1. UNDERSTANDING OCCUPATIONAL SAFETY & HEALTH STANDARDS JEHREMIAS M. FLORANTE, MD, DPCOM Occupational Health Officer Health Control Division Occupational Safety & Health Center

2. Objectives Discuss the core provisions of the OSHS. Describe the scope & components of the different OSH-related DOLE issuance that form part of the Labor Laws Compliance Checklist – Legal basis Review the basic info, statistics, management, & prevention of HIV & AIDS, hepatitis B, TB, & drugs; & Discuss the different DOLE issuance on drug-free workplace, TB, HIV & AIDS, & hepatitis B including the key principles in the implementation of policies & programs in the workplace.

3. OSH Legislations PD 442, Book IV, Title I – Chapter I: Medical & Dental Services – Chapter II: Occupational Health & Safety

4. OSH Legislations PD 442, Book IV, Title I, Chapter II Art. 168: Safety & Health Standards – The SOLE shall, by appropriate order, set & enforce mandatory OSHS to eliminate or reduce OSH hazards in all workplaces, & institute new & update existing programs to ensure safe & healthful working conditions in all places of employment. Art. 171: Administration of Safety & Health Laws – DOLE shall be solely responsible for the administration, enforcement of laws, policies & programs on OSH. Chartered cities may be allowed to conduct TSI of establishments within their respective jurisdiction.

5. OSH Legislations Book IV, Title I: Medical, Dental, & Occupational Safety Occupational Safety & Health Standards (OSHS)

6. OSH Standards A set of mandatory rules on OSH which codifies all safety orders issued prior to its promulgation Patterned after the Standards of other developed countries

7. Rules of OSHS 1000 – Gen. Provisions 1010 – Other Safety Rules 1020 – Registration 1030 – Training & Accreditation 1040 – OSH Committee 1050 – Notification & Keeping of Occupational Illnesses & Injuries 1060 – Premises of Establishments 1070 – Environmental Control 1080 – PPE 1090 – Hazardous Materials 1100 – Gas & Electric Welding & Cutting Operations 1120 – Hazardous Work Processes 1140 – Explosives 1150 – Materials Handling & Storage 1160 – Boiler 1170 – Unfired Pressure Vessels 1180 – Internal Combustion Engines 1200 – Machine Guarding 1210 – Electrical Safety 1220 – Elevators & Related Equipment 1230 – Identification of Piping System 1240 – Power Piping Lines 1410 – Construction Safety 1420 – Logging 1940 – Fire Protection & Control 1950 – Pesticides & Fertilizers 1960 – OH Services 1970 – Fees 1980 – Authority of LGUs 1990 – Final Provisions

8. Rule 1005 – Duties of Employer – Furnish his workers a place of employment free from hazardous conditions. – Give complete job safety instructions to all his workers. – Comply with the requirements of the OSHS. – Use only approved devices & equipment in his workplace.

9. A Rule 1005 – Duties of Workers Cooperate with the employer in carrying out the provisions of the OSHS. Report any work hazard in the workplace. Make proper use of all safeguards & safety devices furnished in accordance with the provisions of OSHS for his protection & the protection of others. Follow all instructions by the employer in compliance with the OSHS provisions.

10. Rule 1020 - Registration Every employer shall register his business with the DOLE RO to provide DOLE with information as guide in its enforcement activities Free of charge Valid for lifetime, except when there is change in name, location, ownership, opening after previous closing – Lay-out plan, IP Form 3

11. Rule 1030 – Training & Accreditation of Personnel in OSH The BWC, either directly or through accredited organizations, shall conduct continuing training programs to increase the supply & competence of personnel qualified to carry out the provision of this Standards. Employer to appoint a SO on a full-time or part-time basis depending on the type of workplace (whether hazardous or non-hazardous) & number of workers in the workplace. *Based on DO 16-01

12. Required No. of SO in the Workplace Required No. of SO in the Workplace (OSHS, 1978) Number of WorkersHighly HazardousHazardousNon-Hazardous 1 – 501 FT SO1 PT SO 51 – 200 1 FT SO & 1 PT SO 1 FT SO 201 – 2502 FT SO 1 FT SO & 1 PT SO 251 – 500 2 FT SO & 1 PT SO 2 FT SO2 PT SO 501 – 7501 FT SO 751 – 10002 FT SO Every additional 500 or a fraction thereof 1 FT SO Every additional 250 or a fraction thereof 1 FT SO

13. Duties of Safety Officer Advice the employer, supervisors, & workers on OSH; Investigate accidents; Coordinate safety training programs; Conduct OSH inspections; Maintain accident records system; & Provide assistance to government agencies in the conduct of OSH inspection, accident investigation, or any other related programs. Rule 1030 – Training & Accreditation of Personnel in OSH

14. A FT SO must be duly accredited by the DOLE. ACCREDITATION PROGRAM OF DOLE – Note: The employment of a FT SO may not be required if the employer enters into a written contract with a qualified consultant or consulting organization whose duties & responsibilities shall be the duties of a safety practitioner as stated in this Rule. The employment of a consultant, however, will not excuse the employer from the required training of his supervisors or technical personnel. Rule 1030 – Training & Accreditation of Personnel in OSH

15. Rule 1040 – OSH Committee a group of employees & management personnel which plans & develops polices in all matters pertaining to safety & health in the workplace.

