Occupational health

OCCUPATIONAL HEALTH

1. OCCUPATIONAL HEALTH -RUSHIKESH .B. PAWAR II ND YEAR MSC NSG CON ,PIMS, LONI (DU)

2. Occupational health refers to the potential risks to health and safety for those who work outside the home Hazard   something that can cause harm if not controlled. Occupational disease Disease directly caused by a person’s occupation.

3. Workplace  setting in which many people spend the largest proportion of their time. exposes many workers to health hazards

4. DEFINITION:- “OCCUPATIONAL HEALTH is the promotion & maintenance of the highest degree of physical, mental & social wellbeing of the workers in all occupations”.

5. AIM “The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations"

6. OBJECTIVES OF OCCUPATIONAL HEALTH: 1. To maintain and promote the physical, mental and social well being of the workers. 2. To prevent occupational diseases and injuries. 3.  To adapt the work place and work environment to the needs of the workers i.e application of ergonomics principle. 4. It should be preventive rather than curative .

7. FUNCTIONS OF OCCUPATIONAL HEALTH SERVICE - 1. Pre-employment medical examination.   2. First Aid and emergency service.   3. Supervision of the work environment for the control of dangerous substances in the work environment.   4. Special periodic medical examination particularly for the workers in dangerous operations.   5. Health education for disseminating information on specific hazards and risks in the work environment.  

8. 6. Special examination and surveillance of health of women and children 7. Advising the employer or management for improving working conditions, and placement of hazards. 8. Monitoring of working environment for assessment and control of hazards. 9. Supervision over sanitation, hygiene and canteen facilities. 10. Liaison and cooperation with the safety committees FUNCTION OF HEALTH SERVICE -

9. FUNCTION OF HEALTH SERVICE - 10. Liaison and cooperation with the safety committees 11. Maintenance of medical records for medical check-up and follow-up for maintaining health standards and also for evaluation. 12. To carry out other parallel activities such as nutrition programme , family planning, social services recreation etc., Concerning the health and welfare of the workers.

10. Physical hazards Chemical Biological Psychosocial a. Psychological and behavioral changes. b. Psychosomatic ill-health OCCUPATIONAL HAZARDS

11. OCCUPATIONAL HAZARDS 1. Physical hazards Heat – Direct & indirect effect of high temperature, radiant heat, heat stagnation. Cold – General & local cold injury Light – Acute & chronic effect of bright & dim light & glare. Radiation Ionizing - X-rays,gamma rays,beta particles , alpha particles Non-ionizing - microwaves, infrared, and ultra-violet light Noise – Auditory & non auditory effect. Vibration – hazardous in the frequency range of 10- 500Hz

12. Diseases due to Physical agents Heat – Heat stroke, Heat hyperpyrexia, Heat syncope, Heat Exhaustion, Heat rash. Light – Occupational cataract, Miners nystagmus . Cold – Hypothermia, Frost bite, Trench foot. Pressure – Air embolism, Blast injuries. Vibration – Osteoarthritis, Reynauds disease [white fingers] Noise – Occupational deafness. Radiation - Cancer, genetic changes, Aplastic anaemia .

13. OCCUPATIONAL HAZARDS 2. Chemical hazards Acids Bases Heavy Metals – Lead Solvents – Petroleum Particulates – Asbestos, Silica and other fine dust/fibrous materials Fumes – noxious gases/vapors Highly- reactive Metals

14. Ways of acquiring Chemical Hazards A. Local action: irritants, sensitizers B. Inhalation : Dusts – organic , Inorganic Gases – Simple asphyxiants : Methane, Nitrogen, CO2. – Chemical asphyxiants : CO, Hydrogen sulphide , HCN – Irritant gases: Ammonia, – Anesthetic gases: Chloroform, Ether, Trichloroethylene. Metallic compounds C. Ingestion: Metallic compounds : Arsenic, Antimony, Beryllium, Chromium, Cadmium, Cobalt, Lead, Mercury, Manganese, Zinc.

