Pinnacle Enterprises Canada
Healthcare Safety Info-eLinkT

"Dedicated toHealthcare Occupational Health and Safety Management Performance Improvement
to Facilitate Cost Effective Safe Patient Care Success


To successfully achieve high quality safe, error-free patient care, continuous improvement of occupational health and safetyconditions 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 healthcaresafety practice excellence for staff and patients.There is a link at the bottom centre of this home page that provides useful information on health, safety, and related topicsfor the general public because understandingmany aspects of this subject as it applies at home closely corresponds tosafe and healthy practices in the workplace.


Maximize Efforts to Improve Safe Patient Care in Hospitals through improvingHealthcare 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-reliabilityorganizations.


Data on the Canadian workforcehas 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 ? involvedat 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 of Medicine. 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, andcreation 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 meaningfulimprovement initiatives to their maturity, this website offers the user a simplified means of accessing credible healthcare specificoccupational health and safety information including associated topics. However - "Knowing is not enough; we must apply"
~ Goethe
Christopher J. Lipowski, CRSP


Christopher J. Lipowski, CRSP
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?
This website is dedicated to the memory of Z.J. Lipowski, M.D., C.I.P., former Emeritus Professor 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"

Linkedin - Christopher J. Lipowski, CRSP



COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) - (Active MAP of world cases)

SARS-CoV-2/COVID-19 TOOLBOX - COVID-19 is the respiratory disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome- Coronavirus-2) - American Biological Safety Association - The Association for Biosafety and Biosecurity; May 4, 2020)

Coronavirus Resource Center - As coronavirus spreads, many questions and some answers; (Harvard Public Health, Harvard Medical School, May 22, 2020)

Coronavirus disease (COVID-19); (Government of Canada, 2020-05-25)

Hydroxychloroquine (Oral Route - Side Effects - unusual behavior?); Mayo Clinic

Hydroxychloroquine Side Effects; (severe mood or mental changes?) -

Coronavirus disease(COVID-19) (The Government of Canada - 2020-03-16)

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

Coronavirus Disease 2019 (COVID-19) - Information for Healthcare Professionals - (CDC)

List N: Disinfectants for Use Against SARS-CoV-2 -(CFDA)

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)

Advice on COVID-19 (coronavirus) - (HSC Public Health Agency)

The website for the "International Severe Acute Respiratory and Emerging Infection Consortium" "COVID-19" - (ISARIC)

Resolve to Save Lives - "Our goals are to save 100 million lives from cardiovascular disease and to prevent epidemics."; - (Resolve to Save Lives is led by Dr. Tom Frieden, former Director of the Centers for Disease Control and Prevention, and is housed within Vital Strategies)

Coronavirus disease (COVID-19) advice for the public: MYTH BUSTERS - (WHO) - NOTE: The W.H.O. announced on Feb. 11 a new name for the disease caused by the current novel coronavirus epidemic: Coronavirus Disease 2019 (COVID-19). As for the virus itself, the International Committee on Taxonomy of Viruses has decided on (SARS-CoV-2), which "formally recognizes this virus as a sister to severe acute respiratory syndrome coronaviruses." COVID-19 and SARSCoV2 are the common social media signatures WHO isencouraging people use.

(COVID-19) advice for the public - (WHO)

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

Information about Coronavirus - (Infection Control and Prevention Canada)

Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control - (WHO Online Course)

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)

The National Personal Protective Technology Laboratory (NPPTL) - "Respirator Information" "(CDC / NIOSH)

Healthcare Respiratory Protection Resources; (CDC, 2018)

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

Masks and N95 Respirators; (U.S. FDA)

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


Selective stockpiling for pandemic (3M Science. Applied to Life)

THE NEXT PANDEMIC: Hospital Management (AHC Media LLC)

Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector - (Government of Canada 2017-10-04)

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

Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2018?2019 - "People at high risk of influenza-related complications or hospitalization - People 65 years of age and older" (Health Canada)

Simulation Study of the Effect of Influenza and Influenza Vaccination on Risk of AcquiringGuillain-Barré Syndrome - Steven Hawken, et al - (CDC)

Flu may be spread just by breathing, new study shows; coughing and sneezing not required (Maryland School of Public Health - January 18, 2018)

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)

The effect of aging of the immune system on vaccination responses - (NCBI; Hum Vaccin Immunother. 2013 Jun 1; 9(6): 1364?1367)

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




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 theAmerican 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."

