Pinnacle Enterprises Canada
Healthcare Safety Info-eLink™

Occupational and Patient Safety Managent Improvement in Healthcare

ABOUT THE WEBSITE FOUNDER

Christopher J. Lipowski
Principal, Pinnacle Enterprises Canada
Healthcare Occupational Health and Safety Professional,
first and former McGill University Health and Safety Officer is founder and webmaster of Healthcare Safety Info-eLink™

LinkedIn – Christopher J. Lipowski

This website is dedicated to the memory of Z.J. Lipowski, M.D., C.I.P., former Professor Emeritus of Psychiatry, University of Toronto author of:
"The Theory of Attractive Stimulus Overload"
"Affluence Information Inputs and Health"
"Psychosomatic Medicine and Liaison Psychiatry, Selected Papers"
"Viruses, Immunity, and Mental Disorders"
"Delirium: Acute Confusional States - Revised Edition"

MISSION

To successfully achieve high quality safe, error-free patient care, continuous improvement of occupational health and safety conditions must be a major priority. Healthcare Safety Info-eLink™ is a not-for-profit website provided as a personal contribution by Christopher Lipowski, CRSP, primarily for Occupational Health, Safety, Industrial Hygiene, and Public Health professionals who are interested in and dedicated to advancing healthcare safety practice excellence for staff and patients.

GUIDING PRINCIPLE - "First Do No Harm"

Maximize Efforts to Improve Safe Patient Care in Hospitals through improving Healthcare Workplace Health and Safety Conditions and Practices. To close the gap between best practice and common practice by encouraging hospitals to reach levels of quality and safety that are comparable to those of the best high-reliability organizations.

PURPOSE

Data on the Canadian workforce has consistently indicated that healthcare workers are at greater risk of workplace injuries and more mental health problems than any other occupational group. In the U.S. for example:

Health Care is the second-fastest-growing sector of the U.S. economy, employing over 12 million workers. Women represent nearly 80% of the health care work force. Health care workers face a wide range of hazards on the job, including needlestick injuries, back injuries, latex allergy, violence, and stress. Although it is possible to prevent or reduce health care worker exposure to these hazards, health care workers actually are experiencing increasing numbers of occupational injuries and illnesses. Rates of occupational injury to health care workers have risen over the past decade. By contrast, two of the most hazardous industries, agriculture and construction, are safer today than they were a decade ago, NIOSH.

