Medical Surveillance

Medical Surveillance
Session Objectives
At the end of the session, participants will be
able to:
discuss and differentiate the various

monitoring strategies;
explain the role of medical surveillance in
preventing occupational illnesses;
Department of Labor and Employment

OCCUPATIONAL SAFETY AND HEALTH CENTER
Session Objectives (cont)

describe the different steps in
conducting medical surveillance; and
comply with the surveillance-related
provisions of the OSHS and other
relevant OSH issuances, laws and
guidelines.

Occupational Health Hazards

PHYSICAL AGENTS
BIOLOGICAL AGENTS
noise, vibration, radiation,

defective illumination,
temperature extremes
viruses, bacteria, fungi,

parasites
CHEMICAL AGENTS
dusts, gases, vapors,
fumes, mists, etc.
ERGONOMIC STRESSES
exhaustive physical exertions,
excessive standing, improper
motions, lifting heavy load, job
monotony, etc.
EXPOSURE - Acute or repeated oral,

inhalation, skin
absorption,
metabolism,
distribution,
elimination
Toxic effects
Molecular level
(DNA, RNA, protein)
Cellular/
biochemical
level
System/ organ level

(CNS, lung, reproductive
systems, etc.)

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

Monitoring
Types of monitoring
Ambient / Environmental
Biologic
Medical surveillance

Prevention and Control Of Occupational

Hazard
Monitoring Activity
Environmental
monitoring
Workplace-Related Events
Exposure at the workplace
- Chemicals
- Physical agents
Health Effects
None
Biologically significant exposure

- Chemicals absorbed
- Early (reversible) changes
Biological monitoring and

surveillance
Clinical diagnosis
Early
- measurable health effects
Treatment and
surveillance
-Morbidity
-mortality
End effects
- diseases
- unfavorable events (spontaneous
abortion)
Late
Purpose of surveillance in
occupational health is prevention of
illness
Identify cases
Early detection of job-related health

problems (2)
Determine their causes

10
Surveillance in occupational health

practice covers periodic, systematic
and continuous hazard assessment
and medical examination
Surveillance data will provide trends or
emerging patterns in workplace
hazards and illnesses

11
Surveillance has to be followed by

preventive action and evaluation of the
effectiveness of intervention
Surveillance is conducted to meet
regulatory requirements

When is Medical Surveillance

necessary?
12
When diseases in question are

associated with particular exposure or
industry
Monitoring of certain high-risk groups
Required by law

High-risk population
1.
2.
13
Workers new to a hazardous job

Workers returning after injury or
illness

High-risk population
3.
Workers with concurrent condition or

illness which can be adversely affected by
the workplace hazard
4.
14
pregnant worker using materials which could

affect the unborn child
sensitized painter spraying an isocyanatecontaining urethane paint
Workers exposed to very hazardous

substances or work processes
Vulnerability
Hazard levels within "safe" or

acceptable limits do not guarantee that
workers will not be affected
Employee populations are not
homogeneous
15
certain members will be particularly

vulnerable or at greater risk than others

Surveillance of Occupational
Diseases
1.
2.
3.
4.
5.
6.
7.
16
Hazard and exposure assessment

Identification of target organ toxicities for
each hazard
Selection of medical screening tests
Interpretation of data and Recommendation
Communication of results
Recordkeeping
Evaluation of control measures
1.
Hazard and exposure

assessment
Types of
substances
Process Involved
Exposure pathways
Exposed population
Estimate intensity,
frequency and
duration of
exposure to toxic
agent
17
2.
Identification of target organ

toxicities for each hazard
Causative Agent
Industry / Process
Disease
Inorganic dusts
Mining, sandblasting,
construction, coalhandlers
Pneumoconiosis:
- Silicosis
- Asbestosis
- Coal workers
pneumoconiosis
Hemp, flax
Textile, cotton
Byssinosis
Molds
Agriculture
Farmers lung,
Bagassosis
18

3.
Selection of Medical
Screening Test/s
Medical screening
19
Clinical in focus
One source of medical
data
Detection and
treatment of actual
disease
No analysis of data
because deals with
individual
Preventive in focus
Monitor results of screening
Systematic continuous,
repetitive health-related
activities that should lead to
corrective action
Group experience analysis
of pattern of illness in a
target population

3.
Screening Test/s (cont)
Medical screening test
available, sensitive, specific, reliable
relatively simple and straightforward tests
20

3.
interval of screening tests
At the time of first hire or first exposure
(pre-placement or baseline)
Periodically as required by regulation or
as recommended by the physician
21

3.
interval of screening tests
When exposure or employment ends
(termination)
After accidental or unanticipated
exposure
22

4.
Interpretation of Data and

Recommendation
Medical screening
Individual action
What to do if tests are
abnormal?
Removal from exposure

Referral for further tests
Group patterns
What to do if a group of
workers show poorer lab
results than the others?
23
Determine relation between

exposure and test results
Was there overexposure?
Ineffective control
measures?

