Occupational Health: A Manual For Primary Health Care Workers

Occupational health
A manual for primary health care workers

World Health Organization
Regional Office for the Eastern Mediterranean
WHO-EM/OCH/85/E/L
Distribution: Limited
OccupaIional healIh
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21
WorId HeaIth OrganIzatIon 200T
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DesIgn by ]ohn ShImweII, EDR]EMRO
Document WHO-EM]OCH]085]E]L]04.0T]2000
Contents
Foreword 7
PreIace 9
ntroductIon T3
TraIner`s CuIde 2T
ModuIe 1
Work environment 27
T. ObjectIves 27
2. ntroductIon and basIc concepts 27
3. RecognItIon oI heaIth hazards 28
4. EvaIuatIon oI HeaIth Hazards 36
5. ControIIIng hazards 39
6. Tasks Ior traInees 40
AppendIx T.T
PotentIaIIy hazardous operatIons and assocIated aIr contamInants 4T
AppendIx T.2
An occupatIonaI hygIene survey check IIst 42
ModuIe 2
Occupational and other workrelated diseases 45
T. ObjectIves 45
3. OccupatIonaI dIseases 47
4. WorkreIated dIseases 69
ModuIe 3
Early detection of occupational diseases 77
T. ObjectIves 77
3. EarIy detectIon oI occupatIonaI dIseases caused by physIcaI Iactors 79
4. EarIy detectIon oI occupatIonaI dIseases caused by bIoIogIcaI agents 80
5. EarIy detectIon oI occupatIonaI dIseases caused by chemIcaIs 80
ModuIe 4
Occupational ergonomics 87
T. ObjectIves 87
3. ErgonomIcs: a muItIdIscIpIInary scIence 89
ModuIe 5
Stress and adverse psychological factors at work 97
T. ObjectIves 97
2. IntroductIon and basIc concepts 97
3. preventIon and controI oI stress T00
4. PrIncIpIes oI job desIgn T0T
5. Tasks Ior traInees T02
ModuIe b
Occupational safety and accident prevention 103
T. ObjectIves T03
2. ntroductIon and basIc concepts T03
3. RecordIng and InvestIgatIng accIdents T07
4. AccIdent rates T08
5. PreventIon and controI oI occupatIonaI accIdents T09
6. Tasks Ior traInees TT0
ModuIe 7
First aid and its practice 113
T. ObjectIves TT3
2. mportance oI IIrst aId TT3
3. njurIes TT3
4. Fractures TT6
5. ThermaI InjurIes TT7
6. PoIsonIng TT9
7. Haemorrhage TT9
8. Shock T20
9. mpaIred breathIng T20
T0. Tasks Ior traInees T20
ModuIe
Health education in occupational health 121
T. ObjectIves T2T
2. OccupatIonaI dIseases T2T
3. OccupatIonaI accIdents T22
4. Work envIronment and controI measures In the workpIace T24
5. PreventIon oI occupatIonaI dIseases and accIdents T26
6. LegIsIatIon T27
7. EIIects oI IIIestyIe and behavIour on heaIth T27
8. HeaIth educatIon In the workpIace T28
9. HeaIth educatIon methods and aIds T30
T0. CommunIcatIon skIIIs In heaIth educatIon T32
TT. Tasks Ior traInees T33
ModuIe 9
Epidemiology and biostatistics in occupational health 135
T. ObjectIves T35
2. deIInItIons T35
3. IostatIstIcaI data T37
4. Types oI epIdemIoIogIcaI study T38
5. Common measures oI dIsease Irequency T39
ModuIe 1U
Record keeping 143
T. ObjectIves T43
2. Purpose and types oI record T43
3. Record keepIng T45
ModuIe 11
Occupational health in special areas 147
T. MInIng T47
2. SmaIIscaIe Industry T50
3. AgrIcuIturaI and ruraI areas T52
ModuIe 12
Occupational health for women and children 159
T. WorkIng women T59
2. ChIId Iabour T65
Further readIng T73
lOREWORD
A heaIIhy workIorce Is vIIaI Ior susIaInabIe socIaI and economIc deveIopmenI on a
gIobaI, naIIonaI, and IocaI IeveI.
The cIassIc approach Io ensurIng heaIIh and saIeIy In Ihe workpIace has depended
maInIy on Ihe enacImenI oI IegIsIaIIon and InspecIIon oI workpIaces Io ensure
compIIance wIIh heaIIh and saIeIy sIandards. WhIIe IhIs approach has been eIIecIIve
In conIroIIIng many specIIIc occupaIIonaI hazards sInce Ihe IndusIrIaI RevoIuIIon, II
has noI been very eIIecIIve In Ihe pasI severaI decades, parIIcuIarIy In deveIopIng
counIrIes, Ior severaI reasons.
IIrsI, Ihe deveIopmenI oI prIvaIe enIerprIse, resuIIIng In a proIIIeraIIon oI smaII and
medIumsIzed workpIaces, has meanI IhaI In many InsIances producIIon occurs In
Ihe workers' own homes where Ihere can be serIous heaIIh hazards, IncIudIng
harmIuI dusI, chemIcaIs, noIse and heaI. InspecIIon oI such workpIaces Is IargeIy
ImpossIbIe In vIew oI Ihe Iarge numbers and wIde dIsIrIbuIIon.
Second, wIIh Ihe InIroducIIon oI new agrIcuIIuraI IechnIques, agrIcuIIure has
become an IndusIry Ior whIch sysIems based on InspecIIon are InadequaIe. There Is
a need Io deveIop oIher sysIems Io proIecI Ihe heaIIh oI agrIcuIIuraI workers.
ThIrd, occupaIIonaI heaIIh probIems have graduaIIy Increased In Iype and magnIIude
and have Ied Io or aggravaIed dIseases resuIIIng Irom exposure Io severaI rIsk
IacIors, onIy one oI whIch beIng Ihe work envIronmenI. LxampIes IncIude chronIc
obsIrucIIve puImonary dIsease whIch Is maInIy caused by smokIng buI may be
aggravaIed by IrrIIanI gases or dusIs In Ihe workpIace. Lowback paIn syndrome has
severaI rIsk IacIors IncIudIng rheumaIIc dIsorders, scoIIosIs and InapproprIaIe
posIure aI work.
The DecIaraIIon oI AImaAIa In 1978 Ied Io Ihe recognIIIon oI Ihe ImporIance oI
prImary heaIIh care (PHC) workers and communIIy heaIIh workers In brIngIng heaIIh
care Io where peopIe IIve and work. PHC and communIIy heaIIh care workers In mosI
deveIopIng counIrIes are noI IraIned In Ihe specIaI needs oI workers nor In Ihe
sImpIe measures IhaI can be Iaken Io prevenI or overcome and conIroI many
workers' heaIIh probIems.
WorId HeaIIh AssembIy resoIuIIon WHA 40.28 (1987) requesIed Ihe DIrecIor
GeneraI oI Ihe WorId HeaIIh OrganIzaIIon "Io deveIop guIdeIInes on IraInIng oI PHC
workers In occupaIIonaI heaIIh". The RegIonaI CommIIIee Ior Ihe LasIern
MedIIerranean aI IIs S8Ih sessIon In 1991 passed resoIuIIon LM/RC.S8/R.8 urgIng
Member SIaIes In Ihe RegIon Io "IncIude In prImary heaIIh care servIces eIemenIs oI
occupaIIonaI heaIIh". In response, Ihe RegIonaI OIIIce, Ihrough a RegIonaI
ConsuIIaIIon (Amman, |ordan, 26-29 May, 1997) caIIed Ior Ihe deveIopmenI oI a
IraInIng manuaI whIch wouId enabIe PHC workers and communIIy heaIIh workers
Io recognIze Ihe mosI common hazards In Ihe workpIace, know how Io prevenI and
conIroI Ihem and use Ihe supporI sysIem avaIIabIe Io Ihem Ior reIerraI and
consuIIaIIon.
HIghIy quaIIIIed experIs In Ihe IIeId oI occupaIIonaI heaIIh have conIrIbuIed Io Ihe
deveIopmenI oI IhIs manuaI, whIch we hope wIII meeI Ihe needs oI Member SIaIes
OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
In IheIr eIIorIs Io IncIude occupaIIonaI heaIIh In Ihe PHC servIces. I hope IhIs sImpIe,
IaskorIenIed pubIIcaIIon wIII be useIuI noI onIy Ior PHC workers and IheIr IraIners
aI aII IeveIs buI aIso Ior aII specIaIIsIs and InIeresIed auIhorIIIes.
HusseIn A. GezaIry MD, IRCS
WHO RegIonaI DIrecIor Ior Ihe LasIern MedIIerranean
PRElACE
WHO poIIcy has, sInce IIs IoundaIIon, aIways IncIuded eIemenIs oI occupaIIonaI
heaIIh Issues. Numerous key WHO documenIs and bodIes, e.g. Ihe WHO
ConsIIIuIIon, Ihe DecIaraIIon oI AIma AIa, Ihe HeaIIh Ior AII SIraIegy, Ihe GeneraI
Programmes oI Work and severaI resoIuIIons oI Ihe WorId HeaIIh AssembIy, WHO's
GIobaI HeaIIhy Work Approach (HWA), Ihe meeIIngs oI Ihe neIwork oI WHO
CoIIaboraIIng CenIres In OccupaIIonaI HeaIIh, Ihe LxecuIIve Board, Ihe RegIonaI
CommIIIee Ior Ihe LasIern MedIIerranean RegIon and oIher RegIonaI CommIIIees,
have aII emphasIzed Ihe need Io proIecI and promoIe heaIIh and saIeIy aI work
Ihrough Ihe prevenIIon and conIroI oI hazards In Ihe work envIronmenI and Ihrough
Ihe promoIIon oI heaIIh and Ihe work capacIIy oI workIng peopIe.
The WHO GIobaI SIraIegy Ior OccupaIIonaI HeaIIh Ior AII, deveIoped Ihrough Ihe
gIobaI neIwork oI Ihe WHO CoIIaboraIIng CenIres In OccupaIIonaI HeaIIh provIdes
an ImporIanI mechanIsm Ior proIecIIng and promoIIng heaIIh aI work.
