Occupational health and safety

Occupational hazards, occupational health
Occupational safety and health should not be sidelined as a service delivery issue. Health worker health and well-being is an important aspect of workers’ motivation and job satisfaction, which influence productivity as well as retention. Health worker safety also affects the quality of care; caring for the caregiver should be a priority area of concern for the health system’s performance.

1. OCCUPATIONAL HEALTH & SAFETY Presented BY Priyanka Kumari M.Sc . Nursing

2. DEFINITION: “ Occupational health is the promotion & maintenance of the highest degree of physical, mental & social wellbeing of the workers in all occupations”. Hazard is, “ something that can cause harm if not controlled.” Occupational disease is, “ Disease directly caused by a person’s occupation .

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

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

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

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

7. Maintenance of medical records for medical check-up and follow-up for maintaining health standards and also for evaluation . To carry out other parallel activities such as nutrition programme, family planning, social services recreation etc., Concerning the health and welfare of the workers.

8. COMPONENTS OF OCCUPATIONAL HEALTH INDUSTRIAL HYGIENE. INDUSTRIAL DISEASE. INDUSTRIAL ACCIDENTS. INDUSTRIAL HAZARDS. INDUSTRIAL REHABILITATION. OCCUPATIONAL PSYCHOLOGY.

9. ILO RECOMMENDATION Focus on providing the following to promote health of the employees as follows: Nutrition . Prevention & control of communicable disease . Environmental sanitation. Water supply. Provision food & snacks . Toilet facilities.

10. General Plant cleanliness. Floor Space /air space (500 cu ft ) Wastage & Garbage disposal. Lighting & Ventilation. Protection against hazards. Housing . Maternity benefit. First Aid. Crèches . Family Planning. Mental Health. Health Education.

11. DIRECTIVE PRINCIPLES OF STATE POLICY INDIAN CONSTITUTION States ; “The state shall in particular direct it’s policy towards security that the health & strength of the workers, man, woman, & the tender age of children are not abused & that citizens are not forced by economic necessity to enter a vocation unsuited to their strengths ”. The state shall make provisions for securing just & humane conditions of work

12. OCCUPATIONAL HAZARDS

13. OCCUPATIONAL DISEASES 1. Diseases due to physical agents. 2. Diseases due chemical agents. 3. Diseases due to biological agents. 4. Occupational cancers. 5. Occupational dermatitis. 6. Diseases of psychological origin.

14. PHYSICAL HAZARDS • Heat and cold • Light • Noise • Vibration • Ultraviolet radiation • Ionizing radiation

15. HEAT The direct effects are: Burns Heat exhaustion Heat stroke Heat cramps The indirect effects are Decreased efficiency, Increased fatigue Enhanced accident rates.

16. COLD Chilblains Erythrocyanosis Immersion foot Frostbite as a result of cutaneous vasoconstriction . General hypothermia

17. LIGHT The acute effects of poor illumination are Eye strain, Headache, Eye pain, Lacrimation, Congestion around the cornea Eye fatigue. The chronic effects on health include " miner's nystagmus "

18. NOISE ( i ) Auditory effects Temporary or permanent hearing loss (ii ) Non auditory effects Nervousness , Fatigue , Interference with communication by speech, Decreased efficiency

19. VIBRATION Exposure to vibration may also produce injuries of the joints of the hands elbows and shoulders .

20. ULTRAVIOLET RADIATION Conjunctivitis Keratitis (welder's flash).

21. IONIZING RADIATION The radiation hazards comprise Genetic changes Malformation Cancer Leukaemia Depilation Ulceration Sterility In extreme cases death.

22. 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

23. 1)Local Action : Dermatitis, Eczema, and Ulcers Cancer by primary irritant action (2) Inhalation : Dusts Gases Metals and their compounds

24. CLASSIFICATION OF DUSTS: Inorganic and organic dusts; Soluble and insoluble dusts . GASES: Simple gases (e.g., oxygen, hydrogen), Asphyxiating gases (e.g. carbon monoxide, cyanide gas, sulphur dioxide, chlorine) Anaesthetic gases (e.g., chloroform, ether,

25. INGESTION: Occupational diseases may also result from ingestion of chemical substances such as: lead, mercury , arsenic, zinc, chromium, cadmium, phosphorus etc.

26. BIOLOGICAL HAZARDS Bacteria Viruses Fungi – molds Insects – mosquitoes Hazardous Plants – Poison Ivy Birds Animals Blood-borne Pathogens

27. Diseases due to Biological Agents 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

28. Psychosocial hazrds The health effects can be classified in two (a) Psychological and behavioural changes Frustration Lack of job satisfaction , Insecurity Poor human relationships , Emotional tension

29. (b) Psychosomatic ill health : D epression , sickness Absenteeism , Peptic ulcer, Rapid ageing, Heart disease,

30. 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

31. 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

32. 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.

33. 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

34. 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

35. 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

36. 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

37. 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

38. Prevention Methods Medical Methods Engineering Measures Legislative protection

39. MEASURES FOR HEALTH PROMOTION OF WORKERS Nutrition Communicable disease control Environmental sanitation Mental health Measures for women and children Health education Family planning

40. PREVENTION OF OCCUPATIONAL DISEASE MEDICAL MEASURES Pre-placement examination Periodical examination Medical and health care services Supervision of working environment Maintenance and analysis of records Health education and counseling

41. ENGINEERING MEASURES Design of building Good housekeeping General ventilation Mechanization Substitution Dust-enclosure and isolation Protection device Environmental monitoring

42. LEGISLATION The Factory Act.1948. The Employees State Insurance Act 1948.

43. THE FACTORIE’S ACT- 1948 HEALTH SAFETY & WELFARE: The act addresses matters as cleanliness, lighting , ventilation , treatment of waste & effluents , disposal & elimination of dust, fumes – provision of spittoons, control of temperature, supply of safe drinking water, employment of cleaners .