5.
Medical screening
24
Feedback of individual
results
Prompt and informative
feedback
Implications of tests
Confidentiality
Feedback of group results

Collective findings
Overall findings and trends
(normal or abnormal)
Recommendations for
prevention
Ensure confidentiality (use job
codes, job titles or other
exposure surrogates instead of
the names of individual
employees)

5.
(cont)
Communicate to the Health and Safety

Committee
facilitates continuous review of preventive
programs
provides a mechanism for continuously
improving health and safety performance
25

6.
26
Recordkeeping
Medical recordkeeping test results,

interpretation, records of notifications
Exposure evaluations
Resulting environmental modifications
Requirements, procedures, and
interpretation of findings for health
surveillance as specified by national
legislation

6.
Recordkeeping (cont)
Medical History of workers

personal illnesses
family health problems
reproductive history
lifestyle (e.g., smoking, drug use, etc.)
27

6.
Recordkeeping (cont)
Occupational History
descriptions of all jobs held
work exposures
symptoms or illnesses at previous jobs
personal protective equipment used
28

6.
Recordkeeping
Physical Examination
complete system review

cardiovascular, pulmonary, and
musculoskeletal
eyes, ears, nasopharynx, abdomen
29
evaluation of susceptibility (obesity,

smoking) to exposures and physical
problems (heat stress, noise)

7.
30
Evaluation of control
measures
Steps should be established to remedy
matters of concern

Occupational Diseases 1995-2000
Evaluation of Control Measures

60
60
55
55
50
50
45
45
40
40
35
35
30
30
25
25
20
20
15
15
10
10
1995
96
97
asthma
98
99
2000
Low back pain
31
Musculoskeletal Disorders (all)

Company A: 1997/2000

90
80
70
60
50
40
30
20
10
0
72
66
57
52
31 31
MSD
Shoulderneck
Backache
32
Seasonal Changes in Disease

100
90
80
70
60
50
40
30
20
10
0
Ja
n
Fe
b
M
ar
A
pr
M
ay
Ju
ne
Ju
ly
A
ug
Se
pt
O
ct
N
ov
D
ec
33
Standards, Policies and

Guidelines
Occupational Safety and Health

Standards
Rule 1050
34
Notification and Keeping of Records of

Accidents and/or Occupational illnesses

Standards, Policies and

Guidelines
Rule 1070
Rule 1960
35
Occupational Health and Environmental

Control
Occupational Health Services

Rule 1050- Records of Accidents

and /or Illnesses
accidents/illnesses must be reported

to the DOLE Regional Office every
month
Annual Work Accident / Illness Exposure
Data Report
basis of accident trends
36

Summary of Reporting
Requirements
1.
2.
3.
37
Employers Work Accident/Illness

Report-IP-6
Annual Work Accident/Illness
Exposure Data Report-IP-6B
Annual Medical Report Form- 47-A

Rule 1070- Control of Physical &

Chemical Agents
Threshold Limit Values (TLVs)

Permissible exposures
Work Environment Measurements
(WEM)
38
should be done annually

Rule 1960: Occupational Health

Services
39
Requirements for medical personnel in

hazardous and non-hazardous
workplaces
Duties of employers, physicians,
nurses, first-aiders


Services
Occupational Health Program:

Health examinations: Entrance, Periodic.
Special, Transfer and Separation
Immunization Program
Health Education and Counseling
Health records maintenance
40


1.
2.
41
Identification and assessment of

health hazards
Surveillance of the factors in the
working environment and working
practices, including sanitary
installations, canteens, and housing
where these facilities are provided by
the employer;

3.
42
Advice on planning and organization

of work, including the design of the
workplace, on the choice,
maintenance, and condition of
machinery and other equipment, and
on substances used in work;


4.
43
Participation in the development of

programs for the improvement of
working practices as well as testing
and evaluation of health aspects of
new equipment;


5.
6.
7.
44
Advice on occupational health, safety

and hygiene, and an ergonomics and
individual and collective protective
equipment;
Surveillance of workers health in
relation to work;
Promoting the adaptation of work to
the workers