In addition to this unacceptable situation, many patients suffer preventable care-related adverse events (AEs) during hospitalization. AEs among hospital patients are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. The Canadian Institute for Health Information (Measuring Patient Harm in Canadian Hospitals, 2016) reported that "138,000 hospitalizations — or 5.6% of all hospitalizations in Canada — involved at least 1 occurrence of harm in 2014–2015. The Hospital Harm data is meant to support quality improvement efforts and is not intended to assign blame". Most patients recover within six months, but each year, between 9,250 and 23,750 Canadian adults who experience a "preventable" adverse event in hospital later die, according to a study "The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada" Baker et al. 2004; JAMC • 25 MAI 2004; 170 (11). A Report to the Canadian Health Services Research Foundation and the Canadian Patient Safety Institute, "Effective Governance for Quality and Patient Safety in Canadian Healthcare Organizations" provides guidance on improvement strategies. The Institute of Medicine's "To Err is Human: Building a Safer Health System" reported: "The human cost of medical errors is high. Based on the findings of one major study, medical errors kill some 44,000 people in U.S. hospitals each year. Another study puts the number much higher, at 98,000." The Institute for Healthcare Improvement . In Canada, healthcare acquired infections or nosocomial infections, affect more than 220,000 people annually resulting in excess of 8,000 deaths in Canadian hospitals each year. Therefore, patient safety in Canadian healthcare organizations has become an increasingly important topic and led to the creation of the Canadian Patient Safety Institute (CPSI). A study by the CPSI estimated the economic burden of adverse events in Canada in 2009-2010 was 1.1 billion dollars. This estimate did not include the direct costs of care after hospital discharge, or societal costs of illness, such as loss of functional status or occupational productivity. To address the issue of identifying strategies for improving patient care, much valuable effort has been focused on application of new technologies, developing better communication and coordination among clinicians, and creation of a patient adverse (sentinel) event information database to be shared by hospitals for learning purposes, Canadian College of Health Service Executives - ppt. However, a growing body of research indicate that healthcare worker health and safety conditions are not just an important but an essential factor associated with the quality of patient care, Yassi, A. For example, OSHA (U.S.) reports that workplace safety also affects patient care. OSHA recommends hospitals develop a health and safety management system with a holistic approach that integrates patient safety and employee safety programs, Safety and Health Management Systems: A Road Map for Hospitals. Dr. Lucian Leape endorses OSHA Programs on Health Care Worker Safety: "Many of us in medicine have long recognized that hospitals can be dangerous places not only for patients who are at risk of experiencing a medical error or an adverse event, but also for nurses, physicians, and other health care workers", Institute for Healthcare Improvement (IHI) / National Patient Safety Foundation (NPSF). The 2004 Canadian Adverse Events Study suggested, "The greatest gains in improving patient safety will come from modifying the work environment of healthcare professionals, creating better defenses for averting adverse events and mitigating their effects", The Role of Healthcare Environments in Shaping a Safety Culture - Lowe, G.S. The Joint Commission published a monograph recently stating that greater awareness of the potential synergies between patient and worker health and safety activities is required, Improving Patient and Worker Safety. One major step that healthcare institutions can take toward championing patient and healthcare worker safety, according to the monograph, is becoming a high-reliability healthcare organization (HRO) -- described as "systems operating in hazardous conditions that have fewer than their fair share of adverse events". The monograph also identifies functional management systems and processes, strategies and tools that have been used to successfully integrate health and safety activities. A report by The Lucian Leape Institute presents details on healthcare safety challenges. Therefore, efforts to increase the quality of hospital occupational health and safety conditions and practices can be expected to have a direct positive impact on patient safety outcomes and an overall reduction in healthcare costs.
One strategy to achieve sustainable healthcare safety performance excellence is to implement an "Integrated Healthcare Safety Management System", a holistic approach that manages patient and staff safety programs together. Since the first step toward solving a problem is to understand it and knowledge is essential for advancing meaningful improvement initiatives to their maturity, this website offers the user a simplified means of accessing credible healthcare specific occupational health and safety information including associated topics. However - "Knowing is not enough; we must apply"
~ Goethe

NOTE: Wildfire Smoke - Exposure to wild fire smole and particle air pollution can irritate the lungs, cause inflammation, and alter immune function.

MicrobeTV - The amazing host of MicrobeTV - MicrobeTV is an independent podcast network for people who are interested in the life sciences. Our shows are about viruses, microbes, parasites, evolution, and even urban agriculture. Vincent Racaniello, Ph.D. (@profvrr) is Higgins Professor of Microbiology & Immunology at Columbia University Medical Center. He has been studying viruses for over 40 years, starting in 1975, when he entered the Ph.D. program in Biomedical Sciences at Mt. Sinai School of Medicine of the City University of New York. His thesis research, in the laboratory of Dr. Peter Palese, was focussed on influenza viruses. In 1979 he joined the laboratory of Dr. David Baltimore at Massachusetts Institute of Technology, for postdoctoral work on poliovirus. In 1982 Vincent joined the faculty in the Department of Microbiology at Columbia University College of Physicians & Surgeons in New York City. There he established a laboratory to study viruses, and to train other scientists to become virologists. Over the years his laboratory has studied a variety of viruses including poliovirus, echovirus, enteroviruses 70 and D68, rhinovirus, Zika virus and hepatitis C virus. His virology lectures are available online at iTunes University, YouTube, and Coursera. (see This Week In Virology, and Virology 101 courses)