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)

Prohibition of Asbestos and Products Containing Asbestos Regulations - (Government of 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)

MESOTHELIOMA risk after 40 years since first exposure to asbestos: a pooled analysis (Reid A, et al. Thorax 2014;69:843?850)

Surviving Peritoneal Mesothelioma: Stephen Jay Gould's Cancer Journey (Mesothelioma Cancer Alliance at - Aug. 2018)

The Median Isn't the Message- ("In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos") by Stephen Jay Gould, PhD

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 QU?BEC - "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 Switzerlandand 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 DiseasesVolume 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)

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)

A study of leading indicators for occupational health and safety management systems in healthcare - (Joan M. Almost et al.; BMC Health Services Research, April 2018) - "This project, funded by the Ministry of Labour, will examine a new approach to strengthening the occupational health and safety system in healthcare settings - "Ontario's healthcare sector employs more than 800,000 employees with hospitals being the largest employer. Every day, healthcare workers encounter physical risks from repetitive lifting and moving, chemical risks, risks of infection and threats of violence. For the past five years the healthcare sector has ranked second highest for lost-time injury rates (injuries that result in lost time from work) among the 16 Ontario sectors, with female healthcare workers currently ranked the highest among all occupations for lost-time claims (WSIB, 2014). In addition, approximately $2.5B is spent yearly on occupational injuries (WSIB, 2012). Despite an increased focus on improving Ontario's Occupational Health and Safety System, the injury statistics are not improving significantly. One of the potential keys to changing this trend is the development of a culture of healthy and safe workplaces, including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMS). Leading indicators are workplace characteristics that precede occupational health and safety outcomes and, if changed, are expected to change these outcomes. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. Therefore, the aim of this study is to conduct a longitudinal study implementing leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators" - (funded by the Ontario Ministry of Labour and The Ottawa Hospital for providing in-kind funding to support the project")"

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 andefforts 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)

ISO 45001 Occupational Health and Safety Management Systems - Information Guide - (NSF International Strategic Registrations USA, May 3, 2018)

Publication of ISO 45001:2018 - Occupational health and safety management systems - The International Organization for Standardization has published ISO 45001:2018 - Occupational health and safety management systems (link is external). This new standard could have broad applications in Canada
(2018-03-12, Standards Council of Canada)

ONTARIO (CA) To REWARD SAFE EMPLOYERS - WSIB To Provide an Estimated $140 Million in Financial Incentives - "Supporting Ontario's Safe Employers is a voluntary program that recognizes employers across Ontario who successfully implement an occupational health and safety management system (OHSMS) in their workplace. Successful employers will be accredited by Ontario's Chief Prevention Officer (CPO)." - " The program is made up of two parts:
1. Accreditation of an occupational health and safety management system (OHSMS) - At this time, the CPO has accredited the following national and international standards:ISO 45001:2018 - Occupational health and safety management systems - Requirements with guidance for use,CSA Z45001-19 - Occupational health and safety management systems - Requirements with guidance for use,BS OHSAS 18001:2007 - Occupational health and safety management system - Requirements,COR? 2020 updated Standard to be available to implement in January 2020.
2. Recognition of employers who have implemented an accredited OHSMS and met other criteria set by the CPO, including third-party audit, Occupational Health and Safety Act compliance, and worker participation."

The road to safety regulation - "Associations across Canada are seeking self-regulation for the profession, but how will this impact OHS professionals themselves?" - Amanda Silliker - (02/15/2019| CANADIAN OCCUPATIONAL SAFETY)

2018 Report on Work Fatality and Injury Rates in Canada - (Prepared by: Sean Tucker, PhD and Anya Keefe, MSc - University of Regina)

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)

Occupational Health, Safety and Environmental Management Systems: Awareness FREE! - online ecourse - "Understand the principles and theory involved in the use of management systems". - Canadian Centre for Occupational Health and Safety (CCOHS)

Joint Commission issues new alert on developing reporting culture to improve health care safety systems - (Dec 11, 2018, - Maureen LyonsThe Joint Commission

Developing a Safety Culture in the Healthcare Workplace - UL is an American safety consulting and certification company

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)

Canadian groups launch website on preventing occupational diseases - (National Safety Council - February 26, 2019)

WORKPLACE VIOLENCE PREVENTION RESOURCES - ""Violence against our health care workers affect us all. It impacts our families and our communities. Ontario's skilled and compassionate health care workers are our health care system's greatest asset. By tackling violence in our health care sector, we'll be creating safer environments for our workers and improving patient care."" (Registered Practical Nurses Association of Ontario)

