP) in government-owned mortuaries in Kenya. Methodology: A cross-sectional survey was conducted targeting a randomly selected sample size of 39 (40.2%) respondent facilities spanning seven regions/Provinces of Kenya through which the government administers the health care program via the Kenya Essential Package for Health system (KEPH) - level 2 to 6. A standardized research model instrument, “the Morgue OHS-Hazard Identification Risk Assessment and Control (HIRAC) survey” was used to collect data. Results: A total of 24 (61.5%) of surveyed facilities had “No universal precautions in place”; 10 (25.6%) had partially implemented while only 5 (12.8%) had universal precautions fully in place. The presence of a “documented OHS management plan” influenced the practice of the following individual universal precautions among morgue workers: use of (Standard Operating Procedures (SOP) and best practice OHS principles (rho=0.632:P=0.001); protection by vaccination (rho-0.546:P=0.0001); latex allergy alternatives (rho=0.356: P=0.026); inclusion of OHS on facility performance contract (rho=0.875:P=0.0001); appropriate ventilation systems (rho=0.424:P=0.007); ventilation of autopsy suite to ≥6 room air changes/hour with air flow away from operators’ breathing zone (rho=0.478:P=0.002); local exhaust ventilation provision over bone cutting saws/band-saws for sectioning of tissue (rho=0.474:P=0.002); provision of appropriate equipment (power-saws and vacuum systems) (rho=0.331:P=0.040); additional personal protective equipment (PPE) (rho=0.793: P<0.0001); respiratory protection program (rho=0.744:P<0.0001); provision of adjustable cadaver tray/work area (rho=0.401:P=0.011). Conclusion: USP are largely not applied in government-owned mortuaries that were studied hence a need for an urgent and significant improvement in OHS administration. A documented OHS management plan as part of daily operations should be preceded by implementation of individual USP measures.