16. Rule 1040 – OSH Committee Type Number of Workers Composition ChairMembersSecretary A≥ 401 Manager or authorized rep (must be COO) 2 Dep’t Heads 4 Workers OHP SO B201-400 1 Supervisor OHP or OHN 3 workers C101-200 Manager or authorized rep 1 Foreman 3 Workers OHN D≤ 100Manager 1 Foreman 3 Workers OHN or FA

17. Duties of OSH Committee Duties of OSH Committee (OSHS, 1978) 1.Plans & develops accident prevention program 2.Directs the accident prevention efforts. 3.Provides necessary assistance to government inspecting authorities 4.Initiates & supervises safety trainings for employees 5.Develops & maintains a disaster contingency plan

18. Duties of Employer Duties of Employer (OSHS, 1978) 1.Establishes & adopts in writing administrative policies on OSH. 2.Reports to the enforcing authority the policies adopted & required report requirements. 3.Acts on recommended measures of the OSH Committee &, in case of non-adoption, informs the committee of the reason.

19. Rule 1040 – OSH Committee OSH RuleReport/FormWhere To FileWhen To File Rule 1040: OSH Committee Report of Safety Organization (DOLE/BWC/IP-5) Minutes of the Meeting 2 copies to be submitted to concerned RO, copy-furnished BWC Within 1 month after the organization Quarterly

20. RULE 1050 – Notification & Keeping Records of Accidents &/or Occupational Illnesses 1053.01: Notification – All work accidents or occupational illnesses, resulting in disabling conditions or dangerous occurrences shall be reported by the employer to the DOLE RO. – If a major work accident results in death or permanent total disability, employer shall initially notify the DOLE RO within 24 hours. 1054: Keeping of Records – The employer shall maintain & keep an accident or illness record which shall be open at all times for inspection by authorized personnel.

21. Provides the SO means for an objective evaluation of the program. Helps identify high injury rates. Provides information on accident causes which contributes to high injury rates. RULE 1050 – Notification & Keeping Records of Accidents &/or Occupational Illnesses

22. OSH RuleReport/FormWhere To FileWhen To File Rule 1050: Notification & Keeping of Accidents &/or Occupational Illnesses Work Accident/Illness Report (DOLE/BWC/IP-6) Annual Exposure Data Report (DOLE/BWC/IP-6b) Fatal/Major Accident 2 copies to be submitted to concerned RO, copy-furnished BWC On or before the 20th day of the month following the date of occurrence of the accident On or before Jan 20 of the following year Within 24 hours RULE 1050 – Notification & Keeping Records of Accidents &/or Occupational Illnesses

23. RULE 1960 – OH Services Every employer is required to provide in his workplace medical & dental services, emergency medicines, & dental facilities.

24. OH Personnel Refers to the qualified first aider, RN, DMD, or MD, whose services have been engaged by the employer in order to provide OH services in the establishment.

25. Hazardous v Non-Hazardous Workplaces OSHS Rule 1013DOLE MC 02-98, Sec. 2(c) DOLE DO 16-01, Rule 1032.07 Dangerous environmental elements, hazardous contaminants, ionizing radiation, chemicals, flammable substances Construction, mining, fire fighting, stevedoring, dock work, deep sea fishing, mechanized farming Dangerous work conditions Manufacture or handling of explosives, pyrotechnic products Heavy equipment or power driven tools &/or machinery Potential risks of disabling injury, illness or death, either because of the presence of −Biologic agents −Radiation −Chemical substances −Hazardous materials −Physical hazards in the work environment Nature of the work processes performed or equipment used therein Work operations or practices performed by a worker in the establishment or workplace in conjunction with or as an incident to such operations or practices & which exposes the employee or worker to hazards likely to cause disabling injury, illness, death or physical or psychological harm

26. OH Personnel No. of WorkersHazardousNon-Hazardous 1-50FA/shift – Medicines 51-99 FA/shift PT OHN, 4h/d, 6d/wk – ETR FA/shift – ETR 100-199 FA/shift FT OHN PT MD/DMD, 4h/d, 3d/wk – EMC FA/shift PT OHN, 4h/d, 6d/wk – ETR 200-600 FA/shift FT OHN PT MD, 4h/d, 6d/wk PT DMD – EH & DC FA/shift FT OHN PT MD/DMD, 4h/d, 3d/wk – ETR 601-2000 FA/shift FT OHN FT MD or 2 PT MDs FT DMD – EH & DC FA/shift FT OHN PT MD, 4h/d, 6d/wk PT DMD – EMC ≥ 2001 FA/shift OHN/shift FT MD & PT MD/shift FT DMD – EH & DC FA/shift OHN/shift FT MD & PT MD/shift FT DMD – EMC & DC

