Penyakit Akibat Kerja 10 September 2007

Dr. S.
Dr. S.
Widodo
Widodo
PELATIHAN HIPERKES & KESELAMATAN KERJA PELATIHAN HIPERKES & KESELAMATAN KERJA
BAGI DOKTER DAN PERAWAT BAGI DOKTER DAN PERAWAT
JAKARTA, 10 September 2007 JAKARTA, 10 September 2007
PANITIA PELATIHAN HIPERKES DAN KESELAMATAN KERJA BAGI DOKTER PANITIA PELATIHAN HIPERKES DAN KESELAMATAN KERJA BAGI DOKTER
IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN KER IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN KERJA JA
D E N G A N D E N G A N
BALAI HIPERKES DAN KESELAMATAN KERJA DKI JAKARTA
DINAS TENAGA KERJA DAN TRANSMIGRASI
PEMERINTAH PROPINSI DAERAH KHUSUS IBUKOTA JAKARTA
J L. J ENDRAL AHMAD YANI 69-70 J AKARTA 10510. PHONE: (+62).21.4209820. FAX: (+62) 21 4240284
Cak upan
Def i ni si
Di agnosa
Cac at dan penak si r an
Kasus k asus yang banyak t er j adi :
Debu dan Par u, Der mat osi s,
Mat a.
Si st em pel apor an
DEFI NI SI
Penyakit yang disebabkan oleh
Pekerjaan dan/atau lingkungan kerja
(Permen.Nakerstrans No. PER.01/MEN/1981)
Penyakit Yang Timbul Karena Hubungan Kerja.
(Keppres No. 22 Th. 1993)
Occupational Disease = Maladie Proffesionelle
=
PENYAKIT AKIBAT KERJA
DUA ASPEK P A K
Pencegahan Penyakit Akibat Kerja
(UU No. 1 Th. 1970 dan peraturan
pelaksanaannya)
Jaminan Kecelakaan Kerja
(UU No. 3 Th. 1992)
DATA
KECELAKAAN KERJA
DATA KECELAKAAN KERJA
(Rata Rata per Tahun)
100.000 kecelakaan kerja;
Kerugian Rp. 100 200 milyar;
Meninggal : 1500 - 2000 orang;
70 juta hari kerja hilang;
500 juta jam kerja hilang (khusus tahun 2000 )
DATA
TEMUAN PENELITIAN P.A.K.
Tahun Peneliti Jumlah sampel dan populasi Temuan
1964 Sumamur & Diperiksa 111 dari 1082 1% bisinosis dan 40%
Karimuddin tenaga kerja pemintalan keluhanpernafasan
Karimuddin& 976 tenaga kerja pertam- 0.5% silikosis(murni
Sumamur bangan atau campuran TBC paru)
1968 Sumamur 48 dari 167 penenun 8,3% mill fever
1971 Sumamur 20 tenaga kerja blowers 10% bronkhitis kronis;
dan carders 15% kelainan parulain
1974 Sumamur 1559 tenaga kerja pabrik 4,7% bronkhitis kronis
rokok
457 tenaga kerja pabrik 5% bronkhitis kronis
beras
1978/ Sumamur & 54 pekerjapompa bensin 16,7% dermatosis akibat
1979 Susianti Wenas kerja
36 pengecer kerosen 16,7% dermatosisakibat
kerja; 47,2% iritasi kulit;
38,9% kerusakan lapisan
tandukkulit
Tahun Peneliti Jumlah sampel dan populasi Temuan
1984 Sumamur 518 dari 982 tenaga kerja 7,9% timah hitam darah
pabrikaki 800 mikrogram/L ataulebih
1984/ Sumamur, 113 penyemprot hama 48,7%% kadar kolin-esterase
1985 Tjepi Aleuwi & industri perkayuan 62,5% atau kurang
TjiptoPranowo
1984/ Sumamur, 99 petani penyemprot 6% penurunankolin-esterase
1985 Bunandir & hama darah
TjiptoPranowo
1986 SugengBudiono 347 tenaga kerja terpapar 35,7% keracunan ringan;
pestisida 20,2% keracunan sedang;
3,4% keracunan berat
1989/ KarnenGarna 250 tenaga kerja pabrik 2,8% obstruksi paru akut;
1990 Baratawidjaja tekstil; 3,2% obstruksi paru kronis
1375 tenaga kerja pabrik 24,8% bisinosis; obstruksi
tekstil paruakut 1,7% dan0,2% kronis
1989/ RetnoWidowati 230 tenagakerjapabrik cat 0,9% dermatosisakibat kerja
1990 Subaryo 80 tenagakerjabengkel
pengecatan mobil 2,5% dermatosisakibat kerja
4000 tenagakerjapabrik
semen 0,2% dermatosisakibat kerja
200 tenagakerjabangunan 3% dermatosisakibat kerja
1992/ Eddy Charles 425 tenagakerjaterpapar 10,8% restriksi paru; 2%
1993 kepadadebu; 518 kepada obstruksi paru
asbes
1993 Santoso 372 tenagakerja batik 11,8% paruobstruktif; 7,8%
tradisional restriktif dan1,1% campuran

Hasil
Hasil
penelitian
penelitian
kronologis
kronologis
dari
dari
tahun
tahun
1964
1964
sampai
sampai
dengan
dengan
1993 (
1993 (
oleh
oleh
:
:
Suma
Suma
mur
mur
,
,
Karimudin
Karimudin
,
,
Susianti
Susianti
Wenas
Wenas
,
,
Tjepy
Tjepy
F.
F.
Aleuwi
Aleuwi
,
,
Tjipto
Tjipto
Pranowo
Pranowo
,
,
Bunandir
Bunandir
,
,
Sugeng
Sugeng
Budiono
Budiono
,
,
Karnen
Karnen
Garna
Garna
Baratawidjaja
Baratawidjaja
,
,
Retno
Retno
Widowati
Widowati
Soebaryo
Soebaryo
,
,
Santoso
Santoso
,
,
dll
dll
)
)
dan
dan
pada
pada
tahun
tahun
tahun
tahun
selanjutnya
selanjutnya
,
,
mengindikasikan
mengindikasikan
bahwa
bahwa
prevalensi
prevalensi
penyakit
penyakit
akibat
akibat
kerja
kerja
cukup
cukup
tinggi
tinggi
.
.

Dari
Dari
banyak
banyak
temuan
temuan
penelitian
penelitian
tersebut
tersebut
diatas
diatas
dapat
dapat
disimpulkan
disimpulkan
bahwa
bahwa
Penyakit
Penyakit
Akibat
Akibat
Kerja
Kerja
memang
memang
ada
ada
dan
dan
diderita
diderita
oleh
oleh
tenaga
tenaga
kerja
kerja
dan
dan
sering
sering
banyak
banyak
jumlahnya
jumlahnya
!
!
Penyakit Akibat Kerja :
Data Jamsostek pada tahun 2001 :
Terhimpun 104,852 kasus Kecelakaan Kerja.
Sudah termasuk 78 kasus Penyakit Akibat Kerja,
Atau kurang lebih HANYA 0,07%dari semua kasus.
SANGAT MINIM
Mengapa??
KEPPRES. No. 22 Th.1993
KEPPRES. No. 22 Th.1993
(BERDASARKAN UU No. 3 TH. 1992)
(BERDASARKAN UU No. 3 TH. 1992)
o
o
31 JENIS PENYAKIT AKI BAT KERJA
31 JENIS PENYAKIT AKI BAT KERJA
(FAKTOR KIMIA; FISIK; BIOLOGIS;
(FAKTOR KIMIA; FISIK; BIOLOGIS;
ERGONOMIS)
ERGONOMIS)
o
o
TIAP JENIS ADALAH KELOMPOK PENYAKIT
TIAP JENIS ADALAH KELOMPOK PENYAKIT
o
o
JENIS KE 1
JENIS KE 1
5 & 28 : MENGENAI SALURAN

