Pinnacle Enterprises Canada
Healthcare Safety Info-eLink™

"Dedicated to Promoting Healthcare Occupational Health and Safety Management Performance Excellence and Safe Patient Care"


To successfully achieve high quality safe, error-free patient care, continuous improvement of occupational health and safety working conditions must be a priority. My goal in this effort is to provide a high quality comprehensive user-friendly website with well-organized Internet links to credible sources of health and safety information primarily focused on the healthcare sector. Healthcare Safety Info-eLink™ is a not-for-profit service provided as a personal contribution by Christopher Lipowski, CRSP, for occupational health, safety, industrial hygiene, and public health professionals who are dedicated to advancing healthcare quality safety practice excellence for staff and patients. As well, there is a link at the bottom of this home page that provides useful information on health, safety, environmental and related topics for the general public.


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


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

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

In addition to this unacceptable situation, many patients suffer preventable care-related adverse events (AEs) during hospitalization. AEs among hospital patients are unintended injuries or complications resulting in death, disability or prolonged hospital stay that arise from health care management. A study in 2004 funded by CIHI and the Canadian Institutes of Health Research found that 7.5% of adult medical or surgical patients suffered adverse events in hospital, about one third of which were deemed preventable. Although most patients recover within six months, each year between 9,250 and 23,750 Canadian adults experience a “preventable” adverse event in hospital and later die, according to the study, Baker et al. 2004. The Institute of Medicine's "To Err is Human: Building a Safer Health System" reported: "The human cost of medical errors is high. Based on the findings of one major study, medical errors kill some 44,000 people in U.S. hospitals each year. Another study puts the number much higher, at 98,000." IOM. In Canada, healthcare acquired infections or nosocomial infections, affect more than 220,000 people annually resulting in excess of 8,000 deaths in Canadian hospitals each year. Therefore, patient safety in Canadian healthcare organizations has become an increasingly important topic and led to the creation of the Canadian Patient Safety Institute (CPSI). A study by the CPSI estimated the economic burden of adverse events in Canada in 2009-2010 was 1.1 billion dollars. This estimate did not include the direct costs of care after hospital discharge, or societal costs of illness, such as loss of functional status or occupational productivity. To address the issue of identifying strategies for improving patient care, much valuable effort has been focused on application of new technologies, developing better communication and coordination among clinicians, and creation of a patient adverse (sentinel) event information database to be shared by hospitals for learning purposes, Canadian College of Health Service Executives - ppt. However, a growing body of research indicate that healthcare worker health and safety conditions are not just an important but an essential factor associated with the quality of patient care, Yassi, A. For example, OSHA (U.S.) reports that workplace safety also affects patient care. OSHA recommends hospitals develop a health and safety management system with a holistic approach that integrates patient safety and employee safety programs, Safety and Health Management Systems: A Road Map for Hospitals. Dr. Lucian Leape endorses OSHA Programs on Health Care Worker Safety: "Many of us in medicine have long recognized that hospitals can be dangerous places not only for patients who are at risk of experiencing a medical error or an adverse event, but also for nurses, physicians, and other health care workers", Institute for Healthcare Improvement (IHI) / National Patient Safety Foundation (NPSF). The 2004 Canadian Adverse Events Study suggested, "The greatest gains in improving patient safety will come from modifying the work environment of healthcare professionals, creating better defenses for averting adverse events and mitigating their effects", The Role of Healthcare Environments in Shaping a Safety Culture - Lowe, G.S. The Joint Commission published a monograph recently stating that greater awareness of the potential synergies between patient and worker health and safety activities is required, Improving Patient and Worker Safety. One major step that healthcare institutions can take toward championing patient and healthcare worker safety, according to the monograph, is becoming a high-reliability healthcare organization (HRO) -- described as "systems operating in hazardous conditions that have fewer than their fair share of adverse events". The monograph also identifies functional management systems and processes, strategies and tools that have been used to successfully integrate health and safety activities. A report by The Lucian Leape Institute presents details on healthcare safety challenges. Therefore, efforts to increase the quality of hospital occupational health and safety conditions and practices can be expected to have a direct positive impact on patient safety outcomes and an overall reduction in healthcare costs.
One strategy to achieve sustainable healthcare safety performance excellence is to implement an "Integrated Healthcare Safety Management System", a holistic approach that manages patient and staff safety programs together. Since the first step toward solving a problem is to understand it and knowledge is essential for advancing meaningful safety improvement initiatives to their maturity, this web service was founded to provide a simplified and efficient means of accessing credible, useful healthcare safety information.
Christopher Lipowski, CRSP


Christopher J. Lipowski, CRSP
Principal, Pinnacle Enterprises Canada
Healthcare Occupational Health and Safety Professional,
first and former McGill University Health and Safety Officer
is founder and webmaster of Healthcare Safety Info-eLink™
This website is dedicated to the memory of Z.J. Lipowski, M.D.

