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8
Students name : Scoots Bar
Course number and Name : IEE 454 - Risk Management
Instructors Name : Brittany Holloman
RISK MANAGEMENT USING HAZARD IDENTIFICATION RISK
ASSESSMENT AND RISK CONTROL (HIRARC)
1.0 Introduction:
Occupational health is an element of health related to the work environment and work,
which can directly or indirectly affect work efficiency and productivity. Meanwhile, work
safety is a major means of preventing work accidents that can cause losses in the form of
injury or injury, disability or death, loss of property, damage to equipment or machinery and
extensive environmental damage.1
In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
11
0
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
11
2
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
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Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
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the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
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In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
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0
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
12
2
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
12
4
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
12
6
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
12
8
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
13
0
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
13
2
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
13
4
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
13
6
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
13
8
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
14
0
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
14
2
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
14
4
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
14
6
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
14
8
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
15
0
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
15
2
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
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To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
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Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
In essence, Occupational Safety and Health (K3) is an effort to create protection and
security from various risks of accidents and hazards, both physical, mental and emotional to
workers, companies, communities and the environment. In addition, occupational safety and
health is expected to create high work comfort and work safety.2
Based on the government regulation of the Republic of Indonesia No. 50 of 2012
concerning the implementation of occupational safety and health management systems
(SMK3) in appendix 1, the guidelines for implementing SMK3 must carry out K3 planning
which contains identification of potential hazards, risk assessment and control.3
Hazards Identification, Risk Assessment and Risk Control or abbreviated as HIRARC is
a key element in the Occupational Safety and Health management system related to hazard
prevention and control efforts. The whole process of HIRARC, which is also called risk
management, will then produce a HIRARC document which is very useful for preventing
work accidents.4
Based on data from the International Labor Organization (ILO) in 2013, one worker in
the world dies every 15 seconds due to work accidents and 160 workers in the world
experience occupational diseases (PAK). An estimated 2.3 million workers die each year due
to accidents and occupational diseases. More than 160 million workers suffer from
occupational diseases and 313 million workers experience non-fatal accidents per year.5
From the results of the research by Mochamad Afandi, Shanti Kirana Anggraeni, and
Ade Sri Mariawati, it is found that the work carried out is longitudinal check and crosswall
check, from each of these jobs the highest risk category for longitudinal is CO gas poisoning
and falling into the charging hole. As for the crosswall, the highest risk is the risk of CO gas
poisoning, falling into the charging hole and being hit by the charging car wheel. The
conclusion from the HIRARC results is that the longitudinal check has 12 hazard risks while
the crosswall has 14 hazard risks.6
Then from the results of research by Khairul Anwar, Isa Ma'rufi, and Anita Dewi
Prahastuti S, it is known that the very high risk is exposure to Hydrogen Sulfide gas (H2 S) in
the process of descending to the bottom of the crater, taking sulfur at the bottom of the crater,
transporting sulfur from the bottom of the crater to the top of Mount Ijen.7
Globally according to WHO data, out of 35 million healthcare workers, 3 million are
exposed to blood pathogens (2 million exposed to HBV virus, 0.9 million exposed to HBC
virus and 170,000 exposed to HIV/AIDS virus), more than 90% occur in developing
countries, and 8-12% of hospital workers are latex sensitive.8
In Indonesia, according to data from the Social Security Administration (BPJS) of
Employment, until the end of 2015 there were 105,182 cases of work accidents. Meanwhile,
2,375 cases of serious accidents that resulted in death were recorded from the total number of
work accidents.9
From Novie E. Mauliku's research in 2011, the risk of hazards in hospital activities in
the aspect of occupational health, among others, comes from means of activity in polyclinics,
treatment rooms, laboratories, rontgent rooms, nutrition installations, laundry, medical record
rooms, housekeeping, pharmacy, sterilization of medical devices, steam or pressure vessels,
electrical equipment installations, fire protection installations, waste water, medical waste,
and so on.11
Other studies have shown that health workers are at risk of being exposed to infected
blood and body fluids (bloodborne pathogens) which can cause HBV, HCV and HIV
infections through various ways, one of which is through needle stick wounds or other sharp
objects.12 This study aims to determine OHS risk management using Hazard Identification
Risk Assessment And Risk Control (HIRARC) in the Suryanegara Prince room (psychiatry) at
Gunung Jati General Hospital, Cirebon City.