5 & 28 : MENGENAI SALURAN
PERNAPASAN.
PERNAPASAN.
o
o
JENIS KE 26 ^ 27: MENGENAI KULIT
JENIS KE 26 ^ 27: MENGENAI KULIT
o
o
JENIS KE 31 (SEMUA BAHAN KIMIA)
JENIS KE 31 (SEMUA BAHAN KIMIA)
(Lampiran Keppres No. 22 Tahun 1993)
1. Pnemokoniosis yang disebabkan debu mineral pembentuk
jaringan parut(silikosis, antrakosilikosis, asbestosis) dan
silikotuberkulosis yang silikosisnya merupakan faktor utama
penyebab cacat dan kematian.
2. Penyakit paru dan saluran pernafasan (bronkhopulmoner)
yang disebabkan oleh debu logam keras.
3. Penyakit paru dan saluran pernafasan(bronkhopulmoner) yang
disebabkan oleh debu kapas, vlas, henep dan sisal (bissinosis).
4. Asma akibat kerja yang disebabkan oleh penyebab sensitisasi
dan zat perangsang yang dikenal yang berada dalam proses
pekerjaan.
5. Alveolitis allergika yang disebabkan oleh faktor dari luar
sebagai akibat penghirupan debu organik.
6. Penyakit yang disebabkan oleh berillium , dst
(=atau persenyawaannya yang beracun).
7. Penyakit yang disebabkan oleh kadmium , dst
8. Penyakit yang disebabkan fosfor , dst
9. Penyakit yang disebabkan oleh krom , dst
10. Penyakit yang disebabkan oleh mangan , dst
11. Penyakit yang disebabkan oleh arsen , dst
12. Penyakit yang disebabkan oleh raksa , dst
13. Penyakit yang disebabkan oleh timbal , dst
14. Penyakit yang disebabkan oleh fluor atau , dst
15. Penyakit yang disebabkan oleh karbon disulfida.
16. Penyakit yang disebabkan oleh derivat halogen dari
persenyawaan hidrokarbon alifatik atau aromatik
yang beracun.
17. Penyakit yang disebabkan oleh benzena atau
homolognya yang beracun.
18. Penyakit yang disebabkan oleh derivat nitro dan
amina dari benzena dan hoimolognya yang beracun.
19. Penyakit yang disebabkan oleh nitrogliserin atau
ester asam nitrat lainnya.
20.Penyakit yang disebabkan oleh alkohol, glikol atau
keton.
21.Penyakit yang disebabkan oleh gas atau uap
penyebab asfiksia atau beracunan seperti karbon
monoksida, hidrogen sianida, hidrogen sulfida, atau
derivatnya yang beracun, amoniak seng, braso dan
nikel.
22.Kelainan pendengaran yang disebabkan oleh
kebisingan.
23.Penyakit yang disebabkan oleh getaran mekanis
(kelainan-kelainan otot, urat, tulang persendian,
pembuluh darah tepi atau saraf tepi).
24.Penyakit yang disebabkan oleh pekerjaan dalam
udara yang bertekanan lebih.
25.Penyakit yang disebabkan oleh radiasi elektromagnetis
dan radiasi yang mengion.
26. Penyakit kulit(dermatosis) yang disebabkan oleh
penyebab fisik, kimiawi atau biologis.
27. Penyakit kulit epitelioma primer yang disebabkan
oleh ter, pic, bitumen, minyak mineral, antrasena atau
persenyawaan, produk atau residu dari zat tsb.
28. Kanker paru atau mesotelioma yang disebabkan
oleh asbes.
29. Penyakit infeksi yang disebabkan oleh virus, bakteri
atau parasit yang didapat dalam suatu pekerjaan
yang memiliki risiko kontaminasi khusus.
30. Penyakit yang disebabkan oleh suhu tinggi atau
rendah atau panas radiasi atau kelembaban udara
tinggi.
31. Penyakit yang disebabkan oleh kimia lainnya
termasuk bahan obat.
I nt er nat i onal Cl assi f i c at i on
of Di seases.
= Klasifikasi Internasional
untuk berbagai Penyakit.
CONTOH
Keppres No. 22 ICD
JENIS No. 1; PNEUMOKONIOSIS PENYAKIT SALURAN PERNAFASAN: J60-65
JENIS No. 6,7,9,10,12, 13 KERACUNAN LOGAM: T56-
JENIS No. 22 PEMAPARAN BISING: W42-
JENIS No. 26 DERMATOSIS AKIBAT KERJA: L23-24
JENIS No. 29 INFEKSI VIRUS; MIKOSIS;PENYAKIT YANG
BERKAITAN DENGAN PROTOZOA DAN PARASIT
metoda
metoda
Diagnosis
Diagnosis
4 4
Anamnesis
Anamnesis
tentang
tentang
riwayat
riwayat
penyakit
penyakit
dan
dan
riwayat
riwayat
pekerj aan
pekerj aan
;
;
4 4
Pemeriksaan
Pemeriksaan
klinis
klinis
;
;
4 4
Pemeriksaan
Pemeriksaan
laboratoris
laboratoris
;
;
4 4
Pemeriksaan pendukung, misalnya
Pemeriksaan pendukung, misalnya
pemeriksaan sinar tembus;
pemeriksaan sinar tembus;
4 4
Pemeriksaan
Pemeriksaan
tempat
tempat
/
/
ruang
ruang
kerj a
kerj a
=
=
workplace inspection:
workplace inspection:
-
-
management:
management:
peraturan
peraturan
,
,
tanda
tanda
;
;
-
-
machine:
machine:
peralatan
peralatan
;
;
-
-
man :
man :
cara
cara
kerj a
kerj a
.
.
Diagnosis
Diagnosis
Dasar
Dasar
untuk
untuk
mempunyai
mempunyai
hak
hak
atas
atas
Jaminan
Jaminan
:
:
4 4
Biaya
Biaya
pengangkutan
pengangkutan
;
;
4 4
Biaya
Biaya
pemeriksaan
pemeriksaan
,
,
pengobatan
pengobatan
,
,
dan/ atau
dan/ atau
perawatan
perawatan
;
;
4 4
Biaya
Biaya
rehabilitasi
rehabilitasi
;
;
4 4
Santunan
Santunan
berupa
berupa
uang
uang
:
:
santunan
santunan
sementara
sementara
tidak
tidak
mampu
mampu
bekerj a
bekerj a
;
;
santunan
santunan
cacat
cacat
sebagian
sebagian
untuk
untuk
selama
selama
-
-
lamanya
lamanya
;
;
santunan
santunan
cacat
cacat
total
total
untuk
untuk
selama
selama
lamanya
lamanya
,
,
baik
baik
fisik
fisik
maupun
maupun
mental;
mental;
dan
dan
santunan
santunan
kematian
kematian
.
.
CACAT
(KARENA KECELAKAAN KERJA DAN PENYAKIT AKIBAT KERJA)
KEADAAN HILANG,
ATAU BERKURANGNYA FUNGSI ANGGOTA
BADAN
YANG SECARA LANGSUNG ATAU TIDAK
LANGSUNG
MENGAKIBATKAN HILANG
ATAU BERKURANGNYA KEMAMPUAN
UNTUK MENJALANKAN PEKERJAAN
Cacat
Cacat
anatomis
anatomis
:
:
Keadaan
Keadaan
hilang
hilang
anggota
anggota
badan
badan
.
.
Cacat
Cacat
fungsi
fungsi
:
:
Berkurangnya
Berkurangnya
fungsi
fungsi
anggota
anggota
badan
badan
.
.
Anggota
Anggota
badan
badan
:
:
Bagian
Bagian
/organ
/organ
tubuh
tubuh
seperti
seperti
tangan
tangan
, kaki,
, kaki,
hidung
hidung
,
,
telinga
telinga
,
,
mata
mata
,
,
kulit
kulit
,
,
alat
alat
kelamin
kelamin
,
,
paru
paru
,
,
jantung
jantung
,
,
usus
usus
,
,
otak
otak
,
,
dsbnya
dsbnya
)
)
Tabel Lampiran II PP. No.14 Tahun 1993
(KETENTUAN NORMATIF)
A. Cacat anatomis
B. Cacat fungsi
C. Cacat mental (CATATAN KHUSUS)
-Aspek kemampuan bekerja
-Aspek estetika
-Aspek mental-psikologis
CACAT (JENIS)
(KARENA KECELAKAAN KERJA ATAU PENYAKIT AKIBAT KERJA)
DUA MACAM:
I . MACAM CACAT TETAP SEBAGI AN
I I . MACAM CACAT-CACAT LAI NNYA
CACAT (JENIS)
1. Lengan kanan dari sendi bahu ke bawah;
2. Lengan kiri dari sendi bahu ke bawah;
3. Lengan kanan dari atau dari atas siku ke bawah;
4. Lengan kiri dari atau atas siku ke bawah;
5. Tangan kanan dari atau dari atas pergelangan ke bawah;
6. Tangan kiri dari atau dari atas pergelangan ke bawah;
7. Kedua belah kaki dari pangkal paha ke bawah;
8. Sebelah kaki dari pangkal paha ke bawah;
9. Kedua belah kaki dari mata kaki ke bawah;
10. Sebelah kaki dari mata kaki ke bawah;
11. Kedua belah mata;
12. Sebelah mata atau diplopia pada penglihatan dekat;
13. Pendengaran pada kedua belah telinga;
14. Pendengaran pada sebelah telinga;
CACAT (JENIS)
(LANJUTAN)
15. Ibu jari tangan kanan;
16. Ibu jari tangan kiri;
17. Telunjuk tangan kanan;
18. Telunjuk tangan kiri;
19. Salah satu jari lain tangan kanan;
20. Salah satu jari lain tangan kiri;
21. Ruas pertama telunjuk kanan;
22. Ruas pertama telunjuk kiri;
23. Ruas pertama jari lain tangan kanan;
24. Ruas pertama jari lain tangan kiri;
25. Salah satu ibu jari kaki;
26. Salah satu jari telunjuk kaki;
27. Salah satu jari kaki lain.
CACAT (JENIS)
II. MACAM CACAT-CACAT LAINNYA
1. Terkelupasnya kulit kepala (cacat anatomis);
2. Impotensi(cacat anatomis atau cacat fungsi);
3. Kaki memendek sebelah: kurang dari 5 cm; 5 7,5 cm; 7,5 cm
atau lebih (cacat anatomis);
4. Penurunan daya dengar kedua belah telinga setiap 10 desibel
(cacat fungsi);
5. Penurunan daya dengar sebelah telinga setiap 10 desibel
(cacat fungsi);
6. Kehilangan daun telinga sebelah(cacat anatomis);
CACAT (JENIS)
CACAT (JENIS)
II. MACAM CACAT-CACAT LAINNYA
(LANJUTAN)
Kehilangan kedua belah daun telinga (cacat anatomis);
Cacat hilangnya cuping hidung (cacat anatomis);
Perforasi sekat rongga hidung (cacat anatomis);
Kehilangan daya penciuman (cacat fungsi);
Hilangnya kemampuan kerja fisik(cacat fungsi);
Hilangnya kemampuan kerja mental tetap(cacat fungsi);
7. Kehilangan sebagaian fungsi penglihatan; kehilangan efisiensi
tajam penglihatan; kehilangan penglihatan warna; kehilangan
lapangan pandang (cacat fungsi).
I.MACAM CACAT TETAP SEBAGIAN
II.MACAM CACAT-CACAT LAINNYA
DAPAT DIKELOMPOKKAN MENURUT SPESIALISASI
BIDANG KEDOKTERAN:
- Bidang Penyakit Paru;
- Bidang Penyakit Kulit.
- Bidang Penyakit Mata;
- Bidang Penyakit THT;
- Bidang Penyakit Ortopedi;
- Bidang Penyakit Dalam;
- Bidang Bidang Penyakit Radiasi;
- Bidang Penyakit Psikiatri;
- Bidang Penyakit Nerologi;
- Bidang Penyakit Urologi;
CACAT (JENIS)
PENILAIAN CACAT
Tabel,Lp.II PP. No.:14 Tahun 1993
MACAM CACAT TETAP SEBAGIAN
Macam cacat tetap sebagian Nilai%x upah
1. Lengan kanan dari sendi bahu ke bawah 40
2. Lengan kiri dari sendi bahu ke bawah 35
3. Lengan kanan dari atau dari atas siku ke bawah 35
4. Lengan kiri dari atau atas siku ke bawah 30
5. Tangan kanan dari atau dari atas pergelangan ke bawah 32
6. Tangan kiri dari atau dari atas pergelangan ke bawah 28
7. Kedua belah kaki dari pangkal paha ke bawah 70
8. Sebelah kaki dari pangkal paha ke bawah 35
9. Kedua belah kaki dari mata kaki ke bawah 50
10. Sebelah kaki dari mata kaki ke bawah 25
11. Kedua belah mata 70
12. Sebelah mata atau diplopia pada penglihatan dekat 35
13. Pendengaran pada kedua belah telinga 40
14. Pendengaran pada sebelah telinga 20
PENILAIAN CACAT
MACAM CACAT TETAP SEBAGIAN(Lanjutan)
Macam cacat tetap sebagian Nilai%x upah
15. Ibu jari tangan kanan 15
16. Ibu jari tangan kiri 12
17. Telunjuk tangan kanan 9
18. Telunjuk tangan kiri 7
19. Salah satu jari lain tangan kanan 4
20. Salah satu jari lain tangan kiri 3
21. Ruas pertama telunjuk kanan 4,5
22. Ruas pertama telunjuk kiri 3,5
23. Ruas pertama jari lain tangan kanan 2
24. Ruas pertama jari lain tangan kiri 1,5
25. Salah satu ibu jari kaki 5
26. Salah satu jari telunjuk kaki 3
27. Salah satu jari kaki lain 1
PENILAIAN CACAT
MACAM CACAT-CACAT LAINNYA
Macamcacat-cacat lainnya Nilai%x upah
1. Terkelupasnya kulit kepala(cacat anatomis) 10-30
2. Impotensi(cacat anatomis atau cacat fungsi) 30
3. Kaki memendek sebelah: kurang dari 5 cm; 5 7,5 cm; 7,5 cm
atau lebih (cacat anatomis) 10,20,30
4. Penurunan daya dengar kedua belah telinga setiap 10 desibel(cacat fungsi) 6
5. Penurunan daya dengar sebelah telinga setiap 10 desibel(cacat fungsi) 3
6. Kehilangan daun telinga sebelah(cacat anatomis) 5
7. Kehilangan kedua belah daun telinga(cacat anatomis) 10
PENILAIAN CACAT
MACAM CACAT-CACAT LAINNYA
Macamcacat-cacat lainnya Nilai%x upah
8. Cacat hilangnya cuping hidung(cacat anatomis) 30
9. Perforasi sekat rongga hidung(cacat anatomis) 15
10. Kehilangan daya penciuman (cacat fungsi) 10
11 Hilangnya kemampuan kerja fisik(cacat fungsi) 40,20,5
12. Hilangnya kemampuan kerja mental tetap(cacat fungsi) 70
13. Kehilangan sebagaian fungsi penglihatan; kehilangan efisiensi tajam 7,10,7
penglihatan; kehilangan penglihatan warna; kehilangan lapangan pandang
(cacat fungsi).
PENILAIAN CACAT
1. Cacat pada Penglihatan
2. Cacat pada Paru Paru
3. Cacat pada kulit.
Cacat Penglihatan
Parameter diagnostik fungsi indera mata:
1. Tajam penglihatan: bilangan pecahan,
pembilang adalah jarak pemeriksaan
(6m), dan penyebut adalah angka/huruf
paling kecil yang masih bisa dibaca (N :
6/6)
2. Lapang pandang: membandingkannya
dengan pemeriksa.
3. Binokularitas: penglihatan serentak dan
fusi, stereopsis
4. Penglihatan warna.
Penentuan Cacat Penglihatan
1. Mengingat komponen fungsi penglihatan
2. Komponen ini dinilai masing masing mata dan
kemudian diberi nilai dalam fungsi binokuler
3. P.P 14/1993 terdapat:
Cacat tetap kedua mata (70% upah)
Sebelah mata atau diplopia pada mata dekat (35%
upah)
Kehilangan penglihatan warna (10% upah)
Setiap kehilangan lapang pandang 10% ( 7% upah)
Setiap kehilangan efisiensi tajam penglihatan (7%
upah)
Organ Dalam
Beberapa organ dalamyang belumjelas
fungsinya bila diambil dan tidak ada dampak
pada tubuh khususnya untuk bekerja (misal,
appendix, lymphnode spleen, )
kompensasinya masih debat.
Penurunan fungsi organ diketahui dengan
pemeriksaan laboratoriumterkait, contoh
fungsi paru, fungsi ginjal, fungsi hati.
Cacatan Khusus Penetapan Cacat
Azas confidential
Bukan konsumsi informasi/interest publik
Tidak sampai hitungan ekonomis/nominal,
karena hanya sebatas impairment
Professional judgment bebas, tidak boleh
dipengaruhi apapun.
Bersifat global, general.
KESI MPULAN
1. Sangat perlu dan penting mewujudkan kesepahaman
dan pemahaman secara benar;
2. Urgensi sosialisasi;
3. Kesatuan bahasa dan kesamaan/konsistensi tindakan
dokter pemeriksa atau dokter yang merawat,dokter
penasehat dan pegawai pengawas ketenagakerjaan;
4. Penyakit akibat kerja adalah penyakit yang timbul
karena hubungan kerja; tidak semua penyakit akibat
kerja menimbulkan cacat;
5. Diagnosis penyakit akibat kerja adalah dasar penentu
bagi adanya hak jaminan kecelakaan kerja untuk
penyakit akibat kerja;
6. Pegawai pengawas ketenagakerjaan yang dokterlah
yang menetapkan penyakit akibat kerja atau bukan.
Dr.
Dr.
Widodo
Widodo
IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN
KERJA KERJA
Dengan Dengan
J L. J ENDRAL AHMAD YANI 69-70 J AKARTA 10510. PHONE: (+62).21.4209820. FAX: (+62) 21 4240284
PELATIHAN HIPERKES & KESELAMATAN KERJA BAGI DOKTER PELATIHAN HIPERKES & KESELAMATAN KERJA BAGI DOKTER
DAN PERAWAT DAN PERAWAT
JAKARTA, 28 MEI 2007 JAKARTA, 28 MEI 2007
TUJUAN DOKTER
mendalami Debu dan Penyakit Paru Kerja
Dokter diharapkan MAMPU untuk:
O Mengetahui jenis pekerjaan yang dulu dan sekarang yang berpotensi
ikut berperan menyebabkan kelainan dan menjelaskan mengapa dapat
terjadi demikian;
O Memilih, mengartikan dan menggambarkan gejala klinis tiap
kelainan, memaparkan mekanisme patogenesis yang berperan untuk
setiap gejala dan keluhan yang timbul;
O Melakukan tes spirometri dan mengartikan hasilnya; dan
menterjemahkan hasil analisa tekanan gas darah sebagai indikator
kelainan fungsi paru yang mungkin timbul dari kelainan tersebut;
O Mengenali dan menguraikan foto rontgen paru normal & pada foto
rontgen abnormal, mengenali pola pola abnormal yang menjadi
indikasi dari kelainan tersebut;
O Menentukan pemeriksaan yang sesuai untuk diagnosa dan
pengelolaan lanjut, yang harus dimulai oleh dokter pada kontak
pertama, untuk kelainan tersebut;
O Dalamkeadaan klinis tertentu, membahas implikasinya dalam
pekerjaan, paparan bahaya, sehat atau layak-tidaknya untuk kembali
pada suatu jenis pekerjaan tertentu.
Pendahuluan
Pendahuluan
4 4
Industrialisasi
Industrialisasi
ekonomi
ekonomi

