1. Occupational Health Programs

2. Occupational Health Definition
WHO/ILO defines occupational health as:
the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations
the prevention amongst workers of departures from health caused by their working conditions

3. Occupational Health Program Components
1) Safety and Accident Prevention 2) Hazard Identification 3) Exposure Monitoring and Health Surveillance 4) Injury and Illness Management (Case Management) 5) Emergency Response and Disaster Planning 6) International Travel 7) Ergonomics Program 8) Integrated Job Safety Analysis – identify job activities and associated occupational risk factors and modes of remediation and accommodation

4. Occupational Health Service Goals
To protect workers from health and safety hazards
To facilitate safe placement of workers according to their physical, mental and emotional capacities
To assure adequate medical care and rehab of occupationally ill and injured
To assist in measures related to personal health
Source: McCunney, R. A Practical Approach to Occupational and Environmental Medicine, 1994.

5. Occupational Health Directives
OSHA
General Duty Clause
Lab Standard
Respiratory Protection Standard
Etc.
Texas Department of State Health Services
Laboratory Animal Care Accreditation (AAALAC)
Joint Commission accreditation for health care organizations
Occupational management system standards (OHSAS )
Many others

6. Employee Risk Assessment
Recommend placement of employee
Screen for health/safety issues
Baseline data: physical, mental, historical
Meet regulatory mandates (OSHA)
Identify exposure and risk factors that are hazardous to employee’s health
Educate employee on safety & health issues

7. Exposure Reporting Systems
Develop institutional exposure control plan
Identify responsibilities of occupational health personnel
Establish injury/illness reporting mechanisms
report forms, telephone hotlines
Worker’s compensation
Ensure compliance with HIPAA regulations

8. Exposure Follow Up Review of completed report form
Follow-up with ill/injured person
Ensure documentation of type of exposure along with exposure route-trend analysis
Subsequent visits to employee health as determined by individual circumstances

9. Safety Devices and Preventative Measures
Perform job safety analysis to determine employee hazard risk categorization
Implement use of retractable syringes, sharps containers, etc.
Engineering controls
Personal protective equipment
Proper immunizations

10. Workers’ Compensation Benefits System
Board
Insurance Carrier
Injured
Worker
OHN/CM
Manager
Payroll
Information
Health Care Provider

11. Case Management Objectives: avoid inappropriate medical care
avoid lost time when able to perform modified duty
avoid anger, frustration of employee
maintain open communications between all parties
avoid permanent disability
encourage rehabilitation, when possible
The effectiveness of case management needs to be evaluated; set measurable goals-ie reduced lost days, another example may me premium paid per employee, needs to be tracked over the long term 3-5 years
More intangible goals, worker satisfaction, safety track record, appropriate and effective care
Consider cost benefit analysis-report to your manager-avoided fees, negotiated fees, outcome of the care, review your interventions; savings realized
Medical payments, cost of procedures avoided, costs associated w/potential lost work days

12. Program Evaluation Build evaluation into the design of the program
Evaluate based on the objectives (be sure they were established to start with)
Choose an evaluation tool-
Chart review or document review, Customer Survey, Observed practices, Trends in employee injury data
Report program information in terms of impact or benefits as well as cost
Consider cost benefit analysis as a part of the evaluation (small cost up front vs. large payout later?)
Plan to collect evaluation data in a manner that avoid the DRIP (data rich, information poor) issue. Certainly it is good to know the percentage of the targeted population participating in a program but what does that really tell you about the quality of the program? Referring back to the needs assessment, how well did the program meet the need of the employees? For blood borne pathogens, the employee need is protection from needlestick injuries. How many needlestick injuries occurred from a preventable cause? How does that compare to pre-program numbers? How did each needlestick occur by category (pt. Jumped, disposal issues, needle in bed, dropped needle, over full sharps container). How have those trends changed? How many of the needlestick injuries were managed according to protocol (seen within 2 hours, got meds in a certain way, got certain meds, etc.). Where were the problems and why? Systems barriers or employee compliance?
This type of information will assist you in improving the program and provide feedback to management on the actual effectiveness of the intervention rather than the effectiveness of the nurse in tracking the employees.

13. Characteristics of Successful Health Promotion Programs
Support from the top
Priority within mission
Input from mgmt & workers
Qualified staff
Include all shifts
Source: Chenoweth, D.H. (1991) Health Promotion at the Worksite
Defined budget
Use on/off site facilities
Conduct assessments & screenings with follow up
Participate in community programs