27. OH Services Emergency Hospital – An employer need not put up an emergency hospital or dental clinic if there is a hospital or dental clinic which is not more than 5 km. away in urban areas & 25-min. travel in rural areas provided contracts are entered into with the said hospital or dental clinic & that the employer provides transportation facilities. However, not an excuse of not maintaining in the workplace an emergency treatment room for his workers. MD/DMD shall be subject to call at any time in other shifts during emergencies.

28. OH Program – The physician engaged by the employer, in addition to providing medical services in cases of emergency, must also perform the following: – Conduct PEME, free of charge, for the proper selection of workers; – Conduct free of charge APE of the workers; – Collaborate with safety & technical personnel in the selection & placement of workers, including investigation of work-related accidents due to exposure to health hazards; & – Develop & implement a comprehensive OH program for the employees. OH Services

29. OSH RuleReport/FormWhere To FileWhen To File Rule 1960: OH Services Annual Medical Report (DOLE/BWC/OH- 47A) 2 copies to be submitted to concerned RO, copy-furnished BWC On or before the last day of March of the year following the covered period RULE 1960 – OH Services

30. Other OSHS Rules/Requirements Rule 1070 – Occupational Health & Environmental Control – The employer shall exert efforts to maintain & control the working environment in comfortable & healthy conditions for the purpose of promoting & maintaining the health of his workers. – The employer shall carry out WEM where hazardous work is performed & shall keep a record of such measurement which shall be made available to the enforcing authority. – WEM shall include temperature, humidity, pressure, illumination, ventilation, concentration of substances, & noise. – The WEM shall be performed periodically as may be necessary but not longer than annually.

31. Rule 1080 – PPE & Devices 1081.01 – Every employer shall at his own expense furnish his workers with protective equipment & barriers whenever necessary. 1081.04 – No person shall be subjected or exposed to a hazardous environmental condition without protection. Other OSHS Rules/Requirements

32. Summary of Administrative Rules N otification & Keeping of Records of Accidents &/or Occupational Illnesses (Rule 1050) O ccupational Health Services (Rule 1960) R egistration of business (Rule 1020) T raining & Accreditation of Personnel in OSH (Rule 1030) H ealth & Safety Committee (Rule 1040)

33. Summary of Report Requirements W ork Accident/Illness Report (WAIR) A nnual Exposure Data Report (AEDR) R eport of Safety Organization (RSO) M inutes of the Meetings of Health and Safety Committee A nnual Medical Report (AMR)

34. DOLE Issuance ISSUANCETITLE DO 53-03 Guidelines for the Implementation of Drug-Free Workplace Policies & Programs for the Private Sector DO 73-05 Guidelines for the Implementation of Policy & Program on Tuberculosis (TB) Prevention & Control in the Workplace DO 102-10 Guidelines for the Implementation of HIV & AIDS Prevention & Control in the Workplace Program DA 05-10 Guidelines for the Implementation of a Workplace Policy & Program on Hepatitis B

35. DOLE DO 53-03 Guidelines for the Implementation of Drug-Free Workplace Policies & Programs for the Private Sector

36. Drug Situationer According to the World Drug Report (2016) – 247 M people worldwide used drugs in 2014 29 M suffer from drug use disorders – Only 1 in 6 people is in treatment 12 M inject drugs – 1.6 M are living with HIV – 6 M are living with hepatitis B – Cannabis & amphetamine are most commonly used drugs According to a 2012 survey commissioned by DDB – Estimated 1.3 M Filipino drug users

37. Profile of drug users in the Philippines National Household Survey (2012) Facility-Based (2015) Age group20 -29 years oldMean age of 31 years old SexMale-to-Female, 10:1Male-to-Female, 14:1 Civil status Married Single Status of employment Employed Unemployed Educational attainmentHigh school levelCollege level Economic status - Average monthly family income of ₱10,172.00 Nature of drug taking Polydrug use Major drugs of abuseMethampethamine HCl (shabu) Cannabis (marijuana) Inhalants (contact cement) Methampethamine HCl (shabu) Cannabis (marijuana) Cocaine

38. Major drugs of abuse & methods of use Drugs of AbuseMethods of Use Methamphetamine HClSniffing (snorting) Ingesting Inhaling (chasing the dragon) Injecting CannabisSmoking Contact cement adhesivesInhaling Nalbuphine HClInjecting Meperidine HClInjecting SolventInhaling Benzodiazepines & cough preparationOral intake

