Risk Of Occupational Diseases Research Articles

Systematic Literature Review: The Effect of Work Posture on Musculoskeletal Disorders in Goods Loading and Unloading Workers

In lifting and transporting activities, many are still done manually, so in this activity, it is necessary to have the correct work posture when carrying out lifting and transporting goods. Lifting activities with the wrong working posture can increase the risk of occupational diseases, namely musculoskeletal disorders. This study aims to find out whether there is an influence of work posture on musculoskeletal disorders. The research method used is a literature review of seven journals that have been selected based on inclusion criteria. The results of this study showed that in lifting and transporting activities, work posture affects musculoskeletal disorders, so there is a need to improve the abnormal working posture in lifting activities.

The Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians: Assessment of Patient-Related Outcomes among Professional Orchestra Musicians in Poland-A Cross-Sectional Study.

Background: Musculoskeletal pain is one of the reasons for a musician's inability to play an instrument. An assessment of the localization, intensity, and interference of those complaints is important among musicians because of the risk of occupational disease. Assessment by validated tools is especially important and serves as an indicator to take up proper preventive or treatment actions. The aim of the study was to assess the prevalence of playing-related musculoskeletal disorders (PRMDs) and the relationships with PRMDs' impact on playing musical instruments among Polish professional orchestra musicians. Methods: The study was conducted on a group of professional orchestra musicians (age 37.19 ± 9.62 years), 99 (55%) women and 83 (45%) men. Work experience in professional orchestra was 18.3 ± 9.83 years and the reported years of playing musical instrument were 31.4 ± 9.50. The study used the online version of a musician-dedicated questionnaire, Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians of the Polish Population (MPIIQM-P). Results: In the study group, 89.9% of women and 83.1% of men had experienced playing-related pain in their lifetime. The most intense pain among the group with current playing-related musculoskeletal complaints (n = 85) was located in the neck area for 19 (22.4%). Conclusions: The results of the study indicate a high prevalence of playing-related musculoskeletal problems among professional musicians.

Gender and sex differences in occupation-specific infectious diseases: a systematic review

Occupational infectious disease risks between men and women have often been attributed to the gendered distribution of the labour force, with limited comparative research on occupation-specific infectious disease risks. The...

Design of Table and Chairs for Packaging Tempe Chips Work Station for Reducing the Risk of Occupational Diseases in Putra Tunggal Home Industry Wonosobo

Home Industry Putra Tunggal Wonosobo is a tempeh chip industry whose production process is manual, so it can have a negative impact on worker ergonomics. Preliminary research was conducted by interviewing pain complaints and assessing work posture using the OWAS method. The tempeh chips packaging workstation was the workstation that had the most pain complaints at 67.86% (19 of 28 body parts) and the highest OWAS score at 4, so this was at high risk of experiencing musculoskeletal disorders. The next study used the NBM questionnaire to analyze the level of pain due to work and RULA for work posture. CATIA software was used to design tables and chairs, as well as assess the posture of the design results using the RULA method. Worker performance will be compared before and after using tables and chairs based on the level of body pain due to work (NBM) and work posture (RULA). The research results showed a decrease in the risk of work-related diseases by 80 and 78 to 40 and 44 (from high to low-risk levels) as well as a decrease in the RULA score from 7 (dangerous posture) to 2 (good posture).

Occupational risk management in construction supply chain

The building is historically a driver of the economy, creating thousands of direct and indirect jobs, moving a huge chain of suppliers of raw materials, supplies and services, besides building a country’s infrastructure and the homes of millions of people. But working conditions in this sector that is so important to the country are not the best, exposing workers to risks of work accidents and occupational diseases. Therefore, this study sought to present the main occupational hazards in the construction industry, discussing alternatives for effective risk management by reducing the rates of accidents and illness among workers. In this research, case studies were done in small and medium-sized construction sector facing the residential construction market. It was also proposed solutions for the implementation of risk management and occupational health and safety for businesses to succeed and lower the rates of accidents at work, health and safety, and quality of work life in these companies.

