PEKERJAAN :
Penambangan, penggalian
Peleburan logam, sand-blasting
Tempat peleburan pasir, pekerjaan konstruksi,
Pekerjaan yg melibatkan pengasahan, pengeboran atau
memecahkan batu, keramik yg mengandung silika
Pabrik kaca, serat optik
Aktivitas Yg Meningkatkan Risiko
Crushing, drilling, chipping rock
Blasting, loading, shovelling and dumping rock
Abrasive blasting (sandblasting)
Polishing stone
Cutting, hammering, drilling concrete
Excavation and moving rock or earth
Demolition
Silica exposure and its health effects were responsible
for the largest industrial disaster in American history.
The events took place in Gauley Bridge, West Virginia during
from 1930 - 1932. Union Carbide and its subsidiary power
company were building a hydroelectric project along the New
River and the Kanawha River in southern WV and were building
a tunnel, to divert water near the town of Gauley Bridge, WV.
The subcontractor for the tunnel construction project recruited
workers from the rural hill country of WV and from out of state.
Working conditions in the tunnel were very bad. Drilling
operations with no suppression of the dust and with no
ventilation exposed hundreds of workers to high
concentrations of dust. The crystalline silica (quartz) content of
the rock was greater than 90%.
As the project continued increasing numbers of workers
became short of breath and died within only a few months of
exposure. It was estimated that 169 black workers who died in
the tunnel were buried in a mass grave in nearby fields. It is
estimated that more than 475 workers both black and white-
died during the project and that 1,500 workers contracted
silicosis and were disabled from the disease.
SILIKOSIS
Paparan dosis rendah yg cukup lama opasitas bulat kecil
terutama di bgn atas paru (simple silicosis) opasitas bertambah
besar & lebih profus setelah paparan berhenti secara perlahan
PMF
Silikotuberkulosis
Proses Fibrotik
Infeksi Acinetobacter
Penyakit kavitasi
Nodul Silikosis
Nodul Silikosis
SANDBLASTING
Penyemprotan pasir
SILIKOSIS
FOUNDRY
Pengecoran logam
SILIKOSIS
SILIKOSIS
Berhenti merokok
PENCEGAHAN SILIKOSIS
Pencegahan :
Mengontrol paparan debu pada industri di
mana batu dipotong, dihancurkan, dihaluskan
atau dibor
Substitusi, enclosure, ventilasi ekshaust
APD
Pemeriksaan Kesehatan Pra-Kerja
Meliputi
(a) riwayat pekerjaan;
(b) kuesioner pernafasan;
(c) uji fungsi paru / spirometri;
(d) foto toraks (Full size PA view); dan
(e) anamnesis dan pemeriksaan fisik yang
menekankan sistem pernafasan.
Case Study
A 55-year-old man consulted his general practitioner for vague
chest pain and shortness of breath on climbing up stairs for the
past two to three years. A chest X-ray was done and it showed
bilateral scattered opacities through the lung fields. There were
also egg shell calcifications in the hilar areas. The X-ray was
classified as 2/2 pqr according to the International Labour
Organisation (ILO) Classification for Pneumoconiosis.
Clinically, no abnormalities were detected. His FEV1 was 84% and
FVC was 79% of the predicted values. He was a tombstone
engraver for the past 36 years. He was exposed to dust from the
cutting, grinding, polishing and engraving of tombstones. He
smoked 10 cigarettes a day for the past 30 days and has no
history of tuberculosis. A repeat chest X-ray done six months later
showed a similar picture.
Clinical Case 2
55 year old male who worked in mine 32 years.
Regular screening with Chest x-rays. Changes suggestive of
silicosis on recent film.
Upon discussion he has noted increased cough and shortness of
breath on exertion thought it was because he smoked pack of
cigarettes daily.
High resolution CT scan interstitial lung disease suggestive of
silicosis. Decreased lung function on pulmonary function tests.
Lung Biopsy confirms silicosis.
Sampling silika
Silika Respirable tidak terlihat
Debu Visible
Bulk sampling
Instantaneous sampling
Personal sampling
Area sampling
Air monitoring
Air monitoring
Rencana Sampling
Tetapkan goals!