AccordIng Io Ihe DecIaraIIon oI AImaAIa, 1978: "PrImary heaIIh care ... Is Ihe IIrsI
IeveI oI conIacI oI IndIvIduaIs, Ihe IamIIy and communIIy wIIh Ihe naIIonaI heaIIh
sysIem brIngIng heaIIh care as cIose as possIbIe Io where workers IIve and work,
and consIIIuIes Ihe IIrsI eIemenI oI a conIInuIng heaIIh care process."
Workers are IhereIore an InIegraI parI In Ihe body oI Ihe DecIaraIIon. In addIIIon,
Ihe WorId HeaIIh AssembIy has repeaIedIy requesIed Member SIaIes Io gIve workers'
heaIIh a hIgh prIorIIy In Ihe overaII programme oI work and Io IncorporaIe II as an
essenIIaI componenI oI PHC.
There are dIIIerenI IeveIs oI PHC workers: docIors In charge oI occupaIIonaI heaIIh,
dedIcaIed heaIIh care personneI wIIh backgrounds In generaI educaIIon, heaIIh
assIsIanIs, such as nurses and heaIIh IechnIcIans especIaIIy IraIned In occupaIIonaI
heaIIh, and quaIIIIed workers wIIh vocaIIonaI IraInIng backgrounds.
There are many sIraIegIes In common beIween PHC and occupaIIonaI heaIIh. In IacI,
an adequaIe InpIanI occupaIIonaI heaIIh servIce meeIs aImosI aII Ihe prIncIpIes oI
PHC as IoIIows.
HealIh educaIion and communiIy parIicipaIion
These are IundamenIaI aspecIs oI PHC and equaIIy basIc In occupaIIonaI heaIIh, I.e.
Io educaIe workers In saIeIy and heaIIh, seIIcare and heaIIhy IIIesIyIe Ior prevenIIon
oI dIsease and promoIIon oI heaIIh and Io promoIe workers' parIIcIpaIIon In
prevenIIve programmes In Ihe workpIace whIch Is a counIerparI oI "communIIy
parIIcIpaIIon".
PrevenIion ol healIh hazards aI Ihe source
A prImary prIncIpIe In PHC and occupaIIonaI heaIIh. In occupaIIonaI heaIIh,
IdenIIIIcaIIon oI saIeIy and heaIIh hazards Is IundamenIaI. RIsk evaIuaIIon agaInsI
hygIenIc sIandards Is a known pracIIce and conIroI aI Ihe source Is Ihe prImary
objecIIve.
1U OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
Team work
A requIremenI In Ihe PHC approach whIch becomes more specIIIc In occupaIIonaI
heaIIh pracIIce where Ihe envIronmenIaI hygIenIsI In Ihe workpIace, Ihe
occupaIIonaI physIcIans, nurses, saIeIy supervIsors, Ihe empIoyers and workers'
represenIaIIves comprIse Ihe occupaIIonaI heaIIh Ieam. II Is even IegaIIzed In mosI
counIrIes Ihrough "occupaIIonaI heaIIh and saIeIy commIIIees" whIch usuaIIy
comprIse IhIs Ieam.
NaIIonaI occupaIIonaI heaIIh programmes requIre cooperaIIon and Ieam work
among Ihe naIIonaI heaIIh servIces: mInIsIrIes oI heaIIh, educaIIon, envIronmenI,
IndusIry, Iabour, socIaI securIIy and oIIen Ihe mInIsIry oI agrIcuIIure.
EquiIy
OccupaIIonaI heaIIh care does noI dIscrImInaIe among workIng peopIe. II caIIs Ior
equaI heaIIh care Ior Ihe underserved and IrIes Io remove any dIscrImInaIIon
beIween whIIe coIIar and oIher workers as weII as beIween women and men.
AccessibiliIy
There Is noIhIng more accessIbIe In Ihe heaIIh care sysIem Ihan Ihe InpIanI heaIIh
servIce. LIIorIs Io make occupaIIonaI heaIIh care accessIbIe Io remoIe areas as weII
as Io underserved workIng peopIe are whaI Is now requIred.
AllordabiliIy
OccupaIIonaI heaIIh Is aIIordabIe. The esIabIIshmenI oI an occupaIIonaI heaIIh
servIce shouId sIarI In Ihe earIy sIages oI deveIopIng IacIorIes and IndusIrIaI pIanIs.
II Is possIbIe Io use sImpIe IechnoIogy, e.g. dIrecI readIng equIpmenI, such as a noIse
meIer, and Io IoIIow a basIc prevenIIve programme. WIIh earIy deIecIIon mosI
dIseases are prevenIabIe resuIIIng In Ihe mInImIzIng oI Ihe cosIs oI Iherapy.
However, Ihere are some occupaIIonaI dIseases whIch are noI amenabIe Io
IreaImenI, e.g. sIIIcosIs.
ConIribuIion Io Ihe naIional economy
There Is no heaIIh programme IhaI conIrIbuIes more Io Ihe naIIonaI economy Ihan
IhaI aImIng aI a heaIIhy workIng producIIve popuIaIIon. PrevenIIve occupaIIonaI
heaIIh maInIaIns workers' producIIvIIy. HeaIIhy workers Increase IndusIrIaI ouIpuI
and Iower Ihe cosI oI producIIon and, Ihrough IheIr Incomes, Ihey can conIrIbuIe Io
Ihe heaIIh oI IheIr IamIIIes and IheIr communIIIes. Workers consIIIuIe a Iarge secIor
oI Ihe popuIaIIon. II Is noI possIbIe Ior a naIIon Io survIve when IIs Iabour Iorce Is
weak and III.
The goaIs oI IhIs manuaI are:
Io creaIe a caIegory oI heaIIh personneI IhaI Is weII orIenIed In occupaIIonaI
heaIIh pracIIce In order Io IIII Ihe gap In occupaIIonaI heaIIh personneI and
coverage Ior workIng peopIe; and
OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers 11
by IoIIowIng Ihe PHC approach, Io emphasIze Ihe prevenIIve objecIIve oI
occupaIIonaI heaIIh servIces In Ihe workpIace.
The manuaI ouIIInes a currIcuIum Ior IraInIng oI PHC workers/communIIy heaIIh
workers. The IraInIng programme can be adjusIed as requIred dependIng on Ihe
IeveI oI IraInees; Ior exampIe, II can be upgraded Ior generaI pracIIIIoners or
sImpIIIIed Ior workers In Ihe workpIace.
AcknowledgemenIs
The RegIonaI OIIIce Ior Ihe LasIern MedIIerranean Ihanks WHO headquarIers Ior
Ihe IInancIaI conIrIbuIIon whIch enabIed Ihe pubIIcaIIon oI IhIs manuaI and
graIeIuIIy acknowIedges Ihe proIessIonaI conIrIbuIIons and advIce gIven by Ihe
IoIIowIng IndIvIduaIs:
Dr IN Ababneh, OccupaIIonaI HeaIIh Programme Manager, MInIsIry oI HeaIIh,
Amman, |ordan.
Dr S ArnaouI, RegIonaI AdvIser, HeaIIh oI SpecIaI Groups, WHO RegIonaI OIIIce Ior
Ihe LasIern MedIIerranean.
Dr H Bashor, AssocIaIe ProIessor oI LpIdemIoIogy, DeparImenI oI CommunIIy
MedIcIne, IacuIIy oI MedIcIne, Damascus UnIversIIy, SyrIan Arab RepubIIc.
Dr G LIjkemans, OccupaIIonaI and LnvIronmenIaI HeaIIh DeparImenI, ProIecIIon oI
Ihe Human LnvIronmenI, WHO headquarIers, Geneva.
Dr MA LI BaIawI, Iormer ChIeI oI OccupaIIonaI HeaIIh, WHO headquarIers, Geneva.
Dr GH LI Samra, ProIessor, DeparImenI oI IndusIrIaI MedIcIne and OccupaIIonaI
DIseases, IacuIIy oI MedIcIne, UnIversIIy oI CaIro, LgypI.
Dr AM Lmara, ProIessor oI OccupaIIonaI MedIcIne, IacuIIy oI MedIcIne, UnIversIIy
oI CaIro, LgypI.
Dr ZI IakhrI, OccupaIIonaI HeaIIh DeparImenI, MInIsIry oI HeaIIh, RIyadh, SaudI
ArabIa.
Dr AA Iarshad, MInIsIry oI HeaIIh and MedIcaI LducaIIon, Teheran, IsIamIc RepubIIc
oI Iran.
Dr H IrumkIn, AssocIaIe ProIessor oI LnvIronmenIaI and OccupaIIonaI HeaIIh,
RoIIIns SchooI oI PubIIc HeaIIh, Lmory UnIversIIy, GeorgIa, USA.
Dr G HaIez, SpecIaI AdvIser Io Ihe RegIonaI DIrecIor, Iormer DIrecIor, HeaIIh
ProIecIIon and PromoIIon, WHO RegIonaI OIIIce Ior Ihe LasIern MedIIerranean,
CaIro, LgypI.
Dr R HeImer, DIrecIor, ProIecIIon oI Ihe Human LnvIronmenI (PHL), WHO
headquarIers, Geneva.
Dr MA KhaIII, Iormer DIrecIor, HeaIIh ProIecIIon and PromoIIon, WHO RegIonaI
OIIIce Ior Ihe LasIern MedIIerranean, CaIro, LgypI.
12 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
Dr R MahaInI, RegIonaI CoordInaIor, IamIIy and CommunIIy HeaIIh, WHO RegIonaI
OIIIce Ior Ihe LasIern MedIIerranean, CaIro, LgypI.
Dr MI MIkheev, Iormer ChIeI oI OccupaIIonaI HeaIIh, WHO headquarIers, Geneva.
Dr MH NoweIr, ProIessor, IndusIrIaI LngIneerIng DeparImenI, KIng AbdeI AzIz
UnIversIIy, |eddah, SaudI ArabIa.
Dr P Rookmaaker, ProIessor, InIernaIIonaI LrgonomIcs AssocIaIIon, The
NeIherIands.