&
&
sosial
sosial

.
.
4 4
Limbah
Limbah
bahan
bahan
baku
baku
,
,
proses
proses
,
,
produk
produk
4 4
Hazard
Hazard
potensi
potensi
mencemari
mencemari
lingkungan
lingkungan
4 4
Pekerja
Pekerja
terpajan
terpajan
inhalasi
inhalasi
,
,
kulit
kulit
, oral
, oral
4 4
Gangguan
Gangguan
kesehatan
kesehatan
hampir
hampir
semua
semua
organ
organ
4 4
Debu
Debu
, gas,
, gas,
uap
uap
, fume;
, fume;
bila
bila
tidak
tidak
dikendalikan
dikendalikan
penyakit
penyakit
paru
paru
akibat
akibat
kerja
kerja
Penyakit Akibat Kerja Paru PAK-P
Di AS (American Lung Association):
Penyebab utama (cacat, absen & kematian).
Disebabkan oleh pajanan berulang dan lama
Rokok: memperparah PAK-P dan tingkatkan risiko
Kanker.
Di R.I.:
Penyakit Infeksi Saluran Pernapasan: peringkat
atas untuk morbiditas & mortalitas
PAK-P & PPOK (rokok & polusi) bertambah
Perlu dipahami oleh dokter umum, terutama
yang bekerja di tempat dengan resiko tinggi
Anatomi
Anatomi
sistem
sistem
pernafasan
pernafasan
4
4
Empat
Empat
kompartemen
kompartemen

Naso
Naso
-
-
faringeal
faringeal
:
:
nares
nares
s/d
s/d
pita
pita
suara
suara
:
:
saring
saring
,
,
lembab
lembab
,
,
hangat
hangat
.
.

Trakeobronkeal
Trakeobronkeal
:
:
s/d
s/d
bronkiolus
bronkiolus
respirasi
respirasi
.
.
Hantar
Hantar
udara
udara
. 0,25
. 0,25
-
-
0,5
0,5
m.
m.
Proteksi
Proteksi
.
.

Parenkimal
Parenkimal
:
:
s/d
s/d
alveol
alveol
.
.
Ada
Ada
300juta!
300juta!
Luas
Luas
140m
140m
2, 2,
tebal
tebal
1
1
m.
m.
Pertukaran
Pertukaran
gas,
gas,
epitel
epitel
erat
erat
berinteraksi
berinteraksi
dg
dg
vasa
vasa
,
,
saraf
saraf
&
&
sistem
sistem
imunologi
imunologi
.
.

Rongga
Rongga
pleura.
pleura.
4
4
Alveol
Alveol
.
.
Sel
Sel
eptitel
eptitel
I/II,
I/II,
sitoplasma
sitoplasma
0,1
0,1
-
-
0,2
0,2
m,
m,
endotel
endotel
,
,
makrofag
makrofag
, fibroblast.
, fibroblast.
Fungsi
Fungsi
Sistem
Sistem
Pernafasan
Pernafasan
4 4
Pertukaran
Pertukaran
gas
gas
4 4
Perisai
Perisai
terhadap
terhadap
toksikan
toksikan
4 4
Biotransformasi
Biotransformasi
(C
(C
-
-
P450)
P450) mis mis: : parakuat parakuat & 4 & 4- -
ipomeanol ipomeanol membentuk membentuk radikal radikal bebas bebas & & epoxi epoxi yang yang merusak merusak
sel sel paru paru. .
4 4
Ekskresi
Ekskresi
toksikan
toksikan
expirasi
expirasi
4 4
Atur
Atur
kadar
kadar
angiotensin
angiotensin
,
,
amin
amin
biogenik
biogenik
,
,
prostaglandin
prostaglandin
4 4
Proses
Proses
respirasi
respirasi
, 3
, 3
tahap
tahap
:
:
- -
ventilasi
ventilasi: : inspirasi inspirasi & & expirasi expirasi. 12 . 12- -18X/1 18X/1 ; 400 ; 400- -500mL/insp; 500mL/insp;
5 5- -8L/1 8L/1
- -
difusi
difusi : : di di dinding dinding alveol alveol & & kapiler kapiler
- -
perfusi
perfusi : : distribusi distribusi gas gas dlm dlm paru paru, via , via aliran aliran darah darah. .
Pertahanan
Pertahanan
Paru
Paru
4 4
Menghindari
Menghindari
toksikan
toksikan
terinhalasi
terinhalasi
-
-
PENGHIDU
PENGHIDU
-
-
BRONKO
BRONKO
-
-
KONSTRIKSI
KONSTRIKSI
4 4
Deaktivasi
Deaktivasi
toksikan
toksikan
-
-
SEKRESI
SEKRESI
-
-
ANTIBODI
ANTIBODI
,
,
ANTIOXIDAN
ANTIOXIDAN
,
,
ANTIPROTEASE
ANTIPROTEASE
4 4
Membersihkan
Membersihkan
toksikan
toksikan
-
-
BATUK
BATUK
-
-
ESKALATORMUKOSILIAR
ESKALATORMUKOSILIAR
-
-
FAGOSITOSIS
FAGOSITOSIS
4 4
Mengambil
Mengambil
toksikan
toksikan
-
-
FAGOSITOSIS
FAGOSITOSIS
-
-
JARINGAN
JARINGAN
IKAT
IKAT
Faktor
Faktor
yang
yang
Mempengaruhi
Mempengaruhi
Respons
Respons
Sistem
Sistem
Respirasi
Respirasi
terhadap
terhadap
DEBU
DEBU
terinhalasi
terinhalasi
4 4
Sifat
Sifat
fisik
fisik
:
:
ukuran
ukuran
,
,
densitas
densitas
,
,
bentuk
bentuk
,
,
penetrabilitas
penetrabilitas
,
,
solubilitas
solubilitas
,
,
higroskopis
higroskopis
4 4
Sifat
Sifat
kimia
kimia
:
:
asam
asam
,
,
basa
basa
,
,
efek
efek
lokal/sistemik
lokal/sistemik
,
,
fibrogenisitas
fibrogenisitas
,
,
antigenisitas
antigenisitas
4 4
Faktor
Faktor
pejamu
pejamu
:
:
genetik
genetik
,
,
obat
obat
,
,
rokok
rokok
,
,
alkohol
alkohol
,
,
anatomi
anatomi
&
&
fisiologi
fisiologi
, status
, status
imunologi
imunologi
BENTUK FISIK TOKSIKAN
BENTUK FISIK TOKSIKAN
4 4
GAS
GAS
s
s
ubstansi
ubstansi
pd P&T
pd P&T
kamar
kamar
dlm
dlm
fase
fase
gas.
gas.
Mis
Mis
. O
. O
2 2
,
,
CO
CO
2 2
.
.
4 4
VAPOR
VAPOR
fase
fase
gas
gas
dari
dari
substansi
substansi
cair
cair
.
.
Mis
Mis
. water
. water
vapor.
vapor.
4 4
AEROSOL
AEROSOL
substansi
substansi
yang
yang
stabil
stabil
dari
dari
partikel
partikel
padat
padat
/
/
cair
cair
di
di
udara
udara
.
.
Termasuk
Termasuk
:
:
Dust
Dust
:
:
partikel
partikel
solid
solid
hasil
hasil
grinding.
grinding.
Fumes
Fumes
:
:
hasil
hasil
pembakaran
pembakaran
.
.
Mis
Mis
: lead fumes
: lead fumes
.
.
Smoke
Smoke
:
:
hasil
hasil
pembakaran
pembakaran
organik
organik
.
.
Mis
Mis
.
.
rokok
rokok
.
.
Mist & Fog

