Pinnacle Enterprises Canada
Healthcare Safety Info-eLink™

"Committed to Safe Patient Care Through Healthcare Occupational Health and Safety Management Performance Excellence"


To achieve high quality safe patient care, improving the quality of occupational health and safety in healthcare 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 related to healthcare. Healthcare Safety Info-eLink™ is a not-for-profit service offered by Christopher Lipowski for occupational health and safety professionals who are committed and dedicated to advancing safe working conditions in healthcare as well as in all other occupational sectors.


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 Health Canada. 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", National Patient Safety Foundation. 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, Nichol, K.
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 occupational, environmental and patient safety information. In addition, a new section has been added at the botom of this home page that provides credible public health and safety information links for the general public.
Christopher Lipowski, CRSP


ETHICS - A View from the Joint Industrial Hygiene Ethics Education Committee

Case Study: (Scenario Number Three presented at the 1995 AIHCE Ethics)

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

National Association for Healthcare Quality - Code of Ethics and Standards of Practice

International Code of Ethics for Occupational Health Professionals (pdf)

American Board of Industrial Hygiene Code of Ethics

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


Occupational / Organizational Psychology Information (links)

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

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

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)

Workplace 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)

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

The National Institute of Mental Health - (NIMH)

Canadian Institute of Stress

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

Wellness & Health Promotion Programs for Healthcare Staff Information

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)

Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease (WHO Factsheet)

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)

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)

Healthcare-Related Occupational Health and Safety Website (links)


US, World Still Not Ready for Another Flu Pandemic (Global Health NOW, Johns Hopkins School of Public Health - November 8, 2017)

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

For health professionals: Flu (detailed information on seasonal influenza for health professionals - (Government of Canada 2017-10-04)

Avian Influenza A (H7N9) Virus (CDC)

Three mutations switch H7N9 influenza to human-type receptor specificity - Robert P. de Vries et al (PLOSS Pathogens Jume 15, 2017)

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)

The Role of Food in Hospitals - Key informants noted that, as anchor institutions rooted in their communities, hospitals are role models for wellness, good nutrition, and healthy food. ... There is an increased understanding that patients need nutritious, appealing food that tastes good in order for them to eat, regain their strength, and heal (Tracy Murphy, HealthCareCAN)

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"

Survey finds workers in high-risk jobs are afraid to report safety issues. 41 percent of employees working in healthcare settings, said they were afraid to report safety issues (National Safety Council)

Manual Material Lifting: a pain in the neck, back - "In Ontario, ergonomic interventions are legislated only for those in the health care sector and are especially limited in scope; They do not take into account injuries caused by repetitive, awkward or forceful work" - (Workers Health and Safety Centre of Ontario Federation)

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

THE CRITICAL IMPORTANCE OF SAFETY LEADERSHIP video by Dr. Tom Krause - (Krause Bell Group)

Ontario Workplace Safety and Insurance Board -New Rate Framework Model (WSIB, 2017)

Ontario Bill Proposes to Create "Health and Safety Management System" under OHSA - Chelsea Rasmussen (Dentons)

Moving ahead with ISO 45001 for safety and health at work: 2017-04-24 - (Standards Council of Canada)

Welcome to the 'Study of Leading Indicators for Occupational Health and Safety Management Systems in Healthcare' website - A Study of Leading Indicators for Occupational Health and Safety Management Systems in Healthcare. This project, funded by the Ontario Ministry of Labour, will examine a new approach to strengthening the occupational health and safety system in healthcare settings (Queen's University)

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

341 Days Without a C. difficile Infection: How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero (November 1, 2017 by CDC's Safe Healthcare Blog)

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)

Impact of workplace cancers widely underestimated - "Occupational cancer is the number 1 cause of workplace death" (by Amanda Silliker, Canadian Occupational Safety)

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)

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)

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)

Federal government revises occupational exposure limit for asbestos - Employers must have asbestos exposure management program - 07/13/2017 (Canadian Occupational Safety - Thomson Reuters)

Full Asbestos Ban, changed codes and regulations expected by 2018 - Candian Government to prohibit asbestos in new construction and renovations, ban it in imports such as brake pads (CBC News)