Proposal for Prevention of Occupational Disease Risk Using the Hiradc Method at PT X in the Dyeing Department

People in this era have various needs in carrying out life. The needs that need to be used by the community have multiple kinds of things, such as clothing. Clothes used by the community go through various processes before becoming finished goods. Before becoming ready-to-wear, clothes came from raw materials such as fabric rolls. There are multiple production processes, such as yarn, fabric, chemical dyeing, etc. One of the places where fabrics are produced is textile factories. A textile factory is a company that produces products in the form of fabrics. The manufacture of fabrics that occur in textile factories must involve mixing chemicals so that the fabric has good quality. The process of mixing these chemical substances involves workers, and the chemical substances used are classified as Hazardous and Toxic Materials (B3), so these chemicals can have a bad impact on their workers if there is physical contact with the worker's body. Exposure to chemicals in the worker's body will cause a risk of developing Occupational Diseases (PAK). Therefore, in this study, data will be processed to prevent workers' risk of Occupational Diseases (PAK) using the HIRADC (Hazard Identification, Risk Assessment, and Determining Control) method. The proposal given in this study is a proposal for the use of Personal Protective Equipment (PPE) and Standard Operating Procedure (SOP) for preventive measures against Occupational Diseases (PAK) for workers

SUBSTANTIATION OF CHANGES IN THE CERTIFICATION OF THE TRACTOR DRIVER’S WORKPLACE IN MODERN MACHINE-TRACTOR UNITS

The study aims to identify possible changes in the working conditions of tractor drivers under the computerisation of workplaces and to develop proposals for changing the requirements for sanitary standards in the design of tractors and agricultural machinery. The article analyses the impact of modern technologies on the working conditions of tractor drivers in agriculture. It investigates various aspects of work, including using on-board computers, air conditioning, and satellite navigation, and their impact on workers’ health. The authors consider health risks, such as increased noise levels and work with on-board computers, and reveal the lack of consideration of these aspects in regulatory documents. In particular, we have found that using on-board computers significantly simplifies the process of controlling agricultural machinery but can lead to increased noise and vibration levels, negatively affecting workers’ health. Some studies have shown that prolonged work with on-board computers can lead to the development of occupational diseases, such as musculoskeletal disorders, impaired vision, and others. In addition, air conditioning in tractor cabs can cause colds due to sudden temperature changes and increase the risk of legionella infection due to the water condensation accumulation in ventilation systems. The research also found that the legal and regulatory documents governing the working conditions of tractor drivers do not consider the use of modern technologies, which creates gaps in worker protection. Regulatory documents should contain requirements for the parameters of monitors and their placement in the working area of tractor drivers in agricultural production, such as adjusting the reflectivity of the screen, the main adjusted visual characteristics of monitors, and the location of video terminals in the tractor cab without being directly in the line of sight. It is necessary to develop measures to prevent the overwork of tractor drivers. Regulations should include rules for the use of air conditioners, as well as for cleaning air conditioning ducts and replacing filters on time. The general conclusion is that there is a need to strengthen the regulation of tractor drivers’ working conditions and to include requirements for using modern technologies in the relevant regulations. These measures will ensure the safety and health of workers in agriculture and reduce the risk of occupational diseases. Keywords: machine-tractor unit, tractor driver, workplace certification, labour protection, video terminal.

Вредные вещества в воздухе рабочей зоны горнодобывающего сектора металлурги-ческой промышленности как факторы риска для здоровья работников (аналитический обзор)

Working conditions at non-ferrous metallurgical enterprises typically involve exposure to a whole set of harmful chemicals present in occupational air. These chemicals contribute to the development of pathologies in workers, respiratory diseases in particular. Research literature was analyzed using bibliographic databases in order to summarize available information on effects produced by harmful chemicals in workplace air on health of workers employed at mining enterprises. Respiratory diseases such as pneumoconiosis, acute and chronic dust bronchitis prevail among occupational pathologies typical for underground miners. Acute and chronic bronchitis prevail among respiratory diseases as health disorders resulting in temporary disability of miners dealing with non-ferrous metal mining. Huge amounts of dust appear in occupational air at mining enterprises due to drilling, blasting and ore crushing. Priority chemicals found in workplace air in mining industry include several carcinogens such as nickel, lead, formaldehyde, cadmium, and benzo(a)pyrene. There is a unidirectional effect produced by sulfur dioxide, nickel, nitrogen oxides, acrolein, formaldehyde, cadmium, and particular matter on the respiratory organs. The nervous system can be affected by manganese, lead, and selenium; the blood, by nickel, lead, and carbon oxide; the cardiovascular system, by carbon oxide and selenium. Working conditions of underground miners in non-ferrous metallurgy involve intensive exposure to chemicals in occupational air, which create health risks of occupational respiratory diseases and malignant tumors. Diseases of the nervous, immune, cardiovascular systems and the blood are also possible. When planning a set of preventive activities, it is advisable to identify groups of work-related diseases caused, among other things, by a specific chemical factor.

