Introduction of Occupational Health & OHC.pptx

The current presentation gives an insight in to the whole new universe of the still emerging branch of medicine - Occupational & Environmental medicine.
A must for those AFIH course students

1. OCCUPATIONAL HEALTH

2. What is Occupation ? A person's usual or principal work or business, especially as a means of earning a living, vocation. What is Health ? Health is a state of physical, mental and social well-being in which disease and  infirmity are absent What is Occupational Health ? The promotion and maintenance of highest degree of Physical, Mental & Social well being of workers in all occupations

3. History for Occupational Health Hippocrates (460-370 BC), the father of medicine, • Observed lead poisoning among miners Pliny the Elder (23-79), Roman scholar • Recommend respiratory protection to miners German metallurgist, Georgius Agricola's (1494-1555) • "De Re Metallica' ('On the Nature of Metals")

4. History Ramazini - 18th Century Father of occupational medicine . Publish first systemic account of occupational disease (“De Morbis Artificum”/ Disease and Occupation) Emphasize obtaining occupational history Introduce practice of doctors visit at workplace .

5. History The Factory Act-UK (1833) comes into force in action International Labour Organization (ILO) in 1919 The Factories Act, 1948 - India

6. OCCUPATIONAL HAZARDS

7. Physical hazards Heat and cold Light Noise Vibration Ultraviolet radiation Ionizing \non ionizing radiation

8. Burns Heat exhaustion Heat stroke Heat cramps Decreased e f f i c i enc y , Increased fatigue Enhanced accident rates. Heat

9. C o ld Chilblains Erythrocyanosis Immersion foot Frostbite as a result of cutaneous vasoconstriction. Gene r a l h y po th e r m ia 9

10. L i g ht The acute effects of poor illumination are Eye strain, Headache, Eye pain, Lacrymation, Congestion around the cornea Eye fatigue. The chronic effects on health include "miner's nystagmus"

11. Noise Auditory effects Temporary or permanent hearing loss Non auditory effects Nervousness, Fatigue, Interference with communication by speech, Decreased efficiency Ann oyance 11

12. Vibration Exposure to vibration may also produce injuries of the joints of the hands elbows and shoulders. 12

13. Ultraviolet radiation Conjunctivitis Keratitis (welder's flash).

14. Ionizing radiation The radiation hazards comprise Genetic changes Malformation Cancer Leukaemia Depilation Ulceration Sterility in extreme cases death.

15. Ionizing radiation The International Commission of Radiological Protection has set the maximum permissible level of occupational exposure at 5 rem per year to the whole body.

16. Chemical hazards

17. Chemical hazards 1) Local Action : D er m atit i s Eczema Ulcers Cancer by primary irritant action

18. Chemical hazards ( 2) Inhalation : Dusts Gases Metals and their compounds

19. Chemical hazards Dusts Dusts are finely divided solid particles with size ranging from 0.1 to 150 microns Dust particles larger than 10 microns settle down from the air rapidly, IndefinitelyParticles smaller than 5 microns are directly inhaled into the lungs and are retained there and is mainly responsible for pneumoconiosis .

20. Chemical hazards Classification of dusts Inorganic and organic dusts; Soluble and insoluble dusts.

21. Chemical hazards Gases Simple gases (e.g., oxygen, hydrogen), Asphyxiating gases (e.g. carbon monoxide, cyanide gas, sulphur dioxide, chlorine) Anaesthetic gases (e.g., chloroform, ether, trichlorethylene).

22. Chemical hazards Metals and their compounds Lead, antimony, arsenic, beryllium, cadmium, cobalt, manganese, mercury, phosphorus, chromium, zinc and others

23. Chemical hazards (3) Ingestion: Occupational diseases may also result from ingestion of chemical substances such as lead, mercury, arsenic, zinc, chromium, cadmium, phosphorus etc.

