OCCUPATIONAL HEALTH HAZARDS

OCCUPATIONAL HEALTH HAZARDS
Dale M. Hizon, M.D. Occupational Health Officer Occupational Safety and Health Center BOSH Training OSHC BOSH Training 2009

CHEMICAL HAZARD PHYSICAL HAZARD BIOLOGICAL HAZARD ERGONOMIC HAZARD
BOSH Training OSHC

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. BOSH Training OSHC BOSH Training 2009

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 BOSH Training OSHC

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. BOSH Training OSHC

WORKPLACE HAZARDS Safety Hazards Health 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 BOSH Training OSHC

Workers’ Susceptibility
Genetic factors Multiplicity of exposure Lifestyle Duration of exposure Age WORK-RELATED DISEASE Workplace Factors Workers’ Susceptibility Physical properties Race Magnitude of exposure Gender Medical history Timing of exposure BOSH Training OSHC BOSH Training 2009

CHEMICAL HAZARDS BOSH Training OSHC

Chemical Hazards Routes of entry into the body Inhalation Skin Contact
Ingestion BOSH Training OSHC

Chemical Hazards Routes of excretion Gastro-intestinal (feces)
Renal (urine) Respiratory (exhalation) Skin (sweat, hair, nails) BOSH Training OSHC

LD 50 - Dose lethal to 50% of test animals
BOSH Training OSHC

point at which toxicity first appears
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. BOSH Training OSHC

Measures of concentration of toxic substances
Chemical Hazards Measures 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. BOSH Training OSHC

Classification of Toxic Effects
Chemical Hazards Classification 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- occurs almost immediately (hours/days) after an exposure Chronic toxicity- represents cumulative damage to specific organ systems; occurs many months or years to have recognizable clinical disease BOSH Training OSHC

Chemical Hazards Health Effects Renal Diseases Respiratory Diseases
Skin Diseases Hematologic Diseases Cardiovascular Diseases Neurologic Diseases Carcinogenic Teratogenic BOSH Training OSHC

Chemical Hazards Effects 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 BOSH Training OSHC

Chemical Hazards Blood 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 BOSH Training OSHC

Chemical Hazards Liver Disease: Acute liver toxicity
Carbon tetrachloride Cleaning 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, trichloroethylene Refrigeration, solvent workers BOSH Training OSHC

PHYSICAL HAZARDS BOSH Training OSHC

Physical Hazards Noise Vibration Extreme Temperature Illumination
Radiation BOSH Training OSHC

NOISE BOSH Training OSHC

Ear Anatomy BOSH Training OSHC

Types of Noise-Induced Hearing Loss
Temporary Threshold Shift (auditory fatigue) temporary loss of hearing acuity after exposure to loud noise recovery within hrs Permanent Threshold Shift irreversible loss of hearing BOSH Training OSHC

Early Signs of Hearing Loss
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) BOSH Training OSHC

Other Harmful Effects of Noise
Hypertension Hyperacidity Palpitations Disturbs relaxation and sleep BOSH Training OSHC

VIBRATION BOSH Training OSHC

VIBRATION Physical factor which affects man by transmission of mechanical energy from oscillating sources Types Segmental vibration Whole body vibration BOSH Training OSHC

Segmental Vibration: Health Effects:
Hand Arm Vibration Syndrome (HAVS) tingling, numbness, blanching of fingers pain BOSH Training OSHC

Whole Body Vibration: Health effects: Fatigue Irritability Headache
Disorders of the spine BOSH Training OSHC

EXTREME TEMPERATURE BOSH Training OSHC

EXTREME TEMPERATURE Sources of heat stress: Natural Conditions
Hot work processes related to furnaces, kilns, boilers and smelting BOSH Training OSHC

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 BOSH Training OSHC

EXTREME TEMPERATURE Sources of Cold Environment:
Ice plants and freezers in the food industry BOSH Training OSHC

Health Effects of Cold Temperature
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. BOSH Training OSHC

INADEQUATE ILLUMINATION
BOSH Training OSHC

Min Lighting Level (lux)
ILLUMINATION Recommended Illumination Levels Area of Operation Min Lighting Level (lux) Cutting Cloth Fine machining  2000 Transcribing handwriting Drafting 1000 Welding First Aid station 500 Lunch Room Rest Room 300 BOSH Training OSHC

Inadequate Illumination
Health Effects Visual Fatigue Double Vision Headaches Painful irritation Lacrimation Conjunctivitis BOSH Training OSHC

RADIATION BOSH Training OSHC

Electromagnetic Spectrum
Source Frequency in hertz (Hz) X-rays, about 1 billion billion Hz can penetrate the body and damage internal organs and tissues by damaging important molecules like DNA. This is called “ionization.” Gamma rays 1022 1020 IONIZING RADIATION X-rays 1018 Ultraviolet radiation 1016 Visible light 1014 Microwaves, several billion Hz, can have “thermal” or hearing effects on body tissues Infrared radiation 1012 1010 Microwaves 108 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. Radio waves 106 MHz Very low frequency (VLF) 3, ,000 Hz 104 Hz & Hz Extremely low frequency (ELF) ,000 Hz 102 60 Hz Direct current BOSH Training OSHC