'There's not a day that we go into work feeling safe': Video shows violent attack on Winnipeg hospital staff (CBC News, Oct 10, 2018)

Reporting and consequences of workplace violence in six Ontario hospitals - (Dr. Peter Smith, Institute for Work & Health)

Study details extent of violence faced by hospital workers - (Sheryl Ubelacker, The Canadian Press, November 25, 2017)

Workplace Violence and Workplace Harassment (Ontario Ministry of Labour, May 2018)

Workplace Violence Prevention Resources - (Public Services Health and Safety Association, 2018)

The Five Steps to Building your Workplace Violence Program - (Public Services Health & Safety Association)

'Kevlar in the classroom': Teachers turn to protective gear as violence escalates "Violent outbursts by students at Ottawa's largest school board double in 3 years" - (CBS NEWS; Jun 27, 2019)

Bullying, harassment greatest workplace hazard of our generation - "Safety professionals shouldn't think it's just an HR issue" - (Dave Rebbitt; Canadian Occupational Safety; Jun 24, 2019)

Nutritional Update for Physicians: Plant-Based Diets (Perm J. 2013; Spring; 17(2): 61?66)

Low-grade inflammation, diet composition and health: current research evidence and its translation - Anne M. Minihane et al.; (Br J Nutr. 2015 Oct 14; 114(7): 999?1012)

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)

ERGONOMICS in the workplace: understanding the law - " Occupational health and safety laws related to ergonomics and ways to address hazards due to poor ergonomics." (Ontario Ministry of Labour, January 15, 2019)

CSA-Z412-00 (R2016) - Guideline on Office Ergonomics

Psychosocial Ergonomics - Melissa Statham, MHK, CCPE - (Occupational Health Clinics for Ontario Workers Inc.)

Launching the New MSD Prevention Guideline for Ontario - (University of Waterloo Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) ? Events ? 2018 ? October)

The work of emergency medical technician-paramedics: Understanding the risks in order to prevent musculoskeletal disorders (IRSST)

Indoor Air Quality in Photocopy Centers, Nanoparticle Exposures at Photocopy Workstations, and the Need for Exposure Controls - (Martin J, Demokritou P, Woskie S, Bello D: Ann Work Expo Health, 2017 Jan;61(1):110-122)

Emissions of Ultrafine Particles and Volatile Organic Compounds from Commercially Available Desktop Three-Dimensional Printers with Multiple Filaments - (Azimi P., et al:Environ Sci Technol. 2016 Feb 2;50(3):1260-8)

Are 3D printers bad for worker health? - "Some printers produce a large amount of particles, causing respiratory symptoms in workers" -
Olinda Johnson; 02/01/2018| Canadian Occupational Safety)

3D Printer Safety (University of Vermont)

Indoor Particulate Matter (U.S. EPA)

Health and Environmental Effects of Particulate Matter (PM) - (U.S. EPA)

Ultrafine Particles : Efficacy of N95 Respirators in Conditions Representative of Human Breathing (IRSST)

Printer Emitted Particles: Are they safe? (Center for Nanotechnology and Nanotoxicology, T.H. Chan Harvard School of Public Health)

NANOPARTICLE EXPOSURES from nano-enabled toner-based printing equipment and human health: state of science and future research needs - Pirela SV et - Crit Rev Toxicol. 2017 Sep;47(8):678-704.

The effect of exposure to nanoparticles and nanomaterials on the mammalian epigenome - Sierra MI et al.; October 2016, International Journal of Nanomedicine

Nanoparticle exposure reactivates latent herpesvirus and restores a signature of acute infection - Particle and Fibre Toxicology - (Christine Sattler et al.; BMC Open Access)

Nanomaterials ? A Guide to Good Practices Facilitating Risk Management in the Workplace, 2nd Edition (IRSST, 2018)

ARMMs [arrestin domain containing protein mediated microvesicles] as a versatile platform for intracellular delivery of macromolecules (Qiyu Wang et al, Nature Communications, 2018)

Z316.5-15 Fume Hoods and Exhaust Systems Standard - (CSA)

NIOSH Study Finds Widespread Use of Scavenging Systems to Control Waste Anesthetic Gases During Medical Procedures, but Other Recommended Controls Lacking

Exposures to Volatile Organic Compounds among Healthcare Workers: Modeling the Effects of Cleaning Tasks and Product Use - (2019 Oxford University Press)

Work-Related Asthma and Mitigating Employee Exposures to Cleaning Chemicals and Disinfectants (ABIH, March 12, 2018)