24. Biological hazards Brucellosis Leptospirosis Anthrax Hydatidosis Tetanus Encephalitis fungal infections Schistosomiasis A Host of Others

25. Mechanical hazards

26. Psychosocial haz a rds Factors affect health Frustration Lack of job s a t i sf a c ti o n , Insecurity Poor human re l a t i o n sh i ps , Emotional tension

27. Psychosocial haz a rds The health effects can be classified in two Psychological and behavioural changes Psychosomatic ill health

28. OCCUPATIONAL DISEASES Heat Cold Light Pressure Noise Radiation Mechanical factors Electricity I DISEASE DUE TO PHYSICAL AGENT

29. OCCUPATIONAL DISEASES II DISEASE DUE TO CHEMICAL AGENT Gases Dusts (pneumoconiosis) Inorganic dust: coal dust; silica; asbestos; iron Organic(vegetable dust): cane fiber; cotton dust; tobacco; hay or grain dust Metals and their compounds: lead ,mercury, cadmium, manganese, beryllium, arsenic, chromium . Chemicals: acids, alkalies, pesticides Solvents: carbon bisulphide, chloroform , benzene

30. OCCUPATIONAL DISEASES III. DISEASE DUE TO BIOLOGICAL AGENT Brucellosis, leptospirosis, anthrax, tetanus, encephalities, fungal infection. IV. OCCUPATIONAL CANCER Cancer of the skin, lungs, bladder V. OCCUPATIONAL DERMATOSIS Dermatitis, eczema VI. DISEASE OF PSYCHOLOGICAL ORIGIN Industrial neurosis, hypertension, peptic ulcer.

31. Occupational Health center Provision of OHC as per Factory Rules For factories employing up to 50 workers: The services of a Factory Medical Officer on retainership basis, in his clinic to be notified by the occupier. He will carry out the pre employment and periodical medical examination as stipulated in Factory rule B2N and render medical assistance during any emergency A minimum of 5 persons should be trained in first-aid procedures amongst whom at least one shall always be available during the working period A fully equipped first-aid box.

32. Provision of OHC as per Factory Rules (b) For factories employing 51 to 200 Worker. An Occupational Health Centre having a room with a minimum floor area of 15sq meter with floors and walls made of smooth and impervious surface and with adequate illumination and ventilation as well as equipment as per the schedule annexed to this Rule part-time factory Medical Officer shall be in overall charge of the Centre who shall visit the factory at least twice in a week and whose services shall be readily available during medical emergencies One qualified and trained dresser-cum-compounder on duty throughout the working period Fully equipped first aid box in all the departments

33. Occupational Health center Provision of OHC as per Factory Rules (c) For factories employing above 200 worker One fulltime Factory Medical Officer for factories employing up to 500 workers and one more Medical Officer for every additional 1000 workers. An Occupational Health Centre having at least 2 room each with a minimum floor area of 15 sq, meter with Nurse and walls made of smooth and Impervious surface and adequate illumination and ventilation as well equipment as per the schedule annexed to this Rule There the one nurse, one dresser cum-compounder and one ward boy throughout the working period. The Occupational Health Centre shall be suitably equipped to manage medical emergencies.

34. Appointment of Factory Medical officer Within one month of the appointment of a Factory Medical Officer, the occupier of the Factory shall furnish to the Chief Inspector the following particulars: Name and address of the Factory Medical Officer Qualifications Experience, if any, and The sub-rule under which appointed

35. Occupational Health Centre • Model rules under The Factories Act, 1948 (Corrected up to 01-03-2019) • Chapter: IV, Rule No: 82'O', Page: 94 • In respect of any factory carrying on 'hazardous process', there shall be provided and maintained in good order an Occupational Health Centre with the services and facilities as per scale laid down under this rule

36. Main activities at OHC First aid services Investigation for Occupational diseases Pre-employment and Periodic medical examination Notification of Diseases and Injuries Health surveillance Disaster preparedness Health education and Health Promotion Monitoring of work environment

37. Main activities at OHC Preventive and control measures for occupational diseases Occupational preventive and curative health services Liaison and Communications with other stakeholders Rehabilitation services Data collection, Records, analysis, Reporting and Research Materials and Logistics management Risk assessment and prevention of accidents

38. Occupational Health Monitoring 1. Pre-placement Medical Examination : Medical History Physical Examination Routine and special blood investigation. Urine Test Chest X Ray ECG, Echocardiography Eye and Ear Examination Ultrasonography of whole abdomen State of Mind

39. Occupational Health Monitoring 2. Periodic Medical Examination: Medical History Physical Examination Routine and special blood investigation. Urine Test Chest X Ray ECG, Echocardiography Eye and Ear Examination Ultrasonography of whole abdomen State of Mind

40. Occupational Health Monitoring 3. Medical, Health and Welfare Services : Occupational Health Centre First Aid services Immunization Ambulance Services Referral Services Family Welfare 4. Notification of diseases: • The Factories Act -1948