8.
9.
10.
45
Collaboration in providing
information, training, and education in
the fields of occupational health and
hygiene and ergonomics;
Organizing of first-aid and emergency
treatment;
Participation in analysis of
occupational accidents and
occupational
diseases

Services
Health Programs shall include:

Entrance
Periodic
Special examination
Transfer examination
Separation examination
46


Services
Pre-employment/Pre-placement
Examinations includes:
general clinical examination including

special lab. exams necessary
complete and thorough
free of charge to the workers
47
chest x-ray


Services
Periodic Medical Examinations
Purpose:
to follow-up previous findings
allow early detection of occupational and nonoccupational diseases
determine the effects of exposure to health
hazards
48


Services

complete and thorough
include all special examination necessary
chest x-ray including biochemical
monitoring
as frequent as the nature of employment
may warrant
interval of not > 1 year between 2
consecutive years
49


Services
Transfer Examinations:
Other Special Examinations:
50
Examination by a physician needed before

transfer
undue exposure to health hazards, such
as lead, mercury, hydrogen sulfide, sulfur
dioxide, nitro glycol and other similar
substances

Services
Return to Work Exanimations:
Separation from Employment

Exanimation:
51
Fitness to work
detect occupational disease or illness

P.D. 626 Employees Compensation

and State Insurance Fund
Prescribed Minimum Standards for

Designed for the Early Detection of
Occupational Diseases:
52
Exposure to occupational hazards

enumerated in the list of Occupational
Diseases is a requirement to undergo:


Periodic medical examinations :
53
< than 3 mos. - exposure to: Benzene or its

homologues, Ionizing Radiation and
Organophosphates
> than 3 months: Lead, Mercury, Manganese,
Chromium and Carbon disulfide


For diseases not listed above: periodic

examinations not exceeding one year
Specific examinations depending on
exposure (examples):
Audiometric exam with exposure to noise
Examination of Urine and urinary bladder:
alpha naphthylamine, benzidine
54


Examination of the skin: irritants and
sensitizers
Examination of the eyes and respiratory
tract: chlorine and sulfur dioxide
55

Know the hazard
- How worker is affected

- How worker is exposed
Characterize the hazard
- Exposure levels
- Exposure duration
Know the worker
- Susceptibilities
Obtain information on appropriate

medical examinations
- Directed towards affected organ

system
Analyze medical data
- Disease, recovery, rehabilitation
56

Solving Occupational Health

Problems
Identify Hazards
Evaluate Hazards
Prioritize Problems
Select Intervention
Implement Intervention
Monitor and Evaluate

57
Health Promotion
Definition
Health promotion is the science and art of

helping people change their lifestyle to
move toward a state of optimal health.

Health Promotion
Health Examinations Entrance

Periodic
Special
Transfer
Separation
Diagnosis and treatment of all injuries

and occupational and nonoccupational diseases
Health Promotion
Health education and counseling
Nutrition program
Habits of cleanliness, orderliness and

other health information
Under dietician and supervised by
physician
Physical activity
Weight reduction
Health Promotion
Accurate and complete medical

records of each worker
Submission of administrative
requirements
Annual Work Accident/Illness Exposure Data
Report (DOLE/BWC/OHSD/IP-6b)
Annual Medical Report (DOLE/BWC/HSD/OH47-A)

Health Promotion
Health hazards and proper precautions,

safe work practices, use and maintenance
of available personal protective clothing
and devices, and use of available health
services and facilities

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

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

Health Promotion
Department Order No. 73-05: Guidelines

for the Implementation of Policy and
Program on Tuberculosis (TB) Prevention
and Control in the Workplace

Health Promotion
HIV and AIDS in the Workplace

Republic Act 8504: AIDS Prevention and
Control Act of 1998
for the Implementation of HIV and AIDS
Prevention and Control in the Workplace
Program

Health Promotion
Drug Abuse Prevention

RA 9165 Comprehensive Drugs Act of
2002
for the Implementation of a Drug-Free
Workplace Policy and Program for the
Private Sector

Health Promotion

Executive Order No. 187, Instituting a
Comprehensive and Unified Policy for
Tuberculosis Control in the Philippines
(CUP) (March 2003)
for the Implementation of Policy and
Program on Tuberculosis (TB) Prevention
and Control in the Workplace

Health Promotion
Smoking Cessation
Republic Act No. 9211: Tobacco

Regulation Act of 2003
An Act regulating the packaging, use, sale,

distribution and advertisements of tobacco
products and for other purposes.

