RISIKO LINGKUNGAN KERJA DAN

FAKTOR RISIKO PEKERJA TERHADAP

ASMA DAN ‘PPOK’

Dewi Sumaryani Soemarko

Perhimpunan Spesialis Kedokteran Okupasi (PERDOKI)

Program Studi Magister Kedokteran Kerja FKUI
Program PPDS Kedokteran Okupasi FKUI
Divisi Kedokteran Okupasi, Dep Ilmu Kedokteran Komunitas FKUI

‘Asma dan PPOK’ (Sabtu, 4 Maret 2017 di Pegangsaan Timur , Jakarta)

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 Curriculum Vitae
Nama : Dr. dr. Dewi Sumaryani Soemarko, MS, SpOk
Institusi : - Program Studi Magister Kedokteran Kerja FKUI
- PPDS Kedokteran Okupasi FKUI
- Departemen Kedokteran Komunitas
Fakultas Kedokteran Universitas Indonesia

Tempat/tanggal lahir : Jakarta, 29 November

Pendidikan : * Fakultas Kedokteran, Universitas Indonesia – 1987

* Program Studi Ked Kerja, Pascasarjana FK Universitas Indonesia – 1997
* Brevet Pakar Kedokteran Keluarga- IDI 1994
* Brevet Spesialis Kedokteran Okupasi – Kolegium Ked. Okupasi Indonesia , 2003
* Program Doktor Ilmu Kedokteran FKUI - 2010

Organisasi :
* IDI – anggota : 1987 sampai saat ini
* PERDOKI (Perhimpunan Spesialis Kedokteran Okupasi Indonesia) – Sekretaris PP Perdoki (2003-2013)
* Kolegium Kedokteran Okupasi Indonesia – Ketua Komisi Pendidikan (2006 – 2013)
* Kolegium Kedokteran Okupasi Indonesia – Ketua Umum (2013 – 2016)

Praktisi : - Klinik Kedokteran Keluarga FKUI Kayu Putih

- Klinik Kedoktran Okupasi -Prodia Occupational Health Center
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 Outline
• Pendahuluan
• Asma dan COPD(PPOK)
• Health Risk Assessment/Risiko di Lingkungan
kerja vs Asma dan COPD (PPOK)
• Pekerja dengan asma dan COPD (PPOK) : safe
and comfortable
• Program Manajemen untuk asma kerja dan
COPD (PPOK)

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 Pendahuluan
• Epidemi di Masyarakat Modern
Penyakit Infeksi  non infectious diseases
• Indonesia:
Penyakit gangguan respirasi meningkat (infeksi, non infeksi)
Epidemik: kasus infeksi tinggi, kasus non infeksi cenderung naik
Kasus non Infeksi: asma kerja, bronkitis kronik
Early Diagnosed asma kerja dan bronkitis kronik di tempat kerja ?
• Penting: Prevention
• Perlu Identifikasi Pajanan di tempat kerja  mapping hazards + manajemen risiko
kesehatan
• Mapping hazards  penentuan High risk people
• Pemeriksaan khusus/spesifik
• Perlu antisipasi  tahu cara mencegah dan mengendalikan , manajemen risiko
kesehatan

 Perlu diketahui : hazards apa yg dapat menjadi risiko asma kerja dan
Bronkitis Kronik
Pekerja dengan asma dan bronkitis kronik – makin berat di lingkungan kerja

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Gangguan Organ

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Patofisiologi asma

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Penyebab Asma
Animal substances, :
proteins found in dander, hair, scales, fur, saliva
and body wastes.
Chemicals:
anhydrides, diisocyanates and acids used to
make paints, varnishes, adhesives, laminates
and soldering resin. Other examples include
chemicals used to make insulation, packaging
materials, and foam mattresses and upholstery.
Enzymes :
used in detergents and flour conditioners.
Metals:
particularly platinum, chromium and nickel
sulfate.
Plant substances:
proteins found in natural rubber latex, flour,
cereals, cotton, flax, hemp, rye, wheat and
papain, a digestive enzyme derived from papaya.
Respiratory irritants:
chlorine gas, sulfur dioxide and smoke.
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Patofisiologi PPOK