CIDRAP - Center for Infectious Disease Research and Policy - Office of the Vice President for Research, University of Minnesota - Novel Coronavirus (COVID-19) Resource Center

Coronavirus and COVID-19: Who is at higher risk? - Lisa Maragakis, M.D., M.P.H. (The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System)

Public Health Agency of Canada - 2020-03-07)

Recall of certain hand sanitizers that may pose health risks - Government of Cannada - 2020-08-05

Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol — Arizona and New Mexico, May–June 2020 (CDC)

How to operate and use building services in order to prevent the spread of the coronavirus disease (COVID-19) virus (SARS-CoV-2) in workplaces - (REHVA)

Coronavirus Information - (ABSA International - American Biological Safety Association)

Information about Coronavirus - (Infection Control and Prevention Canada)

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 - (Update: May 2019, (CDC)

RESPIRATORY PROTECTION Against Airborne Infectious Agents for Health Care Workers - (Canadian Centre for Occupational Health & Safety, 2020-01-20)

Dust masks vs. respirators: is there a difference? - "Have you ever referred to your respirator as a dust mask? A surprisingly amount of people use the words dust mask interchangeably with respirator, even though there are significant differences between the two." (3M Science)

CAN/CSA-Z94.4-18; "Selection, use, and care of respirators"; (Published by CSA Group)

TECHNICAL GUIDE RG-501; Guide on respiratory protection against bioaerosols; Recommendations on its selection and use - (IRSST)

A Guide to Air-Purifying Respirators; (NIOSH, 2018)

PANDEMICS: Risks, Impacts, and Mitigation - (U.S. National Library of Medicine)

INFLUENZA - ARE WE PREPARED? "FLU PANDEMICS," POSES ONE OF THE WORLD'S GREATEST INFECTIOUS DISEASE CHALLENGES." (CDC, 2018)

THE NEXT PANDEMIC: Hospital Management (AHC Media LLC)

Influenza - (People 65 Years and Older & Influenza) - (U.S. CDC)

VACCINE SAFETY- Guillain-Barré Syndrome "Guillain-Barré syndrome (GBS) is a rare disorder where the body's immune system damages nerve cells, causing muscle weakness and sometimes paralysis. While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria. In the United States, an estimated 3,000 to 6,000 people develop GBS each year. Most people recover fully from GBS, but some have permanent nerve damage. There have been several studies of the risk of GBS after flu vaccine and CDC monitors for GBS during each flu season. The data on an association between seasonal influenza vaccine and GBS have been variable from season-to-season. When there has been an increased risk, it has consistently been in the range of 1-2 additional GBS cases per million flu vaccine doses administered."
"Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination. It is important to keep in mind that severe illness and death are associated with flu, and getting vaccinated is the best way to prevent flu infection and its complications." - (CDC)

Guillain-Barré syndrome (GBS) - (NIH)

Measles (Rubeola) - From January 1 to December 31, 2019, 1,282* individual cases of measles were confirmed in 31 states. Of these cases, 128 were hospitalized and 61 reported having complications, including pneumonia and encephalitis. - This is the greatest number of cases reported in the U.S. since 1992. - The majority of cases were among people who were not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated. - (CDC)

Complications of Measles - (CDC)
- As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
- About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.

Bacteria partners with virus to cause chronic wounds - "A virus that infects a dangerous bacteria helps it thrive in wounds, according to a study by Stanford researchers. But a vaccine against the virus dramatically cuts the bacteria's infectivity."(Paul Bollyky; Stanford Medical News ; Mar, 2019)

ANTIBIOTIC RESISTANCE THREATS IN THE UNITED STATES - According to the report, more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. In addition, 223,900 cases of Clostridioides difficile occurred in 2017 and at least 12,800 people died. - CDC is concerned about rising resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients in healthcare. The emergence and spread of new forms of resistance remains a concern. - The report lists 18 antibiotic-resistant bacteria and fungi into three categories based on level of concern to human health—urgent, serious, and concerning - The report also includes a Watch List with three threats that have not spread resistance widely in the U.S. but could become common without a continued aggressive approach. (CDC) 2019

