OCCUPATIONAL HEALTH HAZARDS

Dale M. Hizon, M.D.

Occupational Health Officer Occupational Safety and Health Center

BOSH Training 2009

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PHYSICAL HAZARD

ERGONOMIC HAZARD

CHEMICAL HAZARD

BIOLOGICAL HAZARD

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OBJECTIVES:

Discuss and explain common hazards in the workplace and their effects to workers health. Recommend appropriate measures to prevent occupational and work-related illnesses.

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OCCUPATIONAL HEALTH ( ILO/WHO )

Promote and maintain the highest degree of physical, mental & social well-being of workers of all occupations Prevent workers from departures due to health caused by their working conditions

Protect workers in their working environment from hazards and risks usually causing adverse health effects
Place & maintain a worker in an occupational environment adapted to his/her physiological ability
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HAZARD AND RISK

HAZARD - any source of potential damage, harm or adverse health effects on something or someone under certain conditions at work.
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RISK - the chance or probability that a person will be harmed or experience an adverse health effect if exposed to a hazard.
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WORKPLACE HAZARDS
Safety Hazards

Health Hazards

working conditions where harm to the workers is of an immediate and violent nature result in broken bones, cuts, bruises, sprains, loss of limbs, etc. the harm results in some kind of injury to the worker associated with poorly guarded or dangerous equipment and machinery
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working conditions which result in an illness

exposure to dangerous substances or conditions, such as chemicals, gases, dusts, noise etc.
often, latency between exposure and disease
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Lifestyle Age

Genetic factors

Multiplicity of exposure

Duration of exposure

Workers Susceptibility
Race

WORKRELATED DISEASE

Workplace Factors Physical

properties
Magnitude of exposure

Gender Medical history

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Timing of exposure
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CHEMICAL HAZARDS

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Chemical Hazards
Routes of entry into the body
Inhalation Skin Contact

Ingestion
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Chemical Hazards
Routes of excretion

Gastro-intestinal (feces)

Renal (urine)
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Respiratory (exhalation)
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Skin (sweat, hair, nails)

LD 50 - Dose lethal to 50% of test animals

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Threshold: point at which toxicity first appears occurs at the point where the body's ability to detoxify or repair toxic injury has been exceeded.
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Chemical Hazards
Measures of concentration of toxic substances

Threshold Limit Value (TLV)- average concentration of an airborne substance to which most workers could be safely exposed over an eight-hour working day or forty-hour working week throughout a working lifetime
Maximal Allowable Concentration (MAC)- peak or maximum concentration of an airborne to which most workers could be safely exposed.
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Chemical Hazards
Classification of Toxic Effects

Local toxicity- occurs at the site of chemical contact Systemic toxicity- occurs distant from point of contact, may involve many organ systems Acute toxicity- occurs almost immediately (hours/days) after an exposure Chronic toxicity- represents cumulative damage to specific organ systems; occurs many months or years to have recognizable clinical disease
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Chemical Hazards

Health Effects Renal Diseases Respiratory Diseases Skin Diseases Hematologic Diseases Cardiovascular Diseases Neurologic Diseases Carcinogenic Teratogenic
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Chemical Hazards
Effects Renal Diseases: acute/chronic renal failure Respiratory Diseases: Irritation, inflammation Pneumoconiosis Chemical Agent Industry/Process Battery, chemical Mercury, cadmium, industries, chloroform pesticide Solvents, ammonia Chemical industries Inorganic dust Mining, construction, sandblasting, coal Plating, metal refining

Cancer

Chromium

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Chemical Hazards
Blood Diseases: Anemia

Lead Benzene

Battery mfg., lead smelting Solvent & soap mfg.

Aplastic anemia
Skin Diseases: Allergic/contact dermatitis Acne Skin Cancer

Plastic epoxides

Plastic, varnish

Cutting oils, grease Machine-tool operators Arsenic, tar

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Petroleum refinery

Chemical Hazards
Liver Disease: Acute liver toxicity Carbon tetrachloride Cleaning fluids, dry cleaners

Liver cancer

Vinyl chloride

Plastics & vinyl chloride mfg.