2.0 Research Methods:
The research design used in this research is qualitative. This qualitative research uses a
case study research design. Case studies are carried out by examining a problem through a
case consisting of a single unit.13 Problem restrictions in qualitative research are called
research focus. The focus in this study is K3 Risk Management Using Hazard Identification
Risk Assessment and Risk Control (HIRARC) in the Prince Suryanegara Room (Psychiatry)
at Gunung Jati General Hospital, Cirebon City, which produces HIRARC documents.
Determination of informants in this study using purpose sampling technique. Informants in
this study were divided into 2 namely main informants and supporting informants. The main
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informants in this study were 1 Head of the room, 1 room administration staff, 2 nurses, and 1
POS (workshop) who worked in the inpatient room of Pangeran Suryanegara (Psychiatry)
RSD Gunung Jati Kota Cirebon, totaling 5 people. Supporting informants in this study were
the K3RS section in Gunung Jati Hospital, Cirebon City, totaling 1 person. The research
instruments used in this study include:14 Human Instrument, Observation Sheet (HIRARC),
Interview Guidelines.
3.0 Research Results:
3.1 Hazard Identification:
Based on the results of research in the Prince Suryanegara inpatient room (Psychiatry)
at Gunung Jati General Hospital, it is known that the work process in handling patients is to
treat infectious disease patients, restrain, bathe patients, change patients' clothes, handle
hallucination patients, handle patients with self-care deficits (training defecation & BAK),
and conduct play therapy (TAK). From these activities there are risks of danger such as being
hit, contracting infectious diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting
attacked by patients.
The condition of the workplace is still new, so the existing building is still lacking in
physical conditions, such as the thickness of the acrylic glass used, the absence of trellis on
the windows, and sunlight. So that it can endanger nurses / officers and even patients. It is
known that data from the sanitation department in August 2017 noise measurements were
44.3 dBA, room temperature 29.30 C, and lighting 117 Lux. The results of hazard
identification in the Pangeran Suryanegara (Psychiatry) room are known from the condition
of the work environment, work activities or SOPs, incident data, and potential hazards.
Work Environment Conditions:
From the results of observations and interviews with nurses and staff in the
psychiatric ward, it is known that the number of rooms includes: visiting room, dining room /
living room, rowdy patient bedroom, male quiet patient bedroom, female quiet patient
bedroom, nurse's room, doctor's room, nurse's room / toilet, patient's room, and patient's
room.
The condition of the room during the day is still not good because the psychiatric
room is under one roof with the mortuary so that almost all of it is covered by walls, and the
use of acrylic glass material is still not safe for the psychiatric room. During the day, lights
are sometimes needed for illumination because natural light is only from the front door and
windows of the doctor's room.
''
Standard Operating Procedures for Nursing:
There are several Standard Operating Procedures that exist in the Pangeran Suryanegara
(Psychiatry) room including: (Appendix 4)
In clients with self-care deficits (training to maintain personal hygiene by bathing)
In clients with hallucinations (controlling hallucinations by talking)
In clients with self-care deficits (training clients to defecate / bathe independently)
In clients with hallucinations (control hallucinations by rebuking)
Music therapy
Play therapy
Group activity therapy (TAK)
Nursing service room lock procedure
Violent behavior clients (removing isolation clients)
Client restraint
In clients with violent behavior (client isolation)
Potential Hazards:
From the results of interviews with nurses and staff, it is known that the potential
hazards in the Pangeran Suryanegara (Psychiatry) room are being hit, contracting infectious
diseases (TB, HIV/AIDS, Hepatitis, etc.), panic, and getting attacked by patients.
