Occupational health

occupational hazards and there treatments

1. O C CUP A T I O NAL HEALTH 1 1 /2 / 1 5 1

2. Definition 3 " Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; The prevention of health The protection of workers in their employment

3. Objectives • The maintenance and promotion of workers’ health and working capacity • • The improvement of working environment and work to become conducive to safety and health Development of work organizations and working which promotes a positive social climate and smooth operation and may enhance productivity of the undertakings. —Joint ILO/WHO Committee on Occupational Health 11/20/15 5

4. Level of preventive measures Health promotion Specific protection Early diagnosis and treatment Disability limitation Rehabilitation

5. Ergonomics Ergon - greek word- means work Nomos - means law Fiting the job to the worker Training involves: Machine designing Tools Equipments Layout of work place Method of work environment

6. OCCUPATIONAL HAZARDS 11 /2 / 1 5 6

7. Physical hazards 1 1 /2 / 1 5 8 Heat and cold Light Noise Vibration Ultraviolet radiation Ionizing radiation

8. Burns Heat exhaustion Heat stroke Heat cramps 1 1 /2 / 1 5 9 Decreased e f f i c i enc y , Increased fatigue Enhanced accident rates. Heat Direct effects I ndirect effects

9. C o ld Chilblains Erythrocyanosis Immersion foot Frostbite as a result of cutaneous vasoconstriction. 1 1 G /2 / e 1 5 ne 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" 11/20/15 10

11. Noise (i ) Auditory effects  Temporary or permanent hearing loss (ii) Non auditory effects Nervousness, Fatigue, Interference with communication by speech, Decreased efficiency A nnoyance 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). 1 1 /2 / 1 5 14

14. Ionizing radiation 1 1 /2 / 1 5 15 The radiation hazards comprise Genetic changes Malformation Cancer Leukaemia Depilation Ulceration Sterility in extreme cases death.

15. Ionizing radiation 1 1 /2 / 1 5 16 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 1 1 /2 / 1 5 17

17. Chemical hazards 1 1 /2 / 1 5 18 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 1 1 /2 / 1 5 19

19. Chemical hazards 1 1 /2 / 1 5 20 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. 1 1 /2 / 1 5 21

21. Chemical hazards 1 1 /2 / 1 5 22 Classification of dusts Inorganic and organic dusts; Soluble and insoluble dusts.

22. Chemical hazards 1 1 /2 / 1 5 23 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).

23. Chemical hazards 1 1 /2 / 1 5 24 • Metals and their compounds Lead, antimony, arsenic, beryllium, cadmium, cobalt, manganese, mercury, phosphorus, chromium, zinc and others

24. Chemical hazards 1 1 /2 / 1 5 25 (3) Ingestion: Occupational diseases may also result from ingestion of chemical substances such as lead, mercury, arsenic, zinc, chromium, cadmium, phosphorus etc.

25. Biological hazards Brucellosis Leptospirosis Anthrax Hydatidosis Tetanus Encephalitis fungal infections Schistosomiasis h o s t o f o t he r s 2 5

26. 1 1 /2 / 1 5 27

27. Mechanical hazards 1 1 /2 / 1 5 28

28. Psychosocial hazrds 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 1 1 /2 / 1 5 29

29. Psychosocial hazrds The health effects can be classified in two Psychological and behavioural changes Psychosomatic ill health 1 1 /2 / 1 5 30

30. OCCUPATIONAL DISEASES DISEASE DUE TO PHYSICAL AGENT Heat Cold Light Pressure Noise Radiation Mechanical factors Electricity 1 1 /2 / 1 5 ARUN PIRAVOM 3

31. OCCUPATIONAL DISEASES ARUN PIRAVOM 32 11 /2 / 1 5 DISEASE DUE TO CHEMICAL AGENT G a se s • • 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

32. OCCUPATIONAL DISEASES ARUN PIRAVOM 33 11 /2 / 1 5 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.

33. PNE U M OCON I O S IS ARUN PIRAVOM 34 11 /2 / 1 5 Dusts within the range of 0.5 micron to 3 micron is a health hazard producing, after a variable period of exposure, a lung disease known as pneumoconiosis, which may gradually cripple a man by reducing his work capacity due to lung fibrosis and other complications.