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Patofisiologi Gangguan Fungsi Paru

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 Penyebab COPD di tempat kerja
Occupations linked with a possible increased chance of
getting COPD:
• Agriculture Substances
• Brick making
• Cadmium
A wide variety of dust or fume have
• Mining the potential to cause COPD if
• Construction exposure is high and over a long
• Dock workers
• Flour and grain workers in the food industry period of time, for example studies
• Foundry workers suggest the following substances
Petroleum workers
•
• Pottery/ceramic workers
have the potential to cause COPD;
• Quarries Cadmium dust
• Rubber Cadmium fumes
• Plastics
• Stonemasonry Grain and flour dust
• Textiles Mineral dust
• Welders Organic dusts
If you work in these industries and are also a smoker, any Silica dust
risk of getting COPD is likely to be increased even more. Welding fumes
Some of these occupations and substances are also linked
to other diseases, for example, welding fume can cause
fume fever and pneumonia. Some can also Source:
D.Fishwick, D Sen, C Barber, L Bradshaw, E Robinson, J Sunner and the COPD Collaboration
cause occupational asthma. Group. Occupational Chronic Obstructive Pulmonary Disease: A standard of care.
OccupationalMedicine 2015;65:270-282.doi:10.109/occmed/kqv019

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Aspek yang dibicarakan

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 Definition
Risk management is the process of evaluating the chance
of loss or harm and then taking steps to combat the
potential risk.(Dictionary of economy)

Risk management refers to a coordinated set of activities

and methods that is used to direct an organization and to
control the many risks that can affect its ability to achieve
objectives.

ISO 31000 2009, the term risk management also refers to

the architecture that is used to manage risk. This
architecture includes risk management principles, a risk
management framework, and a risk management process.
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 Definisi .....

Health Risk management:

function of administration of a hospital or other health facility /
directed toward identification, evaluation, and correction of poten
tial risks that could lead to injury to patients, staff members,
or visitors and result in property loss or damage.(Mosby's
Medical Dictionary, 8th edition. © 2009, Elsevier).

Manajemen risiko kesehatan adalah proses yang bertahap dan

berkesinambungan. Tujuan utama manajemen risiko kesehatan
adalah menurunkan risiko pada tahap yang tidak bermakna
sehingga tidak menimbulkan efek buruk terhadap kesehatan
pekerja.(Seaton A, Agius R, Mc Cloy E, D’Auria D. Practical
occupational medicine. London: Edward Arnold; 1994.)

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 Tujuan Manajemen risiko Kesehatan
1. minimalkan kerugian akibat kecelakaan dan
sakit
2. tingkatkan kesempatan/peluang untuk
meningkatkan produksi melalui suasana
kerja aman, sehat dan nyaman
3. potong mata rantai kejadian kerugian akibat
kegagalan produksi yang disebabkan
kecelakaan dan sakit
4. cegah kerugian akibat kecelakaan dan
penyakit akibat kerja

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 Komponen
Manajemen Risiko Kesehatan

