CLINICAL FIELDWORK - Health and Safety Guidelines

  1. Introduction
  2. Infectious Diseases and Sharps
    2.1 Standard Precautions
  3. Manual Handling
    3.1 Risk Factors for manual handling injury
    3.2 Control Measures to prevent manual handling injury
  4. Radiation
    4.1 Standard Precautions
    4.2 Control Measures
  5. Hazardous Substances
  6. Violent Patients or Clients
  7. Accident Reporting
  8. Responsibility for OH&S
  9. Further Information

1. Introduction

Clinical placement/fieldwork often involves occupational hazards that present some risk to health and safety. These guidelines were developed to increase awareness of these hazards and provide some advice on how to successfully prevent or minimise exposure and subsequent injury.

These guidelines focus on fieldwork or placement in clinical situations, eg in hospitals, community health centres, aged care facilities, outpatient clinics, etc. This document is a supplement to the University's general Fieldwork Safety Guidelines.

2. Infectious Diseases and Sharps

Patients or in-mates in many clinics may be a source of infectious diseases which are transmissible to health care workers/carers via blood, blood products or other body fluids (eg urine, saliva, tears, breast milk, cerebro-spinal fluid, amniotic fluid, semen, vaginal secretions etc). The potential health effects of acquiring such a disease will depend largely on the nature of the infective organism. These effects range from being asymptomatic through to life threatening eg HIV. Transmission of infectious diseases from health care workers to patients is also possible. Students and staff should be familiar with the particular infection control guidelines of the institution in which they are placed. Health care workers are required to maintain awareness of their infection status and keep-up-to date with appropriate vaccinations. Refer to the NSW Health Department Circulars listed in Section 9.


2.1 Standard Precautions

All human blood and body fluids are to be treated as potential sources of infection. Staff and students must adhere rigorously to the specific requirements of the placement institution and the following precautions in order to minimise any exposure.

Avoid needle-stick or sharps injury:
Sharps must be handled with extreme caution. Percutaneous injury with sharps is the most common mode of blood borne pathogen transmission in health institutions. Avoid re-capping needles! Dispose of sharps safely into an approved sharps container.

Avoid contact with blood and other body fluids:
Wear disposable gloves whenever contact with blood or other body fluids is envisaged. If there is a risk of splashing or spraying blood or body fluids, wear safety glasses, goggles or face shield. Wear protective gowns, preferably closed at the front.

Wash hands with water and soap or antiseptic:

  • before and after patient contact
  • immediately that they are contaminated with blood or other body fluids
  • whenever gloves are removed
  • before eating, drinking, or leaving the facility.

Decontaminate surfaces after procedures.

Dispose of contaminated linen and waste (swabs, gloves etc) according to established safe clinical practice.

Report exposure incidents immediately to your supervisor at the institution so that the risk of disease transmission can be assessed.

3. Manual Handling

Manual handling is any activity which requires physical effort by a person to push, pull, lift, or carry etc. Manual handling injuries, particularly back injuries, can be very debilitating and they are a major problem in health care and all other industries (in terms of lost time for recovery, rehabilitation costs etc). Refer to the NSW Health Department Policy and Best Practice Guidelines for the Prevention of Manual Handling Incidents in NSW Public Health Services.

Any activity which is identified as a manual handling task should be assessed for its risk of injury (see risk factors) and suitably controlled to prevent such injuries (see control measures). Consultation with the supervisor and fellow workers will facilitate this process.


3.1 Risk Factors for manual handling injury

  • Frequent or prolonged bending, or reaching, or twisting of the back, or other awkward postures.
  • The load is heavy, or awkward to handle, or the task is performed frequently or for long periods.
  • The workspace is confined and restrictive, or the floor surface is unsafe (slippery, cluttered etc).
  • The individual performing the task has some health, age related or other factor affecting their physical ability, or their clothing interferes with performance.
  • The individual has had inadequate instruction, training and experience in safe manual handling.

