13 Occupational Health

BOSH Training 2009 OSHC

OCCUPATIONAL HEALTH HAZARDS

Dale M. Hizon, M.D.Occupational Health Officer

Occupational Safety and Health Center


CHEMICAL HAZARD

PHYSICAL HAZARD

BIOLOGICAL HAZARD

ERGONOMIC HAZARD


OBJECTIVES: Discuss and explain common hazards in the

workplace and their effects to workers’ health.

Recommend appropriate measures to prevent occupational and work-related illnesses.


OCCUPATIONAL HEALTH ( ILO/WHO ) Promote and maintain the highest degree of physical,

mental & social well-being of workers of all occupations

Prevent workers from departures due to health caused by their working conditions

Protect workers in their working environment from hazards and risks usually causing adverse health effects

Place & maintain a worker in an occupational environment adapted to his/her physiological ability


HAZARD AND RISK

HAZARD- any source of

potential damage, harm or adverse health effects on something or someone under certain conditions at work.

RISK- the chance or

probability that a person will be harmed or experience an adverse health effect if exposed to a hazard.


WORKPLACE HAZARDSSafety Hazards

working conditions where harm to the workers is of an immediate and violent nature

result in broken bones, cuts, bruises, sprains, loss of limbs, etc.

the harm results in some kind of injury to the worker

associated with poorly guarded or dangerous equipment and machinery

Health Hazards

working conditions which result in an illness

exposure to dangerous substances or conditions, such as chemicals, gases, dusts, noise etc.

often, latency between exposure and disease


AgeAge

GenderGender

RaceRace

Medical Medical historyhistory

Genetic Genetic factorsfactors

LifestyleLifestyle

Workers’ Susceptibility Physical Physical

propertiesproperties

Multiplicity of Multiplicity of exposureexposure

Magnitude of Magnitude of exposureexposure

Duration ofDuration ofexposureexposure

Timing of Timing of exposureexposure

Workplace Factors

WORK-RELATED DISEASE


CHEMICAL HAZARDS


Chemical HazardsRoutes of entry into the body

Inhalation

Ingestion

Skin Contact


Chemical HazardsRoutes of excretion

Gastro-intestinal (feces)

Renal (urine) Respiratory (exhalation)

Skin (sweat, hair, nails)


LD 50 - Dose lethal to 50% of test animals


Threshold:

•point at which toxicity first appears

•occurs at the point where the body's ability to detoxify or repair toxic injury has been exceeded.


Chemical HazardsMeasures of concentration of toxic substances

Threshold Limit Value (TLV)- average concentration of an airborne substance to which most workers could be safely exposed over an eight-hour working day or forty-hour working week throughout a working lifetime

Maximal Allowable Concentration (MAC)- peak or maximum concentration of an airborne to which most workers could be safely exposed.


Chemical HazardsClassification of Toxic Effects

Local toxicity- occurs at the site of chemical contact

Systemic toxicity- occurs distant from point of contact, may involve many organ systems

Acute toxicity-Acute toxicity- occurs almost immediately (hours/days) after an exposure

Chronic toxicity-Chronic toxicity- represents cumulative damage to specific organ systems; occurs many months or years to have recognizable clinical disease


Chemical Hazards

Health Effects Renal Diseases Respiratory Diseases Skin Diseases Hematologic Diseases Cardiovascular Diseases Neurologic Diseases Carcinogenic Teratogenic


Chemical HazardsEffects Chemical Agent Industry/Process

Renal Diseases: acute/chronic renal failure

Mercury, cadmium, chloroform

Battery, chemical industries, pesticide

Respiratory Diseases: Irritation, inflammation Solvents, ammonia Chemical industries

Pneumoconiosis Inorganic dust Mining, construction, sandblasting, coal

Cancer Chromium Plating, metal refining


Chemical HazardsBlood Diseases: Anemia Lead Battery mfg., lead

smelting

Aplastic anemia Benzene Solvent & soap mfg.

Skin Diseases: Allergic/contact dermatitis

Plastic epoxides Plastic, varnish

Acne Cutting oils, grease Machine-tool operators

Skin Cancer Arsenic, tar Petroleum refinery


Chemical HazardsLiver Disease: Acute liver toxicity Carbon

tetrachlorideCleaning fluids, dry cleaners

Liver cancer Vinyl chloride Plastics & vinyl chloride mfg.