Mist & Fog
:
:
hasil
hasil
kondensasi
kondensasi
cairan
cairan
pada
pada
partikel
partikel
.
.
Smog
Smog
:
:
komple
komple
ks
ks
gas &
gas &
partikel
partikel
di
di
udara
udara
( (smoke+fog smoke+fog) )
UKURAN PARTIKEL
UKURAN PARTIKEL
4 4
INHALABLE
INHALABLE
PARTICULATE MASS (PM)
PARTICULATE MASS (PM)
+
+
Dapat
Dapat
terhisap
terhisap
ke
ke
saluran
saluran
nafas
nafas
.
.
+
+
Median cut
Median cut
-
-
off aerodynamic (=MCA)
off aerodynamic (=MCA)
30
30
m
m
4 4
THORACAL
THORACAL
PM
PM
Terhirup
Terhirup
masuk
masuk
ke
ke
ronggga
ronggga
dada,
dada,
zona
zona
penghantar
penghantar
&
&
zona
zona
respirasi
respirasi
.
.
+
+
MCA
MCA
10
10
m
m
4 4
RESPIRABLE
RESPIRABLE
PM
PM
+
+
Terhirup
Terhirup
masuk
masuk
zona
zona
respirasi
respirasi
+
+
MCA
MCA
3
3
-
-
4
4
m
m
MEKANISME DEPOSIT
MEKANISME DEPOSIT
4 4
I MPAKSI
I MPAKSI
TERBENTUR KRN ALIRAN LURUS

TERBENTUR KRN ALIRAN LURUS
DI CABANG BRONKUS BESAR

DI CABANG BRONKUS BESAR
30
30
m: 100%. > 5
m: 100%. > 5
m: 95%.
m: 95%.
4 4
SEDIMENTASI
SEDIMENTASI
JATUH MENGENDAP
JATUH MENGENDAP
DI BRONKUS SEDANG
DI BRONKUS SEDANG
1
1
-
-
5
5
m
m
4 4
DIFUSI
DIFUSI
DI ALVEOL
DI ALVEOL
1
1
-
-
5
5
m
m
<1
<1
m
m
GERAK BROWN GERAK BROWN. .

-
-
PARU
PARU
Pneumokoniosis
Pneumokoniosis
Bronkitis
Bronkitis
industri
industri
Asma
Asma
kerja
kerja
Pneumonitis
Pneumonitis
Hipersensitif
Hipersensitif
Kanker
Kanker
paru
paru
akibat
akibat
kerja
kerja
Risalah
Risalah
PAK
PAK
-
-
P
P
O
O
PNEUMOKONIOSIS
PNEUMOKONIOSIS
Akumulasi
Akumulasi
debu
debu
dalam
dalam
paru
paru
dan
dan
reaksi
reaksi
jaringan
jaringan
terhadap
terhadap
keberadaan
keberadaan
debu
debu
.
.
Debu
Debu
= aerosol
= aerosol
mengandung
mengandung
partikel
partikel
padat
padat
.
.
Inflamasi
Inflamasi
& fibrosis;
& fibrosis;
gen
gen
&
&
lingkungan
lingkungan
Asbestosis,
Asbestosis,
silikosis
silikosis
, coal worker
, coal worker
s
s
pneumokoniosis
pneumokoniosis
Standard
Standard
diagnosis
diagnosis
ILO (
ILO (
Radiologis
Radiologis
)
)
+
+
.
.
Alat
Alat
: high KV &
: high KV &
mA
mA
+
+
. Side
. Side
-
-
by
by
-
-
side comparison
side comparison
ILO standard films.

ILO standard films.
+
+
. 2
. 2
pembaca
pembaca
+ 1
+ 1
penentu
penentu
+
+
.
.
Kerapatan
Kerapatan
perselubungan
perselubungan
: 1, 2, 3 / A, B, C.
: 1, 2, 3 / A, B, C.
+
+
.
.
Bentuk
Bentuk
reguler
reguler
: p, q, r.
: p, q, r.
Bentuk
Bentuk
ireguler
ireguler
; s, t, u.
; s, t, u.
PARENCHYMES
PLEURAL abnormalities
CALCIFICATIONS
PARENCHYMAL abnormalities:
OPACITIES: small and large.
SMALL lesions, <1 cm in diameter
E REGULAR=Rounded-shaped: Types: p (<1.5 mm), q (1.5-3 mm), r (3-10 mm)
E IREGULAR-shaped: width of fine linear opacities: Types s (<1.5 mm), t (1.5-3 mm), u ( 3-10 mm).
LARGE opacities:
E A : >1.5 cm.
E B : >5 cm, not larger than right upper lobe.
E C : combined areas exceeds the volume encompassed by the right upper lobe.
PROFUSION Readings: 0, 1, 2, 3.
The readings must be written in two separate numbers, side-by-side. Left: the reading; Right: the comparison.
Left : the category felt by the reader/s) to be most representative of the standard ILO film.
Right: the major category which was considered to be similar to the film being read, but not eventually chosen.
Example of final reading: 3 / 2. The 3: it most resembles standard category 3; while the 2: a similarity to a standard
film of category 2 was seriously considered. The Final readings is one of the 12-point system.
PLEURAL abnormalities
Include: Pleural effusion, calcification, diffuse pleural thickening, and pleural plaques or circumscribed pleural thickening.
Readings: Type, anatomic location, approximate size
CALCIFICATIONS: Readings: present, absence.
THICKENING. Readings: by site.
CHEST RADIOGRAPH EVALUATION OF PNEUMOCONIOSIS
I LO DI AGRAMS
CHEST RADIOGRAPH EVALUATION OF PNEUMOCONIOSIS
FEATURE CLASSIFICATION
No Pneumoconiosis 0
Pneumoconiosis
Rounded small PARENCHYMAL OPACITIES
Profusion 1, 2, 3
Type p, q (m), r (n)
Extent Zones
Irregular small PARENCHYMAL OPACITIES
Profusion 1, 2, 3
Type s, t, u
Extent Zones
Large PARENCHYMAL OPACITIES
Size A, B, C
Type Well-defined / ill-defined
PLEURAL THICKENING By site
Diaphragmatic outline (costophrenic areas) Ill-defined: right, left
Cardiac outline (cardiophrenic areas) Ill-defined 1, 2, 3
PLEURAL CALCIFICATIONS By site and extent
The 1, 2, 3 profusion groups can be extended to a 12-point system:
0/-, 0/0, 0/1, 1/0, 1/1, 1/2, 2/1, 2/2, 2/3, 3/2, 3/3, 3/4
ILO GUIDELINES
ASBESTOSIS
ASBESTOSIS
4 4
Pekerja
Pekerja
asbes
asbes
dan
dan
handling
handling
4 4
Fibrosis
Fibrosis
interstisial
interstisial
difus
difus
parenkhim
parenkhim
paru
paru
4 4
Ferruginous bodies.
Ferruginous bodies.
4 4
Penebalan
Penebalan
pleural
pleural
viseral
viseral
;
;
kadang
kadang
k
k
alsifikasi
alsifikasi
4 4
Tanpa
Tanpa
gejala
gejala

cor
cor
pulmonal
pulmonal
4 4
Kanker
Kanker
mesotelioma
mesotelioma
4 4
Penambang
Penambang
logam
logam
,
,
batu
batu
bara
bara
,
,
penggali
penggali
terowongan
terowongan
,
,
pemotong
pemotong
batu
batu
,
,
keramik
keramik
,
,
penuang
penuang
besi/baja
besi/baja
,
,
pabrik
pabrik
amplas
amplas
&
&
gelas
gelas
.
.
4 4
3
3
bentuk
bentuk
klinis
klinis
:
:
Simpel
Simpel
,
,
Terakselerasi
Terakselerasi
,
,
Akut
Akut. .
4 4
Tanpa
Tanpa
gejala
gejala

sesak
sesak
,
,
cor
cor
-
-
pulmonal
pulmonal
4 4
Kronik
Kronik
&
&
progresif
progresif
,
,
nir
nir
-
-
pulih
pulih
4 4
Silicotic
Silicotic
nodules.
nodules.
4 4
Egg Cell Calcifications
Egg Cell Calcifications
SILIKOSIS
SILIKOSIS
BISINOSIS
BISINOSIS
4 4
Peny
Peny
saluran
saluran
nafas
nafas
akut
akut
&
&
kronik
kronik
pd
pd
pekerja
pekerja
kapas
kapas
,
,
linen
linen
&
&
serat
serat
rami
rami
4 4
Perasaan
Perasaan
dada
dada
tertekan
tertekan
,
,
mengi
mengi
&
&
sesak
sesak
waktu
waktu
kembali
kembali
ke
ke
tempat
tempat
kerja
kerja
Monday sickness
Monday sickness
.
.
4 4
Pemberat
Pemberat
:
:
durasi
durasi
,
,
perokok
perokok
4 4
Foto
Foto
thorax normal,
thorax normal,
FEV
FEV
1 1
pd
pd
permulaan
permulaan
hari
hari
kerja
kerja
;
;
gejala
gejala
respirasi
respirasi
derajat
derajat
0
0
-
-
3
3
.
.
Grade 0 Grade 0 : no symptoms : no symptoms
Grade RTI 1 Grade RTI 1 : cough associated with dust exposure. : cough associated with dust exposure.
Grade RTI 2 Grade RTI 2 : persistent phlegm, initiated/exacerbated : persistent phlegm, initiated/exacerbated
by dust exposure by dust exposure
Grade RTI 3 Grade RTI 3 : persistent phlegm (initiated/made worse : persistent phlegm (initiated/made worse
by dust exposure) either with by dust exposure) either with
exacerbations of chest illness or exacerbations of chest illness or
persisting for 2 years or more. persisting for 2 years or more.
BRONKITIS INDUSTRI
BRONKITIS INDUSTRI
4 4
Pajanan
Pajanan
debu
debu
kadar
kadar
tinggi
tinggi
& lama
& lama
4 4
Pekerja
Pekerja
tambang
tambang
batu
batu
bara
bara
,
,
tepung
tepung
,
,
wool,
wool,
kapas
kapas
,
,
keramik
keramik
,
,
dll
dll
.
.
4 4
Paralisis
Paralisis
silia
silia
,
,
hipertrofi
hipertrofi
&
&
hiperplasi
hiperplasi
kelenjar
kelenjar
mukus
mukus

