Occupational health

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

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.

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

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

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

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.

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.

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 -

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.

1. Physical hazards
2. Chemical
3. Biological
4. Psychosocial
a. Psychological and behavioral
changes.
b. Psychosomatic ill-health

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
a. Ionizing - X-rays,gamma rays,beta particles, alpha
particles
b. Non-ionizing - microwaves, infrared, and ultra-
violet light
Noise – Auditory & non auditory effect.
Vibration – hazardous in the frequency range of 10- 500Hz

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.

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

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.

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

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

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

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

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.

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.

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.

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

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

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

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.

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

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

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

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

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

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

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.

• 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

PREVENTION OF
OCCUPATIONAL DISEASES.

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.

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

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.

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

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

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

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

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%

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 cm2) is calculated using a
mathematical model
3 INGESTION
not quantifiable

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

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

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

Here are some hazard and safety signs

 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.

 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.

 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.

Employee Benefits And Services

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.

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

Benefits to employees
Medical benefits
Sickness benefits
Maternity benefits
Disablement benefits
Dependant’s benefits
Funeral expenses
Rehabilitation benefits

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

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

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

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.

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

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

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)

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

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.

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

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

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

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

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

ROLE OF A OCCUPATIONAL
HEALTH NURSE.

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

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

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

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

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

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.

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

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

Occupational health

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