الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Hospital safety comprises of patient and institutional safety (safety performance). Patient safety can be attained with good institutional safety performance (SP) as they are incorporated. Safety climate (SC) is the psychological perception of employees regarding safe values, principles, satisfaction, and relationship with management and other colleagues. The assessment of SC is an important process to ensure continuous improvement and sustainability.
Joint Commission International (JCI) identifies standards that ensure the quality of healthcare services and patient safety. They provide technical support for healthcare facilities to be compliant. As far as we know, few Egyptian studies have focused on hospital SC and its relationship with safety performance. This gap in data and relationships can be bridged by studying the impact of adherence to safety in JCI accredited and non-accredited hospitals to assess its impact on both SC and SP. The general objectives of this study were to evaluate and compare SC and SP in accredited and non-accredited hospitals in Cairo, Egypt.
The study was conducted at accredited and non-accredited hospitals in Cairo, Egypt. Staff members who had worked in the field for a year or more were eligible to participate in the study, while all casual workers, consultants, students, and vendors were not. The sample size was calculated using G. Power software.
SP was evaluated in both hospitals using OSHA Hospitals e-Tool. The checklist consisted of 17 groups of items with yes, no, and not applicable responses of the researcher. SC was assessed through direct structured interviews using predesigned questionnaire. The questionnaire was created by the NORDIC working dimensions of workplace specialists with funding from the Nordic Council of Ministers. It consists of 50 items across seven SC dimensions. The study participants were selected using stratified random sampling after accepting participation to represent 400 employees from each hospital. Among them 200 workers who had worked full-time for a year or more in the field, 20% from each category (senior management, clinical and non-clinical staff, nurses, and technicians).
According to the study, the accredited hospital had a higher overall safety performance (SP) in terms of safety score percentage (%SS) than the non-accredited hospital (56.3%). For groups I (blood and blood-borne pathogens), III (ergonomic), VIII (infection), and XI (needle stick/sharps injuries), the %SSs of both hospitals were equal (100%). However, there was (75.0%) for group XII (noise), while there was (0.0%) for group VI (glutaraldehyde). Other than that, the accredited had higher SSs for groups II (equipment hazards), IV (fire safety), V (kitchen), VII (hazardous chemicals), IX (latex allergy), X (mercury), XIII (slips, trips, and falls), XIV (workplace stress), XV (tuberculosis), XVI (workplace violence), and XVII (other hazards) than did the non-accredited.
The accredited hospital’s safety performance checklist had a percentage satisfaction of (15 groups out of 17) 83.3% compared to (five groups) merely 27.8% for the non-accredited hospital. In other words, the accredited hospital checklist found three groups that needed improvement, whereas the non-accredited hospital checklist found 12 groups. The percentage of satisfactory items of the overall safety performance (SP) checklist was 89.8% in accredited hospitals compared with 56.3% at non-accredited hospitals.
In terms of the percentage score of safety climate (%SSC), the overall safety climate questionnaire (%SSC) was nearly equal in the recognized hospital [69.5 (6.4)]. As well as the unapproved one [69.0 (10.9)]. Additionally, the SSC (management safety priority and ability, management safety justice, employees’ commitment to safety, safety communication learning, and trust in safety) is the same in both hospitals for dimensions DI, DIII, DIV, DV, and DVI (72.2 (7.6), 60.7 (10.7), 75.0 (25.0), 66.7 (12.5), and 71.9 (6.2) at the accredited hospital and 72.2 (13.9), 60.7 (14.3), 75.0 (12.5), 66.7 (12.5), and 71.9 (12. The accredited hospital’s [71.4 (10.7), 72.2 (7.6)] %SSC of DII (Management safety empowerment) and DVII (workers’ opinion in the effectiveness of safety measures) were higher than that the majority of respondents reported having a generally poor level of the overall safety atmosphere in accredited and non-accredited hospitals, respectively [98.0 (49.0%), 99.0 (49.5%)], followed by a generally excellent level [83 (41.5%), 57 (28.5%)].
Using Spearman’s rho correlation coefficient, this study examined the relationship between hospital SP and SC in terms of safety scores percentage.