Cardiovascular Disease: Hypertension Lead, Cadmium Atherosclerosis Arrythmias Carbon disulfide Fluorocarbon, trichloroethylene
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Battery mfg. & recycling

Degreasing, dry cleaning Refrigeration, solvent workers

PHYSICAL HAZARDS

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Physical Hazards

Noise Vibration

Extreme Temperature
Illumination Radiation
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Ear Anatomy

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NOISE
Types of Noise-Induced Hearing Loss

Temporary Threshold Shift (auditory fatigue)

temporary loss of hearing acuity after exposure to loud noise recovery within 16-48 hrs

Permanent Threshold Shift

irreversible loss of hearing

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NOISE
Early Signs of Hearing Loss

Difficulty in understanding spoken words in a noisy environment Need to be near or look at the person speaking to help understand words Familiar sounds are muffled Complaints that people do not speak clearly Ringing noises in the ears (tinnitus)
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Other Harmful Effects of Noise

Hypertension Hyperacidity Palpitations Disturbs relaxation and sleep

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VIBRATION

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

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Segmental Vibration:

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

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Whole Body Vibration:

Health effects: Fatigue Irritability Headache Disorders of the spine

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EXTREME TEMPERATURE

Sources of heat stress: Natural Conditions Hot work processes related to furnaces, kilns, boilers and smelting

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Health Effects of Heat Stress

Disorders Clinical features

Prickly Heat (Miliaria rubra) Pruritic rash

Heat cramps

Cramps in the body, usually legs Dizziness, fainting attack, blurring of vision, cold, clammy and sweaty skin Cyanosis, muscle twitchings, disorientation, delirium, convulsions
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Heat exhaustion

Heat stroke

EXTREME TEMPERATURE

Sources of Cold Environment:

Ice plants and freezers in the food industry

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Health Effects of Cold Temperature

Frostbite: reddening of skin, localized burning pain and numbness. Fingers, toes, cheeks, nose, ears are most susceptible.

trench foot or immersion foot: numbness, pain, cramps, ulceration and gangrene.

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ILLUMINATION
Recommended Illumination Levels
Area of Operation Min Lighting Level (lux) 2000

Cutting Cloth Fine machining

Transcribing handwriting Drafting

Welding First Aid station Lunch Room Rest Room
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1000
500 300

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

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Electromagnetic Spectrum
Source
X-rays, about 1 billion billion Hz can penetrate the body and damage internal organs and tissues by damaging important molecules like DNA. This is called ionization. Microwaves, several billion Hz, can have thermal or hearing effects on body tissues Power frequency EMFs 50 or 60 Hz carry very little energy, have no ionizing effects and usually no thermal effects. They can, however, cause very weak electric currents to flow in the body.

Frequency in hertz (Hz)

Gamma rays X-rays

Ultraviolet radiation
Visible light Infrared radiation Microwaves Radio waves
800 - 900 MHz 15 - 30 Hz & 50 - 90 Hz

Very low frequency (VLF) 3,000 - 30,000 Hz Extremely low frequency (ELF) 3 - 3,000 Hz Direct current
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10 20 10 18 10 16 10 14 10 12 10 10 10 8 10 6 10 4 10 2 10

22

60 Hz

RADIATION
Types Ionizing Sources X-rays Gamma rays
Ultraviolet

Health Effects Cancer, congenital defects, death

skin redness, premature skin ageing, and skin cancer corneal and conjunctival burns, retinal injury, cataract Skin and eye problem
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Non-ionizing

Infrared Laser
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BIOLOGICAL HAZARDS

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BIOLOGICAL HAZARDS
VIRUSES FUNGI

BACTERIA

PARASITES

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Selected Infectious Diseases and Occupations

Agent / Disease
Colds, influenza, scarlet fever, diphtheria, smallpox Tuberculosis

Occupation
May be contracted anywhere Silica workers, people exposed to heat and organic dusts, and medical personnel Animal handlers and handlers of carcasses, skins, hides, or hair of infected animals, including wool carpet processors and handlers.

Anthrax

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Selected Infectious Diseases and Occupations

Agent / Disease Ringworm (in horses, cattle, deer, pigs, cats, dogs, birds) Occupation Pet shop salesmen, stockmen, breeders of cats and dogs, and other animal handlers

Tetanus

Farmers (spores in soil) or anyone in contact with manure.

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Selected Infectious Diseases and Occupations

Agent / Disease Psittacosis (in parrots, parakeets, pigeons, ducks, turkeys, chickens, etc.) Hookworm Occupation Pet shop personnel, gardeners, housewives, veterinary surgeons, and researchers. Miners, agricultural laborers, planters of sugar, tobacco, tea, rice and cotton, and brick and tunnel workers.

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Selected Infectious Diseases and Occupations

Agent / Disease

Occupation

Rabies (e.g. dogs, bats, rats, pigs, cats)

Veterinarians, letter carriers, laboratory research workers, agricultural workers.

