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Introduction
During the last decade, Colombia has issued a good amount of norms and reforms regarding Health and Safety at work, highlighting among them Legislation 1562 of 2012 1, Decree 1072 of 2015 2, and Resolution 0312 of 2019 3 that establish the minimum standards that must be considered by companies to establish their occupational safety management and health system at work (OSHSW), which has the purpose of applying continuous improvement processes. Notwithstanding the above mentioned, national indicators related to work accidents show that the impact of strategies implemented through OSHSW should include new tools, processes or procedures that allow a greater impact on the health of workers, promoting their well-being and reducing accidents and diseases as a result of work.
The Colombian context lacks tools that allow individual risk assessment, under the assumption that entrepreneurial populations may have different perceptions of the same risk as a result of the socio-cultural diversity in the national territory. Economic activities, such as the provision of health services, must generate great interest among professionals responsible for managing risks within companies, especially, given events affecting the world population, as the COVID-19 pandemic, where personnel involved in the above mentioned economic activity may be directly affected by exposure to this pathology and, in general, to biological risk (BR).
Among health workers, the nursing staff are one of the most exposed to this type of risks, which, depending on the form of intervention, can lead to serious health problems for the workers, putting at risk not only their own health, but also the health of those around them. This is how nursing staff in any hospital, but specially in high level of care hospitals, can be exposed to Baseline Risk (BR) as a result of patients with infectious-contagious diseases who frequently visit these places and which leads to the need to raise collective awareness about adequate risk management, where the evaluation of workers perception can become a valuable tool to improve the chances of success in the interventions that should be proposed to improve the institutional welfare. In this context, the objective of this research is to evaluate the perception of biological risk in nursing staff working in a hospital in the city of Armenia-Colombia, to identify the main attributes and the main components of the risks in order to be able to propose more effective preventive or interventional procedures.
In the work carried out by Cruzet 4 and Ribeiro 5, it is possible to see the high frequency of exposure to Biological Risk presented by health workers, including nursing staff, who can suffer unwanted work events such as accidents due to cuts or punctures, or diseases that may occur in this work context. In his study, García 6 mentions that exposure to biological risk is the main factor that influences occupational accidents in health personnel, where a low perception or lack of awareness, experience and self-care during exposure to risk is evident. In other studies related to Biological Risk, Díaz 7, Tolentino et al 8 and Halatoko et al 9 mention that knowledge about risk plays an important role in the target population of their work, taking into account even more that said population had a significant level of education in health and yet, evidence was obtained of a significant conceptual lack of knowledge, and, perhaps, an attitudinal component, which may have influenced the occurrence of accidents or diseases. It is very clear that exposure to biological risk in different work contexts, but mainly in that of health workers, should be a focus of intervention so that the adoption of new methods generates greater control during exposure, and greater effectiveness in the efforts made to reduce occupational accidents and diseases.
Therefore, the Dimensional Assessment of Perceived Risk at Work (DAPR-W) 10, could become a very useful tool, as well as flexible and low cost, which would provide a significant knowledge of the human factor risk that is one of the principal factors involved in the managing of unsafe actions and occurrence of accidents at work. As suggested by Morales et al 11 and Rodriguez et al 12, the application of this method could allow professionals involved with Occupational Safety and Health at work (OSH) to implement strategies with greater objectivity to intervene in the unwanted work events mentioned above to contribute fundamentally to the promotion of health and well-being of workers through prevention mechanisms.
This study provides an opportunity to apply the EDRP-T methodology to a nursing staff population, a group for which there is limited evidence of the positive impact of such approaches (R1, R2). In low and middle-income countries, where this population may face greater exposure, the study highlights the urgent need to adopt alternative interventions or methodologies. This methodology includes others, such as GTC45 11, which facilitated the assessment of biological risk as one of the most significant in the hospital, justifying this assessment based on the unacceptable level of risk. This finding is consistent with other similar studies, such as the one conducted by Perez et al 13.
In line with the above, bellow is shown how the EDRP-T methodology is based on Principal Component Factor Analysis (PCFA). This approach allows the most relevant aspects to be extracted from all the attributes evaluated (A1 - G1) 7, which allows the identification of the most significant combinations to guide decision-making. This, in turn, gives the person responsible for implementing the methodology the opportunity to propose more effective interventions, thus optimizing the resources available for prevention of occupational risks.