34. PNEUMOCONIOSIS ARUN PIRAVOM 35 11 /2 / 1 5 Silicosis Anthracosis Byssinosis Bagassosis Asbestosis Farmers lungs

35. Silicosis Major cause of morbidity First reported in 1947 in kolar gold mines Caused by inhalation of dust containing free silica or silicon dioxide 1 1 /2 / 1 5 36

36. Incubation period may be from few mths upto 6yrs Chatageriseed by dense nodular fibrosis, 3-4 cm dia nodules SYMP : irritant cough, exertional dyspnea , chest pain Impaired TLC, Snow storm appearance in X ray Advanced condition Silico TB

37. NO TREATMENT Fibrotic changes cannot be reversed Preventio n: Dust control by substitution, complete enclosure, isolation, hydroblasting , protective gears Regular physical examination

38. Anthracosis 1 1 /2 / 1 5 39 It is caused by inhalation of dust containing coal miners. First phase is called simple pneumoc oniasis which is associated with little impairment. Second phase is characterized by Progressive massive fibrosis

39. Byssinosis Inhalation of cotton fibre dust over long periods of time . 7-8% incidence The symptoms are Chronic cough Progressive dyspnoea, Chronic bronchitis 1 • 1 /2 E / 1 5 mp h y s e m a. 3 7

40. Bagassosis Caused by inhalation of bagasse or sugar-cane dust. Bagassosis has been shown to be due to a thermophilic actinomycet for which the name The symptoms Breathlessness Cough haemoptysis 1 1 • /2 / s 1 5 l i gh t f e ver. 3 8

41. Bagassosis Preventive measures Dust control Personal protection Medical control Bagasse control 1 1 /2 / 1 5 3 9

42. Asbestosis Asbestos is of two types- serpentine or chrysolite variety and amphibole type . Clinically the disease is characterized by dyspnoea. Clubbing of fingers, Cardiac distress and cyanosis. The sputum shows " asbestos bodies " An X-ray of the chest shows a ground-glass 1 1 /2 a / 1 p 5 pea ranc e in the l o w e r t w o thi r ds o f t h e l u ng f i e lds 4

43. Asbestosis PREVENTIVE MEASURES Use of safer types of asbestos (chrysolite and amosite) Substitution of other insulants: glass fibre, mineral wool, calcium silicate, plastic foams, etc. Rigorous dust control • • Periodic examination of workers; biological monitoring (clinical, X-ray, lung function), and 1 1 • /2 / C 1 5 on tin u i n g r esea r c h . 4 1

44. Asbestosis Ground glass apperance in X ray chest 1 1 /2 / 1 5 45

45. Farmer's lung 1 1 /2 / 1 5 46 Farmer's lung is due to the inhalation of mouldy hay or grain dust.

46. LEAD POISONING MODE OF ABSORPTION INHALATION. INGESTION. SKIN 1 1 /2 / 1 5 47

47. LEAD POISONING 1 1 /2 / 1 5 48 CLINICAL PICTURE • • • • • • • • • The toxic effects of inorganic exposure abdominal colic Constipation loss of appetite blue-line on the gums stippling of red cells Anaemia wrist drop foot drop.

48. LEAD POISONING 1 1 /2 / 1 5 49 The toxic effects of organic lead compounds are mostly on the central nervous system Insomnia Headache Mental confusion Delirium.

49. 1 1 /2 / 1 5 47

50. LEAD POISONING 1 1 /2 / 1 5 51 DIAGNOSIS HISTORY CLINICAL FEATURES LABORATORY TESTS: Coproporphyrin in urine (CPU) : Amino levulinic acid in urine (ALAU) : Lead in blood and urine: • • Basophilic stipling of RBC

51. LEAD POISONING PREVENTIVE MEASURES • • • • • • • • • S ub stituti o n Isolation Local exhaust ventilation Personal protection. Good house-keeping Working atmosphere: Periodic examination of workers Personal hygiene. Health education : 1 1 /2 / 1 5 52

52. OCCUPATIONAL CANCER Skin cancer: gas workers, oil refiners, tar distillers, oven workers. Lung cancer: gas industry, nickle and chromium work, mining of radio active substance 11 /2 / 1 5 ARUN PIRAVOM 5

53. OCCUPATIONAL CANCER Bladder cancer: dye stuff, dyeing industries, rubber, gas and electrical cable industry. Leukemia: benzol, roengent rays and radioactive substance. 11/20/15 51