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

Malignant Mesothelioma Mortality — United States, 1999–2015 - "Despite regulatory actions and decline in asbestos use, the annual number of malignant mesothelioma deaths remains substantial. Contrary to past projections, the number of malignant mesothelioma deaths has been increasing. The continuing occurrence of mesothelioma deaths, particularly among younger populations, underscores the need for maintaining efforts to prevent exposure and for ongoing surveillance to monitor temporal trends." - (CDC)

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)

Developing a Silica Exposure Control Plan (WorkSafe BC)

Controlling Silica Exposures in Construction While Operating Handheld Masonry Saws

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

Radon in the workplace (Ontario Ministry of Labour)

Antibiotic / Antimicrobial Resistance (CDC)

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)

WHO publishes list of bacteria for which new antibiotics are urgently needed

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

"We are not ready": Experts warn world is unprepared for next Ebola-size outbreak (CBC)

Antibiotic Prescribing and Use Be Antibiotics Aware (formerly Get Smart about Antibiotics) is a national effort to help fight antibiotic resistance and improve antibiotic prescribing and use (Antibiotic Prescribing and Use - CDC)

Report warns of rise in drug-resistant tuberculosis (Center for Infectious Disease Research and Policy Academic Health Center, University of Minnesota)

The Risk of Tuberculosis Reinfection Soon after Cure of a First Disease Episode Is Extremely High in a Hyperendemic Community - Pieter Uys et al - PLOS December 9, 2015

Hospital Sinks May Be Awash in 'Superbugs' (MedlinePlus, 2017)

Drug-resistant 'nightmare bacteria' show worrisome ability to diversify and spread (Harvard T.H. Chan School of Public Health)

NDM-1 Superbug - Dr. R V S N Sarma, MD., MSc (Canada) FIMSA, Senior Consultant physician

Candida auris Interim Recommendations for Healthcare Facilities and Laboratories (CDC)

Herpes Simplex Surveillance Protocol for Ontario Hospitals – Ontario Hospital Association and the Ontario Medical Association (2016)

Indoor Particulate Matter (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)

Printing, Photography and Reproduction Industry - Gordon C. Miller (Encyclopaedia of Occupational Health and Safety -ILO)

Noise and neurotoxic chemical exposure relationship to workplace traumatic injuries: A review (Journal of Safety Research - Volume 60, February 2017, Pages 35–42)

Work Disability Prevention Management System Standard Development Project (CSA Group)

Why sitting is bad for you - Murat Dalkilinç

NIOSH Launches Mobile Lifting Calculator App - (August 14, 2017)

Ergonomics for Healthcare Environments by T. Springer - (Knoll)

Participatory Ergonomics Programs – 9 keys to success - (Humantech Inc.)

Moisture Control Guidance for Building Design, Construction and Maintenance - U.S. EPA (pdf)

Mold remediation in a hospital - Toxicol Ind Health. 2009 Oct-Nov; 25(9-10):723-30 (NCBI)

Prevention and Remediation Strategies for the Control and Removal of Fungal Growth (CDC)

Cryptosporidium parasite - Cryptosporidiosis - Information for Public Health & Medical Professionals (CDC)

Diseases directly transmitted by rodents - (CDC)

Occupational exposure to pesticides and other biocides and risk of thyroid cancer (Occup Environ Med. 2017 Feb 15. - PubMed)

Occupational Causes of Sarcoidosis (NCBI)

Mucormycosis - (CDC)

About Ebola Virus Disease (CDC)

Healthcare Exposure to Zika and Infection Control - (CDC)

Guillain-Barré syndrome (NIH)

Causes of Guillain-Barré syndrome (NHS - UK)

Role of Campylobacter jejuni Infection in the Pathogenesis of Guillain-Barré Syndrome, An Update - (BioMed Research International; Volume 2013 (2013), Article ID 852195)

The Development of Guillain-Barre Syndrome (Gbs) in Association with Confirmed Lyme Disease. A Potential Autoimmune Response in Gbs Secondary to Tick-Borne Diseases? - Seemal F Awan et al (Clin Microbiol 4:199. doi: 10.4172/2327-5073.1000199)

Campylobacter - Guillan-Barré Syndrome (GBS): Although rare, Guillan-Barré Syndrome is the most common cause of acute generalized paralysis in the western world. GBS occurs when the antibodies the body builds up against Campylobacter attack one's nerve cells. Symptoms of GBS appear several weeks after diarrheal illness. Approximately one in every 1000 reported Campylobacter cases results in GBS (Foodborne Illness)