Harmful chemicals in occupational air in the ore mining sector of the metal industry as occupational health risk factors (Analytical review)

Working conditions at non-ferrous metallurgical enterprises typically involve exposure to a whole set of harmful chemicals present in occupational air. These chemicals contribute to the development of pathologies in workers, respiratory diseases in particular. Research literature was analyzed using bibliographic databases in order to summarize available information on effects produced by harmful chemicals in workplace air on health of workers employed at mining enterprises. Respiratory diseases such as pneumoconiosis, acute and chronic dust bronchitis prevail among occupational pathologies typical for underground miners. Acute and chronic bronchitis prevail among respiratory diseases as health disorders resulting in temporary disability of miners dealing with non-ferrous metal mining. Huge amounts of dust appear in occupational air at mining enterprises due to drilling, blasting and ore crushing. Priority chemicals found in workplace air in mining industry include several carcinogens such as nickel, lead, formaldehyde, cadmium, and benzo(a)pyrene. There is a unidirectional effect produced by sulfur dioxide, nickel, nitrogen oxides, acrolein, formaldehyde, cadmium, and particular matter on the respiratory organs. The nervous system can be affected by manganese, lead, and selenium; the blood, by nickel, lead, and carbon oxide; the cardiovascular system, by carbon oxide and selenium. Working conditions of underground miners in non-ferrous metallurgy involve intensive exposure to chemicals in occupational air, which create health risks of occupational respiratory diseases and malignant tumors. Diseases of the nervous, immune, cardiovascular systems and the blood are also possible. When planning a set of preventive activities, it is advisable to identify groups of work-related diseases caused, among other things, by a specific chemical factor.

Assessment of Emerging Risks – is the INCDPM Method, Appropriate for the Assessment of Emerging Risks?

Abstract The rapid evolution of digital technologies has involved a series of important changes throughout society, in everyday life, but also in the evolution of organizations. Organizations' adoption of Industry 4.0 technologies has also given rise to the emergence of new and emerging risks for worker safety and health. These risks reflect the changes in the work environment driven by automation, extended connectivity and the introduction of cutting-edge technologies like the Internet of Things (IoT), data analytics, artificial intelligence, cloud computing and others into the organization's processes. In order to minimize the impact of these digital technologies on workers, it is essential to carry out the procedure of identifying and assessing potential occupational risks before the implementation /introduction of new digital technologies. Identifying risks, clarifying their nature in detail, identifying potential impact and likelihood of materialization, is an essential process for identifying and effectively implementing risk response strategies, ensuring that organizations manage risks in an adaptive and strategic way. Several tools, methods and work methodologies are available to identify, analyze and assess occupational injury and disease risks to which workers are exposed. The purpose of this study is to carry out a careful analysis of the method for assessing the risks of occupational injury and illness elaborated by the National Research and Development Institute for Labor Protection "Alexandru Darabonț" from Bucharest, Romania - to identify the limitations and disadvantages of the method, for determine whether it is appropriate for assessing new, emerging risks linked to recently introduced processes and technologies in the context of organizations' integration of digital technologies.

Pendampingan Prosedur Keselamatan Kerja pada UMKM Produksi Furniture CV Rumah Menyala di Kabupaten Batang

The furniture industry is a strategic commodity supporting national foreign exchange. Indonesia has great potential in developing this industry, supported by the availability of raw materials such as wood, rattan, and bamboo and an abundant workforce. However, workplaces in this sector, both formal and informal, have various potential hazards that can affect the health and safety of workers. This research aims to provide stimulus in the form of Personal Protective Equipment (PPE) and work safety signs to CV Rumah Menyala furniture MSMEs in Tegalsari Village, Kandeman, Batang, to improve worker safety and health. This activity includes the formation of an Occupational Safety and Health Advisory Committee (P2K3), education regarding hazard and risk mapping, and preparing work safety SOP documents. The activity results show increased worker awareness regarding the importance of using PPE and managing work safety. However, ongoing efforts are still needed to implement work safety SOPs with discipline. In this way, it is hoped that the risk of occupational diseases and work accidents can be minimized to increase worker productivity