39. New psychoactive substances Nalbuphine HCl – Included in the List of Dangerous Drugs (DDB Regulation No. 1-2010) – Use: Pain reliever – Side effects: Depression, confusion, hallucinations, feeling of heaviness, numbness, delusions, dysphoria, hypertension, hypotension, bradycardia, tachycardia, pulmonary edema – In Cebu, nalbuphine HCl + methamphetamine HCl = milkshake Serious public health issue as there is a spread of HIV/AIDS & hepatitis

40. Impact of drugs at work A negative impact on – Physical health: elevated heart rate & BP, respiratory failure, convulsions, cardiovascular problems, certain forms of cancers, liver/kidney impairment, & HIV/AIDS – Mental health: altered perceptions & emotions, changes in personality, decreased social inhibitions, paranoia, anxiety, irritability, & depression – Safety: loss of concentration & coordination, distorted vision & hearing, sleepiness, & decreased awareness to touch & pain – Productivity: increase health care cost, number of accidents, absenteeism, replacement costs; poor work relations, & impaired performance

41. Role of the workplace Allows development of policies & strategies Facilitates promotion of health messages Facilitates referral of workers for care & support Provides opportunity for an effective partnership

42. Workers with no problems Workers beginning to experience problems Workers who are dependent Addiction Problem use: – inappropriate use – excessive use – use leading to or worsening physical, psychological, work, social, safety problems Recreational use Experimental use Work-related situations: – shift work – travel away from home – stress/boredom Problem of drugs in the workforce

43. What needs to be done? Prevention: is less expensive has a greater impact reaches more people is feasible in any work environment doesn’t need community resources PhP Focus on prevention rather than treatment.

44. Workers with no problems Beginning to experience problems Dependent Information & education Treatment (if prevention fails) Self-assessment Counselling How do we prevent the problem?

45. RA 9165 Comprehensive Dangerous Drugs Act of 2002

46. RA 9165 Article III – Dangerous drugs test & record requirements. Article V – Promotion of a national drug-free workplace program with the participation of private & labor sectors & the DOLE. Article VI – Participation of private & labor sectors in the enforcement of this Act.

47. Salient workplace provisions of RA 9165 MANDATORY TESTING applicants for firearms’ licenses/permit to carry firearms military, police, & law enforcers Mandatory drug testing for persons’ charged with criminal offense & candidates for public office have been declared unconstitutional by an En Banc Resolution of the SC dated November 2008. RANDOM TESTING students employees of public & private offices Mandatory drug testing for application of driver’s license revoked by new law, RA 10586 or the Anti- Drunk & Drugged Driving Act of 2013.

48. Crafting of policy using tripartite approach – Management – Workers Union, if organized – Contractors, subcontractors, concessionaires – Government organizations – Non-government organizations Salient workplace provisions of RA 9165 Technical assistance

49. DOLE DO 73-05 Guidelines for the Implementation of Policy & Program on Tuberculosis (TB) Prevention & Control in the Workplace

50. TB status Over 95% of TB cases & deaths are in developing countries. Poor communities & vulnerable groups are most affected. In the Philippines, efforts are intensified to reach geographically isolated & disadvantaged populations. (WHO, 2015)

51. TB statistics Ranks alongside HIV as leading cause of death worldwide (WHO, 2015) 9.6 million new cases – 5.4 million were men – 3.2 million were women 1.5 million deaths – 890,000 were men – 480,000 were women PHL is one of the 7 countries that have already achieved the MDGs in 2012 TB is more prevalent among males in PHL than females & among 25 – 55 year olds. However, all sexes & age groups are at risk. Treatment success rate = 90% (DOH-NTP MOP, 5 th ed.)

52. TB estimates 3 lives are lost per minute because of TB. By the time you finish munching your biscuit, 3 lives will be lost unless we fight back. (The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015)

53. Etiology Mycobacterium tuberculosis Typical signs & symptoms

54. Mode of transmission (Illustrations courtesy of The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015) & PBSP

55. Transmission & affectation (Illustration courtesy of The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015) & PBSP

56. PTB TB pleurisy TB lymphadenitis Miliary TB TB pericarditis TB peritonitis TB meningitisPott’s disease Urogenital TB Scrofuloderma Body parts affected by TB

57. Susceptible individuals Children & the elderly Those with medical conditions: – HIV infection – DM II – Severe kidney disease – Substance abuse (alcohol &/or drugs) – Low body weight – Certain cancers – On chemotherapy or corticosteroids

58. TB & smoking (Illustration courtesy of The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015) & PBSP

59. Diagnosis (Illustrations courtesy of The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015) & PBSP

60. Treatment

61. TB-DOTS facilities (Illustration courtesy of The Global Fund to Fight AIDS, Tuberculosis, & Malaria, 2015) & PBSP https://gis.philhealth.gov.ph/

62. Prevention Have a TB prevention & control policy program. Practice good hygiene, i.e., proper coughing & sneezing etiquette. Be conscious of TB disease symptoms for early diagnosis & treatment. Consult with MDs in clinics or nearby health centers. Minimize the crowding of workplaces. Ensure proper ventilation in the workplace. Encourage workers to strengthen their immune system through healthy lifestyle.