batuk
batuk
produktif
produktif
kronik
kronik
.
.
4 4
FEV
FEV
1 1

ASMA KERJA
ASMA KERJA
4 4
Penyakit
Penyakit
obstruksi
obstruksi
saluran
saluran
nafas
nafas
yg
yg
reversibel
reversibel
,
,
oleh
oleh
iritasi
iritasi
zat
zat
di
di
lingkungan
lingkungan
kerja
kerja
4 4
Hanya
Hanya
mengenai
mengenai
sebagian
sebagian
dari
dari
pekerja
pekerja
yang
yang
terpajan
terpajan
4 4
Masa
Masa
latent
latent
yang
yang
berbeda
berbeda
4 4
Tumbuhan
Tumbuhan
,
,
hewan
hewan
,
,
enzim
enzim
,
,
kimia
kimia
,
,
obat
obat
4 4
Uji
Uji
provokasi
provokasi
= pharmacologic challenge test
= pharmacologic challenge test
:
:
- - using using histamin histamin, , methacholin methacholin, or prostaglandin D2 or F2 , or prostaglandin D2 or F2- -
Alpha Alpha
PNEUMONITIS HIPERSENSITIF
PNEUMONITIS HIPERSENSITIF
4 4
Kumpulan
Kumpulan
peny
peny
paru
paru
alergi
alergi
akibat
akibat
sensitisasi
sensitisasi
&
&
pajanan
pajanan
debu
debu
organik
organik
4 4
Difus
Difus
,
,
inflamasi
inflamasi
mononuklear
mononuklear
parenkim
parenkim
paru
paru
di
di
bronkiolus
bronkiolus
terminalis
terminalis
& alveoli
& alveoli
4 4
Diagnosis
Diagnosis
paru
paru
umum
umum
+
+
uji
uji
imunologis
imunologis
4 4
Asbes
Asbes
,
,
arsen
arsen
,
,
nikel
nikel
,
,
krom
krom
,
,
arang
arang
,
,
ter
ter
,
,
batu
batu
bara
bara
,
,
silica
silica
Kanker
Kanker
Paru
Paru
I l u s t r a s i Pneumoconiosis
I l u s t r a s i Pneumoconiosis
Derajat
Derajat
sesak
sesak
VEP 1
VEP 1
%
%
Cacat
Cacat
fungsi
fungsi
0
0
> 2,5 L
> 2,5 L
-
-
1 RINGAN
1 RINGAN
1,6
1,6
2,5 L
2,5 L
25%
25%
2 SEDANG
2 SEDANG
1,1
1,1
1,5 L
1,5 L
50%
50%
3 BERAT
3 BERAT
0,5
0,5
1 L
1 L
75%
75%
4 SANGAT
4 SANGAT
BERAT
BERAT
< 0,1 L
< 0,1 L
100%
100%
Penilaian
Penilaian
Cacat
Cacat
Paru
Paru
REFERENSI UNTUK PENELUSURAN LEBIH DALAM: REFERENSI UNTUK PENELUSURAN LEBIH DALAM:
4 4 DR. Dr. DR. Dr. Suma Suma mur mur PK, PK, MSc MSc., ., Sp.Ok Sp.Ok: ( : (berbagai berbagai penelitian penelitian dan dan
paparan paparan). ).
4 4 Prof. DR. Dr. Prof. DR. Dr. Tjipto Tjipto Suwandi Suwandi, MOH., , MOH., Sp.Ok Sp.Ok: ( : (berbagai berbagai
penelitian penelitian dan dan paparan paparan). ).
4 4 Fishman Fishman s Manual of Pulmonary Diseases and Disorders, s Manual of Pulmonary Diseases and Disorders,
McGraw Hill McGraw Hill 2002 2002
4 4 ILO: Guidelines For The Use of The ILO International ILO: Guidelines For The Use of The ILO International
Classification of Radiograph of Classification of Radiograph of Pneumoconioses Pneumoconioses, Revised , Revised
Edition Edition - - 2000. 2000.
4 4 Occupational Lung Occupational Lung Dsease Dsease D.E. Banks; Chapman & Hall D.E. Banks; Chapman & Hall
Medical Medical 1998 1998
4 4 Occupational Medicine, Carl Occupational Medicine, Carl Zenz Zenz; Mosby Third Edition, ; Mosby Third Edition,
1994 1994
4 4 Merck Merck s Manual on Occupational Lung Diseases, 2002 s Manual on Occupational Lung Diseases, 2002
4 4 Guidelines For Equipment And Technology, Guidelines For Equipment And Technology, Y.Hosoda Y.Hosoda, Et Al, , Et Al,
Dokkyo Dokkyo University, Tochigi, Japan University, Tochigi, Japan - - 1996 1996
4
4
Beberapa
Beberapa
alamat
alamat
Websites
Websites
tentang
tentang
Occupational Medicine:
Occupational Medicine:
New York State Occupational Health Clinic Network: New York State Occupational Health Clinic Network:
http:// http://www.health.state.ny.us/nysdoh/environ/occupate.htm www.health.state.ny.us/nysdoh/environ/occupate.htm
American Lung Association : American Lung Association :
http:// http://www.lungusa.org www.lungusa.org/occupational/ /occupational/
Environmental Protection Agency Asthma and Indoor Environmental Protection Agency Asthma and Indoor
Environments: Environments:
http:// http://www.epa.gov/iaq/asthma/index.html www.epa.gov/iaq/asthma/index.html
Occupational Safety and Health Administration: Occupational Safety and Health Administration:
http://www.osha http://www.osha- -slc.gov/index.html slc.gov/index.html
Dan lain Dan lain lain lain. .
IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN KER IKATAN ALUMNI UNIVERSITAS INDONESIA PASCA SARJANA KEDOKTERAN KERJA JA
d e n g a n d e n g a n
JL. JENDRAL AHMAD YANI 69-70 JAKARTA 10510. PHONE: (+62).21.4209820. FAX: (+62) 21 4240284
PELATIHAN HIPERKES & KESELAMATAN KERJA PELATIHAN HIPERKES & KESELAMATAN KERJA
BAGI DOKTER DAN PERAWAT BAGI DOKTER DAN PERAWAT
JAKARTA, 10 SEPTEMBER 2007 JAKARTA, 10 SEPTEMBER 2007
CONTENTS
CONTENTS
4 4
The Competency of the Doctor
The Competency of the Doctor
4 4
Historical Aspects
Historical Aspects
4 4
Kedudukan
Kedudukan
Perundangan
Perundangan
4 4
The Skin
The Skin
4 4
The
The
Dermatoses
Dermatoses
4 4
The Diagnosis, and The Prognosis
The Diagnosis, and The Prognosis
4 4
Special Work Problems
Special Work Problems
4 4
Treatment
Treatment
4 4
Disability and Compensation
Disability and Compensation
4 4
Rehabilitation
Rehabilitation
4 4
Prevention
Prevention
4 4
Conclusions and Recommendations
4 4
Selected References and Further Readings
Selected References and Further Readings
4 4
Occupational Skin Cancer
4 4
Appendices
Appendices
The Competency
The Competency
:
:
Doctors will be able to
Doctors will be able to
4 4
Work History
Work History
: indicate aspects of a past or present
: indicate aspects of a past or present
occupation which have a potential to contribute to
occupation which have a potential to contribute to
the cause, or aggravation, of the disorder and
the cause, or aggravation, of the disorder and
explain why this might be so;
explain why this might be so;
4 4
A case
A case
: describe and interpret the appearance of
: describe and interpret the appearance of
the skin lesions, and describe the
the skin lesions, and describe the
pathogenetic
pathogenetic
mechanisms responsible for those lesions; and
mechanisms responsible for those lesions; and
4 4
Description of Occupational Situation
Description of Occupational Situation
: state
: state
whether a person should be precluded from
whether a person should be precluded from
pursuing that occupation, or should be advised
pursuing that occupation, or should be advised
against it and, in a given clinical situation, discuss
against it and, in a given clinical situation, discuss
the implications for employment, exposure to risk,
the implications for employment, exposure to risk,
or fitness to a specified job.
or fitness to a specified job.
Historical and Public Health Aspects.
Occupational diseases of the skin historically have paralleled industrial development.
Occupational Dermotosesare one of the most common types of occup.disease.
O1985, in the US, accounted for no less than 65-70% of all reported Occ.Diseases.
OLater on, statistics collected by the United States Department of Labor indicated a
drop in frequency to approximately 42%.
OIn 1997, OSD constituted 13.5%of all Occup. Illnesses reported.
OIn 1999 and later the numbers were still decreasing gradually.
The annual estimated costs of OSD in the US: $1 billion.
From 1990 through 2000, 11,084 skin disorder state fund claims were accepted by
the Washington State workers' compensation system.
The cumulative cost of all skin disorder claims was $7.5 million.
Industries with the highest claims incidence rate are Agriculture, Forestry and
Fishing and Manufacturing.
OJamsostek? Compiled 104,852 occupational accident cases in 2001, with 78 cases
of occupationally related diseases; that is a mere fraction of 0.07%.
OGovernment of Indonesia issued UU no. 1, 1970 on Work Safety, and UU no. 3,
1992 on J aminanSosial TenagaKerja(J amsostek).
OThe recent directives on above laws issued, one was: Kep.79/MEN/2003 on
Pedoman Diagnosis Dan Penilaian Cacat Karena Kecelakaan Dan Penyakit
Akibat Kerja.
Kedudukan
Kedudukan
Perundangan
Perundangan
:
:
Keppres
Keppres
No. 22
No. 22
Tahun
Tahun
1993
1993
Lampiran
Lampiran
: 31
: 31
Penyakit
Penyakit
Akibat
Akibat
Kerja
Kerja
1.
1.
2.
2.
Dst
Dst
26.
26.
Penyakit
Penyakit
Kulit
Kulit
(
(
dermatotis
dermatotis
)
)
yang
yang
disebabkan
disebabkan
oleh
oleh
penyebab
penyebab
fisik
fisik
,
,
kimiawi
kimiawi
atau
atau
biologis
biologis
.
.
27.
27.
Dst
Dst
.
.
31.
31.
Structure, Function, and Occupational
Structure, Function, and Occupational
Disorders of the Skin.
Disorders of the Skin.
STRUCTURE STRUCTURE FUNCTION FUNCTION OCCUPATIONAL DISORDER OCCUPATIONAL DISORDER
Stratum Stratum corneum corneum
Barrier against chemical diffusion and Barrier against chemical diffusion and
microorganisms microorganisms
Chapping from low humidity, Chapping from low humidity,
chemical stains chemical stains
Squamous and basal cells of Squamous and basal cells of
epidermis epidermis
Cell regeneration, synthesis of stratum Cell regeneration, synthesis of stratum
corneum corneum, wound repair , wound repair
Infection, Infection, contact dermatitis contact dermatitis, ,
neoplasms neoplasms
Melanocytes and melanin Melanocytes and melanin Absorption of ultraviolet radiation Absorption of ultraviolet radiation
Toxic Toxic vitiligo vitiligo, melanoma, , melanoma,
hyperpigmentation hyperpigmentation
Langerhans Langerhans cells, cells,
lymphatics lymphatics, dermal , dermal
macrophages macrophages
Immune regulation and surveillance Immune regulation and surveillance Delayed hypersensitivity reactions Delayed hypersensitivity reactions
Merkel cells, nerve tissue Merkel cells, nerve tissue
elements elements
Perception of environment Perception of environment Toxic neuropathies Toxic neuropathies
Blood vessels, mast cells Blood vessels, mast cells Thermoregulation, nutrition of tissue Thermoregulation, nutrition of tissue
Heat stroke, contact and systemic Heat stroke, contact and systemic
urticaria urticaria, flushing reactions, , flushing reactions,
vibration vibration white white finger finger
Connective tissue Connective tissue
Mechanical protection against trauma, Mechanical protection against trauma,
wound repair wound repair
Infection, Infection, granulomatous granulomatous reactions, reactions,
scleroderma, solar scleroderma, solar elastosis elastosis, scar , scar
Eccrine sweat glands Eccrine sweat glands
Thermoregulation, buffering of skin Thermoregulation, buffering of skin
surface surface
Miliaria Miliaria, , rusting rusting
Sebaceous glands Sebaceous glands
Synthesis of skin surface lipids, Synthesis of skin surface lipids,
chemical barrier against chemical barrier against
microorganisms microorganisms
Oil acne, Oil acne, chloracne chloracne
Hair, follicles Hair, follicles
Insulation and protection, secondary Insulation and protection, secondary
sensory organs, social appearance sensory organs, social appearance
Folliculitis Folliculitis, traumatic or toxic , traumatic or toxic
alopecia alopecia
Nails Nails
Grasping and manipulation of small Grasping and manipulation of small
objects objects
Paronychia Paronychia, dystrophy, , dystrophy, oncholysis oncholysis
What is occupational What is occupational dermatoses dermatoses? ?
it is it is one of the most widespread causes of ill health one of the most widespread causes of ill health and affects and affects
people working in many employment sectors, including people working in many employment sectors, including
hairdressing/beauty, catering, housekeeping/cleaning. hairdressing/beauty, catering, housekeeping/cleaning.
signs can be signs can be redness, itching, scaling and blistering to the skin redness, itching, scaling and blistering to the skin. as it . as it
gets worse the skin can crack and bleed and it can spread all ov gets worse the skin can crack and bleed and it can spread all over the er the
body. It can be a very painful condition. body. It can be a very painful condition.
dermatoses dermatoses basically involves a loss of moisture from your skin, for basically involves a loss of moisture from your skin, for
example when hands are constantly immersed in water or if they c example when hands are constantly immersed in water or if they come ome
into contact with detergents/solvents. into contact with detergents/solvents.
Employees in all jobs are entitled to protection from this fores Employees in all jobs are entitled to protection from this foreseeable eeable
condition: it should never be looked upon as acceptable. condition: it should never be looked upon as acceptable.
if it is spotted early and adequate precautions are taken, most if it is spotted early and adequate precautions are taken, most people people
can recover and this is why it is so important for employers to can recover and this is why it is so important for employers to firstly have firstly have
preventative measures in place and proactive management systems preventative measures in place and proactive management systems to to
identify potential problems and deal with them effectively. identify potential problems and deal with them effectively.
once someone develops once someone develops dermatoses dermatoses, they can become sensitized to , they can become sensitized to
what ever caused the condition, which basically means that any f what ever caused the condition, which basically means that any future uture
contact can cause an acute and severe reaction. For this reason contact can cause an acute and severe reaction. For this reason some some
employees even have to change jobs. employees even have to change jobs.
dermatoses dermatoses is not infectious: is not infectious: it cannot be passed from one person to it cannot be passed from one person to
another. another.
The
The
Dermatoses
Dermatoses
How is
How is
dermatoses
dermatoses
caused?
caused?
It is caused by the skin coming into contact with certain It is caused by the skin coming into contact with certain
substances at work substances at work and because of this it is sometimes and because of this it is sometimes
referred to as occupational referred to as occupational dermatoses dermatoses. It usually affects the . It usually affects the
hands or forearms, the places most likely to touch the hands or forearms, the places most likely to touch the
substances. substances.
40% of occupational 40% of occupational dermatoses dermatoses cases in the cases in the catering catering
industry are caused by industry are caused by contact with foods, contact with foods, such as such as
flour/dough, fish and sea foods, meat and poultry. flour/dough, fish and sea foods, meat and poultry. Dermatoses Dermatoses
can also be caused by immersion in water for prolonged can also be caused by immersion in water for prolonged
periods of time. periods of time.
Once a person has become sensitized to a substance, the Once a person has become sensitized to a substance, the
dermatoses dermatoses can spread to parts of the body that haven't even can spread to parts of the body that haven't even
been in contact with it. been in contact with it.
How quickly a person gets How quickly a person gets dermatoses dermatoses depends on a number depends on a number
of things: of things:
- - the substance the substance
- - the strength or potency the strength or potency
- - how long in contact with the skin how long in contact with the skin
- - how often it touches the skin how often it touches the skin
4 4 Contact Contact dermatoses dermatoses are by far the most common are by far the most common