Linkedin - Christopher J. Lipowski, CRSP


Professional Ethics For the OHS Professional
Dr. Peter Strahlendorf (ppt)

What really motivates people to be honest in business - (TED Presentation, Nov 2016 by Alexander Wagner)

International Code of Ethics for Occupational Health Professionals (pdf)

American Board of Industrial Hygiene Code of Ethics


Stress at the workplace (WHO)

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

Chronic mental stress (Ontario WSIB)

Stress, Portrait of a Killer - Dr. Robert Sapolsky (YouTube)

Stress, Portrait of a Killer " investigates the root causes and eventual effects of stress." - (National Geographic)

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

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

Burnout Among Health Professionals and Its Effect on Patient Safety - Audrey Lyndon, PhD (Agency for Healthcare Research and Quality)

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

Improving Work Functioning and Mental Health of Health Care Employees Using an E-Mental Health Approach to Workers' Health Surveillance: Pretest–Posttest Study - {"Working as a nurse involves dealing with a range of potential workplace stressors, such as psychological and emotional demands [1]. Unsurprisingly, mental health complaints including burnout, posttraumatic stress, anxiety, and depression are quite common in nurses [2]. Impaired mental health can have adverse effects endangering the health and safety of the nurses themselves but also of their patients [3,4]. Consequently, it seems worthwhile to pay preventive attention to the mental health and work functioning of nurses." - Sarah M. Ketelaar et al (Saf Health Work. 2014 Dec; 5(4): 216–221)

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

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

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

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

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

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

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


Physician Suicide (Medscape, Aug 01, 2018)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Healthy Work Environments Best Practice Guidelines (pdf)

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

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

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

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

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

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

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

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

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

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

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

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

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


A study of leading indicators for occupational health and safety management systems in healthcare - (Joan M. Almost et al.; BMC Health Services Research, April 2018)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care- Mohr, David C. PhD, et al, Journal of Patient Safety: September 2018 - Volume 14 - Issue 3 - p 181–185

Ontario Nurses Association - "In Ontario, the health-care sector has some of the highest rates of workplace injuries and illnesses – even greater than construction, mining and manufacturing. Yet, health-care employers lag far behind their industrial counterparts in addressing occupational health and safety issues. If workers are not protected from health and safety hazards, patients and the public are not protected either"

Ottawa (Ontario) clinic warns 4,600 patients of hepatitis, HIV risk over unclean equipment (CTV News, July 17, 2018)

Hundreds of patients may have received less than full dose of chemo, Cancer Care Ontario finds - More than expected amounts of drug remained in IV tubing, review finds (CBC News, Aug 17, 2018)

Dysfunctional Organizations and Leadership - Med Jones, President of International Institute of Management

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

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

An epigenetic hypothesis for the genomic memory of pain (Front. Cell. Neurosci., 24 March 2015 )

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

Acute Flaccid Myelitis (CDC)

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

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

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

Influenza - (People 65 Years and Older & Influenza) - "It has been recognized for many years that people 65 years and older are at greater risk of serious complications from the flu compared with young, healthy adults because human immune defenses become weaker with age. While flu seasons can vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, it's estimated that between about 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older and between 54 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in that age group. So influenza is often quite serious for people 65 and older." (U.S. Centers for Disease Control and Prevention)

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

"Influenza (Flu) - "According to the National Advisory Committee on Immunization, there are approximately 3,500 deaths related to influenza on average each year in Canada. In Ontario, there are approximately 1,365 influenza-associated deaths per year in Ontario. The highest mortality rate typically occurs among adults 65 years of age and older." -
NOTE: A high-dose flu vaccine is also available for adults 65 years of age and older protecting against three different flu viruses: two influenza A viruses (A/H1N1 and A/H3N2) and one influenza B virus (B/Colorado). This is a high-dose trivalent vaccine (high-dose TIV). If you are 65 year old or older, your doctor can help you choose between QIV and high-dose TIV. (Ottawa, Ontario Public Health, 2018)