A support tool for choosing respiratory protection against bioaerosols (IRSST)

Synthetic Immunotherapeutics against Gram-negative Pathogens - (Mary Sabulski Feigman et al, Cell Chemical Biology: chembiol.2018.05.019)

When the body attacks the brain: Immune system often to blame for encephalitis, study finds - Susan Barber Lindquist (Mayo Clinic, February 12, 2018)

Echinococcus multilocularis Infection, Southern Ontario, Canada - "transmission of E. multilocularis tapeworms should be considered a public health risk in Ontario - (CDC, February 2019)

The Global Epidemic of the Metabolic Syndrome -
(Curr Hypertens Rep. 2018; 20(2): 12)

Climate Change ? A Health Emergency - Caren G. Solomon, M.D., M.P.H., and Regina C. LaRocque, M.D., M.P.H. (N Engl J Med 2019; 380:209-211)

Diagnosis and Treatment of Lyme Carditis: JACC Review Topic of the Week. - "The incidence of Lyme disease, a tick-borne bacterial infection, is dramatically increasing in North America." - (Yeung C, Baranchuk A.; J Am Coll Cardiol. 2019 Feb 19;73(6):717-726)


Preventing Physician Burnout- "AN URGENT CALL TO ACTION" (October 7, 2018)

An Urgent Issue for Psychiatrists and Medicine. It is estimated that 2 out of 5 psychiatrists have professional burnout. Addressing this problem has become one of the most pressing issues for medicine. APA is committed to helping psychiatrists achieve well-being and addressing individual and system-level challenges which contribute to professional burnout.
(American Psychiatric Association, 2018)

500,000 Canadians miss work each week due to mental health concerns (By Carmen Chai Senior National Online Journalist, Health Global News)

BURNOUT AMONG HEALTH PROFESSIONALS AND ITS EFFECT ON PATIENT SAFETY - Audrey Lyndon, PhD (Agency for Healthcare Research and Quality)


Workplace Stress - (CCOHS - 2018-11-17)

Chronic mental stress (Ontario WSIB)

Canadian Institute of Stress -(Dr. Richard Earle, Ph.D. is an internationally respected and published authority on stress and controlling its impacts on productive wellbeing both in individuals and in rapidly changing workplaces)

StressAssess Workplace Edition - StressAssess is an online survey tool designed for workers and managers who are interested in assessing psychosocial hazards in the workplace, to anonymously, collectively and confidently identify issues (Occupational Health Clinics for Ontario Workers, 2018)

National Academy of Medicine Launches 'Action Collaborative' to Promote Clinician Well-Being and Combat Burnout, Depression, and Suicide Among Health Care Workers (The National Academies of Sciences, Engineering, and Medicine)

Improving Work Functioning and Mental Health of Health Care Employees Using an E-Mental Health Approach to Workers' Health Surveillance: Pretest?Posttest Study - "Working as a nurse involves dealing with a range of potential workplace stressors, such as psychological and emotional demands. Unsurprisingly, mental health complaints including burnout, posttraumatic stress, anxiety, and depression are quite common in nurses. Impaired mental health can have adverse effects endangering the health and safety of the nurses themselves but also of their patients. Consequently, it seems worthwhile to pay preventive attention to the mental health and work functioning of nurses." - Sarah M. Ketelaar et al (Saf Health Work. 2014 Dec; 5(4): 216?221)

Taking Action on Workplace Stress- John Oudyk, Occupational Hygienist - (Occupational Health Clinics for Ontario Workers)

CAN/CSA-Z1003-13/BNQ 9700-803/2013 (R2018) - Psychological Health and Safety in the Workplace"Psychological health and safety (PHS) is embedded in the way people interact with one another on a daily basis, it is part of the way working conditions and management practices are structured. Bearing this in mind mental health is a significant challenge across workplaces. The Canadian Mental Health Commission has reported that, in any given year, one in five people in Canada will experience a mental health problem or illness, with a cost to the economy well in excess of 50 billion dollars. A Psychological Health and Safety Management System can help an organization identify hazards that can contribute to psychological harm to the worker. It is a preventive approach that assesses your workplaces practices and identifies those areas of concern." (CSA Group - SPE Z1003)

The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital - Aristotelis Koinis, et al. (Health Psychol Res. 2015 Apr 13; 3(1))

Psychological health andsafety in the workplace ? Prevention, promotion, and guidance to staged implementation - (CAN/CSA-Z1003-13/BNQ 9700-803/2013, National Standard of Canada)