occupational occupational dermatoses dermatoses. The term refers to the . The term refers to the
induction of induction of cutaneous cutaneous changes, usually changes, usually
accompanied by inflammation, from direct skin accompanied by inflammation, from direct skin
exposure to exogenous chemical or physical exposure to exogenous chemical or physical
substances. Skin disease may be characterized by substances. Skin disease may be characterized by
discrete elevated lesions, patchy rashes that bear a discrete elevated lesions, patchy rashes that bear a
limited geographic resemblance to the area of limited geographic resemblance to the area of
external assault and distinct localized irritation, external assault and distinct localized irritation,
which, usually, is a faithful replica of the area of which, usually, is a faithful replica of the area of
injury. injury.
4 4 Occupational Occupational dermatoses dermatoses or skin inflammation is or skin inflammation is
provoked by either (or both) of two mechanisms: provoked by either (or both) of two mechanisms:
irritation or allergy, and therefore it may be broadly irritation or allergy, and therefore it may be broadly
divided into two groups: divided into two groups:
4 4
Primary Irritant Contact
Dermatoses
Dermatoses
.
.
4 4
Allergic Contact
Allergic Contact
Dermatoses
Dermatoses. .
4 4 Nearly three Nearly three- -quarters quarters ( ( 75%) 75%) of all occupational of all occupational
dermatoses dermatoses are of this type. The irritants produce are of this type. The irritants produce a direct a direct
effect on the skin with which they come into contact effect on the skin with which they come into contact
and the effect will be more dependent on the dose and and the effect will be more dependent on the dose and
duration of exposure than on any inherent response duration of exposure than on any inherent response
emanating from the individual. emanating from the individual.
4 4 For example, For example, concentrated concentrated sulphuric sulphuric acid splashes acid splashes on to the on to the
face of anybody will produce skin reaction. Soap and water are face of anybody will produce skin reaction. Soap and water are
more variable but these seemingly harmless materials can more variable but these seemingly harmless materials can
cause irritation in non cause irritation in non- -allergic subjects allergic subjects
4 4 The inflammatory The inflammatory cutaneous cutaneous changes that occur from skin changes that occur from skin
irritation result from a irritation result from a direct, local, toxic effect on cellular direct, local, toxic effect on cellular
elements in the skin elements in the skin, leading to cell death, release of , leading to cell death, release of
lysosomal lysosomal enzymes and soluble inflammatory mediators, enzymes and soluble inflammatory mediators,
recruitment of inflammatory cells, and further tissue recruitment of inflammatory cells, and further tissue
destruction. Although substantial tissue destruction may destruction. Although substantial tissue destruction may
quickly occur following relatively brief skin exposure to strong quickly occur following relatively brief skin exposure to strong
caustic or corrosives (i.e., chemical burns), the majority of caustic or corrosives (i.e., chemical burns), the majority of
cases of irritant contact cases of irritant contact dermatoses dermatoses result from result from cumulative cumulative
and repetitive exposures to and repetitive exposures to weak weak irritants, irritants, substances substances
that are not likely to produce visible that are not likely to produce visible cutaneous cutaneous injury following injury following
only brief or limited exposure. only brief or limited exposure.
Dermatoses
Dermatoses
Allergic Contact
Allergic Contact
Dermatoses
Dermatoses
4 4 Sensitizing eczemas account for Sensitizing eczemas account for 15 15- -20% of 20% of all occupational all occupational dermatoses dermatoses. The . The
response is usually specific to one agent but may be delayed for response is usually specific to one agent but may be delayed for a week or more a week or more
after contact. The initial sensitizing episode may need to be of after contact. The initial sensitizing episode may need to be of several hours several hours
duration but could be up to life long: even though subsequent re duration but could be up to life long: even though subsequent reactions can be actions can be
provoked by the most transient exposures. provoked by the most transient exposures. Refractory Phase Refractory Phase
4 4 The mechanism of the response is a The mechanism of the response is a delayed hypersensitivity reaction delayed hypersensitivity reaction. The . The
allergen ( allergen (hapten hapten) combines with protein in the epidermis and is engulfed in skin ) combines with protein in the epidermis and is engulfed in skin
macrophages and transported in the macrophages and transported in the lymphatics lymphatics. At the regional lymph nodes, . At the regional lymph nodes,
circulating antibody is produced which is then circulating antibody is produced which is then ready ready to react locally with any to react locally with any
further contact with the further contact with the hapten hapten- -protein complex. This could take from 4 days to protein complex. This could take from 4 days to
several weeks. several weeks. Induction Phase. Induction Phase.
4 4 The acute effect is The acute effect is erythema erythema, eruption, , eruption, vesiculation vesiculation, oozing and desquamation. In a , oozing and desquamation. In a
chronic form, this leads to thickened fissured skin. chronic form, this leads to thickened fissured skin.
4 4 The development of allergic contact The development of allergic contact dermatoses dermatoses requires that the affected individual requires that the affected individual
first become first become immunologically immunologically sensitized to the offending substance. The sensitized to the offending substance. The
sensitization process involves delayed hypersensitivity mechanis sensitization process involves delayed hypersensitivity mechanism, which require a m, which require a
period of 1 to 3 weeks following first exposure before sensitiza period of 1 to 3 weeks following first exposure before sensitization can occur. tion can occur.
4 4 Generally, the allergenic substance must first complex with skin Generally, the allergenic substance must first complex with skin tissue protein, tissue protein,
following which this following which this hapten hapten protein conjugate is processed by circulating T protein conjugate is processed by circulating T- -
lymphocytes to regional lymph nodes, where further antigen proce lymphocytes to regional lymph nodes, where further antigen processing and cell ssing and cell
proliferation occur. Once sensitized, an affected individual wil proliferation occur. Once sensitized, an affected individual will react within several l react within several
hours to 1 to 2 days following hours to 1 to 2 days following cutaneous cutaneous re re- -exposure exposure to extremely low to extremely low
concentrations of the offending substance. concentrations of the offending substance. - - Elicit Phase. Elicit Phase.
4 4 Effector Effector cells may stay for life and able to recognize the specific cells may stay for life and able to recognize the specific Hapten Hapten and yield and yield
inflammation. inflammation. Persistent Phase Persistent Phase
4 4 Unlike irritant contact Unlike irritant contact dermatoses dermatoses, allergic contact dermatitis frequently extends to , allergic contact dermatitis frequently extends to
other body surfaces remote from the primary site of direct skin other body surfaces remote from the primary site of direct skin contact with the contact with the
allergen. allergen.
O
O
EVALUATION 0N EMPLOYEE
EVALUATION 0N EMPLOYEE
O
O
WORKPLACE INSPECTION
WORKPLACE INSPECTION
THE DI AGNOSI S
THE DI AGNOSI S
THE DI AGNOSI S
4 4 In the course of taking the history from a patient who may have In the course of taking the history from a patient who may have
work work- -related skin disease, the following should be obtained: related skin disease, the following should be obtained:
4 4 an accurate chronologic sequence of events surrounding the onset an accurate chronologic sequence of events surrounding the onset of of
the skin disease, its subsequent clinical course, and associated the skin disease, its subsequent clinical course, and associated work work
activities; activities;
4 4 a description of the skin lesions and their initial anatomic loc a description of the skin lesions and their initial anatomic locations ations
and spread to other body sites; and spread to other body sites;
4 4 disability caused by the skin disease; disability caused by the skin disease;
4 4 Identification of all relevant work exposures Identification of all relevant work exposures; ;
4 4 Presence of similar skin disease in co Presence of similar skin disease in co- -workers; and workers; and
4 4 Response to previous medical treatment. Response to previous medical treatment.
4 4 A thorough history should properly determine the presence of A thorough history should properly determine the presence of
important risk factors, such as personal or family history of important risk factors, such as personal or family history of atopic atopic
allergies; antecedent skin disease or reactions, such as allergies; antecedent skin disease or reactions, such as dermatoses dermatoses
from jewelry, cosmetic preparations, or hair dyes; and potential from jewelry, cosmetic preparations, or hair dyes; and potential
causative exposures in the domestic environment. causative exposures in the domestic environment.
I. History / Anamnesis I. History / Anamnesis
EVALUATION ON EMPLOYEE
The Diagnosis
The Diagnosis
II. PHYSICAL EXAMINATION II. PHYSICAL EXAMINATION
4 4 Particular attention should be paid not only to the Particular attention should be paid not only to the
morphological appearance of individual skin lesions but also morphological appearance of individual skin lesions but also
to their distribution on the body surface. The search for a to their distribution on the body surface. The search for a
causative agent should be directed at chemical, physical, or causative agent should be directed at chemical, physical, or
biologic exposures actually occurring at the principal biologic exposures actually occurring at the principal site(s site(s) )
of involvement. of involvement.
4 4 Dermatoses Dermatoses that is confined only to that is confined only to palmar palmar surfaces usually surfaces usually
indicates that endogenous factors are probably operative. indicates that endogenous factors are probably operative.
4 4 The physical examination must help to differentiate The physical examination must help to differentiate
occupational from endogenous occupational from endogenous dermatoses dermatoses, principally , principally
psoriasis, psoriasis, atopic atopic dermatoses dermatoses, and , and dyshidrotic dyshidrotic and various and various
other forms of eczema. The entire skin surface should be other forms of eczema. The entire skin surface should be
examined for the presence of other characteristic skin examined for the presence of other characteristic skin
lesions, particularly the feet. It is not unusual for an affecte lesions, particularly the feet. It is not unusual for an affected d
worker to deny the presence of skin lesions on covered parts worker to deny the presence of skin lesions on covered parts
of the body, especially if these other lesions are of the body, especially if these other lesions are
asymptomatic. If the entire skin surface is not properly asymptomatic. If the entire skin surface is not properly
examined, the correct diagnosis may be overlooked. examined, the correct diagnosis may be overlooked.
The Diagnosis
The Diagnosis
III. LABORATORY: III. LABORATORY:
4 4 Virtually any diagnostic procedure (blood tests, potassium Virtually any diagnostic procedure (blood tests, potassium
hydroxide [KOH] examinations, skin biopsies) may be utilized in hydroxide [KOH] examinations, skin biopsies) may be utilized in an an
evaluation of a suspected occupational evaluation of a suspected occupational dermatoses dermatoses, ,
4 4 Patch testing Patch testing
4 4 the patch test is the most frequently employed. A great deal of the patch test is the most frequently employed. A great deal of
confusion and misunderstanding surrounds this remarkably simple confusion and misunderstanding surrounds this remarkably simple
but useful test. The fundamental purpose of the patch test is to but useful test. The fundamental purpose of the patch test is to
establish a diagnosis of allergic (not irritant) contact establish a diagnosis of allergic (not irritant) contact
dermatoses dermatoses. . Interpretation of the patch test rests on the Interpretation of the patch test rests on the
assumption that a suspected allergen will cause a localized assumption that a suspected allergen will cause a localized
eczematous reaction, resembling the clinical eruption under eczematous reaction, resembling the clinical eruption under
evaluation, when occluded against the skin of a sensitized evaluation, when occluded against the skin of a sensitized
individual; no reaction should occur on the skin of a individual; no reaction should occur on the skin of a nonsensitized nonsensitized
person. person.
4 4 Details of the methodology may be found in appropriate textbooks Details of the methodology may be found in appropriate textbooks
or manuals on the subject. or manuals on the subject.
4 4 The patch test The patch test should not be used to diagnose irritant contact should not be used to diagnose irritant contact
dermatoses dermatoses since the conditions of the test (total occlusion against since the conditions of the test (total occlusion against
the skin for 48 hours) seldom approximate the actual conditions the skin for 48 hours) seldom approximate the actual conditions
under which exposure is occurring. under which exposure is occurring.
4 4 The complications of patch testing include scarring, The complications of patch testing include scarring, pigmentary pigmentary
alterations, infections, and accidental induction of sensitizati alterations, infections, and accidental induction of sensitization, on,
which did not exist prior to the test procedure. which did not exist prior to the test procedure.
TREATMENT = MANAGEMENT
TREATMENT = MANAGEMENT
4 4
General:
General:
4 4
Prevention.
Prevention.
The first step of safety measure is the
The first step of safety measure is the
engineering system: the elimination of the toxic
engineering system: the elimination of the toxic
materials causing the
materials causing the
dermatoses
dermatoses
. When this is not
. When this is not
practicable, then the substances should be substituted
practicable, then the substances should be substituted
with a less toxic ones. From personal side the worker
with a less toxic ones. From personal side the worker
should wear PPE
should wear PPE
Personal Protective Equipment, such