Materials and Methods
Descriptive, cross-sectional study aimed at 116 workers who are part of the nursing staff at a third level hospital in the city of Armenia, department of Quindío, population composed of Nurses and nursing assistants from different areas of the hospital. The Technical Notes for Prevention (TNP) 578 10 from the National Institute of Hygiene and Safety at work, attached to the Ministry of Labor and Social Affairs of Spain were used in this study. It consists of 10 questions and scores range from 0 to 7, with 0 being very low possibility and 7 being very high possibility. If the opinion is strongly or slightly reflected by what is expressed on the left side of the scale, it will be in 1, 2, or 3, as considered. If the opinion is slightly, very much, or totally reflected by what is expressed on the right side, it will be in 5, 6, or 7, as considered. If the opinion is in a middle term between two extremes of the scale, 4 for each source of risk, there will be a final more general question, which asks to assess the magnitude of the risk by using a scale from 0 to 100, with 0 being very low and null risk, and 100 being very high or extreme risk. This method is theoretically based on the Psychometric Paradigm 14, the Cultural theory of risk 15, and the Social theory of risk 16.
To carry out the study, it was initially necessary to resort to the methodology used by the institution to identify hazards and assess and evaluate the previous and more dangerous risks for nursing staff. The most used methodology by the majority of companies in Colombia for this purpose is the Colombian Technical Guide (CTG) 45 17 through which the identification of hazards, the evaluation and assessment of risks, and their management can be carried out. When verifying this matrix, it was established that one of the risks representing the greatest danger and most exposure for the nursing staff is the BR.
The TNP 578 intervenes the qualitative elements of risks, which are then quantified through scales that assign a value to the perception of the worker. The qualitative elements include the available scientific knowledge, the knowledge by the exposed subject, the novelty/familiarity, the delayed effect of the consequences, the volunteering of the exposure, the control/avoidance capacity, the lethality of the consequences, the fear it produces, the catastrophic potential, and the magnitude of the risk. The aforementioned elements take as a reference the risk of greater exposure of the population group focus of this study. The TNP 578 application will assign a code to the attributes, as shown in Table 1.
Table 1 Attribute Coding.
| Code | Attribute |
| A1 | Perception of the level of knowledge about the risk by those exposed |
| A2 | Perception of the level of knowledge of the risk presented by those responsible for prevention in the company |
| A3 | Perception of risk fear |
| A4 | Perception of the possibility of experiencing damage when exposed to risk |
| A5 | Perception of the severity of the damage that the risk could cause |
| A6 | Perception of evitability of an unwanted situation due to exposure to risk |
| A7 | Perception of control over risk |
| A9 | Perception of the time of development of consequences after exposure to risk |
| G1 | Perception of the possibility of suffering an accident or serious disease due to exposure to risk |
Source: own elaboration.
This methodology has a special characteristic since it is of easy access for all preventionists who wish to use it, and it is low cost and relatively easy to manage and interpret for health professionals with knowledge or who have ventured into the field of HSW.
Prior to the execution of the survey with the attributes of the PTN 578 and the variables of interest for the researchers, the focal population was informed of the objectives of the research and the risks involved in it, and then, they carried out the respective review and signed the informed consent that configured the acceptance of the worker to participate in the study. Subsequently, the study executed the method of information collection through a chronogram designed to establish intervention times in the different services (work areas) of the hospital, which guaranteed coverage and collection of information from the 116 workers, and gave way to the phase of information analysis.
Sociodemographic Characterization of the Population
When analyzing the distribution of the workers who participated in the research, it was found that the population sample carried out their usual work as follows: 23.3% in surgical hospitalization; 22.4%, in the Internal medicine area; 19.8% in the emergency service; 12.1% in the intensive care unit (ICU); 11.2% in the maternity area; 6%, in the administrative area; 2.6% in outpatient consultation; and 9% in the renal unit, physiotherapy, and surgery area respectively. The distribution of the individuals who participated in this research, according to their place of work, shows that there were 28 men and 88 women, corresponding to 24% and 76%, respectively, showing once again that the vast majority of workers in nursing continue to be female. Additionally, in the analysis of the age variable, a mean of 32.51 years was found, standard deviation 9.55, being the minimum age 19 years and the maximum age 57 years. Additionally, the age distribution of the sample by decennials, shows that the majority of individuals are between 21 and 30 years of age with 49.1% of the population, followed by the population between 31 and 40 years with 28.4% of the population, and workers between 41 and 50 years of age with 11.2% of the sample., The lower proportion was for the workers between 51 and 60 years of age and individuals with 20 or less years of age, with proportions of 6.9% and 4.3%, respectively.
When analyzing the average ages of the participating workers, according to their usual place of work, it was found that the service with the lowest age average is the emergency department with 29.69 years, and the service with the highest age average was the maternity department with 33.85 years. It was also found that the service that provided the largest number of participants in this research was the surgical hospitalization service with 23.3% of the population sample, and the services that provided the least number of individuals were surgery, physiotherapy and the renal unit, each with 0.9% of participants.