RADIATION Types Sources Health Effects Ionizing X-rays Gamma rays
Cancer, congenital defects, death Non-ionizing Ultraviolet Infrared Laser skin redness, premature skin ageing, and skin cancer corneal and conjunctival burns, retinal injury, cataract Skin and eye problem BOSH Training OSHC

BIOLOGICAL HAZARDS BOSH Training OSHC

BIOLOGICAL HAZARDS VIRUSES FUNGI PARASITES BACTERIA
BOSH Training OSHC

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. BOSH Training OSHC

Agent / Disease Occupation 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. BOSH Training OSHC

Agent / Disease Occupation 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. BOSH Training OSHC

Agent / Disease Occupation Rabies (e.g. dogs, bats, rats, pigs, cats) Veterinarians, letter carriers, laboratory research workers, agricultural workers. Fungus Farmers, outdoor workers, animal handlers BOSH Training OSHC

HIV and AIDS A- Acquired H- Human I- Immune I- Immunodeficiency
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 BOSH Training OSHC

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 y/o 12 31 537 Children <15 y/o 1 52 Reported deaths due to AIDS 317 Source: HIV / AIDS Registry, Department of Health, Philippines * Note: No data available on sex for eleven (11) cases. BOSH Training OSHC

Modes of HIV Transmission
Reported Mode of Transmission Feb 2009 n=47 Jan-Feb n= 112 Cumulative Data: 1984—2009 N=3,701 Sexual 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 19 Injecting Drug Use 1 8 Needle Prick Injury 3 Mother-to-Child 2 49 No data available 325 BOSH Training OSHC

Body Fluids with High Viral Load
Blood Semen Vaginal and cervical mucus Breastmilk Amniotic fluid Cerebrospinal fluid BOSH Training OSHC

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 BOSH Training OSHC

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 BOSH Training OSHC

Prevention of HIV Infection
REMEMBER ABCDE! Abstinence Be Faithful Condom Do not inject Drugs/no sharing of needles Education BOSH Training OSHC

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. BOSH Training OSHC

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 BOSH Training OSHC

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 BOSH Training OSHC

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

DOTS Strategy…the Solution! Directly Observed Therapy Short Course
With DOTS 90% CURE RATE BOSH Training OSHC

ERGONOMIC HAZARDS BOSH Training OSHC

MAXIMUM SATISFACTION AND INCREASE PRODUCTIVITY
ERGONOMICS Human Biological Science + Engineering Science ____________________________________ MAXIMUM SATISFACTION AND INCREASE PRODUCTIVITY “ fitting the job to the worker” BOSH Training OSHC

(job content & context)
ERGONOMICS the tool workstation the task (job content & context) organization environment BOSH Training OSHC

ERGONOMICS Goal to reduce work-related musculoskeletal disorders (MSDs) developed by workers MSDs are injuries and illnesses that affect muscles, nerves, tendons, ligaments, joints or spinal discs. BOSH Training OSHC

ERGONOMICS Common Symptoms of MSDs Painful joints
Pain, tingling, numbness in hands, wrists, forearms, shoulders, knees and feet Shooting or stubbing pains Swelling or inflammation BOSH Training OSHC

ERGONOMICS Common Symptoms of MSDs Fingers or toes turning white
Back or neck pain Stiffness BOSH Training OSHC

Risk Factor: ERGONOMICS
Static posture BOSH Training OSHC

Forceful exertion BOSH Training OSHC

Repetitive movement BOSH Training OSHC

Extreme range of motion BOSH Training OSHC

Awkward posture BOSH Training OSHC

ERGONOMICS BOSH Training OSHC

STRESS BOSH Training OSHC

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. BOSH Training OSHC

STRESS: Effects BOSH Training OSHC

STRESS Manifestations of Stress PSYCHOLOGICAL Fatigue Anxiety Tension
Irritability Depression Boredom Inability to concentrate Low esteem 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 BOSH Training OSHC

BOSH Training OSHC

MONITORING Systematic, continuous, repetitive health-related activities that should lead to corrective action Types of monitoring 1. Ambient / Environmental 2. Biological 3. Medical Surveillance BOSH Training OSHC

BIOLOGICAL MONITORING
BOSH Training OSHC

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 BOSH Training OSHC

Biological Monitoring
Chemical / Determinant Sampling Time BEI LEAD Lead in Blood Not critical 30ug/100ml MERCURY Total inorganic in urine Total inorganic in blood Prior to shift End of shift at end of workweek 35ug/g 15ug/L CARBON MONOXIDE Carboxyhemoglobin in blood End of shift 3.5% of Hgb BOSH Training OSHC