Mr AS KaIeem, SpecIaIIsI In WorkIng CondIIIons and LnvIronmenI, InIernaIIonaI
Labour OrganIsaIIon, NorIh AIrIca MuIIIdIscIpIInary AdvIsory Team (ILO/NAMAT),
CaIro, LgypI.
lNTRODUCTlON
OccupaIional healIh: a deliniIion
OccupaIIonaI heaIIh Is a muIIIdIscIpIInary acIIvIIy aImed aI:
Ihe proIecIIon and promoIIon oI Ihe heaIIh oI workers by prevenIIng and
conIroIIIng occupaIIonaI dIseases and accIdenIs and by eIImInaIIng occupaIIonaI
IacIors and condIIIons hazardous Io heaIIh and saIeIy aI work;
Ihe deveIopmenI and promoIIon oI heaIIhy and saIe work, work envIronmenIs
and work organIzaIIons;
Ihe enhancemenI oI Ihe physIcaI, menIaI and socIaI weIIbeIng oI workers and
supporI Ior Ihe deveIopmenI and maInIenance oI IheIr workIng capacIIy, as
weII as proIessIonaI and socIaI deveIopmenI aI work;
enabIIng workers Io conducI socIaIIy and economIcaIIy producIIve IIves and Io
conIrIbuIe posIIIveIy Io susIaInabIe deveIopmenI.
OccupaIIonaI heaIIh has graduaIIy deveIoped Irom a monodIscIpIInary, rIsk
orIenIed acIIvIIy Io a muIIIdIscIpIInary and comprehensIve approach IhaI consIders
an IndIvIduaI's physIcaI, menIaI and socIaI weIIbeIng, generaI heaIIh and personaI
deveIopmenI.
lnIeracIion beIween work and healIh
The socIaI and economIc ImporIance oI work receIves consIderabIe aIIenIIon
because a prImary IuncIIon oI work In any socIeIy Is Io produce and dIsIrIbuIe goods
and servIces. Iar Iess aIIenIIon Is paId Io Ihe ImporIance oI work Io Ihe IndIvIduaI,
yeI II Is cIear Irom recenI research IhaI work pIays a crucIaI and perhaps unparaIIeIed
psychoIogIcaI roIe In Ihe IormaIIon oI seIIesIeem and a sense oI order. Work Is a
powerIuI Iorce In shapIng a person's sense oI IdenIIIy. II can Iend vIIaIIIy Io exIsIence
and esIabIIshes Ihe cycIIcaI paIIerns oI day, week, monIh and year. II Is beIIeved
IhaI work Ior whIch Ihere Is no economIc gaIn, such as chIId care, care Ior Ihe aged
and voIunIary work, aIso has IIs rewards and conIrIbuIes Io personaI graIIIIcaIIon.
PosiIive healIh ellecIs ol work
T\o-\n) ntcncton
There Is a conIInuous Iwoway InIeracIIon beIween a person and Ihe physIcaI and
psychoIogIcaI workIng envIronmenI: Ihe work envIronmenI may InIIuence Ihe
person's heaIIh eIIher posIIIveIy or negaIIveIy and producIIvIIy Is, In Iurn, InIIuenced
by Ihe worker's sIaIe oI physIcaI and menIaI weIIbeIng. Work, when II Is weII
adjusIed and producIIve, can be an ImporIanI IacIor In heaIIh promoIIon, e.g.
parIIaIIy dIsabIed workers may be rehabIIIIaIed by underIakIng Iasks suIIed Io IheIr
physIcaI and menIaI IImIIaIIons and, In IhIs way, may subsIanIIaIIy Increase IheIr
workIng capacIIy. However, Ihe IacI IhaI work can have a posIIIve InIIuence on heaIIh
has noI yeI been IuIIy expIoIIed; knowIedge oI work physIoIogy and ergonomIcs
needs Io be IurIher deveIoped and appIIed Io beneIII worker's heaIIh.
HcntI Inznd:
When work Is assocIaIed wIIh heaIIh hazards, II may cause occupaIIonaI dIsease, be
one oI Ihe muIIIpIe causes oI oIher dIsease or may aggravaIe exIsIIng IIIheaIIh oI
nonoccupaIIonaI orIgIn. In deveIopIng counIrIes, where work Is becomIng
IncreasIngIy mechanIzed, a number oI work processes have been deveIoped IhaI
IreaI workers as IooIs In producIIon, puIIIng IheIr heaIIh and IIves aI rIsk. The
occupaIIonaI heaIIh Iessons Iearned durIng Ihe IndusIrIaI RevoIuIIon shouId be
borne In mInd In pIannIng Ior heaIIh In deveIopIng counIrIes II such probIems are Io
be avoIded.
Uncno)ncnt
|ob Ioss may adverseIy aIIecI a worker's physIoIogIcaI and menIaI heaIIh. II
unempIoymenI persIsIs, Ihe person's heaIIh conIInues Io decIIne and chronIc
dIsorders can appear. The menIaI and IInancIaI dIsIress caused by Ihe job Ioss can
spread Io oIher IamIIy members. In a deveIopIng counIry, job Ioss can have proIound
eIIecIs IhaI spread beyond Ihe worker's own IamIIy sInce, where Ihere Is IImIIed
paId empIoymenI, a person In a weIIpaId job exerIs an ImporIanI InIIuence In Ihe
communIIy. In addIIIon Io havIng an obvIous economIc InIIuence and hIgh socIaI
sIandIng, such a worker may serve as a good source oI heaIIh InIormaIIon and seI
an exampIe wIIh a heaIIhy IIIesIyIe. Loss oI empIoymenI Ior such a person can aIso
aIIecI Ihe ImmedIaIe communIIy as weII as Ihe person's IamIIy. A worker's heaIIh
may aIso suIIer weII beIore Ihe acIuaI job Ioss. BoIh IeeIIngs oI job InsecurIIy and
knowIedge oI ImpendIng job Ioss have been assocIaIed wIIh menIaI and physIcaI
heaIIh compIaInIs.
SImIIarIy, Ihose who have never had Ihe opporIunIIy Io be empIoyed, e.g. because oI
unavaIIabIIIIy oI jobs, have no chance Io deveIop an IdenIIIy or sense oI beIongIng
Ihrough work whIch Is ImporIanI Ior psychoIogIcaI and socIaI weIIbeIng. Such
peopIe are noI accessIbIe Io heaIIh messages In Ihe workpIace and may be unaware
oI Ihe posIIIve reIaIIonshIp beIween work and heaIIh. In addIIIon, because Ihey have
a IoI oI Iree IIme, someIImes assocIaIed wIIh anxIeIy and depressIon, Ihe never
empIoyed are more IIkeIy Ihan Ihose In empIoymenI Io consume aIcohoI, cIgareIIes
and drugs.
HealIh, workplace, economy and susIainable developmenI
The mosI successIuI economIes have demonsIraIed IhaI workpIaces desIgned
accordIng Io good prIncIpIes oI occupaIIonaI heaIIh, saIeIy and ergonomIcs are aIso
Ihe mosI susIaInabIe and producIIve. In addIIIon, a heaIIhy economy, hIgh quaIIIy
oI producIs or servIces and IongIerm producIIvIIy are dIIIIcuII Io achIeve In poor
workIng condIIIons where workers are exposed Io heaIIh and saIeIy hazards.
PrIncIpIe 1 oI Ihe RIo DecIaraIIon on LnvIronmenI and DeveIopmenI (UnIIed NaIIons
ConIerence on LnvIronmenI and DeveIopmenI, RIo de |aneIro, 1992) sIaIes: "Human
beIngs are aI Ihe cenIre oI concern Ior susIaInabIe deveIopmenI. They are enIIIIed
Io a heaIIhy and producIIve IIIe In harmony wIIh naIure". SusIaInabIe deveIopmenI
Is deIIned as a sIraIegy Io "meeI Ihe needs oI Ihe presenI worId popuIaIIon wIIhouI
causIng adverse eIIecI on heaIIh and on Ihe envIronmenI, and wIIhouI depIeIIng or
endangerIng Ihe gIobaI resource base, hence wIIhouI compromIsIng Ihe abIIIIy oI
IuIure generaIIons Io meeI IheIr needs".
In Ierms oI occupaIIonaI heaIIh, Ihe above prIncIpIes mean Ihe saIIsIacIIon oI
maIerIaI needs Ihrough work and oIher producIIon processes wIIhouI causIng
danger Io human heaIIh, Ihe ecosysIem, Ihe resource base or Ihe heaIIh oI Ihe
communIIy, eIIher In Ihe shorI Ierm or Ihe Iong Ierm. OccupaIIonaI heaIIh Is a basIc
eIemenI and consIIIuIes a socIaI and heaIIh dImensIon oI Ihe prIncIpIe oI susIaInabIe
deveIopmenI.
OccupaIIonaI heaIIh Is aI Ihe cenIre oI susIaInabIe deveIopmenI In Ihe IoIIowIng
ways.
The prevenIIon oI occupaIIonaI accIdenIs, InjurIes and dIseases and Ihe
proIecIIon oI workers agaInsI physIcaI and psychoIogIcaI overIoad ImpIy
approprIaIe use oI resources, mInImIzIng Ihe unnecessary Ioss oI human and
maIerIaI resources.
The objecIIve oI heaIIhy and saIe work envIronmenIs caIIs Ior Ihe use oI saIe,
Iowenergy, IowIoxIcemIssIon, IowwasIe (green) IechnoIogy, and In many
counIrIes occupaIIonaI heaIIh IegIsIaIIon requIres Ihe use oI Ihe besI avaIIabIe
producIIon IechnoIogy.
The occupaIIonaI heaIIh approach may IacIIIIaIe undIsIurbed producIIon IhaI
Increases Ihe quaIIIy oI producIs, producIIvIIy and process managemenI and
heIps Io avoId unnecessary Ioss oI energy and maIerIaIs and Io prevenI an
unwanIed ImpacI on Ihe envIronmenI.
Many envIronmenIaI hazards and burdens are derIved Irom occupaIIonaI
seIIIngs, e.g. IndusIry, agrIcuIIuraI pracIIces, IransporIaIIon and servIces.