Cardiovascular Disease: Hypertension Lead, Cadmium Battery mfg. &

recycling Atherosclerosis Carbon disulfide Degreasing, dry

cleaning Arrythmias Fluorocarbon,

trichloroethyleneRefrigeration, solvent workers


PHYSICAL HAZARDS


Physical Hazards Noise

Vibration

Extreme Temperature

Illumination

Radiation



Ear Anatomy


Types of Noise-Induced Hearing Loss

Temporary Threshold Shift (auditory fatigue) temporary loss of hearing acuity after exposure to

loud noise recovery within 16-48 hrs

Permanent Threshold Shift irreversible loss of hearing

NOISE


Early Signs of Hearing Loss• Difficulty in understanding spoken words in a

noisy environment• Need to be near or look at the person

speaking to help understand words• Familiar sounds are muffled• Complaints that people do not speak clearly• Ringing noises in the ears (tinnitus)

NOISE


Other Harmful Effects of Noise

• Hypertension• Hyperacidity• Palpitations • Disturbs relaxation and sleep



Physical factor which affects man by transmission of mechanical energy from oscillating sources

TypesSegmental vibrationWhole body vibration

VIBRATION


• Health Effects:—Hand Arm Vibration Syndrome (HAVS)—tingling, numbness, blanching of fingers—pain

Segmental Vibration:


Health effects:Fatigue IrritabilityHeadacheDisorders of the spine

Whole Body Vibration:



EXTREME TEMPERATURE

Sources of heat stress:

Natural ConditionsHot work processes related to furnaces, kilns,

boilers and smelting


Health Effects of Heat Stress

Disorders Clinical features

Prickly Heat (Miliaria rubra) Pruritic rash

Heat cramps Cramps in the body, usually legs

Heat exhaustion Dizziness, fainting attack, blurring of vision, cold, clammy and sweaty skin

Heat stroke Cyanosis, muscle twitchings, disorientation, delirium, convulsions


EXTREME TEMPERATURE

Sources of Cold Environment:

Ice plants and freezers in the food industry


Frostbite: reddening of skin, localized burning pain and numbness. Fingers, toes, cheeks, nose, ears are most susceptible.

trench foot or immersion foot: numbness, pain, cramps, ulceration and gangrene.

Health Effects of Cold Temperature



Area of Operation Min Lighting Level (lux)

Cutting ClothFine machining

2000

Transcribing handwritingDrafting

1000

WeldingFirst Aid station

500

Lunch RoomRest Room

300

Recommended Illumination LevelsRecommended Illumination Levels

ILLUMINATION


Health Effects Visual FatigueDouble VisionHeadachesPainful irritation LacrimationConjunctivitis

Inadequate Illumination



0102104106108101010121014101610181020

X-rays, about 1 billion billion Hz can penetrate the body and damage internal organs and tissues by damaging importantmolecules like DNA.This is called “ionization.”

Microwaves, several billion Hz,can have “thermal” or hearingeffects on body tissues

Power frequency EMFs 50 or 60 Hz carry very little energy, have no ionizing effects and usually no thermal effects. They can, however, cause very weak electric currents to flow in the body.

Gamma rays

X-rays

Ultraviolet radiation ION

IZIN

G R

A DIA

TIO

N

Visible lightInfrared radiation

Microwaves

Radio waves

1022

Very low frequency (VLF)3,000 - 30,000 Hz

Extremely low frequency (ELF) 3 - 3,000 HzDirect current

60 Hz

15 - 30 Hz &50 - 90 Hz

800 - 900 MHz

Source Frequency in hertz (Hz)

Electromagnetic Spectrum


RADIATION

Types Sources Health EffectsIonizing X-rays

Gamma raysCancer, congenital defects, death

Non-ionizing Ultraviolet

Infrared

Laser

skin redness, premature skin ageing, and skin cancer corneal and conjunctival burns, retinal injury, cataractSkin and eye problem


BIOLOGICAL HAZARDS


VIRUSES FUNGI

BACTERIA PARASITES

BIOLOGICAL HAZARDS


Selected Infectious Diseases and Occupations

Agent / Disease Occupation

Colds, influenza, scarlet fever, diphtheria, smallpox

May be contracted anywhere

Tuberculosis Silica workers, people exposed to heat and organic dusts, and medical personnel

Anthrax Animal handlers and handlers of carcasses, skins, hides, or hair of infected animals, including wool carpet processors and handlers.




Ringworm (in horses, cattle, deer, pigs, cats, dogs, birds)

Pet shop salesmen, stockmen, breeders of cats and dogs, and other animal handlers

Tetanus Farmers (spores in soil) or anyone in contact with manure.




Psittacosis (in parrots, parakeets, pigeons, ducks, turkeys, chickens, etc.)