On the other hand, it was found that the majority of the participants in this research reported belonging to the mestizo ethnic group in 92.2% of the cases, followed by 6% of the individuals who reported being of white ethnicity, and one person who stated being of Afro-descendant ethnicity and another of indigenous Yanacona ethnicity (with 0.9%, respectively).
According to data obtained through the information collection tool of the workers participating in this research, the minimum time of work experience was close to 1 year, and the maximum time of work experience was 30 years, with an average of 8 years and standard deviation of 7.16.
The different means of each of the attributes evaluated in the population sample addressed by this work are analyzed below. Attribute A1 has a mean of 5.60, which means that the most exposed workers perceive that they have a high level of knowledge about the BR factor, with a variance of 1.33. Attribute A2 has a mean of 4.66, which means that the workers perceive that the person in charge of HSW at the institutional level has medium, close to medium high knowledge about BR, with a variance of 4.56, which shows a little more dispersion of the concept yielded by the sample. Attribute A3 indicates a mean of 6.13, suggesting that the individuals referenced in this study perceive a high degree of fear to BR, with a variance of 1.19. Attribute A4, with a mean of 5.28, means that workers perceive that when exposed to BR, they have a medium high possibility of experiencing harm as a consequence of said exposure, with a variance of 2.74. Attribute A5 has a mean of 5.96, which means that the nursing staff in this hospital perceives that, when exposed to BRs, the severity of the damage that can be produced is medium high, with 1.26 standard deviation. Attribute A6 shows a mean of 5.96, indicating that the nursing staff mentioned perceives that in a medium high to high degree, they can avoid BRs, with a mean of 2.38. Attribute A7 has a mean of 5.26, which means that the nursing staff perceives they have a medium-high control of the damage that can occur as a consequence of exposure to BRs. Attribute A8 shows a mean of 4.34, which means that the sample population perceives that BRs could cause immediate and group damage in a medium degree, with a variance of 4.03. Attribute A9 has a mean of 4.93, indicating that the nursing staff perceives that the consequences of exposure to BRs could occur in the mid-term, with a mean of 2.31. Finally, attribute G1_rec presents a mean of 4.16, which means that the nursing staff perceives that, being exposed to BRs, puts them at high risk of suffering an accident or serious disease, with a variance of 1.008.
Factorial Analysis of Principal Components
According to the methodology proposed by the NTC 578, taken as a reference in this study, factorial analysis of principal components, which is a descriptive statistics technique that has as its main basis the attributes evaluated in the population sample under study and uses tools such as correlations to establish whether there is a strong relationship between any of the attributes, was carried out. The SPSS computational tool 18 was used to develop the correlation matrix and establish that there is not a sufficient relationship between the attributes evaluated in this study, since most of the correlations between different attributes are less than 0.5. Table 2 show de correlation matrix.
The Kaiser Meyer Olkin - KMO test yields, as a result, a value of 0.558, which suggests that the variables were well selected because the result mentioned is > 0.05. Likewise, the Bartlett’s test has as reference a result < 0.05, indicating the possibility of working with the present design.
Table 2 Correlation matrix.
| Correlation | A1 | A2 | A3 | A4 | A5 | A6 | A7 | A8 | A9 | G1 |
|---|---|---|---|---|---|---|---|---|---|---|
| A1 | 1.000 | -0.035 | 0.199 | -0.033 | 0.107 | 0.282 | 0.237 | -0.103 | 0.202 | 0.330 |
| A2 | -0.035 | 1.000 | 0.008 | -0.273 | -0.014 | 0.063 | -0.014 | -0.275 | -0.265 | -0.155 |
| A3 | 0.199 | 0.008 | 1.000 | 0.298 | 0.267 | 0.118 | -0.039 | -0.020 | 0.089 | 0.208 |
| A4 | -0.033 | -0.273 | 0.298 | 1.000 | 0.236 | 0.044 | -0.167 | 0.069 | 0.077 | 0.344 |
| A5 | 0.107 | -0.014 | 0.267 | 0.236 | 1.000 | 0.144 | 0.113 | 0.041 | 0.197 | 0.161 |
| A6 | 0.282 | 0.063 | 0.118 | 0.044 | 0.144 | 1.000 | 0.096 | -0.116 | 0.121 | 0.259 |
| A7 | 0.237 | -0.014 | -0.039 | -0.167 | 0.113 | 0.096 | 1.000 | 0.321 | 0.218 | -0.004 |
| A8 | -0.103 | -0.275 | -0.020 | 0.069 | 0.041 | -0.116 | 0.321 | 1.000 | 0.087 | 0.134 |
| A9 | -0.265 | -0.265 | 0.089 | 0.077 | 0.197 | 0.121 | 0.218 | 0.087 | 1.000 | 0.107 |
| G1 | 0.330 | -0.155 | 0.208 | 0.344 | 0.161 | 0.259 | -0.004 | 0.134 | 0.107 | 1.000 |
| Determinant | = 0.258 |
Source: own elaboration.