41. Occupational Health Monitoring 5. Monitoring of the working environment: Periodic inspection of the working environment Acquainted with raw materials, processes & products Interpersonal relationship with others 6. Health Education Programme: Health Education and Behavior Change Communication 7. Maintenance and Analysis of records: Proper records are essential Information and Communication Technologies

42. Medical Ethics in Occupational Health Monitoring Protect the privacy of the workers Health surveillance not for discrimination Medical examination, subject to the worker’s consent . Not to investigate the reasons for absence Protection of health-related data Appropriate Rehabilitation

43. Prevention of Occupational Disease Primary Prevention Health Promotion Health Education Environmental Modification Nutritional Intervention Lifestyle and Behavioral change Specific Protection Immunization Personal Protection Secondary Prevention Early Diagnosis and Management Tertiary Prevention Disability Limitation Rehabilitation

44. Engineering Measures for Prevention of Occupational Diseases Design of buildings Good Housekeeping, sanitation Good Ventilation and lighting Mechanization, Substitution Dust control, Enclosure, Isolation Personal Protective Equipment Equipment monitoring8. Research and Development

45. Legislative Measures for Prevention of Occupational Diseases The Factories Act 1948 The Employees' State Insurance Act, 1948 Health and Safety law enforcement Health and Safety Audits Accident Investigation Disaster Preparedness Injuries Reporting Safety Meeting

46. Notifiable Diseases List of notifiable diseases Lead poisoning including poisoning by any preparation or compound of lead or their sequelae. Lead tetra-ethyl poisoning. Phosphorous poisoning or its sequelae. Mercury poisoning or its sequelae. Manganese poisoning or its sequelae. Arsenic poisoning or its sequelae. Poisoning by nitrous fumes. Carbon bisulphide poisoning. Benzene poisoning, including poisoning by any of its homologues, their nitro or amido derivatives or its sequelae. Chrome ulceration or its sequelae. Anthrax. Silicosis. Poisoning by halogens or halogen derivatives of the hydrocarbons, of the aliphatic series.

47. Notifiable Diseases Pathological manifestation due to : a) Radium or other radioactive substances. b) X-rays. Primary epitheliomatous cancer of the skin. Toxic anemia. Toxic jaundice due to poisonous substances. Oil acne or dermatitis due to mineral oils and compounds containing mineral oil base. Byssinosis. Asbestosis. Occupational or contact dermatitis caused by direct contract with chemical and paints. These are of types, that is, primary irritants and allergic sensitizers. Noise induced hearing loss (exposure to high noise levels) . Beryllium poisoning. Carbon monoxide. Coal miners' pneumoconiosis. Phosgene poisoning. Occupational cancer. Isocyanates poisoning. Toxic nephritis.

48. /20 Description of Asbestos Asbestos is a generic term for a group of mineral silicates Asbestos fibers are (Length: L ≥ 5  μ m, Diameter: D < 3  μ m) : Very strong Highly flexible Resistant to breakdown by acid, alkali, water, heat, and flame Non-biodegradable Environmentally persistent

49. /20 Types of Asbestos Serpentine / Chrysotile Actinolite Amosite Anthophyllite Crocidolite Tremolite Amphibol 99%

50. /20 Current Use (Maximum) Automobile clutches Brake pads Corrugated sheeting Cement pipe Roofing materials Fireproof materials

51. /20 Past Use / Minimum Current Use Boilers and heating vessels Cement pipe Conduits for electrical wire Corrosive chemical containers Electric motor components Heat-protective pads Laboratory furniture Paper products Pipe covering Roofing products Sealants and coatings Insulation products

52. /20 Occupational Exposure to Asbestos   Auto mechanics Boilermakers Bricklayers Building Inspectors Carpenters Demolition workers Electricians Floor covering workers Furnace workers  Operating engineers Painters Pipefitters Plasterers Plumbers Roofers Refinery workers Shipyard workers

53. /20 Epidemiology Number of deaths from asbestosis is approx. 1500 per year (USA) Hospitalizations per year 10,000 to 20,000 (USA) In 2016 in the UK, 1050 new cases of asbestosis identified There is a latency period of around 20 years from time of first exposure to asbestos to development of radiographic changes Exposures to workers in Africa, Asia, and South America are significantly greater than those currently occurring in the USA, Canada, Australia and Europe

54. /20 Route of Exposure Most common exposure pathway: Inhalation of fibers Minor pathways: Ingestion Dermal contact