Risk • Hazards Identification

• Dose-effect assesment
assessment • Risk Characterization

Health • Medical Surveilance

Surveilance • Biomonitoring

Records • Pembuatan catatan dan laporan

• Penyimpanan arsip

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 Risiko di Lingkungan kerja vs
Risk Asma dan PPOK
Assessment
1. IDENTIFIKASI HAZARDS:
Table 1: Substance Groups and Common Activities can Cause ASTHMA
Substance Groups
• Isocyanates
• Flour/grain/hay
• Electronic soldering flux
• Latex rubber
• Laboratory animals
• Wood dusts
• Glues/resins
• Gluteraldehyde
• Hair dyes
• Penicillin’s/cephalosporin’s
• Chromium compounds
• Platinum salts
• Cobalt
• Nickel sulphate
• Subtilisin/enzymes
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apakah menggunakan bahan-bahan alergen ?
Common Activities
Vehicle spray painting, foam manufacture
Handling grain at docks, milling, malting, baking
Soldering, electronic assembly, computer manufacture
Gloves in health care, laboratories
Laboratory animal work
Saw milling, woodworking, furniture manufacture
Curing glues and epoxy resins in joinery and construction
Health care
Hairdressers
Pharmaceutical
Welding stainless steel
Catalyst manufacture
Hard metal production, diamond polishing
Electroplating
Detergent manufacture
Source: Health and Safety Authority. Guideline on Occupational asthma. The
Health and Safety Authority, The Metropolitan Building, James Joyce Street,
Dublin 1. Republic of Irelend. July 2008
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 Risiko di Lingkungan kerja vs
Asma dan PPOK
1. IDENTIFIKASI HAZARDS: apakah anda bekerja di bidang ini ?

Source: Health and Safety Executive. Risk Assessment.: a Brief guide to controlling risks in the workplace. Diunduh dari
http://www.erswhitebook.org/files/public/Chapters/07_occupational_risk.pdf , tanggal3 maret 2017

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• Proses identifikasi dapat dilakukan dengan:
- inspeksi faktor fisik
- analisis tugas/ jabatan
- analisis proses kerja
- pekerja, tempat kerja, proses lain

• Daftar wajib manajemen risiko diperoleh

antara lain melalui Lembar Data Keselamatan
Bahan/Material Safety Data Sheet (MSDS).

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 Risk
Assessment
2. Penilaian Bahaya Potensial
(Dose-effect assesment)

Bahaya potensial yg sudah teridentifikasi

• Menilai hazards yang berbahaya dibuat dalam daftar (hazard register),
• Pembagian:
- potensial harm : potensi gangguan
- serious harm kesehatan
- description of hazards: actual hazard that cause
- harm harm
- significant hazard : hazard yg ‘serious harm’
- harm that can not be detected - intervention method : eliminasi, isolasi,
until a significant time after minimalis
exposure - action proposed/control: identifikasi
pengendalian utk
 Setelah ini perlu tindakan mengatasi hazard
pengendalian - frequency : jumlah pajanan dan jumlah
pengendalian
- completion : jadwal pengendalian, off control
bila hazards terkendali
- risk : risk assessment tools

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 Exposure – Effect Continuum

(Angerer,et al, 2006)

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 3. Kategorisasi risiko
Risk
Assessment
(Risk Characterization)

• Yang dimaksud dengan “penilaian risiko”

adalah proses menentukan prioritas
pengendalian dan tindak lanjut terhadap
tingkat risiko kesehatan dan kecelakaan akibat
kerja karena tidak semua aspek bahaya
potensial dapat ditindaklanjuti.

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 Analisis Derajat Risiko Bahaya Kerja
• mendahulukan pengendalian bahaya kerja
yang dapat berakibat paling buruk atau
bahaya kerja yang paling sering terjadi, tahap
evaluasi bahaya kerja selanjutnya
• menganalisis derajat risiko bahaya kerja untuk
menentukan beratnya risiko dan
besarnya kemungkinan bahaya kerja yang
mungkin terjadi.
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 Klasifikasi berat risiko bahaya kerja
a. Sangat berat (catastrophic)
 dapat mengakibatkan kematian atau kehancuran seluruh
property berserta fasilitas yang ada di dalamnya.
b. Berat (critical)
 dapat mengakibatkan ganguan kesehatan akibat kerja yang
berat atau kerusakan property dalam skala besar.
c. Sedang (marginal)
 dapat mengakibatkan gangguan kesehatan akibat kerja
yang ringan, biasanya mengakibatkan pekerja tidak dapat
masuk kerja untuk beberapa hari, atau kerusakan property dalam
skala kecil.
d. Ringan (negligible)
 kemungkinan tidak berpengaruh dalam kesehatan dan keselamatan
pekerja, tetapi jalas dalam kondisi yang menyalahi syarat syarat
kesehatan kerja yang baik.
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 Klasifikasi kemungkinan dan frekuensi
risiko terjadinya bahaya kerja.
a. Kemungkinan terjadi dalam waktu yang
sangat pendek setelah terpajan pada suatu
bahaya kerja.
b. Kemungkinan besar akan terjadi pada suatu
waktu
c. Ada kemungkinan untuk terjadi apda suatu
waktu.
d. Sangat tidak mungkin terjadi.
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 Prioritas risiko bahaya kerja
1. Risiko ringan:
kemungkinannya kecil untuk terjadi serta akibat yang
ditimbulkannya ringan maka bahaya kerja ini dapat
diabaikan.
2. Risiko sedang:
kemungkinannya kecil untuk terjadi akan tetapi akibat
yang ditimbulkannya cukup berat, atau sebaliknya, maka
perlu pelaksanaan manajemen risiko khusus.
3. Risiko berat:
sangat mungkin terjadi dan akan berakibat sangat buruk,
maka harus dilaksanakan penganggulangan sesegara
mungkin.
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 Berat ringan Risiko
Risk
Assessment