63. Infectiousness Patients are not considered infectious if... … Cough becoming less & less productive. … Appetite becoming good. … Gaining weight. … Show increasing body strength & stamina.

64. TB & THE WORKPLACE

65. Why the workplace? Workers spend a significant portion of their day at work Presence of existing facilities, services, personnel for health care delivery Easy to implement health promotion activities & convenient site for TB-DOTS Facilitates monitoring, recording, & reporting

66. Workplace issues in TB transmission Transmission is most likely to occur from TB-infected workers: – Have unrecognized PTB – Not on effective anti-TB therapy – Continue to work despite being infectious Host factors that enhance transmission: – Presence of coughing, sneezing, or other forceful expiratory measures – Presence of the acid-fast bacilli in sputum – Inability to perform coughing & sneezing etiquette Work environment factors that enhance the likelihood of transmission: – Exposure in relatively small & enclosed spaces – Inadequate local or general ventilation that results in insufficient dilution &/or removal of infectious droplet nuclei – Re-circulation of air containing infecious droplet nuclei

67. Workplaces with increased TB risk Health care facilities Homeless shelters Prisons Nursing homes Workplaces with exposure to silica, biological wastes Workplaces with poor conditions, i.e., overcrowded, poor ventilation, & enclosed work areas Industries with large migrant workforce Sweatshops

68. TB & Silicosis The risk of PTB is even higher because the effect of silica is superimposed on a high rate of PTB within the population. Silicosis → is the accumulation of dust in the lungs & the tissue reactions to its presence (ILO, 1970) – Fibrogenic dusts (silica, asbestos, mixed dusts) are the causative agents – Industries involved: Mining, quarrying, tunneling Milling Foundry work, abrasive blasting, glass manufacturing Stone mason, sand blasting, pottery making, ceramics & tile manufacturing, clay production, cement production

69. DOLE DO 102-10 Guidelines for the Implementation of HIV & AIDS Prevention & Control in the Workplace Program

70. Definition HIV- Human Immunodeficiency Virus - destroys the immune system & causes AIDS. HIV infection- a lifetime uncurable infection which may not present signs & symptoms. AIDS- Acquired Immune Deficiency Syndrome - serious & usually fatal condition in which the body’s immune system is severely weakened & cannot fight off infection. - condition where signs & symptoms appear as a result of various opportunistic infections.

71. Definition Opportunistic infection- caused by biological agents which find the opportunity to infect a body that doesn’t have the ability to defend against illness or has a compromised immune system.

72. Disease Process HIV infects T h cells Blocks the recognition of foreign substances HIV replicates inside T cells T cells unable to fight off infections Infected T cells produce more HIVs to destroy other T cells

73. Progression of HIV infection

75. HIV remains dormant in the body for several years before some unknown factors trigger the infections associated with AIDS. Median incubation period can be as long as 10 years. During the incubation period, PLWH are in asymptomatic stage & may look healthy & unaware of their infection status. PLHIV can live a normal & productive life & should not be discriminated & isolated. HIV & AIDS

76. Body fluids with high viral load Blood Semen Vaginal & cervical mucus Breast milk Amniotic fluid Cerebrospinal fluid

77. Modes of transmission

78. Reported Mode of HIV Transmission Reported Mode of HIV Transmission (DOH-NEC, Jun 2016)

79. Prevention of HIV Infection REMEMBER ABCDE! Abstinence Be faithful Condom Do not inject drugs Education

80. Am I at risk for HIV or AIDS? 1.Have you & your partner/s engaged in oral, vaginal, or anal sex without using condom? Y/N 2.Have you & any of your partner/s had multiple sexual activities in the last 12 months? Y/N 3.Did you or your partner/s have any STIs in the last 12 months? Y/N 4.Have you or your partner/s injected drugs, or shared needles & syringes? Y/N 5.Did you or your partner/s receive blood transfusion or organ transplant from a source not approved or authorized by DOH or the hospital? Y/N

81. Who are at risk? ANYONE 1.MARP a.MSM b.Female sex workers c.IDU 2.Workers exposed to blood & blood products a.Health workers, first aiders b.Mortuary workers c.Cleaners, garbage collectors 3.Vulnerable population a.Street children 4.Workers with increased vulnerability 1.Migrant workers 2.Seafarers 3.Transport workers

82. Testing Confidentiality – Exceptions: When complying with the requirements for monitoring procedures; When informing other health workers directly involved or about to be involved in the treatment or care of a PLWH; &/or When responding to a subpoena duces tecum &/or subpoena ad testificandum Consent Counseling Recommended 3 – 6 mos. after possible exposure to HIV