55. /20 Pathogenesis Asbestos fibers induce pathogenic changes via: Direct interaction with cellular macromolecules Generation of reactive oxygen species (ROS) Other cell-mediated mechanisms lead to cell injury, fibrosis, and possibly cancer Asbestos is genotoxic and carcinogenic

56. /20 Asbestos Associated Diseases Respiratory diseases: Parenchymal asbestosis Asbestos-related pleural abnormalities Lung carcinoma Pleural mesothelioma Nonrespiratory diseases: Peritoneal mesothelioma Possibly, other extrathoracic cancers Rarely, cor pulmonale or constrictive pericarditis

57. /20 Monitoring Air Sampling PEL (NIOSH): TWA 0.1 fiber/cc (8hour shift of a 40 hour workweek  Excursion limit (1.0 f/cc over 30-minute period)  Environmental Monitoring Maximum Contaminant Level (EPA): 7 MFL (million fibers per liter) > 10 μ m in length  

58. /20 Medical Monitoring Medical evaluation of all patients should include: Assessment of clinical presentation Exposure history Medical history Physical examination Chest radiograph and pulmonary function tests Radiologic and laboratory testing can include: CT or HRCT BAL Lung biopsy (rarely needed)

59. /20 Management Asbestos-associated Disease Treatment Strategy Parenchymal Asbestosis and Asbestos-Related Pleural Abnormalities Stopping additional exposure Careful monitoring to facilitate early diagnosis Smoking cessation Regular influenza and pneumococcal vaccines Pulmonary rehabilitation as needed Disability assessment Aggressive treatment of respiratory infections Lung Cancer and Mesothelioma Early diagnosis Surgery Chemotherapy Radiation

60. Silicosis  : one of the most important occupational health illnesses in the world. It is a progressive lung disease caused by inhalation of silica over a long period of time. Silicosis is characterized by shortness of breath, cough, fever and bluish skin. Silica (SiO 2  / silicon dioxide) is crystal-like mineral found in abundance in sand, rock, and quartz. Silicosis occurs most commonly as an occupational disease in people working in the quarrying, manufacturing and building construction industries. It is also reported from population with non-occupational exposure to silica dust from industrial as well as nonindustrial sources. Exposure to large amounts of free silica may not be noticed because silica is odourless, non-irritant and does not cause any immediate health effects, but long-term exposure to crystalline silica-containing dust is associated with pneumoconiosis, and progressive massive fibrosis of the lung (PMF), lung cancer, pulmonary tuberculosis, and other lung diseases and airways diseases. In India, more than 10 million workers are at risk of silicosis.

61. There are three types: Acute: Symptoms happen a few weeks up to 2 years after exposure to a large amount of silica. Chronic : Problems may not show up until decades after you’re exposed to low or moderate amounts of silica. It’s the most common type of silicosis. Symptoms may be mild at first and slowly worsen. Accelerated  : You’ll notice signs about 5 to 10 years after heavy exposure to silica. They’ll worsen quickly.

62. Who Gets Silicosis? Most people get silicosis because they’re exposed to silica dust at work. Jobs in these fields may put you at higher risk: Mining Steel industry Construction Plaster or drywall installation Glass manufacturing Road repair Sandblasting Masonry Roofing Farming

63. What Are the Symptoms? If your job exposes you, you might have early symptoms like: A nagging  cough Phlegm Trouble breathing  as an early symptom of silicosis. Later symptoms include: Trouble breathing Fatigue Weight loss Chest pain Fever  that comes on suddenly Shortness of breath Swollen legs Blue lips

64. What Causes Silicosis? Silicosis is your body’s reaction to silica dust build up in your  lungs . When you breathe in silica, the tiny particles of dust settle deeply into your  breathing  passages. Scar patches form on your lung tissue. Scarring stiffens and damages your lungs, and this makes it hard to breathe.

65. Can Silicosis Be Prevented? The simplest steps include: Limit the time you’re exposed to silica. Wear a mask or other protective clothing while you work around it. Your employer is required to provide proper safety equipment. Other ways to prevent silicosis on the job: Use blasting cabinets or proper ventilation. Use wet methods to cut, chip, or grind materials. Swap blasting material that contains silica for other types. Use respirators that protect you from inhaling silica. Don't eat or drink near silica dust. Wash your hands  and face before you eat. Shower and change clothes after work.