Commonalities
From the statistical analysis of the common points 19, the attributes with the highest importance or close to 1 are reported as follows: A7 (Damage control) is found with 0.743, followed by A4 (Possibility of experiencing damage due to exposure to BR) with 0.708. Subsequently, there is A5 (Severity of damage) with 0.691, and A2 (Knowledge of those in charge of HSW on BR) with 0.684 and, finally, attribute A1 (Knowledge of the exposed worker about BR) with 0.659. From the above, it can be deduced that a significant number of the individuals who were approached in this study perceive that when faced with a situation of exposure to biological risk, they can intervene to avoid or reduce the damage that could occur.
Table 3 shows the total variance explained, in which the components that, can provide the greatest explanation for the variability of the data or for what is happening with the problem can be selected. Thus, it can be found that component 1 can provide a better explanation for the focal problem of this study with 21.934%.
Table 3 shows that the first four components are the most important because they are > 1 and, in addition, they largely explain the total variability of the data and can be taken into account to solve the problem. These components can also be obtained and validated using a sedimentation chart.
Component Matrix
Table 4 shows the component matrix, which includes the four components obtained that can be considered if their value exceeds 0.5.
By obtaining the rotated component matrix, using the Kaiser Varimax 20 normalization rotation method, the component conformation can be carried out as follows:
Discussion
From the results obtained by applying the method presented, interesting results are obtained for professionals and people interested in the application of strategies related to Occupational Health and Safety. It is worth highlighting in this study that the knowledge of workers about the risks to which they are exposed is an attribute of high importance when assessing risk perception. This can be evidenced in the research presented by Soler et al. 21, where the need to estimate the understanding (knowledge) of the risks to properly address a training system is presented, understanding it as one of the most important attributes in this type of work.
It should be noted that the population targeted by this research has a level of education that allows it to have a basic knowledge of the risks evaluated, as it is the case of biological risk. However, the application of the perception evaluation method suggests focusing attention precisely on the attribute that includes knowledge about the risk evaluated, as a part of the main components. From the above, the question about the results that can be obtained in populations with low or no levels of education remains. Thus, the educational activities promoted by the companies for the intervention of risks and dangers, and the ways in which they are developed, are important in the process of strengthening the knowledge of workers.
On the other hand, attribute A6, which refers to the perception of the evitability of an unwanted situation, can be considered as one of the attributes that influences the appearance of human errors during the development of the work activity, possibly making part of the group of characteristics that configure overconfidence. This behavior commonly results in accidents at work, or other unwanted situations in the work context. This is evidenced in the study presented by Soria, et al. 22.
The results show that the workers in this study perceive that exposure to this type of risk can result in serious diseases or accidents, which indicates that they recognize this type of phenomenon and the dangers it may involve.
Conclusions
From the results found when evaluating the perception on biological risk (BR) in the nursing staff working in a hospital in the city of Armenia, the following assessments can be made: i) There is no significant relationship between the sociodemographic variables and the different attributes evaluated through the DERP-W tool. ii) A close relationship is established between the perception of fear and the magnitude of the risk, which is also evidenced in the studies presented by González 23, Fajardo et. al 24 and Alrawad, Lutfi et. al 25. iii) Knowledge and fear of biological risk are essential attributes in the application of BR assessment methodologies. These attributes favor the appearance of accidents resulting from unsafe acts, such as overconfidence derived from work routine, knowledge about the risk obtained through institutional training and acquired work experience. iv) The application of this type of methodology in the evaluation of BR, can be considered as a valuable input, within the strategies for the adequate communication of the important risks in the processes that have the intention of intervening effectively to the risks present within the work context. The above confirms what was presented by Velázquez and Medellin 26, Rivera 27 and Armas and Avram 28. v) However, the analysis carried out in this work, which obtains results that suggest educational and training processes that the institution regularly carries out aimed at a population of relatively young nursing workers, must be also carried out in work areas and individuals with inappropriate perceptions on BR, intervening directly the attributes most compromised in the assessment process of perceived risk. vi) The DERP-W method, once again, proves to be a flexible tool of easy application and use in a multidisciplinary setting which aims to identify biased perceptions by workers in the provision of health services, although it is necessary to continue with applications in other health professions different from nursing, searching for significant differences in the way of perceiving risks and as a fundamental and indispensable tool for their effective intervention, based on the understanding of the differences present in the workplace.