3.2 Control Measures to prevent manual handling injury

  • Do the task a different way. Use safer actions, mechanical assistance or arrange team lifting.
  • Provide and use mechanical handling equipment such as wheeled trolleys, patient lifting devices etc.
  • Provide training and instruction in safe manual handling technique ie plan the lift, determine the best lifting technique, get a secure grip and hold the load close to your body.
  • Redesign the job by either modifying the object to a more manageable size and weight, or improve the workplace layout or workflow (timing, paths).
  • Consider the individual’s health and physical ability to perform the task and provide any personal protective equipment eg gloves, footwear etc, which may add protection.

4. Radiation

Clinical fieldwork or placement may require staff or students to work in areas where ionising radiation is used. For example, students studying Medical Radiation Sciences or Health Physics are required to do clinical placement in hospital Diagnostic, Nuclear Medicine or Radiotherapy departments.
The sources of radiation in these areas are primarily diagnostic X-ray equipment or radioactive isotopes used for Nuclear Medicine and Radiotherapy. It is worth noting that since Nuclear Medicine and Radiotherapy procedures involve the injection of patients with radioactive isotopes, patients also become a source of radiation.

4.1 Standard Precautions

When working with any source of radiation, the primary aim is to keep personal doses as low as reasonably achievable. This is usually achieved by adopting the following precautions in combination:

  • minimising time spent near source of radiation
  • maximising distance from the source of radiation
  • shielding the source of radiation

During Clinical placement at any institution, personal monitoring devices must be worn to record the cumulative radiation dose received. Monitors will be issued by the University through the course co-ordinator or departmental radiation safety officer.
University criteria for wearing Personal Monitoring devices is given in the Radiation Safety Committee's Information Sheet on Personal Monitoring. This can be accessed through the Radiation section of the OHS web page.

4.2 Control Measures

In Diagnostic X-ray, Nuclear Medicine and Radiotherapy facilities, occupational radiation exposure is kept as low as reasonably achievable by a combination of building design, shielding, equipment QA and operating procedures.
Staff and students on clinical fieldwork or placement must comply with the radiation safety procedures of the institution in which they are placed.

Further information about safety requirements for Dental, Diagnostic, Nuclear Medicine, Radiotherapy and Veterinary facilities, can be found in ARPANSA's Radiation Protection Series on:

5. Hazardous Substances

Toxic chemicals may be encountered in various forms, from cytotoxic agents or chemicals used in chemotherapy to laboratory or cleaning chemicals. These hazardous substances can only be handled safely with appropriate information, equipment and procedures.

Information on the nature of the chemical hazard, safe handling techniques, spill clean-up, first aid, storage conditions and waste disposal should be available on the product label and/or material safety data sheet (MSDS). The supplier of the substance is obliged by law to provide this information (MSDS can also be accessed through the ChemAlert Database). The institution's spill control and disposal procedures for cytotoxic agents should be followed. Guidelines on safe handling of cytotoxic agents are available from the NSW Health Department Policy Directive Cytotoxic Drugs & Related Waste - Safe Handling in the NSW Public Health System.

6. Violent Patients or Clients

In some clinics there may be an increased risk of client aggression. Good communication and inter-personal skills and familiarity with the client will help to avoid most problems.

When confronted by a violent patient:

  • Stand still, do not make any sudden moves. Stand slightly side- on to the aggressor and avoid staring (be submissive).
  • Obey the aggressor’s instructions.
  • Remain calm and quiet. Avoid shouting or provoking the aggressor.

When dealing with clients with a history of violence, work in pairs. Report aggressive client behaviour to your supervisor.

7. Accident Reporting

All incidents, injuries and accidents must be reported in order that (a) suitable measures can be put in place to prevent any recurrence of the incident and (b) the incident is put on record for future reference if needed, eg if there are some future health consequences. All reports of incidents (including near misses), injuries, illnesses and hazards are to be submitted by staff on the University's RiskWare system within 24 hours of the incident. Log in or find out more. Students are to report all incidents to their supervisor, who will then enter the report on RiskWare for actioning.

8. Responsibility for OH&S

The supervisor or clinical supervisor has responsibility for the health and safety of staff and students working under their direction (refer to 'Roles and Responsibilities' in the OHS Policy). Visiting teachers in clinical situations are also responsible for the health and safety of their students.

Staff and students on clinical fieldwork/placement must use the safety equipment and procedures put in place for their protection and not jeopardise the health or safety of others. Perceived risks should be raised with the relevant supervisor for information and resolution.