83. Testing hubs Testing hubs (www.pnac.org.ph) Social Hygiene Clinics [Angeles City, Caloocan City, Laoag City, Makati City, Mandaluyong City, Manila, Marikina City, Pasay City, Pasig City, Puerto Galera, Puerto Princesa City, Quezon City (Batasan Hills, Bernardo, Project 7), Santiago City, Tuguegarao City, Cebu City, Iloilo City, Lapu Lapu City, Mandaue City, Butuan City, Davao City, Gen. Santos City, & Zamboanga City]

84. Testing hubs Testing hubs (www.pnac.org.ph) LBaguio Gen. Hospital & Medical Center LCagayan Valley Medical Center LRITM LBicol Reg’l Training & Teaching Hospital LSan Lazaro Hospital LIlocos Training & Regional Medical Center LJose B. Lingad Memorial Medical Center LJose Reyes Memorial Medical Center/MEDI-JRMMC LPGH

85. Testing hubs Testing hubs (www.pnac.org.ph) VVicente Sotto Sr. Memorial Medical Center VCorazon Lacson Montelibano Memorial Regional Hospital VWestern Visayas Medical Center MSouthern Philippines Medical Center MDavao Regional Hospital MZamboanga City Medical Center

86. Treatment There are no proven cures yet for HIV infection & AIDS. – ARV drugs or ARTs only slow down the reproduction of HIV. – Other drugs are used against the opportunistic infections occurring among AIDS patients. Antibiotics don’t prevent HIV infection or any STI. Even if treatment & vaccines proved to be available, HIV pandemic will not necessarily come under control. Health education & promotion remain the foundations of control.

87. Treatment Hubs Treatment Hubs (DOH, Jun 2016) Ilocos Training & Reg’l Medical Center Cagayan Valley Medical Center Baguio Gen. Hospital & Medical Center James L. Gordon Memorial Hospital Jose B. Lingad Medical Center MMC PGH RITM San Lazaro Hospital TMC Bicol Reg’l Training & Teaching Hospital Corazon Locsin Montelibano Memorial Reg’l Hospital Western Visayas Medical Center Gov. Celestino Gallares Memorial Hospital Vicente Sotto Memorial Medical Center Southern Phils. Medical Center Northern Mindanao Medical Center Zamboanga City Medical Center Eastern Visayas Regional Medical Center

88. Procedure on testing & follow up (+)(-) Get tested! 1.Counseling 2.Screen for HIV Ab ELISA test Confirmatory testing Western blot (-) (+) Early medical treatment Regular blood testing for CD4 count & viral load Healthy lifestyle & positive attitude

89. IMPACT OF HIV & AIDS

90. Quick facts Quick facts (DOH-NEC, Jun 2016)

91. Figures on newly-diagnosed cases Figures on newly-diagnosed cases (DOH-NEC, Jun 2016) Percentage per region No. per day

92. HIV & AIDS & THE WORKPLACE

93. Impact on workers Stigma & discriminationLoss of income & benefits Pressure on families; dealing with orphans & dependents

94. Impact on enterprise Loss of skills & experienceReduced supply & increase of labor costThreatened OSHDecreased productivityReduced profit & investment

95. Impact on the country Decrease in life expectancyDecrease workforceWeakened economic growth & developmentThreatened food securityPressure on health & social security systemsIncrease child labor incidence

96. HIV & AIDS & the workplace HIV & AIDS is a workplace issue – Impact is felt by both workers & employers together with their families HIV primarily affect people who are in the peak of their productive life. Workplace intervention can help limit the spread & mitigate the impact of HIV & AIDS.

97. Role of the workplace Allows development of policies & strategies Facilitates promotion of health messages Facilitates referral of workers for care & support Provides opportunity for an effective partnership

98. DOLE DA 05-10 Guidelines for the Implementation of a Workplace Policy & Program on Hepatitis B

99. Global impact of hepatitis B  Almost half of the world’s population lives in an area with high hepatitis B prevalence. World population: 6 billion 2 billion with evidence of HBV infection 300 – 400 million with chronic HBV 15% – 25% die of cirrhosis/liver cancer Source: WHO & CDC fact sheets

100. Local impact of hepatitis B HBsAg Prevalence High (≥ 8%) Intermediate (2% to 8%) Low (< 2%) Mast EE, et al., MMWR Recomm Rep., 2006;55:1-33. Custer B, et al., J Clin Gastroenterol., 2004;38(10 suppl.):S158-S168.

101. Local impact of hepatitis B  An estimated 16% or 1 out of 8 Filipinos have hepatitis B (2003).  Approx. more than 13 million Filipinos have been or will be discriminated from gainful work & employment unless this discriminatory practice of unlawfully labeling them as “unift to work” is expressly prohibited.