"ANTIMICROBIAL RESISTANCE THREATENS THE VERY CORE OF MODERN MEDICINE AND THE SUSTAINABILITY OF AN EFFECTIVE, GLOBAL PUBLIC HEALTH RESPONSE TO THE ENDURING THREAT FROM INFECTIOUS DISEASE" (WHO)

APPROXIMATELY 10,000 CANADIANS DIE EVERY YEAR AS A RESULT AN INFECTION ACQUIRED IN HEALTH CARE BUILDINGS - Introduction to CSA Z317.13 - Public Health Ontario - (pdf)

MORE THAN 200,000 PATIENTS GET INFECTIONS EVERY YEAR WHILE RECEIVING HEALTHCARE IN CANADA; MORE THAN 8,000 OF THESE PATIENTS DIE AS A RESULT - (Public Health Agency of Canada)

Economic burden of healthcare-associated infections: an American perspective - Patricia W Stone, PhD, FAAN

Dirty hospitals: Hidden camera investigation (CBC Marketplace)

Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals - Shelley S. et al - (N Engl J Med 2018; 379:1732-1744 - Massachusetts Medical Society)

Study Shows Nurses' Scrubs Become Contaminated with Bacteria in Hospitals - Sarah Avery (The Society for Healthcare Epidemiology of America - Aug. 29, 2017)

Covers for Hospital Bed Mattresses: Learn How to Keep Them Safe (U.S. Department of Health and Human Services)

The Potential for Airborne Dispersal of Clostridium difficile from Symptomatic Patients (Oxford Journals Volume 50, Issue 11)

The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009–2015) (CMAJ June 25, 2018 190 (25) E758-E765)

The Environment of Care and Health Care- Associated Infections - An Engineering Perspective - (The American Society for the Healthcare Engineerig of the American Hospital Association)

The negative effects of workplace injury and illness on workplace safety climate perceptions and health care worker outcomes - Deirdre McCaughey et al. (Safety Science, Elsevier B.V., Volume 51, Issue 1, January 2013)

REPORT RELEASE: BURDEN OF OCCUPATIONAL CANCER IN CANADA (2019) - Burden of Occupational Cancer in Canada presents estimates of occupational exposure and the associated burden of cancer by industry, as well as exposure reduction strategies for the most common occupational carcinogens in Canada. Key findings of the report include: Collectively, exposure to cancer-causing agents in the workplace is estimated to cause approximately 10,000 cancers in Canada each year. The 13 occupational carcinogens featured in this report contribute to the bulk of these. Solar radiation, asbestos, diesel engine exhaust and crystalline silica had the largest estimated impact on cancer burden and also the highest number of Canadian workers exposed. Solar Radiation: Approximately 1.4 million Canadian workers are exposed, causing an estimated 4,600 non-melanoma skin cancer cases per year. Asbestos: Just over 150,000 workers are exposed but it is estimated to cause 1,900 lung cancers, 430 mesotheliomas, 45 laryngeal cancers and 15 ovarian cancers annually. Diesel Engine Exhaust: About 897,000 workers are exposed and every year it accounts for 560 lung and 200 suspected bladder cancer cases. Crystalline Silica: An estimated 382,000 Canadian workers are exposed to crystalline silica, which annually causes almost 570 lung cancer cases.

"THERE IS NO "SAFE" LEVEL OF ASBESTOS EXPOSURE FOR ANY TYPE OF ASBESTOS FIBER. Asbestos exposures as short in duration as a few days have caused mesothelioma in humans. Every occupational exposure to asbestos can cause injury or disease; every occupational exposure to asbestos contributes to the risk of getting an asbestos related disease."
(U.S. OSHA)

COSTS RELATED TO ASBESTOS EXPOSURE MUCH HIGHER THAN ORIGINAL ESTIMATES: IWH - Price tag of new cases of work-related mesothelioma, lung cancer soars to $2.35 billion (Canadian Occupational Safety - 09/19/2017)