Farmers, outdoor workers, animal handlers

Fungus

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HIV and AIDS

H- Human I- Immunodeficiency V- Virus virus which causes AIDS A- Acquired I- Immune D- Deficiency S- Syndrome serious and usually fatal condition in which the bodys immune system is severely weakened and cannot fight off infection.
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Epidemiology of HIV and AIDS

Demographic Data
Total Reported Cases Asymptomatic Cases

Feb 2009
47 45

Jan Feb 2009

112 107

Cumulative Data 1984 2009

3,701 2,893

AIDS Cases
Males Females Youth 15-24 y/o Children <15 y/o Reported deaths due to AIDS

2
38 9 12 1 0

5
95 17 31 2 0

808
2,595* 1,095* 537 52 317

Source: HIV / AIDS Registry, Department of Health, Philippines BOSH Training 2009

* Note: No data available on sex for eleven (11) cases. OSHC

Modes of HIV Transmission

Reported Mode of Transmission
Sexual Contact Heterosexual contact Homosexual contact Bisexual contact Blood / Blood Products Injecting Drug Use Needle Prick Injury Mother-to-Child No data available

Feb 2009 n=47

43 13 14 16 0 0 0 1 3
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Jan-Feb 2009 n= 112

107 36 37 34 0 1 0 2 3
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Cumulative Data: 19842009 N=3,701

3,297 2,034 (62%) 872 (26%) 391 (12%) 19 8 3 49 325

Body Fluids with High Viral Load

Blood Semen Vaginal and cervical mucus Breastmilk Amniotic fluid Cerebrospinal fluid

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Modes of Transmission

Unprotected penetrative sex

semen, blood, vaginal secretions

Blood transfusion on infected blood and blood products Sharing needles among I.V. drug users

Vertical/perinatal

mother to infant

Breastfeeding
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HIV is NOT transmitted

through casual contact in any setting schools, homes, hospitals through insect, food, water, clothes, toilets, swimming pools, and drinking and eating utensils

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Prevention of HIV Infection

REMEMBER ABCDE! Abstinence Be Faithful Condom Do not inject Drugs/no sharing of needles Education
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TETANUS

A neurological disorder characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a protein toxin elaborated by the organism Clostridium tetani.
It arises from the contamination of wounds with Clostridium spores.
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TETANUS

Clinical Manifestations Increased tone in the masseter muscle (lockjaw) Sustained contraction of the facial muscles (risus sardonicus) and back muscles (opisthotonus) Prevention Active immunization with tetanus toxoid Careful wound management
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TUBERCULOSIS

caused by the bacteria, Mycobacterium tuberculosis caused by droplet nuclei released when sneezing and coughing Symptoms: weight loss, low grade afternoon fever, persistent cough and sometimes, blood-streaked expectoration or hemoptysis
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Ten Leading Causes of Death by Sex Number, Rate/100,000 Population & Percentage, Philippines, 2004
Both Sexes Cause 1. Heart Diseases 2. Vascular System Diseases 3. Malignant Neoplasm 4. Accidents** 5. Pneumonia 6. Tuberculosis, all forms 7. Ill-defined and unknown causes of mortality 8. Chronic lower respiratory diseases 9. Diabetes Mellitus 10. Certain conditions from perinatal period Male 40,361 28,930 21,395 28,041 15,822 17,841 10,941 13,084 7,970 7,809 Female No. 30,500 22,750 19,129 6,442 16,276 8,029 10,362 5,891 8,582 5,371 70,861 51,680 40,524 34,483 32,098 25,870 21,278 18,975 16,552 13,180 Rate 84.8 61.8 48.5 41.3 38.4 31.0 25.5 22.7 19.8 15.8 Percent* 17.6 12.8 10.1 8.6 8.0 6.4 5.3 4.7 4.1 3.6

Source: 2004 Philippine Health Statistics, Last Update: February 11, 2008 * percent share from total deaths, all causes, Philippines ** External Causes of Mortality BOSH Training 2009

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DOTS Strategythe Solution! Directly Observed Therapy Short Course

With DOTS
90% CURE RATE

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ERGONOMIC HAZARDS

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ERGONOMICS
Human Biological Science + Engineering Science ____________________________________

MAXIMUM SATISFACTION AND INCREASE PRODUCTIVITY

fitting the job to the worker
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ERGONOMICS
the task (job content & context) the organization the tool

the environment

the workstation

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ERGONOMICS

Goal to reduce work-related musculoskeletal disorders (MSDs) developed by workers