Identifikasi Bahaya Proses Blasting dan Painting di Perusahaan Fabrikasi Menggunakan Job Hazard Analysis (JHA)

The risk of accidents and occupational diseases is difficult to avoid, one of which is in fabrication companies because workers are in direct contact with objects and heavy equipment during work. One of the work areas that is at high risk of accidents and occupational diseases is the blasting and painting area. The objectives of this study are: (1) to identify potential hazards and possible risks (2) to control the risks of each process activity to ensure that the work is in a safe condition. The research method used is a qualitative descriptive approach method with risk analysis using job hazard analysis. The results of the study identified 52 potential hazards and risks with 9 types of hazards, namely psychological hazards, mechanical hazards, electrical hazards, fire hazards, blasting hazards, physical hazards, chemical hazards, biological hazards, and ergonomic hazards derived from 7 classifications of processes or work stages in the blasting and painting work area. Prevention and control efforts are carried out to reduce the risk as a whole by using a hierarchy of control.

Analisis K3 pada Mesin Blow Moulding PT. XY dengan Metode HAZOP sebagai Upaya Meminimalisir Kecelakaan Kerja

XY is an industrial company that makes home care and food-grade plastic packaging. The purpose of this study is to analyze the risk of accidents and occupational diseases that occur and control the risk of work accidents ergonomically. In analyzing the risk of accidents and occupational diseases, an appropriate method is needed. The HAZOP (Hazard And Operability Study) method is a systematic and structured method that can analyze hazards in the operating system or processes that may pose a risk of occupational hazards. The results of the analysis indicate several sources that can result in the risk of occupational hazards including crushed feet, slipping, slashing, injuries to the musculoskeletal part, sprained feet, and hand lift pinches. Risk control can be done by conducting training based on work instructions and regulations regarding K3 to workers, cleaning the ventilation of the work area, changing work tools that are not ergonomic, conducting regular monitoring by related management, making checksheets of PPE completeness before workers enter the work area, and conducting Safety Talk once a month by the relevant management Keywords: Ergonomic, HAZOP, Hazard, K3, and Risk

FACTORS INHIBITING THE IMPLEMENTATION OF THE OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT SYSTEM (HOSHMS) AT CILEGON CITY REGIONAL HOSPITAL

Hospitals are one of the places that have a risk of occupational diseases and work accidents caused by various dangerous factors. The potential risk of disease or work accidents does not only occur to workers, patients but also to visitors and the community around the hospital. Therefore, hospitals are obliged to implement occupational safety and health through the management of the Hospital Occupational Safety and Health Management System (HOSHMS). This study aims to determine the relationship between inhibiting factors and the implementation of HOSHMS at Cilegon City Regional Hospital in 2023. The population in this study was all 335 nurses with a sample of 88 respondents. The samples were taken with proportional random sampling. The research design used is cross-sectional with chi square test at the level of significance (CI=95%, α=5%). The research data was collected through direct interviews using a questionnaire. The results of the analysis showed that there was no relationship between the quality of human resources and the implementation of OSHMS (p-value = 1.000) and no relationship between education and OSH training (p-value = 0.578) with the implementation of HOSHMS. In addition, there was a relationship between data management and OSH information (p value = 0.004) and a relationship between the implementation of law enforcement and the implementation of HOSHMS (p value = 0.012). Hospitals were advised to carry out a continuous OSH monitoring which is carried out in all work units and implement law enforcement more intensively.

Recommendations on the Development of a Hazard Register for Assessing the Level of Risks in the Field of Occupational Health and Safety at Food Industry Enterprises