54. OCCUPATIONAL CANCER The control measures • • • • • • Elimination or control of industrial carcinogens. Medical examinations Inspection of factories, Notification, Licensing of establishments, Personal hygiene measures, Education of workers and management, research. 52

55. OCCUPATIONAL DERMATITIS Causes Physical Chemical Biological Plant products 11 /2 / 1 5 ARUN PIRAVOM 53

56. OCCUPATIONAL DERMATITIS PREVENTION Pre-selection Protection Personal hygiene Periodic inspection 1 1 /2 / 1 5 54

57. RADIATION HAZARDS 11 /2 / 1 5 Shielding of workers Monitoring the employees Protective clothing Adequate ventilation Replacement and periodic examination Avoidance of pregnant women to work ARUN PIRAVOM 55

58. Sickness Absenteeism 1 1 /2 / 1 5 59 Causes Economic Social Medical Non occupational causes

59. Sickness Absenteeism 1 1 /2 / 1 5 60 Prevention Good factory managementand practices Adequate preplacement examination Good human relations Application of ergonomics

60. Ac c i d e n t s Causes a. Human factors Physical Physiological (age, Sex, time, experience, working hrs) Psychological Environmental factors 1 1 /2 / 1 5 61

61. Ac c i d e n t s Prevention Adequate preplacement examination Adequate job training Continuing education • • • Ensure safe working conditions • Establishing safety department in the organization under a competent safety engineer. Periodic surveys for finding out hazards • 1 1 / 2 C / 1 a 5 r e f u l r e po r ti n g 59

62. HEALTH PROBLEM DUE TO INDUSTRIALIZATION Environmental sanitation problems Communicable disease Food sanitation Mental health Accidents and social problems Morbidity and mortality ARUN PIRAVOM 63 11 /2 / 1 5

63. MEASURES FOR HEALTH PROMOTION OF WORKERS Nutrition Communicable disease control Environmental sanitation Mental health Measures for women and children Health education Family planning ARUN PIRAVOM 64 11 /2 / 1 5

64. Nutrition Under Indian factory act, One canteen when number of employees exceeds 250 Education of workers on the value of balanced diet. 1 1 /2 / 1 5 65

65. Communicable disease control Adequate immunization against communicable diseases 1 1 /2 / 1 5 66

66. Environmental sanitation Water supply Installation of drinking water fountains Food Sanitary preparation, storage and handling of food Education of food handlers 1 1 /2 / 1 5 67

67. Environmental sanitation 1 1 /2 / 1 5 68 Toilet One sanitary convenience for 25 employees for the first 100 employees and thereafter one for 50 General plant cleanliness

68. Environmental sanitation 1 1 /2 / 1 5 69 • Sufficient space The recommended standard is of minimum of 500cuft Lighting Standards for illumination High precision work 50-75 foot candles Regular work- 6 to 12 foot candles Corridoors and passages- 0.5 foot candles

69. Environmental sanitation 1 1 /2 / 1 5 70 Ventilation, temperature Protection against hazards Housing

70. Mental health To promote the health and happiness of the workers. To detect signs of emotional stress and strain and to secure relief of stress and strain where possible The treatment of employees suffering from mental illness and the rehabilitation of those 1 1 /2 w / 1 5 h o beco m e ill. 68

71. MEASURES FOR WOMEN AND CHILDREN Expectant mothers are given maternity leave for 12 weeks, Provision of free antenatal, natal and postnatal services. The Factories Act (Section 66) prohibits night work between 7 p.m. and 6 a.m.; The Indian Mines Act (1923) prohibits work underground. The Factories Act, 1976 provides for creches in factories 1 1 / 2 w / 1 h 5 e r e m o r e t h a n 3 w o m e n w o rk e rs a r e em p l o y e d , 6 9

72. Health education 1 1 /2 / 1 5 73

73. Family planning 1 1 /2 / 1 5 74

74. PREVENTION OF OCCUPATIONAL DISEASE 1 1 /2 / 1 5 75

75. PREVENTION OF OCCUPATIONAL DISEASE MEDICAL MEASURES  Pre-placement examination  Periodical examination  Medical and health care services  Notification  Supervision of working environment  Maintenance and analysis of records  Health education and counseling ARUN PIRAVOM 76 11 /2 / 1 5