MEDICAL SURVEILLANCE BOSH Training OSHC

Medical Surveillance Identify cases
Analyze Trends and Patterns in the Workforce to Guide Prevention Efforts Meet Regulatory Requirements BOSH Training OSHC

Medical Surveillance 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 specific medical examinations organ system Analyze Medical Data - Disease, recovery, rehab - Effectiveness or failure of control measures BOSH Training OSHC BOSH Training 2009

PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS
Monitoring Activity Workplace-Related Events Health Effects None Early Late Exposure at the workplace - Chemicals - Physical agents Environmental monitoring Biological monitoring and surveillance Treatment and surveillance - Morbidity - Mortality Biologically significant exposure - Chemicals absorbed - Early (reversible) changes Clinical diagnosis - measurable health effects End effects - diseases - unfavorable events (spontaneous abortion) BOSH Training OSHC BOSH Training 2009

Standards, Policies and Guidelines
Occupational Safety and Health Standards Rule 1050 Notification and Keeping of Records of Accidents and/or Occupational illnesses Rule 1070 Occupational Health and Environmental Control Rule 1960 Occupational Health Services BOSH Training OSHC BOSH Training 2009

Rule 1960: Occupational Health Services
1961: General Provisions 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. BOSH Training OSHC BOSH Training 2009

1963: Emergency Health Services : Medicines and Facilities : Emergency Medical and Dental Services BOSH Training OSHC BOSH Training 2009

Hazardous Workplaces: Number of workers OH Physician OH Dentist OH Nurse First Aider 1 – 50 1 Full time 1 Part time 4 hours/day 6x/week 100 – 199 4hrs/day 3x/week * 4hrs/day 6x/week ** 1 Full time or 2 Part Time 4hrs/day 6x/week 1 Full time every shift 2000 and more *Alternate each day ** Alternate workshift in a day BOSH Training OSHC BOSH Training 2009

Non - Hazardous Workplaces: Number of workers OH Physician OH Dentist OH Nurse First Aider 1 - 99 1 Full time 100 – 199 1 Part time 4hrs/day 6x/week 4hrs/day 3x/week * 4hrs/day 6x/week ** 1 Full time every shift 2000 and more *Alternate each day ** Alternate workshift in a day BOSH Training OSHC BOSH Training 2009

: Emergency Hospital 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. BOSH Training OSHC BOSH Training 2009

Health Examinations: Entrance Periodic Special examination Transfer examination Separation examination BOSH Training OSHC BOSH Training 2009

OCCUPATIONAL HEALTH PROGRAMS
BOSH Training OSHC

Key Elements of the Occupational Health Program
Health Protection Health Promotion Health Rehabilitation BOSH Training OSHC BOSH Training 2009

Health and Safety Programs
Hazards/ Disease Source Health Effect Health Program Chemical Solvents Paints, Thinners Irritant, Multisystem effects Surveillance for chemical exposure Exposure monitoring (Biologic Monitoring) Physical Noise Woodwork Operations Hearing Impairment Hearing Conservation Program BOSH Training OSHC BOSH Training 2009

Health and Safety Programs
Hazards/ Disease Source Health Effect Health Program Biologic Tetanus Dirty Nails, soil Lockjaw, rigidity, death Immunization Ergonomic Stresses Cumulative Trauma Disorder Awkward postures, Heavy loads Musculoskeletal Disorders Management or personnel methods; Workplace modification Worker education and training; Back Care Program BOSH Training OSHC BOSH Training 2009

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 BOSH Training OSHC BOSH Training 2009

Health Promotion Drug Abuse Prevention and Control
RA 9165 Comprehensive Drugs Act of 2002 Department Order No : 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 : Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace BOSH Training OSHC BOSH Training 2009

DEPARTMENT ORDER NO RATIONALIZING THE IMPLEMENTATION OF THE FAMILY WELFARE PROGRAM (FWP) IN DOLE SECTION 2. New Priorities of the Family Welfare Program a) Reproductive Health and Responsible Parenthood b) Education/Gender Equality c) Spirituality or Value Formation d) Income Generation/Livelihood/Cooperative e) Medical Health Care f) Nutrition g) Environmental Protection, Hygiene and Sanitation h) Sports and Leisure i) Housing j) Transportation BOSH Training OSHC BOSH Training 2009

Approach in Ensuring Well-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 BOSH Training OSHC BOSH Training 2009

Participatory Approach
Participation and involvement from stakeholders Coordinated intervention Learning from specifications/guidelines, scientific data best practice BOSH Training OSHC BOSH Training 2009

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 BOSH Training OSHC BOSH Training 2009

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 THANK YOU FOR YOUR ATTENTION! BOSH Training OSHC

OCCUPATIONAL HEALTH HAZARDS

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