The results of research on the implementation of the requirements of the ISO 45001 standard in the field of hazard identification and occupational risk assessment to ensure safe working conditions, preservation of life and health of employees of Kazakhstani food industry enterprises are presented. The Deming-Shuhart cycle «Plan-Do-Check-Act» is proposed as a methodology. It has been established that documentation of the hazard identification procedure and risk assessment is carried out through the development of Hazard and Risk Registers. The Register of Identified Hazards for the oil and fat industry enterprise «Shymkentmay» JSC, the Register of Identified Hazards in the production of meat products of «Karkyn-2030» LLP, the Register of Identified Risks for the operator of the ice cream production line of «Balmuzdak» LLP were developed as examples. Identification of hazards makes it possible to form a Risk map for each employee of enterprises that are taken as objects of research, depending on the existing hazards of a particular workplace. On the basis of such a map, an assessment of each risk is carried out with the establishment of its significance in three categories – high, medium and low. Depending on the established significance of the risk, preventive measures are being developed that allow to prevent the risks of occupational diseases and occupational injuries. The developed documents and completed activities serve as proof of compliance with the requirements of the ISO 45001 standard for monitoring, measurement and improvement of the occupational health and safety management system when confirming compliance with the requirements of this standard.

Manajemen risiko pada industri batu bara

Background: The coal industry has a high potential risk of work accidents and occupational diseases, therefore implementing risk management is important to maintain work safety and health. This paper aims to analyze the application of risk management based on ISO 31000 in the coal industry. Methods: This paper uses a literature study method, which is sourced from literature such as scientific articles, books, journals and online media. Findings: Risk management methods begin with establishing the internal and external context of the coal industry. Next, hazards and risks are identified at all stages of the coal production process, from land clearing, soil transportation, rock excavation, to coal transportation and storage. Conclusion: The identification results are analyzed using a likelihood and consequence matrix to determine the level of risk. Unacceptable risks are further evaluated and appropriate controls recommended. Control is carried out by technical engineering, administration and the use of personal protective equipment. The entire risk management process needs to be monitored and reviewed regularly. Implementing a risk management system in the coal industry can reduce work accident rates and improve production quality.

POTENTIAL HAZARDS AND RISK FACTORS OF THE WORK ENVIRONMENT IN THE FOUNDRY INDUSTRY X

Background: Workers have a risk of work accidents and Occupational Diseases (PAK) caused by the work process, behavior at work, and the work environment. Identification of potential hazards and risk assessment is the first step to find hazards in the workplace and then carry out control measures to create a safe and healthy workplace.
 Objective: Knowing potential hazards, environmental risk values, and physical working conditions in the Metal Casting Industry of X.
 Method: The method used in this study is a descriptive survey. The number of samples in this study were 36 workers. Data collection techniques are carried out through observation activities using sheetsJob Safety Analysis (JSA) and risk assessment sheets, interviews using interview guides, and measurements of physical working conditions usingenvironment meter. The data analysis carried out is descriptive analysis which provides an overview of potential hazards and environmental risk values.
 Results: Overall there are 54 potential hazards in the production process at CV Dwi Jaya Logam which consist of a wet mold making process, there are 12 potential hazards, dry mold making CO method2 there are 10 potential hazards, metal smelting has 20 potential hazards, pouring molten metal into the mold has 6 potential hazards, and disassembling the mold has 6 potential hazards. There are 28 potential hazards in the production process at CV Mulya Jaya consisting of grinding there are 6 potential hazards, cutting iron using a saw machine there are 2 potential hazards, drilling there are 6 potential hazards, turning there are 4 potential hazards, making holes using machinesscrap there are 3 potential hazards, the formation of workpieces using machinesmilling there are 2 potential hazards, welding has 3 potential hazards, and product painting has 2 potential hazards. Overall, the physical working environment conditions in the form of temperature and lighting at CV Dwi Jaya Logam and CV Mulya Jaya did not meet the requirements, while the results of noise measurements at the two locations met the requirements.
 Conclusion: Potential hazards found in the metal casting industry CV Dwi Jaya Logam, namely 54 potential hazards which are divided into 2 levels of risklow, 10 levels of riskmoderate, 30 levels of risk high, and 12 levels of riskextreme. CV Mulya Jaya Metal casting industry identified 28 potential hazards divided into 4 risk levelslow, 4 levels of riskmoderate, 12 levels of risk high, and 8 levels of riskextreme. These potential hazards come from the physical work environment (temperature, lighting, and noise) and the production process at each work step. The results of measurements of the physical working environment in the form of temperature do not meet the requirements according to the Regulation of the Minister of Manpower of the Republic of Indonesia No. 5 of 2018, the average lighting measurement results are also . do not meet the requirements according to Regulation of the Minister of Health No. 70 of 2016, and the average noise measurement results meet the requirements according to the Indonesian Minister of Manpower Regulation No. 5 of 2018.