Personal Protective Equipment, such
as proper clothing, hand gloves of appropriate
as proper clothing, hand gloves of appropriate
materials, safety helmet, safety glasses/goggles or face
materials, safety helmet, safety glasses/goggles or face
mask, etc.
mask, etc.
4 4
More details are elaborated in
More details are elaborated in
Prevention
Prevention
.
.
4 4
Specific:
Specific:
4 4
Systemic:
Systemic:
Antihistamin
Antihistamin
, antibiotics, corticosteroid (if
, antibiotics, corticosteroid (if
the disease is extensive), and vitamin supplement.
the disease is extensive), and vitamin supplement.
4 4
Topical:
Topical:
when wet, apply open compress with KMnO4
when wet, apply open compress with KMnO4
solution. If it is dry, apply thinly the corticosteroid
solution. If it is dry, apply thinly the corticosteroid
cream.
cream. ( (calon calon) ) Pekerja Pekerja. .
Prognosis
Prognosis
Irritant
Irritant
dermatoses
dermatoses
, acne and infective
, acne and infective
dermatoses
dermatoses
are usually
are usually
cured when the
cured when the
causative agents are eliminated
causative agents are eliminated
.
.
The prognosis
The prognosis
of allergic eczema would depend on the
of allergic eczema would depend on the
characteristic of the allergens and the duration of
characteristic of the allergens and the duration of
exposure.
exposure.
If employee can be excluded from the exposure

If employee can be excluded from the exposure
earlier, or exposure is limited within work
earlier, or exposure is limited within work
environment, the prognosis is good.
environment, the prognosis is good.
However, if the allergen exposure is large, such as

However, if the allergen exposure is large, such as
chromium or detergent, or if there is a secondary
chromium or detergent, or if there is a secondary
allergic reaction to bacterial infection on
allergic reaction to bacterial infection on
eczematous lesion, the skin disease
eczematous lesion, the skin disease
might be long
might be long
life.
life.
SPECIAL WORK PROBLEMS,
SPECIAL WORK PROBLEMS,
restrictions, or needs caused by skin conditions.
restrictions, or needs caused by skin conditions.
4 4
Certain type of works may be considered
Certain type of works may be considered
unsuitable from the point of view of the employer,
unsuitable from the point of view of the employer,
the insurer, or the safety engineer, though skin
the insurer, or the safety engineer, though skin
conditions rarely pose a safety concern.
conditions rarely pose a safety concern.
4 4
Public health considerations in healthcare,
Public health considerations in healthcare,
catering, and pharmaceutical industries, may
catering, and pharmaceutical industries, may
preclude or delay the employment of certain
preclude or delay the employment of certain
applicants, for example those with untreated
applicants, for example those with untreated
hand
hand
eczema
eczema
,
,
otitis
otitis
externa
externa
, or
, or
scalp psoriasis
scalp psoriasis
.
.
4 4
People working with ionizing radiation may not be
People working with ionizing radiation may not be
considered suitable for work in areas of potential
considered suitable for work in areas of potential
contamination if they have
contamination if they have
widespread skin
widespread skin
lesions
lesions
since these may provide a portal of entry
since these may provide a portal of entry
and can present difficulties if decontamination
and can present difficulties if decontamination
becomes necessary.
becomes necessary.
Kep.79/MEN/2003:
Kep.79/MEN/2003:
Pedoman Pedoman Diagnosis Dan Diagnosis Dan Penilaian Penilaian Cacat Cacat karena karena Kecelakaan Kecelakaan
Dan Dan Penyakit Penyakit Akibat Akibat Kerja Kerja: : Cacat Cacat Kulit Kulit Tidak Tidak mudah mudah
untuk untuk ditetapkan ditetapkan. .
Lampiran
Lampiran
PP No. 14
PP No. 14
Tahun
Tahun
1993.
1993.
Masih
Masih
perlu
perlu
pemahaman
pemahaman
yang
yang
lebih
lebih
mendalam
mendalam
.
.
Cacat
Cacat
kulit
kulit
dirujuk
dirujuk
kepada
kepada
cacat
cacat
anatomis
anatomis
atau
atau
fungsi
fungsi
anggota
anggota
badan
badan
.
.
Contoh
Contoh
:
:
Cacat
Cacat
tetap
tetap
pada
pada
kulit
kulit
yang
yang
menyebabkan
menyebabkan
hilangnya
hilangnya
seluruh
seluruh
fungsi
fungsi
lengan
lengan
kanan
kanan
,
,
dari
dari
atas
atas
siku
siku
kebawah
kebawah
,
,
nilai
nilai
kecacatannya
kecacatannya
adalah
adalah
:
:
35% x
35% x
upah
upah
.
.
Cacat
Cacat
tetap
tetap
pada
pada
kulit
kulit
yang
yang
menyebabkan
menyebabkan
hilangnya
hilangnya
fungsi
fungsi
telunjuk
telunjuk
tangan
tangan
kanannya
kanannya
,
,
nilai
nilai
kecacatannya
kecacatannya
adalah
adalah
9 %x
9 %x
upah
upah
.
.
Penilaian
Penilaian
Cacat
Cacat
Kulit
Kulit
4 4
Penetapan
Penetapan
cacat
cacat
:
:
cacat
cacat
pada
pada
kulit
kulit
dapat
dapat
terjadi
terjadi
baik
baik
karena
karena
keloid
keloid
/ cicatrix,
/ cicatrix,
hipo
hipo
atau
atau
hiperpigmentasi
hiperpigmentasi
,
,
papul
papul
yang
yang
keras
keras
dsb
dsb
. yang
. yang
mengganggu
mengganggu
fungsi
fungsi
organ
organ
(
(
cacat
cacat
fungsi
fungsi
)
)
4 4
Cacat
Cacat
kulit
kulit
aesthetica
aesthetica
sejauh
sejauh
ini
ini
masih
masih
belum
belum
dapat
dapat
ditetapkan
ditetapkan
.
.
4 4
Penetapan
Penetapan
cacat
cacat
tergantung
tergantung
pada
pada
gangguan
gangguan
fungsi
fungsi
organ yang
organ yang
tertutup
tertutup
kulit
kulit
yang
yang
cacat
cacat
.
.
Penilaian
Penilaian
Cacat
Cacat
Kulit
Kulit
Rehabilitation
Rehabilitation
4 4 Rehabilitation of people with occupational Rehabilitation of people with occupational dermatoses dermatoses rarely rarely
requires special facilities. requires special facilities.
4 4 Patients need not necessarily achieve complete clearance of Patients need not necessarily achieve complete clearance of
their dermatitis before returning to work, especially if they ca their dermatitis before returning to work, especially if they can n
temporarily be offered alternative work away from the offending temporarily be offered alternative work away from the offending
irritant or allergen. Too often employees are advised to stay of irritant or allergen. Too often employees are advised to stay off f
work until all traces of abnormality is gone, causing unnecessar work until all traces of abnormality is gone, causing unnecessary y
emotional and financial strain and endangering the patient emotional and financial strain and endangering the patient s s
eventual chance of returning to their original jobs. Such action eventual chance of returning to their original jobs. Such action, ,
although taken for what is thought to be the best of motives, although taken for what is thought to be the best of motives,
can hinder rather than help recovery. can hinder rather than help recovery.
4 4 The aim of rehabilitation in occupational dermatology is to keep The aim of rehabilitation in occupational dermatology is to keep
the patient in the same job if at all possible, but this can be the patient in the same job if at all possible, but this can be
irretrievably jeopardized by prolonged sickness absence. irretrievably jeopardized by prolonged sickness absence.
4 4
The foundations of successful rehabilitation are
The foundations of successful rehabilitation are
close working relationships
close working relationships between general between general
practitioners, dermatologists, occupational physicians, practitioners, dermatologists, occupational physicians,
occupational hygienists, and employers; maintenance of occupational hygienists, and employers; maintenance of
contact between the patient and the place of work during contact between the patient and the place of work during
any periods of sickness absence; and monitoring the any periods of sickness absence; and monitoring the
employees employees progress on their return to work. progress on their return to work.
Prevention
Prevention (continued) (continued)
4 4 Work Work- -related dermatitis is preventable. related dermatitis is preventable.
4 4 Engineering controls, personal protective equipment, and Engineering controls, personal protective equipment, and
employer/employee education are all potential strategies employer/employee education are all potential strategies
that can be used to prevent this serious illness. that can be used to prevent this serious illness.
4 4 Awareness Awareness of various types of occupational of various types of occupational dermatoses dermatoses and the and the
agents that may cause them is essential to many successful agents that may cause them is essential to many successful
preventive programs. Exposures, which may cause occupational ski preventive programs. Exposures, which may cause occupational skin n
disease within various occupational settings, are listed in Appe disease within various occupational settings, are listed in Appendix ndix
Potential Occupational Exposures (see separate text provided). Potential Occupational Exposures (see separate text provided).
4 4 Protective measures Protective measures that contain the industrial process and that contain the industrial process and
reduce workers reduce workers exposures have been the traditional preventive exposures have been the traditional preventive
measures for reducing the incidence of occupational skin disease measures for reducing the incidence of occupational skin disease. .
Protective clothing, such as gloves, boots, and aprons, are avai Protective clothing, such as gloves, boots, and aprons, are available lable
in a number of fabrics or materials; these should be carefully in a number of fabrics or materials; these should be carefully
selected with regard to chemical and physical resistance to selected with regard to chemical and physical resistance to
workplace exposures, and workers should be cautioned concerning workplace exposures, and workers should be cautioned concerning
entrapment and occlusion of potentially noxious substances again entrapment and occlusion of potentially noxious substances against st
the skin beneath protective clothing. the skin beneath protective clothing.