Risk Assessment:
Risk assessment is one of the processes of risk analysis, risk assessment in this study
uses a qualitative method, namely a risk matrix that describes the level of likelihood and
severity of an event expressed in the form of a range from the lowest risk to the highest risk.
According to the AS/NZS 4360 standard, the probability is given a range between a risk that
rarely occurs to a risk that can occur happens all the time. For severity (consecuence) is
categorized between events that cause no injury or only minor losses and the most severe if it
can cause fatal events (death) or major damage to organizational assets.
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Risk Control:
Based on hazard identification, risk control efforts for work activities in the Pangeran
Suryanegara (Psychiatry) room with five hierarchical controls, namely:
Caring for patients during the day
Substitution: Use good lighting, so that the vision can see clearly on the object.
Doing room cleaning
Administration: Pay attention to warning signs at the work site to anticipate hazards and
perform work according to procedures.
Caring for people with infectious diseases
PPE: Personal protective equipment Nurses use gloves and masks when performing
actions on patients.
Performing restraint
Administration: Carried out work management by training nurses to handle mentally ill
patients. Restrained patients during tantrums, and isolated patients during agitation.
Bathing the patient
Technique: Repetitive work can be draining, with additional personnel or machine
assistance.
Changing the patient's clothes
Administration: Must carry out good procedures in good and correct ergonomic
SOPs/SPOs.
Night service that exceeds 8 hours
Administration: Carry out work management to avoid overloading tasks.
Handling hallucination patients
Elimination: Eliminate the fear of work that causes psychological disturbances at work.
Handling patients with self-care deficits (practicing defecation & toileting)
Administration: Understand the procedures for doing work and mental health training
for nurses.
Performing play therapy / PPT
Administration: Understand how to perform physical tool work in order to improve
physical, mental, and workload well-being. Mental health nursing training for nurses.
4.0 Discussion:
Hazard Identification:
The potential physical hazard identified is lighting, by treating patients during the day.
There can be a risk of eye fatigue, aches and decreased work efficiency. From the regulation
of the Indonesian Minister of Health No. 1204 / MENKES / SK / X / 2004 concerning
hospital environmental health requirements, patient room lighting is 100-200 lux with
moderate light color.
Potential chemical hazards identified are disinfectants, by cleaning the room. There is
a risk of poisoning, eye injury and infection. From Law No. 1 of 1970 concerning
occupational safety, Chapter III Article 3 paragraph 1 maintains cleanliness, health and order.
As well as Permenkes No. 66 of 2016 concerning Hospital Occupational Safety and Health
CHAPTER III Occupational Safety and Health Standards, that chemical hazards, namely
disinfectants, are in all areas and the most at-risk workers are cleaners and nurses.
Potential biological hazards identified are providing care to people with infectious
diseases. There is a risk of contracting AIDS, contracting tuberculosis, contracting Hepatitis
A and Hepatitis B, contracting diphtheria. From Law No. 36 of 2009 concerning Health
CHAPTER X communicable and non-communicable diseases part one communicable
diseases article 152 paragraph (2) efforts to prevent, control, and eradicate communicable
diseases are carried out to protect the public from contracting diseases, reduce the number of
people who are sick, disabled and/or die, and to reduce the social and economic impact of
infectious diseases. Paragraph (3) Efforts to prevent, control, and manage infectious diseases
are carried out through promotive, preventive, curative, and rehabilitative activities for
individuals or communities. Paragraph (4) Control of sources of infectious diseases as
referred to in paragraph (3) is carried out on the environment and/or people and other sources
of transmission. Indonesian Minister of Health Decree Number: 382/Menkes/SK/III/2007 on
infection prevention and control guidelines in hospitals and other health facilities, CHAPTER
II which contains important facts about several infectious diseases including HIV/AIDS and
Tuberculosis.