Contoh 1

Adapted from the AS/NZ 4360 Standard Risk Matrix and NHS QIS Risk Matrix
Sumber: Ramli, Soehatman. “Pedoman Praktis Manajemen Risiko Dalam Perspektif K3 OHS Risk Management”

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 Metode Pengendalian Risiko
1. Pengendalian teknis/rekayasa yang meliputi
eliminasi, subtitusi, isolasi, ventilasi, higiene dan
sanitasi
2. Pendidikan dan pelatihan
3. Pembangunan kesadaran motivasi
4. Evaluasi melalui internal audit
5. Penegakan hukum

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 Model: “Health Risk Asessment, Pengendalian, Pencegahan,
Medical Surveilans” (Courtesy: Dewi S Soemarko, 15 Nov 2014)

Risk Asessment/Health Risk Asessment:

-Identifikasi
-Pengukuran
-Evaluasi

Sumber Along the Path PEKERJA

Pajanan

PENGENDALIAN:
Eliminasi Administration
Penggunaan APD
Control
Engineering Control
PENCEGAHAN:
Medical Surveilance: untuk individu & kelompok
1. Asesmen bahan berisiko 7. Interpretasi hasil
Courtesy: Dewi S Soemarko, 15 Nov 2014 2. Seleksi Pemeriksaan / Biomonitoring 8. Tindak lanjut
3. Standarisasi prosedur 9. Pencatatan dan Pelaporan
4. Pemeriksaan Pekerja 10. Pengarsipan
5. Pekerja yg diperiksa 11. Program Penjaminan Mutu
6. Pelatihan
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 SURVEILEN KESEHATAN
Health
Surveilance DI TEMPAT KERJA
Yang dimaksud dengan “Surveilans Kesehatan di tempat kerja”
adalah kegiatan pengamatan yang sistematis dan terus
menerus terhadap data dan informasi tentang kejadian
penyakit atau masalah kesehatan dan kondisi yang
mempengaruhi terjadinya peningkatan dan penularan
penyakit atau penyakit menular dan tidak menular di tempat
kerja, penyakit akibat kerja, penyakit terkait kerja, dan cidera
akibat kerja untuk memperoleh dan memberikan informasi
guna mengarahkan tindakan pengendalian dan
penanggulangan secara efektif dan efisien.