LUNG CANCER - PRIORITY CARCINOGENS ("CANADIANS MAY BE EXPOSED TO HIGHER-THAN-AVERAGE LEVELS OF ASBESTOS in air if they live near asbestos-containing waste or industrial sites, if they use asbestos-containing consumer products, or if they live or work in buildings with deteriorating asbestos insulation or that have undergone poorly performed asbestos removal.") - CAREX Canada)

Asbestos Exposure and Cancer Risk - "Although it is clear that the health risks from asbestos exposure increase with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after exposure. It can take from 10 to 40 years or more for symptoms of an asbestos-related condition to appear" - National Institutes of Health (National Cancer Institute)

Health Hazard Evaluation - office building, office workers, asbestos - a case presentation - (NIOSH)

Exposure–Response Analyses of Asbestos and Lung Cancer Subtypes in a Pooled Analysis of Case–Control Studies - "Our results show an excess risk of lung cancer and its subtypes at relatively low levels of cumulative exposure (>0.5 ff/ml-years), which persisted at least up to 40 years after last exposure. Furthermore, the slope of the exposure– response relationship seemed steeper in this exposure range than at higher (and previously studied) levels. Together, this implies that the future burden of disease due to asbestos exposure may be underestimated." - (Epidemiology: March 2017 - Volume 28 - Issue 2 )

ABOUT THE SAFE USE OF ASBESTOS IN QUÉBEC - "The occupational exposure limit for chrysotile asbestos (1 fibre/ml) currently in force in Québec is 100 times higher than the one prevailing in the Netherlands and in Switzerland and it is ten times higher than the one adopted by many western countries and other Canadian provinces. Moreover, in the current state of knowledge, there is no cancer protective threshold for persons exposed to asbestos. The studies carried out in Québec in asbestos products factories and in the construction industry show that the current laws and regulations are not always enforced, thereby leading to the finding that asbestos is not used safely in these industries." - (Quebec Public Health Expertise and Reference Centre)

Genomics and Epigenetics of Malignant Mesothelioma - Adam P. Sage et al.;27 July 2018, MDPI)

Biological responses to asbestos inhalation and pathogenesis of asbestos-related benign and malignant disease - Eduardo Solbes, Richart W Harper - (Journal of Investigative Medicine; Volume 66, Issue 4, 2017)

Autoimmunity and Asbestos Exposure - Jean C. Pfau et al.; Autoimmune Diseases Volume 2014, Article ID 782045

IWH research raises awareness of the economic burden of asbestos-related disease as Canada commits to ban - (Institute for Work & Health, March 2018)

The economic burden of lung cancer and mesothelioma due to occupational and para-occupational asbestos exposure - Emile Tompa et al - (BMJ: Occupational and Environmental Medicine)

RESPIRABLE CRYSTALLINE SILICA: Breathe Easier - CAREX Canada reports that approximately 380,000 Canadians are exposed to silica at work, primarily in the construction sector. According to 2011 cancer statistics from CAREX, 570 lung cancer cases (2.4% overall) were attributed to occupational exposure to crystalline silica in Canada. (CCOHS)

FORMALDEHYDE CONFIRMED AS KNOWN HUMAN CARCINOGEN -
The National Academies of Sciences, Engineering, and Medicine

Potential health hazards for students exposed to formaldehyde in the gross anatomy laboratory - Raja DS1, Sultana B. (J Environ Health. 2012 Jan-Feb;74(6):36-40)

FORMALDEHYDE EXPOSURE IN GROSS ANATOMY "Your classroom work in gross anatomy will expose you to formaldehyde. This document will inform you of the potential hazards formaldehyde exposure and describe the protective equipment you should wear and the procedures to follow to limit your exposure." - University of Pennsylvania, Environmental Health & Radiation Safety

Workers exposed to chemotherapy drugs at increased risk for cancer, organ damage, reproductive issues - Nurses, pharmacists and housekeeping staff all must be aware of this toxic hazard - Amanda Silliker, Canadian Occupational Safety, (06/05/2018)