102.  Hepatitis B is caused by a virus that infects the liver.  It’s considered as the silent Asian epidemic.  Most don’t even know they’re infected. Why should Filipinos be aware of hepatitis B?

103. How is hepatitis B life-threatening? 1 in 4 hepatitis B carriers may die from liver cancer or liver cirrhosis Most common cause of liver cancer & liver cirrhosis among Filipinos Liver cancer – 4th most common cause of cancer among Filipinos & 2nd leading cause of cancer- related deaths in the Philippines 70%-80% can lead healthy & productive lives if diagnosed early & monitored regularly by a MD

104. How can hepatitis B affect one’s work? Occupations considered high risk for the transmission of hepatitis B in the workplace are those in the health care setting because it involves exposure to blood & body fluids. All other occupations that don’t involve exposure to blood & body fluids → low risk for the transmission of hepatitis B.

105. HEPATITIS 101

106. Hepatitis is... … an inflammation of the liver caused by viruses, drugs, & toxins.

107. Types of viral hepatitis HAVHBVHCVHDVHEVHGV SourceFeces Blood Body fluids Blood Body fluids Blood Body fluids FecesBlood Route of transmission Fecal-oral Childbirth Needles Sex Blood transfusion Needles Blood transfusion (sex, childbirth) Needles Sex Blood transfusion (requires HBV co-infection) Fecal-oral Blood transfusion (requires HBV, HCV, or HIV co- infection) ChronicityNoYes No No (whether it’s pathogenic to humans remains unclear) Prevention Active & passive vaccination Blood donor screening, Risk mgt., & Education HBV vaccine Ensure safe drinking water Blood donor screening

108. How is hepatitis B transmitted? Mother to child (during pregnancy & childbirth) – Breastfeeding of infants by infective mothers provided that HBIg & hepatitis vaccine are given at birth. Exposure to contamined blood/body fluids – Cuts or grazes on skin & mucosa – Sharing personal items – Needle stick & sharps injuries – Acupuncture, tattooing, piercing, manicure, pedicure – Inadequately sterilized dental & surgical instruments Sexual contact Blood transfusion → rare

109. Who are at risk for hepatitis B? Infants born to HBsAg(+) mothers Individuals born in endemic areas People with family history of liver disease Recipients of blood products before 1990s HCWs Patients undergoing hemodialysis Sexual partners of HBV carriers Patients with STIs IV drug users People with multiple sexual partners

110. Who are at risk for hepatitis B? Category 1Category 2Category 3 HCWs who are performing or who have reasonable expectation of performing EPPs Other workers whose occupation involves potential for exchange of bodily fluids HCWs who are not performing or who don’t have the reasonable expectation of performing EPPs Non-HCW All other occupations that don’t fall into Categories 1 & 2 Categories of occupations according to risk of HBV exposure from infected workers Categories of occupations according to risk of HBV exposure from infected workers (HSP, 2011)

111. How can we eliminate or prevent transmission of hepatitis B? Prenatal screening for all mothers Vaccination – All newborn infants – Children of high risk groups – Adolescents & all children up to 18 – Adults in high risk groups – Susceptible individuals HBsAg (-) & anti-HBs (-) HCWs Universal precaution PPE

112. How to take care of your liver? Avoid drinking alcohol in excess Avoid non-essential drugs or medications that may adversely affect your liver Avoid diet high in cholesterol & fat

113. OH-RELATED DOLE ISSUANCE

114. Scope & Components TITLESCOPECOMPONENTS DO 53-03: Guidelines for the Implementation of a Drug-Free Workplace Policies & Programs for the Private Sector Mandatory for companies with 10 or more workers to include supply chain A.Advocacy, Information, Education &Training B.Preventive Strategies C.Social Policy D.Health Care Services E.Benefits & Compensation F.Monitoring & Enforcement DO 73-05: Guidelines for the Implementation of Policy & Program on Tuberculosis (TB) Prevention & Control in the Workplace All workplaces in the private sector including their supply chain DO 102-10: Guidelines for the Implementation of HIV & AIDS Prevention & Control in the Workplace Program DA 05-10: Guidelines for the Implementation of a Workplace Policy & Program on Hepatitis B

115. Policy & Program Components POLICY & PROGRAM DO 53-03 (Drugs) DO 73-05 (TB) DO 102-10 (HIV & AIDS) DA 05-10 (Hepatitis B) Jointly developed by management & workers //// Mandatory; covers all workplaces ≥ 10 workers /// Advocacy, education, & training//// Preventive strategies//// Medical management (diagnosis, treatment, & referral) //// Social policy (non-discrimination, & work accommodation) //// Roles & responsibilities: Employers, Workers, SHC, & Gov’t ////

116. Highlights of DOLE Issuance for Illnesses & Related Concerns (Drugs, TB, HIV/AIDS, Hepatitis B) Formulation of workplace policy & program – Policy & program may be a separate or integrated into existing OSH policy & program of establishment. – Collaboration of management & workers representatives in development & implementation of policy & program. – May be included as provisions of the CBA.