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 Occupational Health Surveillance
Health
Surveillence

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 Occupational Health Surveilance
1. Environmental Surveilance
• Sasaran : Lingkungan kerja
• Tujuan : tahu pajanan pada pekerja

2. Medical Surveilance
• Sasaran : Pekerja
• Tujuan : Tahu status kesehatan pekerja

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 Monitoring hazards di lingkungan kerja
(environmental surveilance)

1. Apa yang diukur?

• Semua hazards di tempat kerja yang diprediksi memberikan efek
kesehatan pada pekerja
• Cara ukur: langsung dan tidak langsung

2. Bagaimana cara mengukur?

• Sesuai standar yang ditetapkan (Kemenaker, ISO, OSHA, NIOSH, dll)

3. Nilai hasil ukuran mengacu kemana?

• TWA/TEL/PEL atau Nilai Ambang Batas

4. Siapa yang melakukan pengukuran? Alat ukur nya?

• Institusi yang berwenang, berkompetensi, berkualitas
• Alat ukur terkalibrasi dan valid

5. Apa data hasil pengukuran harus disimpan?

• Ya, harus disimpan setiap tahun dan dianalisis setiap tahunnya
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 model Deteksi dini , pengendalian dan
pencegahan:
“Hazards masuk ke dalam tubuh”

Health Risk Molecullar -Marker

BIOMARKER BIOMARKER
Asessment Succeptibilty
/ MARKER / MARKER
(Polymorphysm)

Absorbsi Distribusi Metabolisme Kelainan Kelainan

Hazards
Sel Organ
exposure
Ekskresi (penyakit)

BIOMONITORING Courtesy: Dewi S Soemarko, 15 Nov 2014

Gunakan: Note: = environmental Surveillence

-Masker
-Sarung tangan sesuai = Medical Surveillence

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 SURVEILANS MEDIS (Medical Surveillance)
Health
Surveillence
• Surveilans medis  investigasi yang sistematis dari masalah kesehatan
pada kelompok tertentu dan terdiri dari: pengumpulan data, analisis,
diseminasi data dan tindak lanjut

• Surveilans medis mengandalkan pada data yang dikumpulkan secara rutin.

• Surveilans dapat menghasilkan hipotesis bagi penelitian yang lebih lanjut.

• Program:
Upaya-upaya untuk melindungi, mendidik, memonitor pekerja
dan dalam beberapa hal sampai pada upaya kompensasi bagi pekerja.
• Dalam program surveilans medis a.l. termasuk menentukan jenis
pemeriksaan, melakukan pemeriksaan, dokumentasi, tindak lanjut dan
analisis data individu maupun kelompok.

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 TUJUAN Surveilens medis
1. Identifikasi pola penyakit
2. Deteksi dini adanya pajanan
3. Melindungi pekerja yang sangat rentan atau
sensitif
4. Mematuhi peraturan atau undang-undang

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 KAPAN Surveilens Medis DIBUTUHKAN ?
• DIHARUSKAN OLEH UNDANG-UNDANG /Peraturan:
– OSHA: 28 Pajanan yang harus dilakukan Surveilens Medis
– Permenakertrans no 2/Men/1980 : Pemeriksaan Kesehatan Pekerja 
surveilens Medis?

• DIANJURKAN UNTUK DILAKUKAN:

1. Pajanan yang cukup berisiko
2. Bila belum tahu Efek thd kesehatan
3. Bila banyak keluhan pekerja
4. Bila ada ada individu dg risiko tinggi
5. Bila ‘ACTION LEVEL” suatu bahan belum diketahui

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 Komponen Medical Surveilance
Health
Surveillence
(individu dan kelompok)

1. Asesmen bahan berisiko

2. Seleksi Pemeriksaan / Biomonitoring
3. Standarisasi prosedur
4. Pemeriksaan Pekerja
5. Pekerja yg diperiksa
6. Pelatihan
7. Intepretasi Hasil
8. Tindak Lanjut
9. Pencatatan dan Pelaporan
10. Pengarsipan
11. Program Penjaminan Mutu
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Skema Asesmen Pajanan

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Employee with asthma and COPD:
safe and comfortable

• Hazards Identification in the workplace  is

there a sensitizer?
• Avoid the sensitizer/hazards that can be alregen
• Knowing the apnoe
• Do the breathing exercise for Asthma/COPD
• Take the medicine
• Emergency case Be hurry to the hospital

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Employee with Asma and COPD :
safe and comfortable

• Early detection : Medical Check Up (Pre and Annual)

• Must know the worker task (= Occupation)  job description

• FIT TO WORK * based on:

1. job description
2. Job Demand (physical, mobility, specific senses, balancing, motoric,
emergency respons,communication, mental, organization,
temporal aspect, ergonomic)
3. Medical status
4. Risk in the workplace
5. Tolerance aspect
6. Disability status
7. Dangerous apsect for her/him,
other person and work environtment
8. Fit to work status
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* Perhimpunan Spesialis Kedokteran Okupasi (PERDOKI ) 2011 workplace)
42
 In Clinic/hospital

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Remember ...