Those responsIbIe Ior occupaIIonaI heaIIh and saIeIy are weII InIormed oI
processes and agenIs IhaI may be hazardous Io Ihe envIronmenI. OIIen IhIs
InIormaIIon Is avaIIabIe Io Ihem Irom Ihe earIIesI sIage oI a probIem enabIIng
prImary prevenIIon whIch Is no Ionger possIbIe once Ihe hazardous eIemenIs
are reIeased InIo Ihe generaI envIronmenI.
The ImpacI oI occupaIIonaI heaIIh on envIronmenIaI proIecIIon Irom IndusIry
Is IIkeIy Io be boIh eIIecIIve and cosIeIIecIIve. In many IndusIrIaIIzed counIrIes
Ihere are moves Io make cIoser IInks beIween occupaIIonaI heaIIh and
envIronmenIaI heaIIh approaches.
OccupaIIonaI heaIIh servIces aIm Io ensure workers' heaIIh, saIeIy, workIng
capacIIy and weIIbeIng. A heaIIhy, producIIve and weII moIIvaIed workIorce Is
Ihe key agenI Ior overaII socIoeconomIc deveIopmenI. In addIIIon, hIghquaIIIy
and producIIve work ensures heaIIhy producIIon oI maIerIaIs, goods and
servIces and Ihe consIderaIIon and pracIIcaI ImpIemenIaIIon oI Ihe prIncIpIes
oI susIaInabIe deveIopmenI.
MosI envIronmenIaI heaIIh hazards IhaI have IaIer been Iound Io aIIecI Ihe
heaIIh oI Ihe generaI popuIaIIon were IIrsI deIecIed In Ihe work envIronmenI.
The occupaIIonaI envIronmenI provIdes an earIy warnIng sysIem Ior cerIaIn
1b OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
1
In) dctccton o IcntI nnncnt n occuntonn cxo:uc to IcntI Inznd:. Kcot o n
WHO 5tud) Cou. Geneva, WorId HeaIIh OrganIzaIIon, 197S (WHO TechnIcaI ReporI SerIes No.
S71).
envIronmenIaI heaIIh hazards jusI as II aIso provIdes eIIecIIve modeIs Ior
prevenIIve acIIon.
Ior many aduIIs Ihe work envIronmenI Is Ihe mosI demandIng envIronmenI In
Ierms oI physIcaI, chemIcaI, ergonomIc or psychoIogIcaI sIresses and physIcaI
workIoad. The prIncIpIe oI Ihe RIo DecIaraIIon wIIh regard Io a heaIIhy and
producIIve IIIe Is parIIcuIarIy reIevanI Io Ihe work envIronmenI and caIIs Ior
occupaIIonaI heaIIh acIIon.
The sIaIe oI Ihe generaI envIronmenI and Ihe ecosysIem has an ImpacI on Ihe
heaIIh oI workers eIIher dIrecIIy or IndIrecIIy In severaI occupaIIons, e.g.
agrIcuIIure, mInIng, IIshery and manuIacIurIng. There Is a Iwoway reIaIIonshIp
beIween occupaIIonaI heaIIh and saIeIy on Ihe one hand, and occupaIIonaI
heaIIh and sound envIronmenIaI deveIopmenI on Ihe oIher.
LquaIIy ImporIanI Ior personaI weIIbeIng and Ior socIoeconomIc deveIopmenI
oI communIIIes and counIrIes Is an empIoymenI poIIcy IhaI ensures access Io
work Ior everyone and enabIes IndIvIduaIs Io susIaIn IhemseIves and IheIr
IamIIIes. HIghesI possIbIe empIoymenI Is aIso a key IacIor In Ihe saIe, sIabIe
and susIaInabIe socIaI deveIopmenI oI counIrIes, whIIe hIgh unempIoymenI
raIes and oIher assocIaIed probIems endanger such deveIopmenI.
In deveIopIng counIrIes, Ihe heaIIh and weIIbeIng oI Ihe IamIIy Is crIIIcaIIy
dependenI on Ihe heaIIh and producIIvIIy oI IIs workIng member, Ihus makIng
severaI members oI Ihe communIIy dependenI on Ihe heaIIh oI Ihe worker. In
a sIIuaIIon where organIzed socIaI proIecIIon Is IackIng, Ihe Ioss oI heaIIh, IIIe
or workIng capacIIy oI such a key member oI Ihe IamIIy oIIen means severe
crIsIs Ior Ihe resI oI Ihe IamIIy, aIIecIIng IndIrecIIy Ihe weIIbeIng, heaIIh and
economy oI communIIIes aI Iarge and oI IuIure generaIIons.
OccupaIIonaI heaIIh Is a basIc eIemenI and consIIIuIes a socIaI and heaIIh dImensIon
oI Ihe prIncIpIe oI overaII deveIopmenI. OccupaIIonaI heaIIh pracIIces consIIIuIe a
seI oI key acIIvIIIes Ior such deveIopmenI.
Work as a lacIor in healIh promoIion
WHO deIInes heaIIh as a sIaIe oI compIeIe physIcaI, menIaI and socIaI weIIbeIng
and noI mereIy Ihe absence oI dIsease or InIIrmIIy. AccordIng Io Ihe WHO SIudy
Group on LarIy DeIecIIon oI HeaIIh ImpaIrmenI In OccupaIIonaI Lxposure Io HeaIIh
Hazards:
HeaIIh ... connoIes raIher a way oI IuncIIonIng wIIhIn one's envIronmenI (work,
recreaIIon, IIvIng). II noI onIy means Ireedom Irom paIn or dIsease, buI aIso
Ireedom Io deveIop and maInIaIn one's IuncIIonaI capacIIIes. HeaIIh deveIops
and Is maInIaIned Ihrough InIeracIIon beIween Ihe genoIype and Ihe IoIaI
envIronmenI. The work envIronmenI consIIIuIes an ImporIanI parI oI man's
IoIaI envIronmenI, so heaIIh Is Io a Iarge exIenI aIIecIed by work condIIIons.
1

HeaIIh promoIIon was deIIned by Ihe OIIawa CharIer Ior HeaIIh PromoIIon, 1986, as:
... Ihe process oI enabIIng peopIe Io Increase conIroI over, and Io Improve, IheIr
heaIIh. To reach a sIage oI compIeIe physIcaI, menIaI and socIaI weIIbeIng, an
IndIvIduaI or group musI be abIe Io IdenIIIy and Io reaIIze aspIraIIons, Io saIIsIy
needs, and Io change or cope wIIh Ihe envIronmenI. ThereIore, heaIIh promoIIon
Is noI jusI Ihe responsIbIIIIy oI Ihe heaIIh secIor, buI goes beyond heaIIhy
IIIesIyIes Io weIIbeIng.
2
HeaIIh promoIIon Is a conIInuum rangIng Irom Ihe IreaImenI oI dIsease Io Ihe
prevenIIon oI dIsease IncIudIng proIecIIon agaInsI specIIIc rIsks, Io Ihe promoIIon
oI opIImaI heaIIh. AchIevIng opIImaI heaIIh IncIudes: ImprovIng physIcaI abIIIIIes In
reIaIIon Io sex and age; ImprovIng menIaI abIIIIy; deveIopIng reserve capacIIIes;
adapIabIIIIy Io changIng cIrcumsIances oI work and IIIe and reachIng new IeveIs oI
IndIvIduaI achIevemenI In creaIIve and oIher work. In a work seIIIng Ihese heaIIh
IndIcaIors may be evaIuaIed quanIIIaIIveIy by IndIces oI absenIeeIsm, job
saIIsIacIIon and work sIabIIIIy.
HealIh proIecIion and promoIion acIiviIies in Ihe workplace
Nntonn go\cnncnt:
NaIIonaI governmenIs have an InIeresI In workers' heaIIh parIIy because II has a
dIrecI InIIuence on naIIonaI producIIvIIy. GovernmenIs are responsIbIe Ior
esIabIIshIng and maInIaInIng saIe workIng condIIIons and ensurIng, Ihrough
IegIsIaIIon, IhaI occupaIIonaI heaIIh servIces are provIded Ior aII workers In aII
branches oI economIc acIIvIIy, IncIudIng Ihose In Ihe pubIIc secIor. HeaIIh
promoIIon programmes are noI usuaIIy a sIaIuIory requIremenI buI occupaIIonaI
heaIIh servIces can provIde a Iocus Ior IheIr ImpIemenIaIIon.
Mnnngcncnt
Those responsIbIe Ior Ihe managemenI oI a workpIace have an InIeresI In workers'
heaIIh promoIIon Ior Ihe same reason as naIIonaI governmenIs: heaIIhy workers are
essenIIaI Ior opIImaI producIIvIIy. In addIIIon Io Ihe humanIIarIan vaIue oI
ImprovIng workers' heaIIh, Ihe economIc vaIue Is IhereIore parIIcuIarIy ImporIanI
Io empIoyers. ThIs Is aIso Irue Ior seIIempIoyed workers as IheIr producIIvIIy Is
oIIen compIeIeIy dependenI on IheIr own heaIIh.
The prIme responsIbIIIIy Ior heaIIh and saIeIy In a workpIace resIs wIIh Ihe
managemenI, whIch IhereIore pIays an essenIIaI roIe In Ihe success oI any heaIIh
promoIIon programme. To ensure Ihe success oI a programme, managemenI musI
aIIow Ihe necessary resources and IIme Io be dedIcaIed Io II, demonsIraIe IIs desIre
Ior empIoyees Io parIIcIpaIe and be wIIIIng Io accepI suggesIIons Irom empIoyees
on whaI shouId be done. ManagemenI musI aIso have suIIIcIenI apprecIaIIon oI Ihe
need Ior heaIIh promoIIon and dIsease prevenIIon Io be abIe Io assess Ihe reIaIIve
merIIs oI varIous programmes, deIermIne prIorIIIes and deIegaIe responsIbIIIIy Ior
achIevIng programme success.
2
OIIawa CharIer Ior HeaIIh PromoIIon. IIrsI InIernaIIonaI ConIerence on heaIIh PromoIIon,
OIIawa, Canada, 17-21 November 1986.
