Quality Assurance for Occupational Health and Safety Administration (OSHA) In the Morgue: The Impact of SOP Domestication on Implementation and Practice of Universal Safety Precautions in Kenya

Abstract

The growing need for mortuary services in sub-Saharan Africa amid competing priorities poses occupational health and Safety (OHS) challenges to industry stakeholders.  OHS Administration (OSHA) in the healthcare sector in sub-Saharan Africa has not only been overlooked on the assumption that the sector is a ‘safe zone’ given that “health” is its core mandate, but morgues have been sidelined in resource allocation losing out to presumed priority areas like maternal and child health. Quality implementation of universal safety precautions is however critical in such risky work environments as the morgues. While deliberate morgue safety quality assurance (QA) efforts have been made, emerging data raises an alarm.  In over 2.3 million fatalities reported annually in hospital environment related accidents and diseases, morgues are a contributor.  However there is lack of information on OHS exposures among mortuary workers in the light of rapid expansions.  This study investigated the quality assurance for OSHA in morgues specifically the impact of standard operating procedures (SOP) domestication on practice of universal safety precautions in government mortuaries in Kenya. This was a cross-sectional survey targeting a saturated sample of 39 facilities out of a population of 97 randomly sampled from 3,448 government health facilities.  A research model instrument, the Morgue OHS-Hazard Identification Risk Assessment and Control (HIRAC) survey comprising 30 variables developed from the principles of universal mortuary safety precautions was used to collect data.  100% (39) response rate was achieved.  The tool tested the presence and implementation of the universal precautions in a scale of 1-5 and the variables used for stratification to identify factors that correlate with major constructs and relationships between factors determined by Spearman’s rank correlation analyses.  The result shows cases of “Universal Precautions fully in Place” at 9.8%, “Universal Precautions Partially (Certain Elements) in Place” 27.8%, while cases of “No Universal Precautions in Place” at 62.4%.  In addition, a correlation was observed between the presence of SOPs and the practice of universal precautions in the morgues (P£0.05).  Regression analysis revealed approximately 70% (r=0.7) of variance in presence of SOPs as the determinant factor and the practice of individual elements of universal precautions namely; staff protection through vaccination (P=0.502^**) Appropriate ventilation systems (P=0.535^**) provision of appropriate equipment e.g. power-saws (P=0.658^**); Use of additional PPE when gross contamination is anticipated (P=0.664^**) and Respiratory protection measures at (P=0.726^**) among others. This study confirms an empirical relationship between SOP domestication and the practice of universal precautions in government owned morgues in Kenya. Results show that morgues which had SOPs were largely compliant with universal safety precautions as opposed to those without SOPs.  The findings are significant in improving quality assurance for OHSA in the mortuaries and healthcare sector in Kenya.

Keywords: Practice, Occupational Safety and Health (OHS), Universal Precautions, Mortuary/Morgue, Workers, Public Health Facilities.