Potential ergonomic hazards identified are restraining, bathing patients, and changing
patients' clothes. There can be a risk of back pain, joint pain, muscle pain, and bruises from
incorrect posture doing repetitive work and getting attacks from patients such as being hit and
scratched. In Law No. 23 of 1992 concerning Health, article 23 concerning occupational
health states that occupational health efforts must be organized in every workplace, especially
workplaces that have a large risk of health hazards for workers so that they can work
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healthily without endangering themselves and the surrounding community, to obtain optimal
work productivity, in line with labor protection programs. As well as Permenkes No. 66 of
2016 concerning occupational safety and health in hospitals CHAPTER III occupational
safety and health standards that the potential hazards of ergonomics are incorrect posture and
repetitive work.
Potential psychosocial hazards identified are night duty exceeding 8 hours, managing
hallucinatory patients, managing patients with self-care deficits, conducting play
therapy/TAK. There can be a risk of stress, excessive fear, emotion, being hit, scratched,
panic, getting attacked and bad behavior from patients. From Law No. 1 of 1970 concerning
Work Safety CHAPTER III work safety requirements article 3, and Kepmenkes RI Number
432 / MENKES / SK / IV / 2007 concerning guidelines for occupational health and safety
management (K3) in hospitals that hospital activities have the potential to cause physical,
chemical, biological, ergonomic, and psychosocial hazards, which can endanger the health
and safety of both workers, patients, visitors and the community in the hospital.
Risk Assessment:
The risk assessment of caring for patients during the day is known to have a severity level of
1 and a probability level of A with a risk category of High.
Severity 1 insignificant, no injury with little financial loss due to fatigue at work due to
inappropriate lighting.
Possibility A is almost certain, it can occur at any time under normal conditions due to the
fact that the work is done every day.
The risk assessment of cleaning the room is known to have a severity level of 3 and a
probability level of D with a Moderate risk category.
Severity 3 moderate, moderate injury, need for medical treatment, large financial loss on the
grounds that there can be poisoning when in contact with disinfectants and slipping, risking
bruises and even fractures.
Probability D is unlikely, the possibility is rare because when you want to clean the room the
patient is secured in the room and gives a sign when the floor is being cleaned.
The risk assessment of providing care to infectious disease patients is known to have a
severity level of 3 and a probability level of A with a risk category of Extreme.
Severity 3 moderate, moderate injuries, need medical treatment, large financial losses on the
grounds that they can contract various infectious diseases such as HIV/AIDS, Hepatitis,
tuberculosis, and others which of course need medical treatment to cure them.
The possibility of A almost certain, can occur at any time under normal conditions for the
reason that patient handling is carried out every day and when the patient is rowdy it can hit
the nurse / officer, thus the officer is exposed to infectious diseases from the patient.
Risk assessment is known to perform restraint severity level 2 and probability level B with
risk category High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may cause joint
pain, back pain caused by incorrect posture.
The possibility of Blikely, the possibility of occurring often for the reason that when nurses
do work, they will certainly come into contact with patients so that rowdy patients will attack
or accidentally injure nurses / officers.
For bathing patients, the severity level is 2 and the probability level is D with a risk category
of Low.
Severity 2 minor, minor injuries moderate financial losses with reasons may cause joint pain,
back pain caused by incorrect posture.
Probability D unlikely, the possibility of occurrence is rare for the reason that not all patients
are bathed by nurses, patients can usually do their own bathing but are still supervised by
nurses.
To change the patient's clothes, the severity level is 2 and the probability level is B with a risk
category of High.
Severity 2 minor, minor injury moderate financial loss on the grounds that it may result in
muscle pain, back pain, due to repetitive work and bruises or scratches due to attacks from
patients.
B likely, the possibility of occurring often with the reason being to keep the patient clean so
the work is done quite often.