Edukasi: Promosi Kesehatan

Modifikasi gaya hidup untuk preventif dan
pengendalian :
– hindari pajanan
– Diet (healthy food) , hindari ‘makanan alergen’
– Pola hidup sehat (Good life style)
• Stop merokok
• Latihan pernapasan teratur
• Minum obat teratur
• Annual Medical Check up for Lung function and fit for
work

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 Simple Exercises for asthma
Buteyko Breathing Technique

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 Prevention
Primer:
• High risk person (ethnic, race, atopy history,
high activitiy, un healthy diet)
• Topics: knowing your body and workplace,
healthy diet, breathing excercises, stop
smoking
• Management for asthma and COPD
• Management the risk factor: respiratory
sensitizer
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 Prevention
Secunder:
• For asthma/ COPD patient  medicine, early
detection for asthma
• Especially for new ‘alergen’

Tertier:
• For asthma/COPD patient with complication
• Holistic and integration

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Accomodation for employee with
Asma and COPD
• Spirometry Test reguraly
• Take the X ray chest , if necessary take ILO
radiograph
• Administering for Cases
• Food and drink properly
• Avoid the alergen
• Warning the emergency case go to hospital

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 CONCLUSION

• Prevention is the important in management asthma and COPD

Healthy life style  prevention
Early detection of Asma and COPD  less complication
• Most of MCU in the production worker with respiratory substance
without PPE: asthma, COPD

• A lot of dust/chemical Hazards in the workplace:  can make worst

• Employee with asthma before working : must be replace to other
location , becareful for getting worst
• Remember: Case by case

• Management Programme for Asthma: as usual the same in clinic –

inhaler asthma drugs, oxygen, referal to hospital

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 References
1. Health and Safety Authority. Guideline on Occupational asthma. The Health and Safety Authority, The
Metropolitan Building, James Joyce Street, Dublin 1. Republic of Irelend. July 2008
2. Health and Safety Executive. Risk Assessment.: a Brief guide to controlling risks in the workplace.
Diunduh dari http://www.erswhitebook.org/files/public/Chapters/07_occupational_risk.pdf , tanggal3
maret 2017
3. Mansyur M. Manajemen Risiko Kesehatan. Maj Kedokt Indon, Volum: 57, Nomor: 9, September 2007
4. Seaton A, Agius R, Mc Cloy E, D’Auria D. Practical occupational medicine. London: Edward Arnold; 1994.
5. Bisesi MS. Industrial hygiene evaluation methods. 2nd Edition.London: Lewis Publishers; 2004.
6. Lauwerys RR, Hoet P. Industrial chemical exposure, guidelinesfor biological monitoring. 3rd Edition,
Florida: CRC Press; 2001.
7. Greenberg MI. Occupational and environmental medicine. New York – London: Mc Graw Hill; 2006.
8. Faculty of Occupational Medicine The Royal College of Physician. An Employer’s Guide to engaging an
Occuptional health Physician. Diunduh dari
9. http://www.fom.ac.uk/wp-content/uploads/empopguid.pdf...meet, tanggal3 Maret 2017
10. D.Fishwick, D Sen, C Barber, L Bradshaw, E Robinson, J Sunner and the COPD Collaboration Group.
Occupational Chronic Obstructive Pulmonary Disease: A standard of care. OccupationalMedicine
2015;65:270-282.doi:10.109/occmed/kqv019

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Thank you for your attention .....

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