Woc:
The worker sIands Io beneIII Irom heaIIh promoIIon programmes by havIng a saIe
and heaIIhy work envIronmenI, a convenIenI IocaIIon Io Iearn abouI and puI InIo
pracIIce a heaIIhy IIIesIyIe, readIIy avaIIabIe opporIunIIIes Ior screenIng and heaIIh
care and an opporIunIIy uIIImaIeIy Io achIeve opIImaI heaIIh. HeaIIh has an aII
encompassIng ImpacI on Ihe worker's IIIe, by aIIecIIng hIs or her abIIIIy Io InIeracI
wIIh oIhers, Io work and Io be seIIreIIanI.
The worker's conIrIbuIIon Io workpIace heaIIh promoIIon Is essenIIaI Io any
programme's success. Workers shouId be InvoIved In Ihe programme's desIgn and
encourage IheIr coworkers Io parIIcIpaIe.
Woc:' cc:cntnt\c: nnd unon:
The roIe oI workers' represenIaIIves, organIzaIIons and unIons Is Io negoIIaIe wIIh
Ihe managemenI Io ensure IhaI approprIaIe heaIIh programmes are ImpIemenIed
and IhaI an approprIaIe baIance Is achIeved beIween Ihe varIous heaIIh programmes.
The workers' organIzaIIons shouId aIso ensure IhaI cerIaIn prIncIpIes be IoIIowed,
e.g. conIIdenIIaIIIy and nondIscrImInaIIon.
Connuntc:
HeaIIh Is InIIuenced by many IacIors ouIsIde Ihe workpIace. ConsequenIIy, heaIIh
promoIIon Ior Ihe workIorce cannoI be regarded soIeIy as Ihe responsIbIIIIy oI
occupaIIonaI heaIIh proIessIonaIs. The communIIy, Ihrough IIs prImary heaIIh
workers and pubIIc heaIIh proIessIonaIs, has cIearcuI responsIbIIIIIes Ior IndIvIduaI
and group heaIIh educaIIon as a means oI heaIIh promoIIon. Wherever possIbIe,
heaIIh educaIIon programmes shouId be a joInI acIIvIIy oI occupaIIonaI and
communIIy heaIIh proIessIonaIs. Mass medIa can aIso pIay an ImporIanI roIe In
heaIIh educaIIon.
In deveIopIng counIrIes, parIIcuIarIy In ruraI areas and smaII workpIaces, Ihe
prImary heaIIh worker may be Ihe soIe provIder oI heaIIh proIecIIon and promoIIon
servIces Ior boIh workers and Ihe resI oI Ihe communIIy.
Occuntonn IcntI oc::onn:
HeaIIh promoIIon Is an essenIIaI parI oI Ihe occupaIIonaI heaIIh proIessIonaI's
mandaIe. PhysIcIans, nurses, saIeIy oIIIcers, heaIIh educaIors and PHC workers wIII
pIay dIIIerenI roIes In work pIace heaIIh promoIIon and shouId be IraIned
accordIngIy e.g. Ihe roIe oI Ihe occupaIIonaI heaIIh nurse Is Io educaIe, screen and
counseI workers, whereas IhaI oI an occupaIIonaI hygIenIsI Is Io assess Ihe conIroI
oI heaIIh hazards whIIe keepIng In Iouch wIIh Ihe deveIopmenI and progress oI
heaIIh promoIIon programmes.
TogeIher wIIh oIhers, such as ergonomIsIs, nuIrIIIon specIaIIsIs and psychoIogIsIs,
occupaIIonaI heaIIh proIessIonaIs can:
proIecI workers' heaIIh by conIroIIIng hazards In Ihe workpIace and by
InIroducIng ergonomIcs
advIse workers and managers on heaIIh promoIIon acIIvIIIes and on how Io
Improve workIng condIIIons
monIIor Ihe work envIronmenI and workers' heaIIh wIIh a vIew Io earIy
IdenIIIIcaIIon oI heaIIh rIsks and evaIuaIIon oI Ihe eIIecIIveness oI heaIIh
proIecIIon and promoIIon programmes.
In many cIrcumsIances, In deveIopIng as weII as deveIoped counIrIes, occupaIIonaI
heaIIh proIessIonaIs can cover onIy a smaII proporIIon oI workpIaces and workers.
In such cases, oIhers responsIbIe Ior provIdIng heaIIh care Ior workers shouId
recognIze heaIIh promoIIon as one oI IheIr major Iasks and shouId receIve some
IraInIng In occupaIIonaI heaIIh.
MODULE 1
Work environment
1. OB|ECTlVES
DeIecI work hazards as reIaIed Io occupaIIon, work and work envIronmenI
InspecI workpIaces Ior Ihe dIscovery oI acIuaI hazards and unsaIe workers'
behavIour
Use sImpIe meIhods and IechnIques Ior evaIuaIIon oI work hazards and Ior
IesIIng conIroI measures
ReporI work and envIronmenIaI hazards Io concerned bodIes
Know prIncIpIes oI Ihe conIroI oI work hazards and work envIronmenI and
parIIcIpaIe In seIecIIng approprIaIe conIroI measures and opIImaI use oI
avaIIabIe resources
ParIIcIpaIe In Ihe managemenI oI work emergency pIans and In IIrsI aId
LducaIe workers on Ihe prIncIpIes oI saIe conducI aI work
ParIIcIpaIe In InvesIIgaIIng work compIaInIs, compensaIIon cases, rehabIIIIaIIon,
socIaI weIIare, eIc.
CoordInaIe wIIh oIher proIessIonaIs In Ihe occupaIIonaI muIIIdIscIpIInary
Ieam: saIeIy oIIIcer and commIIIee, occupaIIonaI hygIenIsI, physIcIan and
nurse, sanIIarIan, IIrsI aId aIIendanI, pIanI engIneer and Ioreman.
2. lNTRODUCTlON AND BASlC CONCEPTS
2.1 OccupaIional hygiene
ThIs Is Ihe pracIIce oI assessmenI and conIroI oI envIronmenIaI IacIors and sIresses
arIsIng In or Irom Ihe workpIace, whIch may cause Injury, sIckness, ImpaIred heaIIh
and weIIbeIng or sIgnIIIcanI dIscomIorI and IneIIIcIency among workers or among
Ihe cIIIzens oI Ihe communIIy.
II encompasses Ihe sIudy oI:
IoxIcoIogy
IndusIrIaI processes
Ihe chemIcaI and physIcaI behavIour oI aIr conIamInanIs
envIronmenIaI sampIIng IechnIques and sIaIIsIIcs
Ihe desIgn and evaIuaIIon oI venIIIaIIon sysIems
noIse conIroI
radIaIIon proIecIIon
Ihe heaIIh eIIecIs oI occupaIIonaI hazards.
OccupaIIonaI/IndusIrIaI hygIenIsIs use envIronmenIaI monIIorIng and anaIyIIcaI
meIhods Io deIecI Ihe exIenI oI worker exposure and empIoy engIneerIng, work
pracIIce conIroIs and oIher meIhods Io conIroI poIenIIaI heaIIh hazards.
OccupaIIonaI/IndusIrIaI hygIenIsIs musI work wIIh physIcIans Io deveIop
comprehensIve occupaIIonaI heaIIh programmes and wIIh epIdemIoIogIsIs Io
perIorm research on heaIIh eIIecIs.
2.2 Work-siIe analysis
ThIs Is an essenIIaI procedure IhaI heIps In deIermInIng whaI jobs and worksIaIIons
are Ihe sources oI poIenIIaI probIems. DurIng Ihe worksIIe anaIysIs: exposures,
probIem Iasks and rIsks are IdenIIIIed and measured. The mosIeIIecIIve worksIIe
anaIyses IncIude aII jobs, operaIIons and work acIIvIIIes. The occupaIIonaI/IndusIrIaI
hygIenIsI InspecIs, researches or anaIyses how Ihe parIIcuIar chemIcaIs or physIcaI
hazards aI Ihe worksIIe aIIecI worker heaIIh. II a sIIuaIIon hazardous Io heaIIh Is
dIscovered, he or she recommends Ihe approprIaIe correcIIve acIIon.
Ixnnc
An occupaIIonaI/IndusIrIaI hygIenIsI mIghI be asked Io deIermIne Ihe composIIIon
and concenIraIIons oI aIr conIamInanIs In a workpIace where Ihere have been
compIaInIs oI eye, nose and IhroaI IrrIIaIIon. The hygIenIsI In IhIs sIIuaIIon wouId
aIso deIermIne II Ihe conIamInanI exposures exceeded Ihe permIssIbIe exposure
IImIIs requIred by Ihe naIIonaI reguIaIIons and sIandards. II Ihe probIem was Ihe
resuII oI aIrborne maIerIaIs (a concIusIon IhaI mIghI be reached In consuIIaIIon wIIh
a physIcIan or epIdemIoIogIsI), Ihen Ihe hygIenIsI wouId be responsIbIe Ior seIecIIng
Ihe IechnIques used Io reduce or eIImInaIe Ihe exposure e.g. InsIaIIIng exhausI
venIIIaIIon around Ihe source oI Ihe aIr conIamInanIs and IsoIaIIng II Irom Ihe
generaI work area. IoIIowup sampIIng Io verIIy IhaI Ihe conIroIs had been eIIecIIve
wouId aIso be Ihe hygIenIsI's responsIbIIIIy.
3. RECOGNlTlON Ol HEALTH HAZARDS
3.1 lnspecIion
ThIs Is Ihe IIrsI sIep In Ihe process IeadIng Io evaIuaIIon and conIroI and enIaIIs Ihe
IdenIIIIcaIIon oI maIerIaIs and processes IhaI have Ihe poIenIIaI Io cause harm Io
workers.
InspecIIon oI Ihe workpIace Is Ihe besI source oI dIrecIIy reIevanI daIa abouI heaIIh
hazards. There Is no subsIIIuIe Ior observaIIon oI work pracIIces, use oI chemIcaI
and physIcaI agenIs, and Ihe apparenI eIIecIIveness oI conIroI measures. The PHC
worker shouId be abIe Io recognIze major and obvIous heaIIh hazards and
dIsIInguIsh Ihose IhaI requIre IormaI evaIuaIIon by Ihe IndusIrIaI hygIenIsI.