Pet shop personnel, gardeners, housewives, veterinary surgeons, and researchers.

Hookworm Miners, agricultural laborers, planters of sugar, tobacco, tea, rice and cotton, and brick and tunnel workers.



Agent / Disease OccupationRabies (e.g. dogs, bats, rats, pigs, cats)

Veterinarians, letter carriers, laboratory research workers, agricultural workers.

Fungus Farmers, outdoor workers, animal handlers


HIV and AIDSA- Acquired

I- Immune

D- Deficiency

S- Syndrome serious and usually fatal

condition in which the body’s immune system is severely weakened and cannot fight off infection.

H- Human

I- Immunodeficiency

V- Virus virus which causes

AIDS


Epidemiology of HIV and AIDS

Demographic Data Feb 2009 Jan – Feb 2009 Cumulative Data 1984 – 2009

Total Reported Cases 47 112 3,701

Asymptomatic Cases 45 107 2,893

AIDS Cases 2 5 808

Males 38 95 2,595*

Females 9 17 1,095*

Youth 15-24 y/o 12 31 537

Children <15 y/o 1 2 52

Reported deaths due to AIDS

0 0 317

Source: HIV / AIDS Registry, Department of Health, Philippines * Note: No data available on sex for eleven (11) cases.


Modes of HIV Transmission

Reported Mode ofTransmission

Feb2009n=47

Jan-Feb2009

n= 112

Cumulative Data:1984—2009

N=3,701Sexual Contact 43 107 3,297

Heterosexual contact 13 36 2,034 (62%)

Homosexual contact 14 37 872 (26%)

Bisexual contact 16 34 391 (12%)

Blood / Blood Products 0 0 19

Injecting Drug Use 0 1 8

Needle Prick Injury 0 0 3

Mother-to-Child 1 2 49

No data available 3 3 325


Body Fluids with High Viral Load

Blood Semen Vaginal and cervical mucus Breastmilk Amniotic fluid Cerebrospinal fluid


Modes of Transmission• Unprotected penetrative sex

— semen, blood, vaginal secretions

• Blood transfusion on infected blood and blood products

• Sharing needles among

I.V. drug users

• Vertical/perinatal

— mother to infant

• Breastfeeding


HIV is NOT transmitted…• through casual contact in any setting– schools, homes,

hospitals

• through insect, food, water, clothes, toilets, swimming pools, and drinking and eating utensils


Prevention of HIV InfectionREMEMBER ABCDE!Abstinence

Be FaithfulCondomDo not inject Drugs/no

sharing of needles

Education


TETANUS A neurological disorder

characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a protein toxin elaborated by the organism Clostridium tetani.

It arises from the contamination of wounds with Clostridium spores.


TETANUS Clinical Manifestations

Increased tone in the masseter muscle (lockjaw)

Sustained contraction of the facial muscles (risus sardonicus) and back muscles (opisthotonus)

Prevention Active immunization with

tetanus toxoid Careful wound

management


TUBERCULOSIS caused by the bacteria,

Mycobacterium tuberculosis caused by droplet nuclei

released when sneezing and coughing

Symptoms: weight loss, low grade afternoon fever, persistent cough and sometimes, blood-streaked expectoration or hemoptysis


Ten Leading Causes of Death by Sex Ten Leading Causes of Death by Sex Number, Rate/100,000 Population & Number, Rate/100,000 Population & Percentage, Philippines, 2004Percentage, Philippines, 2004

Cause Male Female Both Sexes

No. Rate Percent*

1. Heart Diseases 40,361 30,500 70,861 84.8 17.6

2. Vascular System Diseases 28,930 22,750 51,680 61.8 12.8

3. Malignant Neoplasm 21,395 19,129 40,524 48.5 10.1

4. Accidents** 28,041 6,442 34,483 41.3 8.6

5. Pneumonia 15,822 16,276 32,098 38.4 8.0

6. Tuberculosis, all forms 17,841 8,029 25,870 31.0 6.4

7. Ill-defined and unknown causes of mortality 10,941 10,362 21,278 25.5 5.3

8. Chronic lower respiratory diseases 13,084 5,891 18,975 22.7 4.7

9. Diabetes Mellitus 7,970 8,582 16,552 19.8 4.1

10. Certain conditions from perinatal period 7,809 5,371 13,180 15.8 3.6

Source: 2004 Philippine Health Statistics, Last Update: February 11, 2008* percent share from total deaths, all causes, Philippines ** External Causes of Mortality


With DOTS90% CURE RATE

DOTS Strategy…the Solution!Directly Observed Therapy Short Course


ERGONOMIC HAZARDS


ERGONOMICS

Human Biological Science+

Engineering Science____________________________________

“ fitting the job to the worker”

MAXIMUM SATISFACTION AND INCREASE PRODUCTIVITY


thetool

theworkstation

the task(job content &

context)

theorganization

theenvironment

ERGONOMICS


Goalto reduce work-related musculoskeletal

disorders (MSDs) developed by workers

MSDs are injuries and illnesses that affect muscles, nerves, tendons, ligaments, joints or spinal discs.