44. OTHER RECOMMENDATIONS INCLUDE 500 cu ft space for each worker. Precautions regarding the safety of the workers. Appointment of safety officers 1976 amendment.( 1000 or more workers.). Specific welfare measures.– washing facilities, facilities for drying & storing, facilities for sitting, first aid appliances , rest rooms, lunch rooms, canteens , crèches, welfare officer – 500 employees. ( 200 worker – canteen, 30 women – crèche .)

45. EMPLOYMENT OF CHILDREN The act prohibits employment of children below the age of 14 yrs., 15 – 18 years – Adolescents for employment should be certified by surgeon for fitness of work.( 6AM- 7PM ). The act prohibits employment of women & children in dangerous occupations .

46. HOURS OF WORK The act prescribes a maximum of 48 hrs /week not exceeding 9 hrs / day with half an hour rest after continuous work. Work – The act promotes spread over work – 10 -12 hrs work. The total working hours must not exceed incl OT- 60 hrs.

47. LEAVE WITH WAGES Workers are entitled for a leave with wages after 12 months continuous service . 1 day / 20 days – adults. 1 day / 15 days – children. The leave can be accumulated up to 30 days in adults, 40 days in children.

48. OCCUPATIONAL DISEASES . The act enlists the schedule of notifiable diseases . The act includes for provision for occupational health surveys in factories & industries .

49. EMPLOYMENT IN HAZARDOUS PROCESS The amendment act specifies procedures relating to hazardous process. The site appraisal committees is to be involved in examining the service conditions of employees involved in the hazardous process .

50. THE ESI ACT – 1948 The act was amended 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.

51. Cinemas & theatres. Road – motor transport establishments . News paper establishments. The act involves employees of all cadres ( manual, clerical, supervisory, technical drawing up to 7500/mo.

52. ESI Act- Administration ESI Corporation Chairman – The Union Ministry of labour Vice Chairman- Secretary to Govt. of India Chief executive officer- Director general Assisted by four principal officers • Insurance commissiners • Medical commissioners • Finance commissioners • Acturay

53. EXTRA BENEFITS Extended sickness' benefit. Artificial limbs/dentures/family planning. Family medical care. Protection against dismissal / discharge from service. Funeral expenses. Rehabilitation allowances. Medical facilities to dependents.

54. FINANCE --- ESI The ESI scheme is run by contributions of employers , employees & grant from central & state govt. Employee – 4.75 % of the total wage bill . Employer – 1.75 % (1.1.97). Employees getting wages below Rs 15/day are exempted from contribution.

55. BENEFITS. Medical benefits : Full medical care, out patient care , supply of drugs & dressings, specialist services in all specialties –(pathological & radiological services), ambulance services, immunization , family planning, AN,PN services, & in- patient care. ESI dispensaries : & insurance for medical practitioners in having 1000 employees. out patient & inpatient services available. Dentures , spectacles, hearing aids, artificial limbs & special appliances.

56. SICKNESS BENEFIT Cash payment to injured sick person(91 days) on certification by insurance medical officer.( 365 Days – at daily rate – 50 % of the daily wages.). Extended sickness benefit : for TB, leprosy, chronic empyema, AIDS , neoplasm, and endocrine disorder like DM and nephropathy payable upto 730 days . Maternity : Confinement services for insured women , miscarriage or sickness arising out of pregnancy. Maternity leave – 28 wks., miscarriage – 6 wks., sickness – 30 days.

57. DISABLEMENT BENEFIT : 70% of the wage for temporary disabled. Pension at partial & at full rate. DEPENDENT’S BENEFIT : Pension at the rate of 7 0 % to widows & children. And Rs 14 / day – for children up to the age of 18 or marriage . FUNERAL EXPENSES – Rs 5000 cash payment. REHABILITATION : on payment of RS 10 insured person & his family members continue to avail treatment .

58. Rules of safety at workplace 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. 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. 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.

59. SAFETY IN THE CONSTRUCTION INDUSTRY

60. WORK PERMITS : Do not perform work without a valid work permit. 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 . CONFINED SPACES: Do not enter a confined space until isolation has been verified and the atmosphere checked.

61. 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 .

62. OCCUPATIONAL HEALTH TEAM Occupational health nurse Physiotherapist. Specialist doctor Industrial manager Supervisor Shift in charge Rehabilitation specialist Labour welfare officer Labour union representative. Representative of voluntary organizations Other invited members as per the need

63. FUNCTIONS OF OCCUPATIONAL HEALTH NURSE 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. Primary prevention Secondary prevention Tertiary prevention

64. Clinician • Primary prevention • Emergency care • Treatment services • Nursing diagnosis • General Health advice and health assessment • Research and the use of evidence based practice

65. Specialist • Occupational health policy, and practice development , implementation and evaluation • Occupational health assessment • Health surveillance • Sickness absence management • Rehabilitation • Maintenance of work ability • Health and safety • Hazard identification • Risk assessment • Advice on control strategies

66. Manager Co- ordinator Adviser Health educator Counsellor Researcher

67. CONCLUSION Occupational safety and health should not be sidelined as a service delivery issue. Health worker health and well-being is an important aspect of workers’ motivation and job satisfaction, which influence productivity as well as retention. Health worker safety also affects the quality of care; caring for the caregiver should be a priority area of concern for the health system’s performance. What is good for employee health is good for patient health. The PPE Campaign represents an important approach to bringing occupational safety and health policies to practice, ensuring the well-being of the health sector’s most important resource and in turn that of the patients and populations they serve, thus helping to transform the health system at large.

68. THANK YOU…