Work envronnent: ModuIe 1 23
3.2 PoIenIial healIh hazards
A contnnnnnt:
These are commonIy cIassIIIed as eIIher parIIcuIaIe or gas and vapour conIamInanIs
(a) ParIIcuIaIe conIamInanIs
DusIs: soIId parIIcIes generaIed by handIIng, crushIng, grIndIng, coIIIdIng,
expIodIng, and heaIIng organIc or InorganIc maIerIaIs such as rock, ore, meIaI,
coaI, wood and graIn. Any process IhaI produces dusI IIne enough Io remaIn
In Ihe aIr Iong enough Io be InhaIed or IngesIed shouId be regarded as
hazardous unIII proven oIherwIse.
Iumes: Iormed when maIerIaI Irom a voIaIIIIzed soIId condenses In cooI aIr. In
mosI cases, Ihe soIId parIIcIes resuIIIng Irom Ihe condensaIIon reacI wIIh aIr
Io Iorm an oxIde.
MIsIs: IIquId suspended In Ihe aImosphere. MIsIs are generaIed by IIquIds
condensIng Irom a vapour back Io a IIquId or by a IIquId beIng dIspersed by
spIashIng or aIomIzIng.
AerosoIs: a Iorm oI a mIsI characIerIzed by hIghIy respIrabIe, mInuIe IIquId
parIIcIes.
IIbres: soIId parIIcIes whose IengIh Is severaI IImes greaIer Ihan IheIr dIameIer,
e.g. asbesIos.
(b) Gas and vapour conIamInanIs
Gases: IormIess IIuIds IhaI expand Io occupy Ihe space or encIosure In whIch
Ihey are conIIned. They are aIomIc, dIaIomIc or moIecuIar In naIure as opposed
Io dropIeIs or parIIcIes, whIch are made up oI mIIIIons oI aIoms or moIecuIes.
Through evaporaIIon, IIquIds change InIo vapours and mIx wIIh surroundIng
aImosphere.
Vapours: Ihe voIaIIIe Iorm oI subsIances IhaI are normaIIy In a soIId or IIquId
sIaIe aI room IemperaIure and pressure.
CIcncn Inznd:
HarmIuI chemIcaI compounds In Ihe Iorm oI soIIds, IIquIds, gases, mIsIs, dusIs,
Iumes and vapours exerI IoxIc eIIecIs by InhaIaIIon (breaIhIng), absorpIIon (Ihrough
dIrecI conIacI wIIh Ihe skIn) or IngesIIon (eaIIng or drInkIng). AIrborne chemIcaI
hazards exIsI as concenIraIIons oI mIsIs, vapours, gases, Iumes or soIIds. Some are
IoxIc Ihrough InhaIaIIon and some oI Ihem IrrIIaIe Ihe skIn on conIacI; some can be
IoxIc by absorpIIon Ihrough Ihe skIn or Ihrough IngesIIon and some are corrosIve
Io IIvIng IIssue. The degree oI worker rIsk Irom exposure Io any gIven subsIance
depends on Ihe naIure and poIency oI Ihe IoxIc eIIecIs and Ihe magnIIude and
duraIIon oI exposure.
oogcn Inznd:
These exIsI In exposures Io bacIerIa, vIruses, IungI and oIher IIvIng organIsms IhaI
can cause acuIe and chronIc InIecIIons by enIerIng Ihe body eIIher dIrecIIy or
Ihrough breaks In Ihe skIn.
OccupaIIons IhaI deaI wIIh pIanIs or anImaIs or IheIr producIs, or wIIh Iood and
Iood processIng may expose workers Io bIoIogIcaI hazards. LaboraIory and medIcaI
personneI aIso can be exposed Io bIoIogIcaI hazards. Any occupaIIons IhaI resuII In
conIacI wIIh bodIIy IIuIds expose workers Io bIoIogIcaI hazards.
In occupaIIons where anImaIs are InvoIved, bIoIogIcaI hazards are deaII wIIh by
prevenIIng and conIroIIIng dIseases In Ihe anImaI popuIaIIon as weII as properIy
carIng Ior and handIIng InIecIed anImaIs.
AIso, eIIecIIve personaI hygIene, parIIcuIarIy proper aIIenIIon Io mInor cuIs and
scraIches especIaIIy on Ihe hands and Iorearms, heIps keep worker rIsks Io a
mInImum. In occupaIIons where Ihere Is poIenIIaI exposure Io bIoIogIcaI hazards,
workers shouId pracIIce proper personaI hygIene, parIIcuIarIy hand washIng.
HospIIaIs shouId provIde proper venIIIaIIon, proper personaI proIecIIve equIpmenI
such as gIoves and respIraIors, adequaIe InIecIIous wasIe dIsposaI sysIems and
approprIaIe conIroIs IncIudIng IsoIaIIon In InsIances oI parIIcuIarIy conIagIous
dIseases, e.g. IubercuIosIs.
II):cn Inznd:
These IncIude excessIve IeveIs oI noIse, vIbraIIon, IIIumInaIIon and IemperaIure, and
IonIzIng and nonIonIzIng eIecIromagneIIc radIaIIon.
Noise, Ior exampIe, Is a sIgnIIIcanI physIcaI hazard, whIch can be conIroIIed by:
InsIaIIIng equIpmenI and sysIems IhaI have been engIneered, desIgned and
buIII Io operaIe quIeIIy
encIosIng or shIeIdIng noIsy equIpmenI
makIng cerIaIn IhaI equIpmenI Is In good repaIr and Is properIy maInIaIned
wIIh aII worn or unbaIanced parIs repIaced
mounIIng noIsy equIpmenI on specIaI mounIs Io reduce vIbraIIon
InsIaIIIng sIIencers, muIIIers or baIIIes
subsIIIuIIng quIeI work meIhods Ior noIsy ones, e.g. weIdIng parIs raIher Ihan
rIveIIng Ihem
IreaIIng IIoors, ceIIIngs and waIIs wIIh acousIIc maIerIaI Io reduce reIIecIed or
reverberanI noIse
erecIIng sound barrIers aI adjacenI worksIaIIons around noIsy operaIIons Io
reduce worker exposure Io noIse generaIed aI adjacenI worksIaIIons
IncreasIng Ihe dIsIance beIween Ihe source and Ihe receIver, e.g. by IsoIaIIng
workers In acousIIc booIhs, IImIIIng workers' exposure IIme Io noIse and
provIdIng hearIng proIecIIon.
OccupaIIonaI hygIene reguIaIIons requIre IhaI workers In noIsy surroundIngs be
perIodIcaIIy IesIed as a precauIIon agaInsI hearIng Ioss.
lonizing radiaIion can be conIroIIed by:
ReducIng exposure IIme: danger Irom radIaIIon Increases wIIh Ihe
amounI oI IIme one Is exposed Io II. The shorIer Ihe IIme oI exposure Ihe
smaIIer Ihe radIaIIon danger.
IncreasIng dIsIance: a vaIuabIe IooI In conIroIIIng exposure Io boIh
IonIzIng and nonIonIzIng radIaIIon. RadIaIIon IeveIs Irom some sources can be
esIImaIed by comparIng Ihe squares oI Ihe dIsIances beIween Ihe worker and
Ihe source.
ShIeIdIng: Ihe greaIer Ihe proIecIIve mass beIween a radIoacIIve source
and Ihe worker, Ihe Iower Ihe radIaIIon exposure. SImIIarIy, shIeIdIng
workers Irom nonIonIzIng radIaIIon can aIso be an eIIecIIve conIroI
meIhod.
In some InsIances, however, IImIIIng exposure Io or IncreasIng dIsIance Irom cerIaIn
Iorms oI non-ionizing radiaIion, e.g. Iasers, Is noI eIIecIIve. An exposure Io Iaser
radIaIIon IhaI Is IasIer Ihan Ihe bIInkIng oI an eye can be hazardous and wouId
requIre workers Io be mIIes Irom Ihe Iaser source beIore beIng adequaIeIy proIecIed.
RadianI heaI exposure can be conIroIIed by: InsIaIIIng reIIecIIve shIeIds and by
provIdIng proIecIIve cIoIhIng In IacIorIes such as sIeeI mIIIs.
Igononc Inznd:
The scIence oI ergonomIcs sIudIes and evaIuaIes a IuII range oI Iasks IncIudIng, buI
noI IImIIed Io, IIIIIng, hoIdIng, pushIng, waIkIng and reachIng.
Many ergonomIc probIems resuII Irom IechnoIogIcaI changes:
Increased assembIy IIne speeds
addIng specIaIIzed Iasks
Increased repeIIIIon.
Some probIems arIse Irom poorIy desIgned job Iasks. Any oI Ihose condIIIons can
cause ergonomIc hazards:
excessIve vIbraIIon
noIse
eye sIraIn
repeIIIIve moIIon
heavy IIIIIng probIems
poorIy desIgned IooIs or work areas.
RepeIIIIve moIIons or repeaIed shocks over proIonged perIods oI IIme as In jobs
InvoIvIng sorIIng, assembIIng and daIa enIry can oIIen cause IrrIIaIIon and
InIIammaIIon oI Ihe Iendon sheaIh oI Ihe hands and arms, a condIIIon known as
carpaI IunneI syndrome. LrgonomIc hazards are avoIded prImarIIy by Ihe eIIecIIve
desIgn oI a job or jobsIIe and by beIIer desIgned IooIs or equIpmenI IhaI meeI
workers' needs In Ierms oI physIcaI envIronmenI and job Iasks.
Through Ihorough worksIIe anaIyses, empIoyers can seI up procedures Io correcI
or conIroI ergonomIc hazards by:
usIng Ihe approprIaIe engIneerIng conIroIs, e.g. desIgnIng or redesIgnIng work
sIaIIons, IIghIIng, IooIs and equIpmenI
IeachIng correcI work pracIIces, e.g. shIIIIng workers among severaI dIIIerenI
Iasks, reducIng producIIon demand and IncreasIng resI breaks
provIdIng and mandaIIng personaI proIecIIve equIpmenI where necessary.