GOOD SKIN HYGIENE and CLEANSING
GOOD SKIN HYGIENE and CLEANSING
are other important
are other important
measures, but workers must be instructed not to clean or wash
measures, but workers must be instructed not to clean or wash
excessively with harsh substances.
excessively with harsh substances.

BARRIER CREAM
BARRIER CREAM
have been highly touted as effective
have been highly touted as effective
deterrents, but from a scientific viewpoint, hard evidence of
deterrents, but from a scientific viewpoint, hard evidence of
efficacy is lacking. Commercially available barrier creams may
efficacy is lacking. Commercially available barrier creams may
be divided into four general categories:
be divided into four general categories:

-
-
vanishing creams that simply facilitate skin cleansing;
vanishing creams that simply facilitate skin cleansing;

-
-
water
water
-
-
repellent
repellent
barrier creams that contain film
barrier creams that contain film
-
-
forming,
forming,
hydrophobic substances (silicone,
hydrophobic substances (silicone,
stearates
stearates
, waxes, oils);
, waxes, oils);

-
-
oil
oil
-
-
and solvent
and solvent
-
-
repellent barrier creams, which contain
repellent barrier creams, which contain
beeswax or lanolin to repel oil, or
beeswax or lanolin to repel oil, or
tragacanth
tragacanth
and acacia to
and acacia to
repel solvent;
repel solvent;

-
-
ionic exchangers that contain acidic or alkaline bases to
ionic exchangers that contain acidic or alkaline bases to
buffer the effects of acids and alkalis.
buffer the effects of acids and alkalis.
Prevention
In summary, Prevention of dermatitis in the workplace should In summary, Prevention of dermatitis in the workplace should
ideally be accomplished through ideally be accomplished through total elimination total elimination of of
cutaneous cutaneous exposure to hazardous substances. Often, this is exposure to hazardous substances. Often, this is
not feasible. Mathias sets forth the main elements of a not feasible. Mathias sets forth the main elements of a
multidimensional approach to prevention that have been multidimensional approach to prevention that have been
identified. These elements include: identified. These elements include:
4 4 RECOGNITION RECOGNITION of potential of potential cutaneous cutaneous irritants and allergens irritants and allergens
4 4 ENGINEERING CONTROLS ENGINEERING CONTROLS or chemical substitution to or chemical substitution to
prevent skin exposure prevent skin exposure
4 4 PPE PPE = with appropriate clothing or barrier creams = with appropriate clothing or barrier creams
4 4 personal and environmental hygiene personal and environmental hygiene
4 4 REGULATIONS REGULATIONS of potential allergens and irritants within the of potential allergens and irritants within the
workplace workplace
4 4 EDUCATION EDUCATION: : efforts to promote awareness of potential efforts to promote awareness of potential
allergens and irritants allergens and irritants
4 4 motivational motivational TECHNIQUES TECHNIQUES to promote safe work conditions to promote safe work conditions
and practices and practices
Prevention
4 4
MEX
MEX
Medical Examination
Medical Examination
:
:
4
4
PE
PE
-
-
MEX
MEX
(
(
preemployment
preemployment
medical
medical
examination) and P
examination) and P
-
-
MEX (periodic
MEX (periodic
medical examination).
medical examination).
Must cover questionnaire on
Must cover questionnaire on
medical
medical
history, and physical examination with
history, and physical examination with
emphasis on all body surface area,
emphasis on all body surface area,
screening out for sign of eczema and /or
screening out for sign of eczema and /or
atopy
atopy
. Patch test is not recommended for
. Patch test is not recommended for
screening on otherwise healthy candidate.
screening on otherwise healthy candidate.
4
4
P
P
-
-
MEX
MEX
(Periodic
(Periodic
Medical Examination ).
Medical Examination ).
In essence it is the same as PE
In essence it is the same as PE
-
-
MEX,
MEX,
conducted at least annually.
conducted at least annually.
4 4
Thorough dermatological investigation.
Thorough dermatological investigation.
4 4
Walk through survey
Walk through survey
4 4
Medical advice is subject to error.
Medical advice is subject to error.
4 4
Prompting an overcautious approach should
Prompting an overcautious approach should
be resisted in a rational manner, which can
be resisted in a rational manner, which can
be legally defended.
be legally defended.
4 4
Emphasize on accurate identification that
Emphasize on accurate identification that
have genuine implications for employment.
have genuine implications for employment.
4 4
Disclosing medical report should be supplied
Disclosing medical report should be supplied
only with the patient
only with the patient
s
s
written
written
consent,
consent,
after due consideration.
after due consideration.
Selected References and Further Readings.
Selected References and Further Readings.
4 4 Adams RM: Adams RM: Occupational Dermatology Occupational Dermatology, ed 2, New York, 1990, , ed 2, New York, 1990, Grune Grune & &
Stratton. Stratton.
4 4 Champion, RH, Burton JL, Burns DA, Champion, RH, Burton JL, Burns DA, Breathnach Breathnach SM (ed) SM (ed) Textbook of Textbook of
Dermatology Dermatology, 6th edition, pp. 144 , 6th edition, pp. 144- -145, Oxford, Blackwell, 1998. 145, Oxford, Blackwell, 1998.
4 4 Cox, R.A.F., Edwards F.C., Palmer, K, Cox, R.A.F., Edwards F.C., Palmer, K, Fitness For Work Fitness For Work, , The Medical The Medical
Aspects, Oxford Medical Publications, Third Edition, 2000. Aspects, Oxford Medical Publications, Third Edition, 2000.
4 4 Deteksi Deteksi Dini Dini Penyakit Penyakit Akibat Akibat Kerj a Kerj a, , Terjemahan Terjemahan dari dari Early Detection of Early Detection of
Occupational Disease, World Health Organization, EGC, 1993. Occupational Disease, World Health Organization, EGC, 1993.
4 4 Dr. Dr. Zulmiar Zulmiar Yanri Yanri, PhD: , PhD: Kebij akan Kebij akan Pemerintah Pemerintah Tentang Tentang Penyakit Penyakit Akibat Akibat
Kerj a Kerj a, , Pertemuan Pertemuan Ilmiah Ilmiah Dermatosis Dermatosis Akibat Akibat Kerja Kerja II, 24 II, 24- -25 25 Agustus Agustus 2002. 2002.
4 4 Posch Posch A, Chen Z, A, Chen Z, Raulf Raulf- -Heimsoth Heimsoth M, M, Baur Baur X, latex allergens. X, latex allergens. Clin Clin Exp Exp
Allergy Allergy 1998; 1998;28 28:134 :134- -140. 140.
4 4 Prof. Dr. R.S. Prof. Dr. R.S. Siregar Siregar DTM & H: DTM & H: Saripati Saripati Penyakit Penyakit Kulit Kulit, Atlas , Atlas Berwarna Berwarna, ,
Penerbit Penerbit Buku Buku Kediokteran Kediokteran, EGC,1996. , EGC,1996.
4 4 Suma Suma mur mur P.K.: P.K.: Pandangan Pandangan Hiperkes Hiperkes Mengenai Mengenai Dermatosis Dermatosis Akibat Akibat
Kerj a Kerj a, , Simposium Simposium Dermatosis Dermatosis Akibat Akibat Kerja Kerja. Jakarta, 19 . Jakarta, 19 Juli Juli 1986. 1986.
4 4 Zenz Zenz, Carl, O. B. Dickerson, E.P. , Carl, O. B. Dickerson, E.P. Horvarth Horvarth, , Jr Jr: : Occupational Medicine Occupational Medicine, ,
Third Edition, 1996. Third Edition, 1996.
4 4 Keputusan Keputusan Menteri Menteri Tenaga Tenaga Kerja Kerja dan dan Transmigrasi Transmigrasi Tentang Tentang Pedoman Pedoman
Diagnosis Dan Diagnosis Dan Penilaian Penilaian Cacat Cacat Karena Karena Kecelakaan Kecelakaan Dan Dan Penyakit Penyakit Akibat Akibat Kerja Kerja
Menteri Menteri Tenaga Tenaga Kerja Kerja Dan Dan Transmigrasi Transmigrasi, , Maret Maret 2003. 2003.
4 4 Open sources in Web sites on related subjects. Open sources in Web sites on related subjects.

Penyakit Akibat Kerja 10 September 2007

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Penyakit Akibat Kerja 10 September 2007

Diunggah oleh

Hak Cipta:

Format Tersedia

Dr. S.

5 & 28 : MENGENAI SALURAN

Mist & Fog

TERBENTUR KRN ALIRAN LURUS

DI CABANG BRONKUS BESAR

GERAK BROWN GERAK BROWN. .

ILO standard films.

Personal Protective Equipment, such

If employee can be excluded from the exposure

However, if the allergen exposure is large, such as

Anda mungkin juga menyukai