Health Promotion
Sec. 6. Designated Smoking And NonSmoking Areas
In all enclosed places that are open to the

general public, private workplaces, and other
places not covered under the preceding
section, where smoking may expose a person
to the other than the smoker to tobacco
smoke, the owner, proprietor, possessor,
manager or administrator of such places shall
establish smoking areas.
Health Promotion
Sec. 6. Designated Smoking And NonSmoking Areas (cont)
Such areas may include a designated smoking

area within the building, which may be in an
open space or separate area with proper
ventilation, but shall not be located within the
same room that has been designated as a nonsmoking area.

Health Promotion
All designated smoking areas shall have at

least one (1) legible and visible sign posted,
namely "SMOKING AREA" for the Information
and guidance of all concerned.

Health Promotion

In addition, the sign posted shall include a
warning about the health effects of direct or
secondhand exposure to tobacco smoke.
Non-smoking areas shall likewise have at least
one (1) legible and visible sign, namely: "NO
SMOKING AREA" or "NO SMOKING".

Health Promotion
DOLE Family Welfare Program
Legal Basis
Article 134 of the Philippine Labor Code
"establishments which are required by the law

(those with 200 or more employees) to maintain a
clinic or infirmary shall provide free family planning
services to their employees....
DOLE Population/Welfare Program at the

Workplace of 1986.

Health Promotion
DOLE Family Welfare Program (cont)

Its ultimate goal is to improve the quality
of life of the Filipino workers.
The Program is being spearheaded by the
Labor Population Program Office and is
being implemented through the Workers'
Amelioration and Welfare Division
(WAWD) of the DOLE regional offices.

Health Protection
Definition
health protection would include
safeguarding people from all hazards to
health
preventing hazards is a key element of
health protection.

Health Protection
Health Examinations Entrance

Periodic
Special
Transfer
Separation
Diagnosis and treatment of all injuries

and occupational and nonoccupational diseases
Health Protection
Immunization program
Tetanus
PPE program
Hearing conservation program
Respiratory protection program

Health Protection
Health hazards and proper precautions,

safe work practices, use and maintenance
of available personal protective clothing
and devices, and use of available health
services and facilities

Health Rehabilitation
Definition
The process of restoration of skills by a

person who has had an illness or injury so
as to regain maximum self-sufficiency and
function in a normal or as near normal
manner as possible.

Health Rehabilitation
DOLE-Employees Compensation
Program
Presidential Decree 626

Income benefits
Medical benefits
Disability benefits
Rehabilitation services
Death benefits

Participatory approach
Participation and involvement from

stakeholders
Coordinated intervention
Learning from
specifications/guidelines,
scientific data
best practice

THANK YOU!

Medical Surveillance

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

Medical Surveillance

Diunggah oleh

Hak Cipta:

Format Tersedia

Medical Surveillance

discuss and differentiate the various

Department of Labor and Employment

Session Objectives (cont)

Department of Labor and Employment

Occupational Health Hazards

noise, vibration, radiation,

viruses, bacteria, fungi,

EXPOSURE - Acute or repeated oral,

System/ organ level

Department of Labor and Employment

Department of Labor and Employment

Department of Labor and Employment

Prevention and Control Of Occupational

Biologically significant exposure

Biological monitoring and

- measurable health effects

Early detection of job-related health

Department of Labor and Employment

Surveillance in occupational health

Department of Labor and Employment

Surveillance has to be followed by

Department of Labor and Employment

When is Medical Surveillance

When diseases in question are

Department of Labor and Employment

Workers new to a hazardous job

Department of Labor and Employment

Workers with concurrent condition or

pregnant worker using materials which could

Workers exposed to very hazardous

Hazard levels within "safe" or

certain members will be particularly

Department of Labor and Employment

Hazard and exposure assessment

Hazard and exposure

OCCUPATIONAL SAFETY AND HEALTH CENTER

Identification of target organ

Department of Labor and Employment

Department of Labor and Employment

Department of Labor and Employment

Department of Labor and Employment

Department of Labor and Employment

Interpretation of Data and

Removal from exposure

Determine relation between

Department of Labor and Employment

Feedback of group results

Department of Labor and Employment

Communicate to the Health and Safety

Department of Labor and Employment

Medical recordkeeping test results,

Department of Labor and Employment

Medical History of workers

Department of Labor and Employment

Department of Labor and Employment

complete system review

evaluation of susceptibility (obesity,

Department of Labor and Employment

Department of Labor and Employment

Occupational Diseases 1995-2000

Evaluation of Control Measures

Low back pain

Musculoskeletal Disorders (all)