LvaIuaIIng workIng condIIIons Irom an ergonomIc sIandpoInI InvoIves IookIng aI Ihe
IoIaI physIoIogIcaI and psychoIogIcaI demands oI Ihe job on Ihe worker. OveraII, Ihe
beneIIIs oI a weIIdesIgned, ergonomIc work envIronmenI can IncIude Increased
eIIIcIency, Iewer accIdenIs, Iower operaIIng cosIs and more eIIecIIve use oI personneI.
I:)cIo:ocn ncto:
These may IncIude borIng, repeIIIIve Iasks, producIIon pressure, sIress, Iow pay and
Iack oI recognIIIon.
Accdcnt ncto:
The maIn causes oI accIdenIs IncIude:
unsaIe mechanIcaI and physIcaI condIIIons
unsaIe acIs
unsaIe personaI IacIors.
3.3 Techniques used in recognizing healIh hazards
Mntcn n\cnto)
A maIerIaI InvenIory Is used Ior keepIng an accounI oI raw maIerIaIs, InIermedIaIe
and end producIs, wasIe producIs and byproducIs. II Is IaIIored Io meeI Ihe specIIIc
requIremenIs oI IocaI cIrcumsIances IakIng InIo consIderaIIon Ihe IoIIowIng.
(a) Who wIII use Ihe InvenIory
saIeIy advIsers and represenIaIIves
occupaIIonaI hygIenIsIs
docIors
nurses
emergency servIce personneI
purchasIng sIaII.
(b) WhaI InIormaIIon Is requIred
Ihe naIure oI Ihe maIerIaI, I.e. composIIIon, physIcaI daIa, IIre and
expIosIon daIa, basIc IoxIcoIogIcaI and saIeIy daIa, eIc.
Ihe use oI Ihe maIerIaI, IncIudIng sIorage, handIIng and conIroI procedures,
IIrsI aId, eIc.
admInIsIraIIve deIaIIs, I.e. Irade and chemIcaI names, company reIerence
numbers, address oI manuIacIures/suppIIers, IabeIIIng and packIng
requIremenIs, wasIe dIsposaI, eIc.
(c) How Ihe InvenIory wIII be updaIed
any new subsIances shouId be consIdered Irom a heaIIh and saIeIy
vIewpoInI beIore purchasIng, use and IncIusIon In Ihe InvenIory
Ior exIsIIng maIerIaIs, heaIIh and saIeIy sIaII shouId have a sysIem Ior
ensurIng, Ihrough IheIr InIormaIIon sources, IhaI Ihe hazard daIa
conIaIned In Ihe daIa sheeI Is Ihe besI InIormaIIon currenIIy avaIIabIe
Ihe avaIIabIIIIy oI compuIerIzed daIahandIIng sysIems augmenIs Ihe
use oI a maIerIaIs InvenIory.
Iocc:: n\cnto)
The aIm Is Io documenI hazards assocIaIed wIIh each process and Io record how each
Is beIng managed and conIroIIed. The process InvenIory shouId IncIude deIaIIs oI:
Ihe process
Ihe maIerIaIs InvoIved (IncIudIng InIermedIaIe and wasIes)
poInIs oI maIerIaI enIry and exII
normaI operaIIng procedures
poIenIIaI hazards
Ihe poIenIIaI Ior emIssIons InIo Ihe aImosphere
Ihe poIenIIaI Ior exposure
arrangemenIs Ior engIneerIng conIroIs
oIher precauIIons IncIudIng proIecIIve equIpmenI.
The process InvenIory aIso provIdes Ihe opporIunIIy Io documenI hazards oIher
Ihan Ihose assocIaIed wIIh chemIcaIs, e.g. heaI, noIse and radIaIIon, and Io IncIude
dIsposaI procedures Ior hazardous wasIe producIs.
The InvenIory couId be based on:
IIow oI a parIIcuIar producI or maIerIaI
deparImenIaI or equIpmenI IIow
geographIc IocaIIon.
Wn-tIougI occuntonn I)gcnc :u\c)
A waIkIhrough survey oI Ihe premIses permIIs observaIIon oI aII pIanI operaIIons
and Is carrIed ouI Io make a preIImInary assessmenI oI poIenIIaI hazards. PossIbIe
sources and poIenIIaI conIamInanIs Irom specIIIc Iypes oI processes can be
IdenIIIIed (see appendIx 1.1). The waIkIhrough survey provIdes an ImporIanI
opporIunIIy Io meeI pIanI personneI and Io InIeracI wIIh engIneers, Ioremen and
oIher workers who know Ihe process probIems and are aware oI compIaInIs or
sympIoms among workers.
(a) GeneraI prIncIpIes addressed by Ihe waIkIhrough survey
hazards presenI In Ihe work pIace
esIImaIed/IIkeIy scaIe oI Ihe IdenIIIIed hazards
Ihe conIroI measures currenIIy In Iorce Ior each hazard
procedures ImpIemenIed Io maInIaIn Ihe conIroI measures
Ihe monIIorIng requIred.
(b) Survey meIhods
Surveys are usuaIIy carrIed ouI wIIhouI Ihe use oI measurIng InsIrumenIs.
Much oI Ihe InIormaIIon requIred can be assembIed In advance oI Ihe survey
(see an occupaIIonaI/IndusIrIaI survey check IIsI In appendIx 1.2).
The IoIIowIng aIds are requIred Io carry ouI Ihe work:
survey reporI Iorms
noIepad or dIcIaIIon machIne
pIan oI premIses
camera
smoke Iubes.
The occupaIIonaI hygIenIsI (or whoever Is nomInaIed Io underIake Ihe Iask by
Ihe PHC workers) proceeds Ihrough each oI Ihe work areas, preIerabIy In
accordance wIIh Ihe workIng IuncIIons, oIIen commencIng wIIh producIIon
Irom goods Inward Io dIspaIch, and preIerabIy accompanIed In each area oI Ihe
premIses by eIIher a IocaI supervIsor or engIneer wIIh generaI responsIbIIIIIes.
Sources oI InIormaIIon used durIng Ihe survey are:
workers InvoIved In IheIr daIIy Iasks
senses oI smeII, hearIng and Iouch Ior deIecIIon oI odours, heaI and
noIse
phoIography Ior documenIIng Ihe generaI vIsuaI appearance oI each
envIronmenI and any acIIvIIy deservIng IurIher aIIenIIon
smoke Iube IesI Ior IocaI exhausI venIIIaIIon
observaIIon, Ihe key Io an eIIecIIve survey, noIIng any ergonomIcs
probIems, e.g. poorIy desIgned IIghIIng, unsaIe workIng pracIIces,
unguarded equIpmenI, eIc.
(c) ReporIs
The reporI shouId be wrIIIen cIearIy and concIseIy and shouId be sIrucIured as
IoIIows:
InIroducIIon
summary oI ImmedIaIe hazards and acIIon Iaken or recommended Io resoIve
Ihe probIem permanenIIy and/or IemporarIIy pendIng IurIher evaIuaIIon
summary oI hazards requIrIng IurIher monIIorIng/evaIuaIIon
waIkIhrough survey reporI Iorms as compIeIed durIng survey
dIscussIons oI meIhods arIsIng Irom survey
proposed occupaIIonaI hygIene work pIan.
(d) Summary oI a survey
a survey Is a preIImInary assessmenI desIgned Io IdenIIIy hazards and conIroI
measures, carrIed ouI by compeIenI sIaII wIIh Ihe heIp oI IocaI supervIsIng
sIaII
II shouId be comprehensIve by IocaIIon and by IIme Ior cycIIcaI/occasIonaI
processes
II Is a necessary preIude Io deIaIIed InvesIIgaIIons oI specIIIc hazards
II Is necessary Io gaIher a range oI daIa perIaInIng Io Ihe subjecI In order Io IuIIy
prepare Ior Ihe survey
Ihe Iwo maIn eIemenIs oI Ihe survey daIa source are Ihe workIorce and
observaIIon
phoIography Is very ImporIanI
reporIs shouId be sIrucIured careIuIIy and be concIse.
A-:nnng ognnnc:
An aIrsampIIng programme musI be desIgned Io answer specIIIc quesIIons
oIherwIse II may noI IuIIII Ihe need Ior whIch II was InIIIaIed, e.g. a prospecIIve
epIdemIoIogIcaI programme requIres random sampIIng In order Ior sIaIIsIIcaI
predIcIIons Io be vaIId. SampIIng Ior worker proIecIIon, on Ihe oIher hand, wIII
requIre seIecIIon oI persons aI maxImum rIsk.
Reasons Ior sampIIng are varIed and may IncIude Ihe IoIIowIng:
heaIIh rIsk evaIuaIIon: Io measure worker exposure In order Io esIImaIe Ihe rIsk
oI undesIrabIe heaIIh eIIecIs and Ihe need Ior conIroI measures
envIronmenIaI proIecIIon: Io deIermIne Ihe amounI oI any IoxIc or hazardous
maIerIaIs reIeased Io Ihe envIronmenI
compIIance: Io ensure IhaI exposure IeveIs Ior workers or envIronmenIaI
reIeases are wIIhIn reguIaIory IImIIs and Io saIIsIy IegIsIaIIve monIIorIng
requIremenIs
process conIroI: Io evaIuaIe Ihe perIormance oI engIneerIng or oIher process
conIroIs and Io ensure IhaI conIamInanI conIroI remaIns adequaIe
source IdenIIIIcaIIon: Io IInd and conIroI conIamInanI sources
documenIaIIon oI exposure: Io maInIaIn records oI exposure Ior prospecIIve
sIudIes or Ior InsIIIuIIonaI proIecIIon agaInsI IuIure IegaI acIIon.
The sampIIng sIraIegy Ior each oI Ihe sIaIed purposes wIII requIre dIIIerenI
proIocoIs and sampIIng sysIems. The Iypes oI sampIes reIer Io wheIher a personaI
exposure sampIe shouId be coIIecIed In Ihe breaIhIng zone oI a worker, or wheIher
an area, sIack or oIher envIronmenIaI sampIe Is preIerabIe. SampIIng Irom exhausI
sIacks Is commonIy done Ior process and emIssIon conIroI. HeaIIh proIecIIon
requIres personaI exposure monIIorIng.