15. Diseases due to chemical agents Gases – gas poisoning. Inorganic dusts: Coal dust - Anthracosis Silica - Silicosis. Asbestos - Asbestosis.(lung disease) Iron - Siderosis . Organic dusts : Cane fiber - Bagassosis . Cotton dust – Byssinosis . Hay or grain dust – Farmer’s lung. Chemicals – Burns, dermatitis, cancer, respiratory illness Metals – lead, mercury, arsenic, chromium cause poisoning

16. OCCUPATIONAL HAZARDS 3. Biological hazards Bacteria Viruses Fungi – molds Insects – mosquitoes Hazardous Plants – Poison Ivy Birds Animals Blood-borne Pathogens

17. Diseases due to B iological A gents Hepatitis B Virus Hepatitis C Virus Tuberculosis – particularly among Healthcare Workers Asthma – among persons exposed to organic dust Blood-borne Diseases – HIV/AIDS Anthrax Brucellosis Tetanus Leptospirosis

18. OCCUPATIONAL HAZARDS 4 . Psychosocial hazards Work-related stress – excessive working time and overwork Violence –  from outside the organization Bullying – emotional and verbal abuse Sexual Harassment Mobbing Burnout Exposure to unhealthy elements – tobacco, uncontrolled alcohol

19. Disorders due to Psychosocial Agents MSDs and work-related psychosocial factors such as high workload/demands, high perceived stress levels, low social support, low job control, low job satisfaction and monotonous work.  Musculoskeletal disorders (MSDs) can affect the body’s muscles, joints, tendons, ligaments and nerves. As well as the back, neck, shoulders and upper limbs; less often they affect the lower limbs. develop over time and are caused either by the work itself or by the employees' working environment.

20. Psychosocial Hazards Psychological hazards basically causing stress to a worker. This kind of hazard troubles an individual very much to an extent that his general well-being is affected. Psychological reactions  the individual may feel frustrated, impatient, anxious or irritable. If the situation is not addressed, the individual may become unmotivated, depressed and apathetic.

21. Psychosocial Hazards Psychological causes Directly related to the job itself: overwork, poor work organization, poor opportunity for promotion, low job responsibility and boring work. Outside pressures: financial problems, family difficulties, transport difficulties. Problems with work colleagues: conflict or bullying.

22. Disorders due to Psychological Agents Psychological Hazards resulting from stress & strain: Depression  Discouragement Boredom Anxiety Memory loss Dissatisfaction Frustration Irritability Discouragement Pessimism

23. Some Numbers... WHO - 100 million occupational injuries  0.1 million deaths in the world India  17 million occupational non-fatal injuries (17% of the world) & 45,000 fatal injuries (45% of the total deaths due to occupational injuries in world) annually 11 million cases of occupational diseases in the world  1.9 million cases (17%) contributed by India Of 0.7 million deaths in the world, 0.12 (17%) from India Adverse occupational factors have been estimated to cost 2-14% of the gross national products for various countries

24. Classification I. Diseases due to physical agents : Heat: Heat hyperpyrexia, heat exhaustion Cold : Trench foot, frost bite Light : Occupational cataract, miner’s nystagmus Pressure: Caisson disease, air embolism, blast (explosion) Noise: Occupational deafness Radiation: Cancer, leukaemia, aplastic anaemia, pancytopenia II.   Diseases due to chemical agents: Gases : Gas poisoning Pneumoconiosis Metals and their compounds: Chemicals & Solvents

25. III.   Diseases due to biological agents: Leptospirosis , anthrax, actinomycosis , tetanus IV.   Occupational cancer: Cancer of skin, lungs, bladder V.   Occupational dermatosis : Dermatitis, eczema VI.   Diseases of psychological origin: Industrial neurosis, hypertension, peptic ulcer, etc.