76. PREVENTION OF OCCUPATIONAL DISEASE ENGINEERING MEASURES  Design of building  Good housekeeping  General ventilation  Mechanization  Substitution ARUN PIRAVOM 77 11 /2 / 1 5

77. PREVENTION OF OCCUPATIONAL DISEASE ENGINEERING MEASURES  Dust-enclosure and isolation  Local exhaust ventilation  Protection device  Environmental monitoring  Statistical monitoring and research 11/20/15 7 5

78. PREVENTION OF OCCUPATIONAL DISEASE LEGISLATION  The Factory Act-1948  The Employees state insurance act-1948 11 /2 / 1 5 ARUN PIRAVOM 7 6

79. FACTORIES ACT,1948 1 1 /2 / 1 5 80 1. Scope For purposes of the act, a factory means an establishment, • • In which 10 or more workers have been employed during the preceding 12 months in a manufacturing process, operated on power Or In which 20 or more workers have been employed during the preceding 12 months in manufacturing process without power.

80. FACTORIES ACT,1948 Appointment and employment Inspector of factories Medical practitioners 1 1 /2 / 1 5 81

81. FACTORIES ACT,1948 2. Health, safety and Welfare. (Chapter iii, iv, ivA , v) Provisions for Industrial workers Employment provisions Welfare provisions Safety provisions Sanitary provisions 1 1 /2 / 1 5 82

82. 3. Employment of young persons Children below 14 are prohibited b/w 15- 18 adolscent - “certificate of fittness ” by the doctors/ surgeon (6am- 7pm) Restriction of women & children in dangerous job

83. 4. Hours of work Max 48 hrs/ week Not exceeding 9 hrs/day ½ hrs rest after 5 hrs of work Adolescent 4n half – 5 hrs/day 1978 ammendment Max 60 hrs a week

84. 5. Leave with wages Weekly holiday Adult- 1 day- 20days of work Adolescent- day- days of work

85. 6. Occupational diseases Information regarding accident, death ,injury 7. Employment and hazardeous process Information regarding accident, deatg injury

86. ESI ACT Employees’ State Insurance Act 1948 Passed in 1949 Amended in 1975, 84, 89 Provides benefit in cash and kind to workers in sickness, maternity, employment injury, thereby removing economic and physical fear

87. Scope All India All employee (manual, clerical, supervisory) with 7500/ mth salary Factory, restaurant, cinema, shops State govt takes responsibility to intervene 1-2.5% of salary is premium

88. Administration Governed by autonomous body “ESI Corporation” Following members Chairman, Vice Chairman, 5 repres . Of Central Govt 1 from each state govt 1 from UT 5 reprs from employee 5 “ “ employer 2 “ “ medical profession 3 MPs

89. ESI Act- Administration Chief executive officer- Director general Assisted by four principal officers Insurance commissiners Medical commissioners Finance commissioners Acturay 1 1 /2 / 1 5 83

90. Finance Regional, sub regional, local offices Contribution by employees: 1.75% of wage Contribution by employers:4.75% of wage of worker State govt: 1/8 total cost of medical expenditure ESI Corporation: 7/8 total cost of medical expenditure Govt of India: 2/3 of administrative expenditure

91. Benefits Sickness benefit Maternity Disablement Dependent Funeral Medical Rehabilitation First 5 in case, 6 th in kind Only for employee with 7500/ mth salary

92. THE EMPLOYEE STATE INSURANCE ACT,1948 1 1 /2 / 1 5 93 Sickness benefit The benefit is payable for a maximum period of 91 days , in any continuous period of 365 days, the daily rate being about 7 % of the average daily wages 34 diseases for which Extended Sickness Benefit where the insured person has been in continuous employment for 2 years:

93. THE EMPLOYEE STATE INSURANCE ACT,1948 Maternity benefit (full wage) For confinement, the duration of benefit is 2 6 weeks, for miscarriage and premature birth 6 weeks and for sickness arising out of confinement etc. 30 days. 1 1 /2 / 1 5 94

94. THE EMPLOYEE STATE INSURANCE ACT,1948 1 1 /2 / 1 5 95 Disablement benefit The rate of temporary disablement benefit is about 90 % of the wages as long as the temporary disablement lasts. In case of total permanent disablement, the insured person is given 90 % life pension on the basis of loss of earning capacity determined by a medical board