117. Highlights of DOLE Issuance for Illnesses & Related Concerns (Drugs, TB, HIV/AIDS, Hepatitis B) Components of prevention & control of workplace policy & program – Advocacy, information, education, & training – Social policy Non-discriminatory policy & practices Confidentiality Work accommodation & arrangement – Diagnosis, treatment, & referral for other services

118. Highlights of DOLE Issuance for Illnesses & Related Concerns (Drugs, TB, HIV/AIDS, Hepatitis B) Roles & responsibilities of employers & workers Implementation & monitoring – Within the establishment, safety & health committee or its counterpart shall be tasked for this purpose. – DOLE through its ROs

119. Key Principles Recognition of the different health concerns as workplace issue Non-discrimination Healthy work environment Social dialogue Confidentiality Continuation of employment relationship Prevention Diagnosis, treatment, & referral for other services Roles & responsibilities of stakeholders

120. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORSREMARKS Registration of establishmentsRule 1020, OSHS Adequate aisles/passagewaysRule 1060, OSHS; Sufficient width & height, & w/ signs & markings Good housekeepingRule 1060, OSHS; Conditions of floors, walls, & storage rooms Emergency exitsRule 1940, OSHS; 2 per floor w/ no obstructions Materials handling & storageRule 1150, OSHS; Appropriate labels, dotting, & storage Waste disposal systemWaste receptacle & its removal; drainage system Adequate lightingRule 1070, OSHS; In work areas, in aisles & passageways Noise pollution controlRule 1070, OSHS; Provision of appropriate PPE or isolation of work area

121. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORSREMARKS Proper ventilationRule 1070, OSHS; Provision of natural or artificial air supply Radiation exposure controlProvision of appropriate PPE, examination of work area Airborne contaminant controlRule 1070, OSHS; Provision of appropriate PPE, improvement of technical process, improvement of ventilation WEMRule 1070, OSHS PPERule 1080, OSHS; Provision & appropriate training Fire protection equipment/facilitiesRule 1940, OSHS; Water tank, fire extinguisher, conduct of fire drill Proper machine guardingRule 1200, OSHS; Railing or casing of moving parts Proper office spacingRule 1060, OSHS; Between workers & machines

122. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORSREMARKS No imminent danger situationCondition that could cause death or serious physical harm Personal facilities a.Separate toilet b.Supply of potable water c.Washing facilities DOLE: Rule 1060, OSHS DOH: IRR on Chapter VII, PD 856, amending AO 111 s. 1991 Safety & health organizationRule 1040, OSHS; According to number of employees Safety personnel a.Safety officer b.Safety practitioner Rule 1030, OSHS; DO 16-01 Health personnel a.FA b.OHN c.OHP/OHD Rule 1960, OSHS

123. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORSREMARKS Medical facilities a.Treatment room b.Clinic c.Hospital Rule 1960; OSHS Emergency medicinesRule 1960, OSHS; Table 47 Continuing training related to OSHRule 1030, OSHS; DO 16-01 Administrative reports on safety & health a.Minutes of meeting of SHC b.Employee’s work accident/illness exposure data c.Annual work accident/illness exposure data d.Annual medical report - Rule 1040, OSHS - Rule 1050, OSHS; For every accident - Rule 1050, OSHS; Whether or not there is an accident - Rule 1050, OSHS; Health record of program & activities Registration w/ PCABDO 13-98

124. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORSREMARKS DOLE-approved CHSPDO 13-98 Construction safety signagesDO 13-98 Construction heavy equipment testingRule 1410, OSHS; DO 13-98 Construction heavy equipment operator, TESDA certified Rule 1410, OSHS; DO 13-98 Construction worker’s skills certificate for critical operations Rule 1410, OSHS; DO 13-98 DO 53-03 (drug-free workplace)Written policies & programs reflecting the elements required DO 102-10 (HIV & AIDS in the workplace)Written policies & programs reflecting the elements required DA 05-10 (hepatitis B in the workplace)Written policies & programs reflecting the elements required DO 73-05 (TB in the workplace)Written policies & programs reflecting the elements required

125. The LLCS Checklist (DO 131-13, as amended) OSHS COMPLIANCE INDICATORS Technical Safety REMARKS BoilerRule 1160, OSHS; Permit to operate Pressure vesselRule 1170, OSHS; Permit to operate Internal combustion engineRule 1180, OSHS; Permit to operate Elevators & other related equipmentRule 1220, OSHS; Permit to operate Power piping lines inspectionRule 1240, OSHS; Permit to operate Crane & hoist equipmentRule 1410, OSHS; DO 13-98; Permit to operate TurbinePermit to operate Electrical wiring installation inspectionRule 1210, OSHS; certificate of electrical inspection