MSDs are injuries and illnesses that affect muscles, nerves, tendons, ligaments, joints or spinal discs.
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ERGONOMICS
Common Symptoms of MSDs

Painful joints Pain, tingling, numbness in hands, wrists, forearms, shoulders, knees and feet Shooting or stubbing pains Swelling or inflammation

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ERGONOMICS
Common Symptoms of MSDs

Fingers or toes turning white Back or neck pain Stiffness

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Risk Factor: ERGONOMICS

Static posture

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Risk Factor: ERGONOMICS

Forceful exertion
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Risk Factor: ERGONOMICS

Repetitive movement
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Risk Factor: ERGONOMICS

Extreme range of motion

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Risk Factor: ERGONOMICS

Awkward posture

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ERGONOMICS

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STRESS

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STRESS
The harmful physical and emotional responses that occurs when the requirements of the job do not match the capabilities, resources or needs of the worker.

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STRESS: Effects

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STRESS
Manifestations of Stress

PSYCHOLOGICAL Fatigue Anxiety Tension Irritability Depression Boredom Inability to concentrate Low esteem

PHYSIOLOGICAL Heart rate Blood pressure Indigestion

BEHAVIORAL Drug use Alcohol intake Heavy smoking Impulsive emotional behavior Poor work & family relationship Social isolation Family abandonment Sleep problems

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MONITORING
Systematic, continuous, repetitive healthrelated activities that should lead to corrective action Types of monitoring 1. Ambient / Environmental 2. Biological 3. Medical Surveillance
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BIOLOGICAL MONITORING

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Biological Monitoring

Measurement of a substance, its metabolites or its effects in body tissues, fluids or exhaled air of exposed person Assess exposure and health risk of workers

Complements exposure assessment by air sampling

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Biological Monitoring
Chemical / Determinant LEAD Lead in Blood MERCURY Total inorganic in urine Total inorganic in blood CARBON MONOXIDE Carboxyhemoglobin in blood Sampling Time BEI

Not critical Prior to shift End of shift at end of workweek End of shift

30ug/100ml 35ug/g 15ug/L

3.5% of Hgb

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MEDICAL SURVEILLANCE

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Medical Surveillance

Identify cases Analyze Trends and Patterns in the Workforce to Guide Prevention Efforts Meet Regulatory Requirements

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Medical Surveillance

Know the hazard

- How worker is exposed - How worker is affected - Exposure levels - Exposure duration - Susceptibilities - Directed towards specific organ system - Disease, recovery, rehab - Effectiveness or failure of control measures
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Characterize the hazard

Know the worker Obtain information on medical examinations Analyze Medical Data

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PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS

Monitoring Activity Workplace-Related Events Health Effects Environmental monitoring

Exposure at the workplace - Chemicals - Physical agents

None

Biologically significant exposure Biological monitoring and surveillance - Chemicals absorbed Early

- Early (reversible) changes

Clinical diagnosis Treatment and surveillance - Morbidity - Mortality - measurable health effects Late

End effects - diseases - unfavorable events (spontaneous abortion)

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Standards, Policies and Guidelines

Occupational Safety and Health Standards Rule 1050 Notification and Keeping of Records of Accidents and/or Occupational illnesses

Rule 1070 Occupational Health and Environmental Control Rule 1960 Occupational Health Services
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Rule 1960: Occupational Health Services

1961: General Provisions
1. Every employer shall establish in his place of employment occupational health services in accordance with the regulation and guidelines provided for under this rule. 2. The employer, workers, and their representatives, where they exist, shall cooperate and participate in the implementation of the organizational and other measures relating to occupational health services.
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Rule 1960: Occupational Health Services

1963: Emergency Health Services
1963.01: Medicines and Facilities 1963.02: Emergency Medical and Dental Services

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Rule 1960: Occupational Health Services

Hazardous Workplaces:
Number of workers 1 50 51 - 99 100 199 200 - 600 601 - 2000 1 Part time 4hrs/day 3x/week * 1 Part time 4hrs/day 6x/week ** 1 Full time or 2 Part Time 4hrs/day 6x/week 1 Full time 1 Part time 4hrs/day 6x/week 1 Part time 4hrs/day 3x/week * 1 Part time 4hrs/day 6x/week ** 1 Full time 1 Part time 4 hours/day 6x/week 1 Full time 1 Full time 1 Full time every shift OH Physician OH Dentist OH Nurse First Aider 1 Full time 1 Full time 1 Full time 1 Full time 1 Full time every shift