ERGONOMICS


Painful joints Pain, tingling, numbness in hands, wrists,

forearms, shoulders, knees and feet Shooting or stubbing pains Swelling or inflammation

Common Symptoms of MSDs

ERGONOMICS


Fingers or toes turning white Back or neck pain Stiffness

Common Symptoms of MSDs

ERGONOMICS


Static posture

Risk Factor: ERGONOMICS


Forceful exertion




Repetitive movement



Extreme range of motion



Awkward posture


ERGONOMICS


STRESS


STRESS

The harmful physical and emotional responses that occurs when the requirements of the job do not match the capabilities, resources or needs of the worker.


STRESS: Effects


Manifestations of Stress

PHYSIOLOGICAL Heart rate Blood pressure Indigestion

BEHAVIORAL Drug use Alcohol intake Heavy smoking Impulsive emotional

behavior

Poor work & family relationship Social isolation Family abandonment Sleep problems

PSYCHOLOGICAL Fatigue Anxiety Tension Irritability Depression Boredom Inability to

concentrate Low esteem

STRESS



MONITORING

• Systematic, continuous, repetitive health-related activities that should lead to corrective action

• Types of monitoring1. Ambient / Environmental

2. Biological3. Medical Surveillance


BIOLOGICAL MONITORING


Biological Monitoring

Measurement of a substance, its metabolites or its effects in body tissues, fluids or exhaled air of exposed person

Assess exposure and health risk of workers

Complements exposure assessment by air sampling


Biological Monitoring

Chemical /Determinant

Sampling Time BEI

LEADLead in Blood Not critical 30ug/100mlMERCURYTotal inorganic in urineTotal inorganic in blood

Prior to shiftEnd of shift at end of workweek

35ug/g15ug/L

CARBON MONOXIDECarboxyhemoglobin in blood

End of shift 3.5% of Hgb


MEDICAL SURVEILLANCE


Medical Surveillance

Identify cases

Analyze Trends and Patterns in the Workforce to Guide Prevention Efforts

Meet Regulatory Requirements


Know the hazard - How worker is exposed- How worker is affected

Characterize the hazard - Exposure levels- Exposure duration

Know the worker - Susceptibilities

Obtain information on - Directed towards specificmedical examinations organ system

Analyze Medical Data - Disease, recovery, rehab- Effectiveness or failure of

control measures

Medical Surveillance


Environmental monitoring

Biological monitoring and surveillance

Treatment and surveillance- Morbidity- Mortality

Workplace-Related Events

Exposure at the workplace- Chemicals- Physical agents

Biologically significant exposure- Chemicals absorbed- Early (reversible) changes

None

Early

Late

Clinical diagnosis

- measurable health effects

End effects- diseases- unfavorable events (spontaneous

abortion)

Monitoring Activity Health Effects

PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS


Standards, Policies and Guidelines

Occupational Safety and Health Standards Rule 1050

Notification and Keeping of Records of Accidents and/or Occupational illnesses

Rule 1070Occupational Health and Environmental Control

Rule 1960Occupational Health Services


Rule 1960:Occupational Health Services

1. Every employer shall establish in his place of employment occupational health services in accordance with the regulation and guidelines provided for under this rule.

2. The employer, workers, and their representatives, where they exist, shall cooperate and participate in the implementation of the organizational and other measures relating to occupational health services.