Berapa Shift
Berapa banyak sample
Area / pekerjaan
Ambil Keputusan
Bandingkan hasil terhadap NAB (ACGIH)
Ambil keputusan :
Pajanan Acceptable
Pajanan Unacceptable
Perlu informasi tambahan
Implementasi Tindakan Pengendalian
Pengendalian Silika
Eliminasi
Substitusi
Pengendalian teknis
Pengendalian Administratif
APD / PPE
Survailans Kesehatan
Eliminasi/Substitusi
Sandblasting/Abrasive blasting
Substitusi pasir silika
Pengendalian Teknis
Ventilasi Mekanik
Local exhaust ventilation
Supresi Basah
Isolasi pekerja
Dust suppression skirting
Local exhaust ventilation
Wet suppression
Isolasi pekerja
Dust suppression skirts
Pengendalian Administratif
Air monitoring
Cara kerja & prosedur kerja aman
Good hygiene practices
Tidak ada sapu kering
Program pemeliharaan preventif
Alat Pelindung Diri
Seleksi Berdasarkan Konsentrasi Udara
Pertahanan terakhir
PARU-PARU ALUMINOSIS
Penyebab : Aluminium
FIBROSIS PARU-PARU BAUKSIT
Penyebab : Bauksit
Beriliosis,
Penyebab : Berilium
Pekejraan : Ekstraksi berilium & metalurgi, industri ruang
angkasa, industri nuklir
Fibrosis paru-paru grafit, kaolin, talc
Penyebab : Debu graft
Pekerjaan : produksi barang grafit, artifisial grafit dari
batu bara atau minyak mineral
SIDEROSIS
Penyebab : Serpihan / debu besi
Pekerjaan : penambangan besi & metalurgi
Pneumonitis Hipersensitif
Trauma Inhalasi
Gas Irritan
Ammonia-Klorine-Fosgene-Ozone
Gejala
Bronkospasme akut-sesak- edema paru
Laboratorium
Arterial blood gases
Uji Fungsi Paru-
Obstruksi jalan nafas asma / bronkitis
Fungsi paru Restriktif bronkiolitis obliterans
Abnormal gas exchange edema paru
Foto toraks
Reaksi Pernafasan Akut terhadap Gas Iritan
Pajanan thdp konsentrasi tinggi gas iritan iritasi saluran nafas atas,
pneumonitis kimia, edema paru, dan kadang kematian
GAS IRITAN
Acrolein Plastik, kimia, tekstil
Amonia Pupuk, obat, kimia
Klorin Kimia
HCL Kimia, zat warna , dll
HF Kimia, kilang
H2S Kimia, karet, produksi ikan
Metil bromid Fumigasi, refrigerasi
NO Pertanian, tambang,
pemadaman api
Ozon Welding, bleaching
Fosgen Pewarnaan, metalurgi
Fosfin Fumigasi, metalurgi
SO2 Kimia, industri kertas
Bronkiolitis obliterans dpt terjadi beberapa hari
atau minggu setelah paparan
Arc welding
melepaskan NO &
Ozone
POLYMER FUME FEVER
SEBAB : Pembakaran polimer fluorokarbon
Pekerjaan berisiko : fabrikasi polimer fluorokarbon
(moulding, solder), pemotongan atau welding metal yg
dilapisi polimer
Onset :
Segera : mis. Paparan klorin
Lambat : mis. Bronkiolitis obliterans
Persisten : mis. Irritable airway syndrome atau asma
FUMES TOKSIK & GAS
Ergonomi :
Mengangkat berat
Posisi tidak lazim
Gerakan repetitif
POTENSI BAHAYA WELDING
Fisik :
Suara bising
Temperatur panas
Sinar UV & Infra merah
Safety :
Kerja ketinggian
Kesetrum listrik
Confined space
Trauma : luka robek, bakar
Psikososial
Kerja shift
Jam kerja yang panjang
GAS ASFIKSIAN
Patofisiologi
Bronkitis Asthma Emfisema
Paru terlibat secara diffus
Hipersekresi lendir airspace melebar radang jalan nafas
Gejala
Batuk produktif selama 3 bulan X 2 thn
Merokok
Gas Irritan + tar+ nikotin
Pajanan Individual
Asbestos silika debu batubara fume welding
Pemadam Kebakaran
Gas Irritan: sulfur dioksida - ozone
Menegakkan hubungan kerja PPOK
Mengurangi pajanan
Skrining pra-kerja
Atopi
Faktor Genetik
Edukasi
Skrin sensitizer paru yang berpotensi
Ringkasan
Kesadaran pajanan kerja sebagai penyebab
penyakit penting
Riwayat pekerjaan mutlak
Untuk menegakan hubungan kerja, bukti
obyektif pajanan dan terjadinya gejala atau
perubahan fungsi paru diperlukan
Mengurangi pajanan merupakan kunci
pencegahan