CDC says Campylobacter bacteria can be transmitted by handling dogs (October 3, 2017 - MedlinePlus)

Nurses' uniforms: How many bacteria do they carry after one shift? (J Public Health Epidemiol. 2012 Dec; 4(10): 311–315)

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)

Indoor Air Quality - The role of HVAC Systems in Healthcare Facilities

Indoor Air Pollution: An Introduction for Health Professionals (EPA)

Controlling exposure to plume in health care - Plume is an airborne contaminant created during surgical procedures that cut, cauterize, or destroy tissue with heat-producing devices. This bulletin outlines the health effects of exposure to plume and how to reduce the risk. (WorkSafe BC pdf)

Contaminated Devices Putting Open-Heart Surgery Patients at Risk (CDC - October 13, 2016)

Heater-Cooler Devices: Information for Health Care Providers and Staff at Health Care Facilities (U.S. FDA - March 28, 2017)

Robotic Surgical Tools Tough to Keep Clean - Findings suggest better cleaning procedures, more monitoring of instruments would help (MedlinePlus / NIH)

Center for Occupational Robotics Research (NIOSH)

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

Are Hospital Floors an Underappreciated Reservoir for Transmission of Clostridium Difficile and Methicillin-resistant Staphylococcus aureus?

Understanding the Role of Contaminated Air in Healthcare Acquired Infections (Webinar) - Infection Control Today

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

Laboratory Ventilation Codes and Standards - (Siemens Industry, Inc.)

Effects of work practices and upper body movements on the performance of a laboratory fume hood - Ahn, K. et al.,J. Chem. Health Safety (2016)

Best practices exceed ANSI Z358.1 eyewash & shower standard - (ISHN - BNP Media)

NIOSH Pocket Guide to Chemical Hazards Mobile Web Application - (NIOSH)

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

LEAD - Training and Medical Guidelines (NIOSH)

A research university's rapid response to a fatal chemistry accident: Safety changes and outcomes (Journal of Chemical Health and Safety)

The role of epigenetics in genetic and environmental epidemiology - Christine Ladd-Acosta1 & M Daniele Fallin (Future Medicine - Epigenomics)

Mitochondria as a Target of Environmental Toxicants - Joel N. Meyer et al - Toxicol Sci. 2013 July; 134(1): 1–17

The Lancet Commission on pollution and health - THE LANCET - October 19, 2017

Evolution of life in urban environments - Marc T. J. Johnson1,2,*, Jason Munshi-South - (Science 03 Nov 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 of medical students and instructors and clinical symptoms during gross anatomy laboratory in Thammasat University - Lakchayapakorn K1, Watchalayarn P. (J Med Assoc Thai. 2010 Dec;93 Suppl 7:S92-8)


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.

“Many healthcare leaders are reluctant to commit to the goal of “High-Reliability“ because they regard it as unrealistic, unachievable or a distraction from their current serious fiscal and regulatory pressures. One of the important roles for policymakers and stakeholders is to encourage, persuade and demand that healthcare organizations embark on this journey. The Joint Commission also encourages and invites them to join us on the journey to High-Reliability, because all patients deserve safe care.”
~ Mark R. Chassin, M.D., FACP, M.P.P., M.P.H. President and Chief Executive Officer, The Joint Commissio

"Culture clearly announces every day to every worker whether safety is a key determines the extent of casualties, trauma disorders, stress claims and compensation paid...and it dictates whether elements of a safety system succeed or fail. The goal is to change your companyís culture until safety becomes an internal value that is incorporated in every plan, decision, and work activity. In the new safety culture, every employee will know that the only way to do anything is safely."
~ Dr. Dan Petersen

“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.”
~ National Patient Safety Foundation, Lucian Leape Institute.

Health, Disease, and Safety Information
for the General Public

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Christopher J. Lipowski, CRSP
Healthcare Occupational Health and Safety Specialist
first & 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. author of The Theory of Attractive Stimulus Overload and Affluence, Information Inputs and Health

LinkedIn - Christopher Lipowski, CRSP

Last updated November 2017

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