1961: General Provisions



1963.01: Medicines and Facilities

1963.02: Emergency Medical and Dental Services

1963: Emergency Health Services


Rule 1960:Occupational Health ServicesHazardous Workplaces:

Number of workers

OH Physician OH Dentist OH Nurse First Aider

1 – 50 1 Full time51 - 99 1 Part time

4 hours/day 6x/week

1 Full time

100 – 199 1 Part time4hrs/day 3x/week *

1 Part time4hrs/day 3x/week *

1 Full time 1 Full time

200 - 600 1 Part time4hrs/day 6x/week **

1 Part time4hrs/day 6x/week **


601 - 2000 1 Full time or 2 Part Time 4hrs/day 6x/week

1 Full time 1 Full time every shift

1 Full time every shift

2000 and more 1 Full time1 Part time 4hrs/day 6x/week

1 Full time 1 Full time every shift

1 Full time every shift*Alternate each day

** Alternate workshift in a day



Non - Hazardous Workplaces:

Number of workers OH Physician OH Dentist OH Nurse First Aider

1 - 99 1 Full time

100 – 199 1 Part time4hrs/day 6x/week

1 Full time

200 - 600 1 Part time4hrs/day 3x/week *

1 Part time4hrs/day 3x/week *


601 - 2000 1 Part time4hrs/day 6x/week **

1 Part time4hrs/day 6x/week **

1 Full time every shift 1 Full time every shift

2000 and more 1 Full time1 Part time 4hrs/day 6x/week

1 Full time 1 Full time every shift 1 Full time every shift

*Alternate each day

** Alternate workshift in a day



An employer may not establish an emergency hospital or dental clinic in his workplace as required in these regulations where there is a hospital or dental clinic which is located not more than five (5) kilometers away from the workplace, if situated in any urban area, or which can be reached in twenty-five (25) minutes of travel, if situated in rural area, and the employer has facilities readily available for transporting workers to the hospital or dental clinic in case of emergency.

1963.03: Emergency Hospital



Health Examinations:EntrancePeriodic Special examinationTransfer examinationSeparation examination


OCCUPATIONAL HEALTH PROGRAMS


Key Elements of the Occupational Health Program

Health Protection

Health Promotion

Health Rehabilitation


Health and Safety Programs

Hazards/ Disease

Source Health Effect Health Program

ChemicalSolvents Paints,

ThinnersIrritant, Multisystem effects

Surveillance for chemical exposureExposure monitoring (Biologic Monitoring)

PhysicalNoise Woodwork

OperationsHearing Impairment

Hearing Conservation Program


Health and Safety ProgramsHazards/ Disease

Source Health Effect Health Program

BiologicTetanus Dirty Nails, soil Lockjaw, rigidity,

deathImmunization

Ergonomic StressesCumulative Trauma Disorder

Awkward postures, Heavy loads

Musculoskeletal Disorders

Management or personnel methods; Workplace modificationWorker education and training;Back Care Program


Health Promotion Physical activity, Nutrition, Weight reduction

Immunization OSHS, RULE 1960

Smoking cessation RA 9211 Tobacco Regulation Act of 2003

HIV/AIDS RA 8504 Philippine AIDS Prevention and Control Act of

1998 National Workplace Policy on STD/HIV/AIDS initiated by

DOLE - 1997


Health Promotion Drug Abuse Prevention and Control

RA 9165 Comprehensive Drugs Act of 2002 Department Order No. 53-03: Guidelines for the

Implementation of a Drug-Free Workplace Policy and Program for the Private Sector

Tuberculosis Prevention and Control Executive Order No. 187, Instituting a Comprehensive

and Unified Policy for Tuberculosis Control in the Philippines (CUP) (March 2003)

Department Order No. 73-05: Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace


DEPARTMENT ORDER NO. 56-03

SECTION 2. New Priorities of the Family Welfare Programa) Reproductive Health and Responsible Parenthoodb) Education/Gender Equalityc) Spirituality or Value Formationd) Income Generation/Livelihood/Cooperativee) Medical Health Caref) Nutritiong) Environmental Protection, Hygiene and Sanitationh) Sports and Leisurei) Housingj) Transportation

RATIONALIZING THE IMPLEMENTATION OF THE FAMILY WELFARE PROGRAM (FWP) IN DOLE


Approach in EnsuringWell-Being of Workers

Looking at developmental strategies

Information Education Training Campaigns Good practices Successful cases Competitions Demonstrations Interventions

Looking at regulatory requirements

Relevant laws, standards, issuances and guidelines Enforcement Implementation Inspection Evaluation


Participatory Approach

Participation and involvement from stakeholders Coordinated intervention Learning from

specifications/guidelines, scientific data best practice


Benefits to the workers Enhanced worker motivation and job satisfaction Added problem-solving capacity Greater acceptance of change Greater knowledge of work and organization Reduces the extent and severity of work related

injuries and illnesses Improves employee morale and productivity Reduces workers’ compensation costs


THANK YOU FOR YOUR ATTENTION!

“I still need more healthy rest in order to work at my best. My health is the main capital I have and I want

to administer it intelligently.”

---Ernest Hemmingway

Nobel Prize winner for literature

Documents

13 Occupational Health