Health and Safety Practices Survey of Healthcare Workers - ANTINEOPLASTIC DRUGS – Compounding (NIOSH 2018)

Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses - An Exploration of the Use of Protective Gloves and Gowns (Lawson, Christina et al; The American Journal of Nursing: January 2019 - Volume 119 - Issue 1 - p 28–35)

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016 - (pdf)

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings: Proposed Additions to the NIOSH Hazardous Drug List 2018

Pulmonary toxicity and lung tumorigenic potential of surrogate metal oxides in gas metal arc welding-stainless steel fume: Iron as a primary mediator versus chromium and nickel. - (Falcone LM et al; PLoS One. 2018 Dec 26;13(12):e0209413. doi: 10.1371/journal.pone.0209413)

Exposure to Glyphosate-Based Herbicides and Risk for Non-Hodgkin Lymphoma: A Meta-Analysis and Supporting Evidence (Luoping Zhang et al; Mutation Research/Reviews in Mutation Research, 2019 - Science Direct, Elsevier B.V.)

Night Shift Work and Breast Cancer Incidence: Three Prospective Studies and Meta-analysis of Published Studies (R.C. Travis et al - JNCI J Natl Cancer Inst (2016) 108 (12)

Beyond the cutting and crushing. Keeping you safe from Crystalline Silica - This free webinar is presented by 3M Science and Canadian Occupational Safety - June 18th @ 12:00 PM EST

Silica (Crystalline) - (CAREX Canada)

Control of Drywall Sanding Dust Exposures - "When silica is present, workers may also face an increased risk of silicosis and lung cancer" - (CDC)

Developing a Silica Exposure Control Plan (WorkSafe BC)

Dust Sampling, Equipment Choice, Equipment Use, Interpreting Results - Bill Walsh, CIH, Galson Laboratories (pdf)

Guidelines for personal exposure monitoring of chemicals: - Part V (J Occup Health. 2018 May 20; 60(3): 203–207)

Commentary: Erosion of trust threatens essential element of practicing medicine (Daniel Wolfson; Modern Healthcare, March 09, 2019)

MEDICAL ERROR - "The most recent study in 2013 suggested the numbers range from 210,000 to 440,000 deaths per year. The latter number would make it the third leading cause of death after heart disease and cancer.[2] However, these numbers can only be estimated because medical records are often inaccurate and providers might be reluctant to disclose mistakes. " -(Niki Carver; John E. Hipskind; National Center for Biotechnology Information, U.S. National Library of Medicine; May 15, 2019)

THE IMPACT OF HOSPITAL HARM ON LENGTH OF STAY, COSTS OF CARE AND LENGTH OF PERSON-CENTRED EPISODES OF CARE: a retrospective cohort study - "Out of 610 979 hospital admissions, 36 004 (5.9%) involved an occurrence of harm. The impact of harm on the incremental length of hospital stay ranged from 0.4 to 24.2 days (p < 0.001); the incremental length of the PCE ranged from 0.3 to 30.2 days (p < 0.001); and the incremental costs of the PCE ranged from $800 to $51 067 (p < 0.001). Total hospital days attributable to hospital harm amounted to 407 696, and the total attributable cost to the Ontario health system amounted to $1 088 330 376.; "We found that experiencing harm in hospital significantly affects both in- hospital and post-discharge use of health services and costs of care, and constitutes an enormous expense to Ontario's publicly funded health system.; (Lauren Tessier, et al; Canadian Medical Association Journal; August 12, 2019)

Preventing occupational disease: Moving the agenda forward - (Dr. Paul Demers delivered the Institute for Work & Health's 2018 Alf Nachemson Memorial Lecture)

Leading Indicators for Workplace Health and Safety: a user guide - (Work Safe Alberta)

Ontario Leading Indicators Project (Institute for Work & Health (IWH)