95. THE EMPLOYEE STATE INSURANCE ACT,1948 1 1 /2 / 1 5 96 Dependent’s benefit DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards . Funeral expenses The amount not exceeding Rs . 1 5000 . Rehabilitation On monthly payment of Rs 10

96. THE EMPLOYEE STATE INSURANCE ACT,1948 Medical benefit • • The services comprises out-patient care supply of drugs and dressings specialist services in all branches of medicine pathological and radiological investigations domiciliary services 1 1 ( / 6 2 ) / 1 5 a nt e n a tal , n at al a n d po s t n at al se r v ice s 85

97. THE EMPLOYEE STATE INSURANCE ACT,1948 Medical benefit immunization services family planning services emergency services ambulance services health education and in-patient treatment. 1 1 /2 / 1 5 98

98. Offensive trade: Offensive trades are premises that are used for the production and/or processing of foods that may cause some kind of offence, generally in terms of odour , environmental pollution and in general posing public health risk

99. Covers a range of potential public health risks including :  physical risk e.g. noise, mechanical hazards, radiation and vibration  chemical risk from either naturally occurring or synthetic substances or  biological risk e.g. viruses, bacteria and vermin.

100. Permit requirement No person may conduct an offensive trade in or on any premises, except in terms of a permit authorizing. Requirements for premises No person may conduct an offensive trade in or on any premises unless The floors of the premises are constructed of cement concrete or a similar impervious material, brought to a smooth finish The floors of the premises are adequately graded and drained for the disposal of effluent to an approved disposal system ; The inside walls, except where glazed or glass brick or glazed tiles are used, are plastered, brought to a smooth finish and painted with a light- coloured , washable paint The surface of any backyard or open space is paved with concrete or similar impervious material, brought to a smooth finish ; The premises are provided with adequate light and ventilation as prescribed An adequate supply of running potable water is provided. An adequate number of portable containers constructed of iron or another nonabsorbent material, equipped with closely fitting lids, are provided for the removal of all waste and waste water from the premises; Adequate means are provided for the disposal of all effluent arising from the manufacturing or other process performed on the premises Adequate accommodation is provided for the storage of all finished products , articles or materials which are used in the manufacturing or other process and which may Discharge offensive or injurious effluent or liquid; or Decompose in the course of the work or trade Adequate means are provided to control the discharge in the open air of any noxious,

101. injurious or offensive gas, fume, vapour or dust produced during any handling, preparation, drying, melting, rendering, boiling or grinding process or storage of material: K. Adequate sanitary fixtures are provided as prescribed in the National Building. Regulations and Building Standards Act 1. A perimeter wall made of brick or some other impervious material, with a minimum height of 2 meters, is constructed around the premises; 2. All gates to the premises are of solid construction with a minimum height of 2 meters; 3. All perimeter walls and gates adequately screen activities on the premises from public view 4. All materials are stacked or stored on the premises below the height of the perimeter screening 5. Adequate separate change-rooms for males and females, where five or more persons of the same sex are employed, must be provided containing - a. An adequate metal locker for every employee; b. A wash-hand basin provided with a supply of persons hot and cold potable water, c. An adequate supply of soap and disposable towels at every wash-hand basin; 6. If no change-room has been provided in terms of paragraph (p) - i A wash hand basin with a supply of running hot and cold potable water, must be provided in an accessible position; and ii . adequate metal locker must be provided for every employee in the work area. Duties of offensive traders Every offensive trader must - A. Maintain the premises in a clean, hygienic and good condition at all times; B. Maintain all walls and floors of the premises in a manner and condition that prevents the absorption of any waste or waste water; C. Maintain all machinery, plant, apparatus, furniture, fittings, tools, implements, vessels, containers, receptacles and vehicles in a clean, hygienic and good condition at all times: D. Prevent any waste accumulating on the premises; and E. Prevent the emission of noxious, injurious or offensive gases, fumes, vapours or dust generated during any handling, preparation, drying, melting , rendering, boiling or

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103. OCCUPATIONAL HEALTH TEAM O ccup ati o n a l h e a lth nurse Physiotherapist. Specialist doctor Industrial manager Supervisor 1 1 /2 / 1 5 105

104. OCCUPATIONAL HEALTH TEAM Shift in charge Rehabilitation specialist Labour welfare officer Labour union representative. Representative of voluntary organizations Other invited members as per the need 1 1 /2 / 1 5 106