Implications of DSM-5 for Health Care Organizations and Mental Health Policy - (Richard Castillo, Journal of Health and Human Services Administration 39(2):217-244 · August 2016)

Suffering in Silence: The Scourge of Physician Suicide (MD Magazine, Feb. 05, 2018)

Preventing Suicide: A Technical Package of Policy,Programs, and Practices (CDC)

11 ways to boost mental health in the workplace (Occupational Safety, Aug 7, 2018)

Workplace Health and Well-being - Comprehensive Workplace Health and Safety Program (CCOHS)

Psychological barriers to safety "Cognitive shortcuts, senior leadership behaviours may be harming your culture" - (Renée Gendron, Canadian Occupational Safety, Feb 5, 2018)

Alexander Wagner: What really motivates people to be honest in business - (TED)

Guarding Minds at Work - A Workplace Guide to Psychological Health and Safety (Centre for Applied Research in Mental Health and Addiction, 2018)

Mental Disorders as Brain Disorders - Thomas R. lnsel, M.D. is director of the National Institute of Mental Health (NIMH), the component of the National Institutes of Health (NIH) charged with generating knowledge needed to understand, treat, and prevent mental disorders. (TEDx)

"Why We Sleep: The New Science of Sleep and Dreams" (Professor Matthew Walker, Director of UC Berkeley's Sleep and Neuroimaging Lab - YouTube)

Circadian Integration of Metabolism and Energetics - Joseph Bass, Joseph S. Takahashi (Science,03 Dec 2010:Vol. 330, Issue 6009, pp. 1349-1354)

How to facilitate the adoption of organizational interventions to prevent mental health problems in the workplace? - ( IRSST - October 10, 2017)

Health and Psychosocial Issues (Quebec Portail santé mieux-être)

Healthy Work Environments Best Practice Guidelines (pdf)

Mental Health Commission of Canada findings set a 'new normal' in the workplace (Maria Gergin - Borden Ladner Gervais LLP)

Case Study Research Project Findings - The National Standard of Canadafor Psychological Health and Safety in the Workplace, 2014-2017 (Mental Health Commission of Canada) (pdf)

Health-care organizations commit to improving mental health - HealthCareCAN - (Thomson Reuters, Occupational Safety)

Role of Chronic Bacterial and Viral Infections in Neurodegenerative, Neurobehavioural, Psychiatric, Autoimmune and Fatiguing Illnesses: Part 2 - Garth L. Nicolson and J?rg Haier, British Journal of Medical Practitioners, March 2010, Volume 3, Number 1

Unusually high levels of herpesviruses found in the Alzheimer's disease brain - The Mount Sinai Hospital / Mount Sinai School of Medicine (21-JUN-2018)

Psychosis: an autoimmune disease? - (Adam A. J. et al, Immunology: Volume152, Issue3, 2017)

Peripherally derived macrophages modulate microglial function to reduce inflammation after CNS injury - Andrew D. Greenhalgh et al. - (October 17, 2018;PLOS / Biology)

A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis - (Journal of Neuroinflammation 2018, 15:40)

Delirium in intensive care: an under-diagnosed reality - Rita da Silva Baptista Faria1 and Rui Paulo Moreno, Rev Bras Ter Intensiva. 2013 Apr-Jun; 25(2): 137?147

What happens when the immune system goes rogue? - (TEDMED - Autoimmune disease investigator Betty Diamond)

Infection, autoimmune disease linked to depression - Patrick J. Skerrett,Former Executive Editor, Harvard Health

Diagnosing autoimmune diseases of the nervous system- (Medical Sciences Division, University of Oxford)

Stanford's Dr. Jose Montoya on Chronic Fatigue Syndrome (Stanford Health Care, 2011) (YouTube)

A reboot for chronic fatigue syndrome research (Nature; 2018)

Chemical Brain Drain - "How Environmental Pollution Impairs Brain Development and How to Protect the Brains of the Next Generation" - Videos

Childhood Infections Linked With Increased Mental Illness Risk(Psych Congress Network; December 12, 2018)




The Quality Worklife-Quality Healthcare Collaborative defines a healthy healthcare workplace as: A work setting that takes a strategic and comprehensive approach to providing the physical, cultural, psychosocial and work/job design conditions that maximize health and well-being of healthcare providers, quality of patient outcomes and organizational performance. "A fundamental way to better healthcare is through healthier healthcare workplaces. It is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces.

"Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams."
~ IHI/NPSF Lucian Leape Institute (Providing a Strategic Vision for Improving Patient Safety)

Last updated May 2020

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