Leading to Safety: How Top Organizational Leaders Impact Safety - Prepared for: WorkSafe Saskatchewan by: Sean Tucker, June 2016 (pdf)

Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes - (Zirui Song, MD, PhD,Katherine Baicker, PhD; JAMA. 2019; 321(15):1491-1501)

Exploring the state of health and safety management system performance measurement in mining organizations - (Saf Sci. 2016 Mar; 83: 48–58)

Measuring Best Practices for Workplace Safety, Health, and Well-Being: The Workplace Integrated Safety and Health Assessment - (Sorensen G et al - J Occup Environ Med. 2018 May;60(5):430-439)

Optimizing Safety Through Leading Indicators by Carrie Young and Todd Lunsford | Sep 20, 2017, EHS Today)

Using lagging and leading indicators for the evaluation of occupational safety and health performance in industry
Int J Occup Saf Ergon. 2015 Jul 3; 21(3): 284–290

Safety and Health Management Systems and Joint Commission Standards - A Comparison (U.S. OSHA)

Overview of Best Practices in Occupational Health and Safety in the Healthcare Industry (Work Safe Alberta - May, 2011)

Physician engagement: A Multistep Approach to Improving Well-Being and Purpose - Alan H. Rosenstein, MD, MBA (June 1, 2015, Patient Safety and Quality Healthcare)

A Systems Approach to Risk Management Through Leading Safety Indicators (Nancy LevesonAeronautics and AstronauticsEngineering Systems, MIT)

CCHSA Accreditation: A Change Catalyst toward Healthier Work Environments - Wendy Nicklin and Melissa Barton (Longwoods Publishing Corporation, HealthcarePapers, 7(Sp) January 2007: 58-63.doi:10.12927/hcpap..18674)

What You Need to Know About ISO 45001: It's a Leading Concern.
" Top management needs to set the tone for ISO 45001 conversation throughout the organization. If leadership is viewed as unwilling converts who resist a change for good and, instead, operate solely on the singular principle of meeting minimum requirements rather than wholly embracing the underlying philosophy of the standard, there will be potential risk for repeated accidents and efforts to improve the safety culture. The fundamental difference of from previous standards is an emphasis on the need for a responsible approach from the very top tier of management to provide a safe workplace embracing concerns for worker safety and well-being as the basis for decision making" - Chris J Ward, Intelex Technologies Inc. (pdf)

Using Leading and Lagging Safety Indicators to Manage Workplace Health and Safety Risk - (UL LLC)

Organizational Safety Culture - Linking patient and worker safety - (Occupational Safety and Health Administration)

Culture of Safety - "The concept of safety culture originated outside health care, in studies of high reliability organizations, organizations that consistently minimize adverse events despite carrying out intrinsically complex and hazardous work. High reliability organizations maintain a commitment to safety at all levels, from frontline providers to managers and executives" (Agency for Healthcare Research and Quality, June 2017)

Ultra-processed foods in Canada: consumption, impact on diet quality and policy implications - (Jean-Claude Moubarac; University of Montreal)

Information for Canadians regarding reports of acute flaccid myelitis (Public Health Agency of Canada, 11/28/2018)

Chronic wasting disease (CWD) of deer and elk (Canadian Food Inspection Agency)

Susceptibility of Human Prion Protein to Conversion by Chronic Wasting Disease Prions - Marcelo A. Barria et al - (Volume 24, Number 8—August 2018: CDC)

Review of the Literature on the Links between Occupational Hearing Loss and Presbycusis - (The Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) - 2018)

Occupational Injuries Causing Permanent Physical or Mental Impairment - Highest-risk groups and risk-influencing variables (IRSST)

NIH-funded pre-clinical study links gut microbes and the immune system to a genetic disorder that can cause stroke and seizures - NIH, May 18, 2017)

The gut–brain connection: triggering of brain autoimmune disease by commensal gut bacteria (Hartmut Wekerle, Rheumatology, Volume 55, Issue suppl_2, 1 December 2016)

November 2023

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