Workplace Hazards and Occupational Risk Assessment for Automotive Industry Workers

Introduction: The automotive industry is characterized by a complex and combined workers’ exposure to occupational risk factors. The problem of early detection, course and development of prognostic criteria for modern forms of occupational pathology remains relevant. Objective: To assess the main workplace hazards in the automotive industry and the risk of occupational diseases in its workers. Materials and methods: We conducted our own occupational health studies, examined production control data (348 units) and results of special evaluation of working conditions (97 units) at an automobile manufacturing enterprise of the Republic of Bashkortostan in 2020–2023. In total, we took 554 measurements of noise, 554 – of hand-arm vibration, 448 – of chemicals, and 554 – of work heaviness. To assess occupational risk, we used an integral indicator of the frequency and severity of occupational diseases, the index of occupational diseases (IOD), as the inverse value of the categories of risk (Cr) and severity (Cs), a single-digit indicator (IOD), combining Cr and Cs. Calculations were done in Microsoft Excel. Results: In the course of work, employees are exposed to a combination of physical factors, such as noise (Class 3.2) and hand-arm vibration (Class 3.1); chemical factors, including fibrogenic aerosols, metal dusts, toxicants from welding fumes, paints and varnishes (Class 3.1), and physical overload (Class 3.1). The overall working conditions correspond to Hazard Class 3, degrees 1–2. We assessed risks of developing the following occupational diseases (IOD = 0.16, total IOD = 0.32): vibration disease from exposure to hand-arm vibration and sensorineural hearing loss from noise exposure; chronic poisoning with manifestations of disorders of the pulmonary system (toxic bronchitis and chronic obstructive pulmonary disease) related to chemical exposures. Occupational diseases had a mild course with minor functional grade 1 manifestations and no progression of the pathological process. Conclusions: The complex and combined exposure to industrial safety hazards in the automotive industry determines the moderate risk of developing occupational diseases in its workers.

Mitochondrial proteins as biomarkers of occupational disease risk of pilots and astronauts

Introduction. Mitochondrial dysfunction is an important pathogenic mechanism of neurodegeneration, characterized by a progressive structural and functional loss of neurons, leading to heterogeneous clinical and pathological manifestations with subsequent impairment of the functional anatomy of the brain. Aim of research. To study the influence of occupational hazards and stress experienced by civil aviation pilots and cosmonauts on the expression of mitochondrial biomarkers in buccal epithelial cells to assess the risk of developing neurodegenerative processes. Material and methods. The study involved 23 male participants in two age groups. 4 groups of investgation were formed, according to the occupation, comparable in age. The expression of mitochondrial proteins prohibitin and parkin in the buccal epithelium of the study participants was assessed by immunohistochemical methods. Results. A decrease in the expression level of the prohibitin protein was found in the group of civil aviation pilots compared to the control group of the corresponding age. There was also a tendency to a decrease in the level of expression of the studied proteins prohibitin and parkin in the group of cosmonauts compared with the control group of the corresponding age. Conclusion. The results obtained indicate a mitochondrial dysfunction, which may increase the risk of developing neurodegenerative changes.

Gambaran Penerapan Sistem Manajemen Keselamatan dan Kesehatan Kerja RSI Ibnu Sina Simpang Empat Tahun 2023

Hospitals are workplaces that have a large workforce with a high risk of occupational disease or work accidents. Based on interviews conducted at RSI Ibnu Sina Simpang Empat and data reports, there were 6 cases of work accidents in 2022. The research aims to find out an overview of the implementation of the occupational safety and health management system at Ibnu Sina Simpang Empat Islamic Hospital in 2023. The research design uses qualitative methods with descriptive approach. The informants in this research were the K3RS committee, nurses and human resources. The research was carried out by means of in-depth interviews, observation and document review. The research results show that the K3 policy has been issued by the hospital director and K3 experts have been consulted. K3RS planning involves identifying the environment in the field and taking considerations. The implementation of the K3RS plan is guided by Minister of Health Regulation No. 52 of 2018. Monitoring and evaluation of K3RS performance is carried out by the K3RS team once every three months. Reviewing and improving K3RS performance is an evaluation carried out twice a year. It is recommended to hospital management that educational delivery is not only verbal but also in writing and on sheets regarding the delivery of the applicable laws.