26. Agricultural Worker’s Diseases Farmer’s Lung a hypersensitivity pneumonitis induced by inhalation of biological dusts could progress into a potentially dangerous chronic condition. Fluid, protein and cells accumulate in the alveolar wall, slows blood-gas interchange and compromises the function of the lung. Silo filler's disease (SFD) pulmonary exposure to oxides of nitrogen – could manifest into pulmonary oedema

27. CT scan of a 44-year-old man with chronic hypersensitivity pneumonitis Farmer’s Lung

28. Circadian Rhythm Sleep Disorder Persistent/recurring pattern of sleep disruption resulting either from an altered sleep-wake schedule or an inequality between a person's natural sleep-wake cycle and the sleep-related demands placed on him/her Extrinsic: Jet Lag, Shift Work Sleep Disorder Intrinsic: Delayed sleep phase syndrome, advanced sleep phase syndrome

29. Hand-arm vibration syndrome Repeated and frequent use of hand-held vibrating tools/vibrating machinery (power drills, chainsaws, pneumatic drills) Probably due to slight but repeated injury to the small nerves and blood vessels in the fingers Raynaud's phenomenon (“white finger”) nerve symptoms, aches and pains

30. Hand-arm vibration syndrome

31. Occupational Dermatitis Inflammation of the skin caused by exposure to a substance in the workplace. Exposure usually occurs from direct contact but may, in rare circumstances, occur through the airborne route Allergic contact dermatitis - when a person becomes sensitized to a substance (allergen) Irritant contact dermatitis when the skin is exposed to a mild irritant (such as detergent or solvents) repeatedly over a long period of time or to a strong irritant (such as acids, alkalis, solvents, strong soaps, or cleansing compounds) that can cause immediate skin damage

32. Pneumoconiosis chronic lung disease caused due to the inhalation of various forms of dust particles, particularly in industrial workplaces, for an extended period of time Shortness of breath, wheezing and chronic coughing are some of the symptoms

33. Coal Workers’ Pneumoconiosis - black lung disease - exposure to particles of carbon When coal dust is inhaled for a long period of time, it builds up in the lungs, which the body is not able to remove - inflammation of the lungs - fibrosis - causes large size cavities in the lungs.

34. Asbestosis - inhalation of fibrous minerals of asbestos Bauxite fibrosis - exposure to bauxite fumes which contain aluminium and silica particles. Berylliosis  - exposure to beryllium and its compounds Siderosis , by deposition of iron in the tissue Byssinosis “brown lung disease”, caused by exposure to cotton dust in inadequately ventilated working environments Silicosiderosis , by mixed dust containing silica and iron

35. PREVENTION OF OCCUPATIONAL DISEASES.

36. Prevention Methods Medical Methods such as periodic examinations, preplacement examinations, working environment supervision and health education. Notification, maintenance and analysis of records, and counselling are also steps towards prevention. Engineering Measures such as proper design of plant, ventilation, dust isolation through enclosure and isolation, and protective devices. Legislative protection like the Factories Act of 1948 and the Employees State Insurance Act of 1948.  

37. PREVENTION OF OCCUPATIONAL DISEASES. MEASURES FOR HEALTH PROTECTION OF WORKERS . Nutrition. Communicable disease control. Environmental sanitation. Water supply Food Toilet Proper garbage & waste disposal. General plant cleanliness. Sufficient space. Lighting. Ventilation. Protection against hazards.

38. 4. Mental health: GOALS: To promote health and happiness of workers. To detect signs of stress and strain and take necessary measures. Treatment of employees suffering from mental illnesses. Rehabilitation of those who become ill. 5. Measures for women and children. 6. Family planning services 7. Health education . PREVENTION OF OCCUPATIONAL DISEASES. MEASURES FOR HEALTH PROTECTION OF WORKERS.

39. OCCUPATIONAL CANCER

40. SOME OF THE MAJOR TYPES:- 1. SKIN CANCER. 2.LUNG CANCER. 3.CANCER BLADDER. 4.LEUKAEMIA.

41. What is cancer? A malignant (“potentially lethal”) neoplasm (“new growth”) that invades normal tissues and spreads ( metastasises ) to distant sites Neoplasms are growths resulting from clonal proliferation of cells following progressive accumulation of hereditary and acquired insults resulting in mutations of genes that control cell proliferation and cell death

42. What is occupational cancer? Cancer specifically attributed to significant levels of exposure to an agent* in the workplace and occurring among substantial numbers of workers. Substantial: > 10,000 workers Significant: As much as, or more than, in the general environment * An agent that has been causally linked with development of cancer is called a carcinogen

43. What is the global and national burden of cancer? 5 million female and 6 million male new cancer cases worldwide (of which 100,000 occur in Nigeria) annually >6 million deaths worldwide annually >50% of patients with cancer live in developing countries , which have <10% of the resources for cancer therapy