2000 and more

1 Full time

1 Full time every shift

1 Full time every shift

*Alternate each day ** Alternate workshift in a day BOSH Training 2009 OSHC

Rule 1960: Occupational Health Services

Non - Hazardous Workplaces:
Number of workers 1 - 99 100 199 1 Part time 4hrs/day 6x/week 1 Part time 4hrs/day 3x/week * 1 Part time 4hrs/day 6x/week ** 1 Part time 4hrs/day 3x/week * 1 Part time 4hrs/day 6x/week ** 1 Full time OH Physician OH Dentist OH Nurse First Aider 1 Full time 1 Full time

200 - 600

1 Full time

601 - 2000

1 Full time every shift

1 Full time every shift

2000 and more

1 Full time 1 Part time 4hrs/day 6x/week

1 Full time

1 Full time every shift

1 Full time every shift

*Alternate each day ** Alternate workshift in a day BOSH Training 2009 OSHC

Rule 1960: Occupational Health Services

1963.03: Emergency Hospital

An employer may not establish an emergency hospital or dental clinic in his workplace as required in these regulations where there is a hospital or dental clinic which is located not more than five (5) kilometers away from the workplace, if situated in any urban area, or which can be reached in twenty-five (25) minutes of travel, if situated in rural area, and the employer has facilities readily available for transporting workers to the hospital or dental clinic in case of emergency.
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Rule 1960: Occupational Health Services

Health Examinations: Entrance Periodic Special examination Transfer examination Separation examination

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OCCUPATIONAL HEALTH PROGRAMS

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Key Elements of the Occupational Health Program

Health Protection
Health Promotion Health Rehabilitation

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Health and Safety Programs

Hazards/ Disease
Chemical Solvents

Source

Health Effect

Health Program

Paints, Thinners

Irritant, Multisystem effects

Surveillance for chemical exposure Exposure monitoring (Biologic Monitoring)

Physical Noise

Woodwork Operations

Hearing Impairment

Hearing Conservation Program

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Health and Safety Programs

Hazards/ Disease
Biologic Tetanus Ergonomic Stresses Cumulative Trauma Disorder

Source

Health Effect

Health Program

Dirty Nails, soil

Lockjaw, rigidity, death Musculoskeletal Disorders

Immunization

Awkward postures, Heavy loads

Management or personnel methods; Workplace modification Worker education and training; Back Care Program

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Health Promotion

Physical activity, Nutrition, Weight reduction Immunization OSHS, RULE 1960

Smoking cessation RA 9211 Tobacco Regulation Act of 2003

HIV/AIDS RA 8504 Philippine AIDS Prevention and Control Act of 1998 National Workplace Policy on STD/HIV/AIDS initiated by DOLE - 1997
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Health Promotion

Drug Abuse Prevention and Control RA 9165 Comprehensive Drugs Act of 2002 Department Order No. 53-03: Guidelines for the Implementation of a Drug-Free Workplace Policy and Program for the Private Sector Tuberculosis Prevention and Control Executive Order No. 187, Instituting a Comprehensive and Unified Policy for Tuberculosis Control in the Philippines (CUP) (March 2003) Department Order No. 73-05: Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace
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DEPARTMENT ORDER NO. 56-03

RATIONALIZING THE IMPLEMENTATION OF THE FAMILY WELFARE PROGRAM (FWP) IN DOLE
SECTION 2. New Priorities of the Family Welfare Program a) Reproductive Health and Responsible Parenthood b) Education/Gender Equality c) Spirituality or Value Formation d) Income Generation/Livelihood/Cooperative e) Medical Health Care f) Nutrition g) Environmental Protection, Hygiene and Sanitation h) Sports and Leisure i) Housing j) Transportation
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Approach in Ensuring Well-Being of Workers

Looking at developmental strategies

Information Education Training Campaigns Good practices Successful cases Competitions Demonstrations Interventions
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Looking at regulatory requirements Relevant laws, standards, issuances and guidelines

Enforcement Implementation Inspection Evaluation

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Participatory Approach

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

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Benefits to the workers

Enhanced worker motivation and job satisfaction Added problem-solving capacity Greater acceptance of change Greater knowledge of work and organization Reduces the extent and severity of work related injuries and illnesses Improves employee morale and productivity Reduces workers compensation costs
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I still need more healthy rest in order to work at my best. My health is the main capital I have and I want to administer it intelligently.

---Ernest Hemmingway
Nobel Prize winner for literature THANK YOU FOR YOUR ATTENTION!
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