6.2. Conclusions:
6.2.1. Safety performance conclusions:
1. The safety performance at accredited hospital is significantly higher than that at non-accredited ones, but it did not reach its full implementation.
A. In the two hospitals
2. The group with the lowest safety performance among both hospitals was the glutaraldehyde (GVI) group. Not measuring employee exposure may affect the health of workers exposed during the disinfection of certain equipment.
3. Both hospitals did not fully implement the requirements for measuring personal noise exposure (GXII), which may pose a risk to workers’ hearing.
4. Both hospitals have not fully implemented requirements to reduce the risk of exposure to hazardous chemicals (GVII) group, which may affect workers’ health.
5. The lowest safety performance of the non-accredited hospital was in the workplace (GXIV), and there were no programs designed to address workplace stress, such as employee assistance programs (EAP) or organizational change programs.
B. In non-accredited hospital.
6. The lowest safety performance of the non-accredited hospital was workplace violence (GXVI), where no programs designed to workplace violence programs.
7. The safety performance of equipment hazards (GII), fire safety (GIV), kitchen (GV)), Mercury (GX) and tuberculosis (GXV) is lower at the non-accredited than the accredited one. This may affect the health of workers due to the risk of electric shock, fire, or infection.
8. The required standards for (GIX) latex allergies have not been fully implemented in non-accredited hospital.
C. In non-accredited hospital.
9. The safety performance of the other hazard group (GXVII) has not reached the full degree in the accredited hospital, which may cause the risk of mixing gases as well as the risk of radiation exposure.
6.2.2. Safety climate conclusions:
10. ‘’The overall SC at accredited hospitals was non-significantly higher than at non-accredited ones.
11. There was very weak correlation between groups of overall SP and SC dimensions in both hospitals.
12. The lowest frequency of good SC level in both hospitals was the hospital management safety justice (DIII).
13. The highest frequency of good level at the accredited hospital was the management’s safety priority, commitment, and efficiency (DI), while the highest frequency of good level at the non-accredited hospital was the employees’ commitment to safety (DIV).
6.4. Recommendation:
Based on the results of the present study and on the hospital scale we recommend the following:
1. Schedule periodic audits for the hospitals and take action when a finding appears.
2. Conducting regular monitoring of glutaraldehyde in both hospitals to monitor staff exposure levels.
3. Periodic examination for Audiometric testing is recommended to monitor staff exposure levels in both hospitals.
4. Ensure that HAZMAT programs are implemented like (availability SDS, labeling system and first aid) for hazardous material in both hospitals.
5. Design an appropriate work stress program to help workers reduce their stress levels effectively at non-accredited hospitals.
6. Develop workplace violence prevention program that includes policies and procedures for identifying and addressing potential violence in the workplace and staff training at the non-accredited hospital.
7. Establish a comprehensive electrical safety program by providing training for employees to connect or disconnect powered equipment, signs to distinguish all damaged electrical equipment, and remove them from service.
8. To improve SP at the non-accredited hospital, it must ensure that it implements the civil defense requirements and adheres to the Ministry of Health’s regulations regarding Mercury and Tuberculosis.
9. Providing nitrile gloves can help prevent latex allergies in workers.
10. Installing warning signs in uneven places and warning signs about the danger of radiation at the accredited hospital radioactive emission sites.
11. Modify the medical gas-coding valves, which includes using labeling valves at the accredited hospital.
12. Implementing a clear process for the log-out tag-out procedure at the accredited hospital.
13. Continuous monitoring of high-risk areas such as the roof and basement can identify potential safety hazards and allow for timely interventions to prevent accidents or injuries.
14. Scheduling periodic assessment of SC can help management comprehend employee issues and facilitate continuous improvement of safety practices while reducing risks.
While on the level of ministry of Health and population we can recommended that:
1. Motivate Egyptian hospitals to be compliment with accreditation standards (JCI, ISO45001:2018, GAHAR, etc.) to ensure better safety performance and climates.
2. Develop laws and regulations governing the handling and use of glutaraldehyde at Egyptian hospitals.
3. Encourage healthcare organizations to enhance a culture of open communication through regular safety meetings, anonymous reporting, and feedback mechanisms.