44. What is the global burden of occupational cancer? POPULATION ATTRIBUTABLE FRACTION (RISK PER CENT) This is defined as the fraction (percentage) of the diseased persons in the population whose disease would have been prevented had the exposure been absent In the case of occupational cancers, a crude estimate for this percentage is between 2-10%

45. What do we know about occupational carcinogens?- 1 Exposure may be acquired via 1 INHALATION average concentration of the substance in the breathing zone over a reference period (8 hours for long-term, and 15 minutes for short-term exposure) 2 DERMAL CONTACT potential dose rate predominantly to the hands and forearms (2000 cm 2 ) is calculated using a mathematical model 3 INGESTION not quantifiable

46. GROUP 1 (DEFINITE)CARCINOGENS 40% (40) IARC group 1 carcinogens are occupational. Others include radiation, viruses and lifestyle factors PHYSICAL AGENTS ASSOCIATED CANCERS Ionizing radiation Breast cancer, leukaemia, skin cancer Unltraviolet light Skin cancer Asbestos Lung cancer, mesothelioma CHEMICAL AGENTS ASSOCIATED CANCERS Arsenic Skin cancer, lung cancer Vinyl chloride Liver angiosarcoma Aromatic amines Bladder cancer

47. GROUP 2A (PROBABLE) CARCINOGENS 30 IARC group 2A carcinogens are occupational. CHEMICAL AGENTS ASSOCIATED CANCERS Polyaromatic hydrocarbons Lung, bladder & skin cancer Wood & Fossil fuel products Skin cancer Plastic & rubber byproducts Bladder cancer Chlorinated hydrocarbons Several cancers Inorganic lead compounds Lung cancer Aromatic amine dyes (e.g. benzidine-based dyes) Bladder cancer

48. Primary prevention of occupational cancer Recognition of hazards and risks Education of management and workforce Elimination of exposure (substitution, automation) Reduction of exposure Provision of personal protective equipment Limiting access Adequate facilities for showering, changing, etc. Legislative provisions

49. Here are some hazard and safety signs

50. Rules of safety at workplace : Let me ask you a good question why the rules of occupational of safety are generated for industries. In answer there are some basic rules where by following you can reduce ratio of accident industries. Below are some major rules or I can say a quick guidance to prevent yourself from accident? 2 . HIGH RISK SITUATIONS : You cannot start up or start down any equipment without having proper knowledge of that machine. Well while doing same you may put yourself in danger . 3 . MACHINE & TOOLS : Do not carry unnecessary Tools with you if you do not have to work with that tool that may cause a physical harm . 4 . PERSONAL PROTECTIVE EQUIPMENT : These is a major part while working in industries. You have to wear a suitable PPE (Personal Safety Product) according to your work. I.e. Helmet, Hand Gloves, Safety Shoes, Respiratory System(Mask), Safety Eye Wear, etc.

51. WORK PERMITS : Do not perform work without a valid work permit. Any work performed on site requires a permit. If you do not have knowledge of that so you can be in Danger.  LIFTING : Do not walk under a load while lifting is taking place. For any work involving a crane, hoist or other mechanical system, a preliminary risk analysis is required. Equipment must be in good condition. Personnel must be qualified and access to the area must be restricted . WORK ON POWERED SYSTEMS : Do not perform work without checking that the power and product source supply has been rendered inoperative . Some works require the energy to be safely discharge or the equipment to be purged and vented. In such cases a lockout system is set up to isolate the energy or product according to a specific method . CONFINED SPACES : Do not enter a confined space until isolation has been verified and the atmosphere checked.

52. EXCAVATION WORK : Do not perform excavation work without a valid work permit comprising a map of all underground hazards. Manual or mechanical excavation work, including dragging rivers and seabeds , can only start after a risk analysis has been performed to identify all hazards in the zone and related precautions have been taken . WORKING AT HEIGHTS : Do not work at heights without a safety harness when there is no collective protective equipment . Work at heights is performed on fixed or mobile platforms with a guardrail designed for the task at hand . Work  on rooftops (buildings, reservoirs) is performed only after the roof’s solidity has been checked and appropriate protection has been set up.Ladders are a means of access only; their use must remain exceptional.