The risk assessment found that for night service exceeding 8 hours the severity level is 2 and
the probability level is A with a High risk category.
Severity 2 minor, minor injury moderate financial loss, reason stress may occur and may
interfere with work resulting in an incident.
The possibility of A is almost certain, it can happen at any time under normal conditions for
the reason that nurses / hospital staff certainly work in shifts, there are morning, noon and
night.
To manage hallucination patients with severity level 2 and probability level A with risk
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category High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that it may cause
excessive fear, stress caused by frequent contact with patients.
The possibility of A is almost certain, it can happen at any time for the reason that mentally
ill people suddenly appear hallucinations and occur at any time.
To treat a patient with a high deficit of self-care (practicing defecation and toileting) severity
level 2 and probability level B with risk category High.
Severity 2 minor, minor injury, moderate financial loss with the reason that nurses/officers
can be attacked suddenly by patients and get bad behavior such as patients throwing feces at
officers.
B likely, the possibility of occurring frequently on the grounds that the work occurs at any
time.
To perform play therapy/TAK severity level 2 and probability level B with risk category
High.
Severity 2 minor, minor injury, moderate financial loss on the grounds that bruises and
abrasions may occur due to being hit or attacked suddenly by the patient.
Likely Blikely, likely to occur frequently due to the fact that every day there are always
activities to do play therapy/ TAK.
Risk Control:
Efforts to control physical hazards (lighting), namely work activities to care for patients
during the day are to obtain sufficient and appropriate lighting. For risk control, that is, use
good lighting so that vision can see with proper lighting clear on the object, to avoid the
possibility of occupational diseases and occupational accidents.
Efforts to control chemical hazards (disinfectants), namely work activities to care for
patients during the day, must pay attention to warning signs in the work area to anticipate the
dangers of chemicals available in the room and pay attention to the use of chemicals
according to procedures.
Efforts to control biological hazards (contracting AIDS, Hepatitis A, Hepatitis B,
Tuberculosis), namely work activities to provide care for infectious disease patients, are to
use PPE needed according to work, such as using gloves and masks when in direct contact
with patients diagnosed with infectious or non-communicable diseases.
Efforts to control ergonomic hazards, namely work activities to restrain, bathe patients, and
change patient clothing, are to understand the SOP / SPO in doing work. Doing a good way
of working in a good and correct ergonimi SOP, the application of ergonomics that is not in
accordance with attitudes and ways of working can result in physical weakness and joint pain
in the body. And work that is done repeatedly can be draining so that it is further reduced by
redesigning work such as adding officers / nurses to do the job.
Efforts to control psychosocial hazards are to avoid fear of work that makes psychology
disturbed at work resulting in occupational diseases and work accidents. Conduct work
management by conducting training to handle mental patients so that they can know how to
handle properly and correctly when the patient suddenly attacks or is restless.
5.0 Conclusion:
It is known that the results of occupational safety risks in the room are: lack of lighting,
disinfectants, contracting HIV/AIDS, Hepatitis A, Hepatitis B, Tuberculosis, and other
infectious diseases, incorrect posture, doing repetitive work, getting patient attacks,
frequent contact with patients, panic, overwork, being hit, and scratched.
The work safety risk assessment in the room has risk levels ranging from the lowest to
the highest score. The risk assessment was grouped and obtained an extreme risk level of
1, a high risk level of 7, a moderate risk level of 1, and a low risk level of 1.
Risk control efforts in the Prince Suryanegara (Psychiatry) inpatient room with five risk
control hierarchies, namely elimination, substitution, technique, administration, and
personal protective equipment (PPE). Risk control that has been carried out by Gunung
Jati Hospital Cirebon City in the Prince Suryanegara (Psychiatry) inpatient room is the
existence of standard operating procedures for nursing, the implementation of work
shifts, providing mental nursing training for nurses, the schedule of red code officers
(Fire prevention and control), the use of masks and gloves.