Getting Ahead of the Next Pandemic: Is the World Ready? (CDC Newsroom - October 26, 2017)

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

The Next Pandemic: Hospital Management (AHC Media LLC)

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

More than 200,000 patients get infections every year while receiving healthcare in Canada; more than 8,000 of these patients die as a result - (Public Health Agency of Canada)

Approximately 10,000 Canadians Die Every Year as a Result an Infection Acquired in Health Care Buildings - Introduction to CSA Z317.13 - Public Health Ontario - (pdf)

Dirty hospitals: Hidden camera investigation (CBC Marketplace)

Health problems and disinfectant product exposure among staff at a large multispecialty hospital (American Journal of Infection Control Volume 45, Issue 10, 1 October 2017, Pages 1133-1138)

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

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

Don't just blame the hospital, bloodborne pathogens were hiding inside the whole time (Louis J. Cohen, Science Translational Medicine, Oct 2018)

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

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

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

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

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

Health and Safety Practices Survey of Healthcare Workers - Antineoplastic Drugs – Compounding (NIOSH 2018)

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

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

Asbestos-Linked Cancer on the Rise (Carcinogens in the News - CAREX Canada)

The Government of Canada proposes new regulations to protect Canadians from exposure to asbestos (News Release, Januar 5, 2018) "Breathing in asbestos fibres is known to cause cancer and other devastating illnesses. Our government is committed to reducing the risks of exposure to asbestos. That's why we are moving forward with these regulations to ban asbestos and asbestos products. My department will continue to increase awareness of simple steps that Canadians can take to avoid exposure to asbestos." Ginette Petitpas Taylor, Minister of Health; "Too many Canadians know first-hand the devastating health problems that can result from exposure to asbestos at home or at work. By launching these new, tougher rules to stop the manufacture, import, use, and sale of asbestos, we are following through on our promise to protect all Canadians from exposure to this toxic substance." Catherine McKenna, Minister of Environment and Climate Change

Workplace exposures account for a significant number of cancers in Ontario: Report - Solar radiation, asbestos among top cancer-causing exposures (Canadian Occupational Safety - 10/11/2017)

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

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

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

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

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

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

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

Costs related to asbestos exposure much higher than original estimates: IWH - Price tag of new cases of work-related mesothelioma, lung cancer soars to $2.35 billion (Canadian Occupational Safety - 09/19/2017)

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

Cancer Care Ontario, Occupational Cancer Research Centre. Burden of occupational cancer in Ontario: Major workplace carcinogens and prevention of exposure. (Toronto: Queen's Printer for Ontario; 2017

Formaldehyde Confirmed as Known Human Carcinogen -
The National Academies of Sciences, Engineering, and Medicine

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

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

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

Silica (Crystalline) - (CAREX Canada)

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

Developing a Silica Exposure Control Plan (WorkSafe BC)

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

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

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

Earn Certification Points with ACGIH Archived Webinars - (2018 American Conference of Governmental Industrial Hygienists (ACGIH®)

Exposure and Chemical Monitoring - Beyond IH Fundamentals "Face-to-Face education" course - October 21-23, 2019 (American Industrial Hygiene Association)

Care of the elderly program at the University of Alberta "Meeting the challenges of treating the aging population" (Lesley Charles, MB ChB CCFP CoE; et al - Can Fam Physicianv.60(11); 2014 Nov) - Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

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

Time to eradicate HTLV-1: an open letter to WHO (Human T-cell leukaemia virus 1 (HTLV-1) is the most potent carcinogenic oncovirus and potentially the most oncogenic risk factor including chemical carcinogens) - Fabiola Martin, Yutaka Tagaya, Robert Gallo - The Lancet: Volume 391, No. 10133, p1893–1894, 12 May 2018

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

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

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

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

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

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

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

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

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

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

3D Printer Safety (The University of Vermont)

Indoor Particulate Matter (U.S. EPA)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Illnesses from Mosquito, Tick, and Flea Bites Increasing in the US (CDC, May 1, 2018)

Guillain-Barré syndrome (NIH)

Conditions & Diseases - These topics are common diseases and conditions that evidence shows may be strongly linked to environmental exposures - (NIH)


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

“Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams.”
~ IHI/NPSF Lucian Leape Institute.



Last updated December 2018

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