53. Employee Benefits And Services

54. THE ESI ACT - 1948 THE ACT WAS AMMENDED IN 1975, 84 & 89.The ESI act is an important measure of social security & health insurance. SCOPE : The act covers whole of India. The act covers all factories using power. The following are the areas that the act extends. Small power using factories.(10 -19 workers). Factories having 20 workers without power. Shops. Hotels & Restaurants.

55. EMPLOYEE STATE INSURRANCE SCHEME, 1948 (ESIS) ESI is a self financing social security & health insurance scheme for Indian workers.

56. Benefits to employees

57. Medical benefits The services comprise of Drugs & dressings Specialist services in all branches of medicine Pathological & radiological investigations Domiciliary services Antenatal, natal & postnatal services

58. Cntd .. Immunization services Family planning Emergency services Ambulance services Health education In-patient treatment

59. Cntd .. Other Dentures, spectacles & hearing aids Artificial limbs Special appliances Cost of medical benefit 1961-62: Rs.23.79 1969-70: Rs.58.91 1973-74: Rs.67.53 1992-93: Rs.406.78 2001-02: Rs.905

60. Sickness benefits Periodical cash payment to an insured person. Payable for a period of 91 days, in continuous period of 365 days. The daily rate are about 50% of average daily wages.

61. Cntd .. Extended sickness benefits for Infectious diseases Neoplasms Endocrine, nutritional & metabolic disorders Disorders of nervous system Disorders of CVS Chest disorders

62. Cntd .. Diseases of digestive system Orthopaedic diseases Psychosis Others

63. Maternity benefits Payable in cash to an insured woman for- Miscarriage: 6 weeks Sickness during pregnancy: 30 days Premature birth of child For confinement the duration of benefit is 12 weeks (3 months)

64. Disablement benefit Free medical treatment Temporary disablement: 70% of wages Permanent disablement: life pension

65. Dependant’s benefit Pension @ 70% of wages monthly In accordance of eligible son or daughter upto the age of 18 The benefit is withdrawn if the daughter is married earlier.

66. Funeral expenses On death of an insured person, the amount given is Rs.2500

67. Rehabilitation On monthly payment of Rs.10, the insured person & his family members continue to get medical treatment after permanent disablement or retirement.

68. Benefits to the employers Exemption from the applicability of workman’s compensation Exemption from maternity benefit Exemption from payment of medical allowance to employees & their medical care Rebate under the Income Tax Act on contribution deposited in ESI account Healthy work-force

69. THE FACTORIES ACT, 1948 Factories Act enacted in 1881. The Act amended in 1911, 1934, 1948, 1976, 1987.

70. Brief description of the Act Scope Health safety & welfare Employment of young persons Hours of work Leave of work Leave with wages Occupational diseases Employment in hazardous processes

71. ROLE OF A OCCUPATIONAL HEALTH NURSE.

72. DEFINITION O ccupational health nursing practices in the speciality of practice thus provides for & delivers health care services to the workers and workers population.

73. ROLE OF NURSE Specialist Manager Co-ordinator Advisor Health educator Counsellor Researcher

74. NURSE’S RESPONSIBILITIES Participate in health assessment program Provide nursing care to workers Counsel workers Plan participation in health programs Advise environmental sanitation Carry out nursing duties

75. Cntd .... Work co-operatively Compile records Evaluate health programs & activities

76. FUNCTIONS OF NURSE Physical & psychological assessment Prevention of occupational & non-occupational illness Provision for treatment Fostering a high level of wellness of the workers

77. OCCUPATIONAL HEALTH NURSES Occupational health nurses work in a variety of settings mainly industry, health services, commerce and education. They can be employed as independent practitioners or as part of a occupational health service team, often attached to a personnel or HR department.

78. Cont… Occupational health nurses are considered to be leaders in public health in the workplace setting. The occupational health nurse role includes: the prevention of health problems, promotion of healthy living and working conditions understanding the effects of work on health and health at work basic first aid and health screening

79. Cont.. workforce and workplace monitoring and health need assessment Health promotion Education and training Counseling and support Risk assessment and risk management