Occupational hygiene sampling protocols
Furpose Type o] snmpIe
HeaIth rIsk evaIuatIon PersonaI
EnvIronmentaI protectIon Area, envIronmentaI
CompIIance PersonaI, envIronmentaI, stack
Process controI Area, personaI, stack
Source IdentIIIcatIon Area, stack
DocumentatIon oI exposure PersonaI
4. EVALUATlON Ol HEALTH HAZARDS
LvaIuaIIon oI heaIIh hazards wIIhIn a pIanI IncIudes measuremenI oI exposures (and
poIenIIaI exposures), comparIson oI Ihose exposures Io exIsIIng sIandards and
recommendaIIon oI conIroIs II needed.
4.1 Exposure measuremenI Iechniques
These IechnIques are based on Ihe naIure oI hazards and Ihe rouIes oI
envIronmenIaI conIacI wIIh Ihe worker, e.g.
aIr sampIIng can show Ihe concenIraIIon oI IoxIc parIIcuIaIes, gases and
vapours IhaI workers may InhaIe
skIn wIpes can be used Io measure Ihe degree oI skIn conIacI wIIh IoxIc
maIerIaIs IhaI may peneIraIe Ihe skIn
noIse dosImeIers record and eIecIronIcaIIy InIegraIe workpIace noIse IeveIs Io
deIermIne IoIaI daIIy exposure.
5cccton nnd cnnton o n:tuncnt:
InsIrumenIs are generaIIy cIassIIIed as IoIIows:
dIrecI readIng InsIrumenIs
sampIIng InsIrumenIs whIch remove Ihe conIamInanI (Ior subsequenI IaboraIory
anaIysIs) Irom a measured quanIIIy oI aIr
sampIIng InsIrumenIs whIch coIIecI a known voIume oI aIr Ior subsequenI
IaboraIory anaIysIs.
AII Ihese Iypes oI equIpmenI musI be caIIbraIed agaInsI a sIandard aIr IIow
measurIng devIce beIore and aIIer use In Ihe IIeId. IurIhermore, dIrecI readIng
InsIrumenIs musI be caIIbraIed agaInsI a known concenIraIIon oI Ihe subsIance Ior
whIch Ihey are used.
I:tn:Ing oc nnn)tcn nctIod:
The use oI accuraIe, sensIIIve, specIIIc and reproducIbIe anaIyIIcaI meIhods Is as
ImporIanI as Ihe proper caIIbraIIon oI Ihe sampIIng equIpmenI. Among dIIIIcuIIIes
IhaI shouId be overcome In Ihe measuremenIs (sampIIng/anaIysIs) are:
InIerIerence and reacIIons when deaIIng wIIh mIxIures oI chemIcaIs, whIch Is
oIIen Ihe case
IIucIuaIIons In concenIraIIon.
OIher IacIors aIIecIIng a worker's upIake oI Ihe conIamInanIs IncIude:
rouIes oI enIry oI maIerIaI oIher Ihan respIraIIon, e.g. skIn absorpIIon
physIcaI acIIvIIy oI workers, whIch aIIecIs Ihe respIraIIon raIe
wheIher or noI respIraIors are used In Ihe workpIace.
When avaIIabIe, sIandard meIhods oI anaIysIs shouId be used such as Ihose
recommended by:
WHO
InIernaIIonaI OrganIzaIIon Ior SIandardIzaIIon
Luropean CommunIIy
AmerIcan IndusIrIaI HygIene AssocIaIIon (AHIA) AnaIyIIcaI CommIIIee
U.S. NaIIonaI InsIIIuIe Ior OccupaIIonaI SaIeIy and HeaIIh (NIOSH)
U.S. OccupaIIonaI SaIeIy and HeaIIh AdmInIsIraIIon (OSHA)
AmerIcan ConIerence oI GovernmenIaI IndusIrIaI HygIenIsIs (ACGIH)
The AmerIcan PubIIc HeaIIh AssocIaIIon (APHA)
The AmerIcan NaIIonaI SIandards InsIIIuIe (ANSI).
5tntcg) o :nnng nnd ncn:ucncnt
Lvery eIIorI musI be made Io geI measuremenIs (or sampIes) IhaI represenI Ihe
workers' exposures. ThIs Is achIeved by answerIng Ihe IoIIowIng:
Where Io sampIe7
Whom Io sampIe7
How Iong Io sampIe7
How many sampIes Io Iake7
When Io sampIe7
A suIIIcIenI number oI sampIes musI be coIIecIed or readIngs made wIIh dIrecI
readIng InsIrumenIs, Ior Ihe proper duraIIon, Io permII Ihe assessmenI oI daIIy,
IImeweIghIed average (TWA) exposures and Io evaIuaIe peak exposure
concenIraIIons when needed.
4.2 lnIerpreIaIion ol lindings
A greaI deaI oI judgemenI musI be used In InIerpreIaIIon and reporIIng Ihe resuIIs.
The InvesIIgaIor musI have Ihe IoIIowIng IacIs:
naIure oI subsIance or physIcaI agenIs
InIensIIy (concenIraIIon) oI exposure
duraIIon oI exposure.
The hygIenIsI's decIsIon on wheIher a hazard Is presenI Is based on Ihree sources oI
InIormaIIon:
scIenIIIIc IIIeraIure and varIous exposure IImII guIdes
Ihe IegaI requIremenIs oI Ihe naIIonaI occupaIIonaI heaIIh and saIeIy reguIaIIons
InIeracIIons wIIh oIher heaIIh proIessIonaIs who have examIned Ihe exposed
workers and evaIuaIed IheIr heaIIh sIaIus.
OccupaIIonaI exposure IImIIs reIer Io aIrborne concenIraIIons oI subsIances
condIIIons under whIch II Is beIIeved IhaI nearIy aII workers may be repeaIedIy
exposed day aIIer day wIIhouI adverse heaIIh eIIecI. They are based on avaIIabIe
InIormaIIon Irom IndusIrIaI experIence, Irom experImenIaI human and anImaI
sIudIes; and, when possIbIe, Irom a combInaIIon oI Ihe Ihree
4.3 Recommended exposure limiIs
Many sIandards have been recommended by dIIIerenI naIIonaI and InIernaIIonaI
agencIes. The mosI popuIar and comprehensIve however are Ihe IIsI oI IhreshoId
IImII vaIues (TLVs) Ior chemIcaI subsIances and physIcaI agenIs and Ihe bIoIogIcaI
exposure IndIces (BLIs) Issued by Ihe AmerIcan ConIerence oI GovernmenIaI
IndusIrIaI HygIenIsIs (ACGIH).
There are Ihree caIegorIes oI TLV:
TImeweIghIed average (TWA8): Ihe empIoyee's average aIrborne exposure In
any 8-hour work shIII oI a 40-hour work week, whIch shaII noI be exceeded.
ShorIIerm exposure IImII (STLL): Ihe empIoyee's 1S-mInuIe TWA exposure,
whIch shaII noI be exceeded aI any IIme durIng a work day unIess anoIher IIme
IImII Is specIIIed In a parenIheIIcaI noIaIIon beIow Ihe IImII. II anoIher IIme
perIod Is specIIIed, Ihe TWA exposure over IhaI IIme IImII shaII noI be exceeded
aI any IIme over a work day.
CeIIIngC: Ihe empIoyee's exposure, whIch shaII noI be exceeded durIng any
parI oI Ihe work day. II InsIanIaneous monIIorIng Is noI IeasIbIe, Ihe ceIIIng
shaII be assessed as a 1S-mInuIe TWA exposure, whIch shaII noI be exceeded
aI any IIme over a work day.
ConsIderaIIons are IncIuded Ior:
skIn noIaIIon (Ior probabIe skIn absorpIIon)
mIxIures (Ior exposure Io mIxIures oI conIamInanIs)
IoIaI, InhaIabIe, IhoracIc and respIrabIe parIIcuIaIe maIIer
ParIIcuIaIe noI oIherwIse cIassIIIed (PNOC)
sImpIe asphyxIaIes: InerI gases or vapours
BIoIogIcaI exposure IndIces (BLI)
physIcaI IacIors
unusuaI work scheduIes.
5. CONTROLLlNG HAZARDS
OccupaIIonaI/IndusIrIaI hygIenIsIs recognIze IhaI engIneerIng, work pracIIce and
admInIsIraIIve conIroIs are Ihe prImary means oI reducIng empIoyee exposure Io
occupaIIonaI hazards.
5.1 Engineering conIrols
These mInImIze empIoyee exposure by eIIher reducIng or removIng Ihe hazard aI
Ihe source or IsoIaIIng Ihe worker Irom Ihe hazard. They IncIude:
eIImInaIIng IoxIc chemIcaIs and subsIIIuIIng nonIoxIc chemIcaIs
encIosIng work processes or conIInIng work operaIIons
InsIaIIIng generaI and IocaI venIIIaIIon sysIems.
5.2 Work pracIice conIrols
These aIIer Ihe manner In whIch a Iask Is perIormed. Some IundamenIaI and easIIy
ImpIemenIed work pracIIce conIroIs IncIude:
changIng exIsIIng work pracIIces Io IoIIow proper procedures IhaI mInImIze
exposures whIIe operaIIng producIIon and conIroI equIpmenI
InspecIIng and maInIaInIng process and conIroI equIpmenI on a reguIar basIs
ImpIemenIIng good housekeepIng procedures
provIdIng good supervIsIon
prohIbIIIng eaIIng, drInkIng, smokIng, chewIng Iobacco or gum and appIyIng
cosmeIIcs In reguIaIed areas.
5.3 AdminisIraIive conIrols
These IncIude:
ConIroIIIng empIoyees' exposure by scheduIIng producIIon and Iasks, or boIh,
In ways IhaI mInImIze exposure IeveIs; e.g. Ihe empIoyer mIghI scheduIe
operaIIons wIIh hIghesI exposure poIenIIaI durIng perIods when Ihe IewesI
empIoyees are presenI.
When eIIecIIve work pracIIces or engIneerIng conIroIs are noI IeasIbIe or whIIe
such conIroIs are beIng InsIIIuIed, approprIaIe personaI proIecIIve equIpmenI
musI be used, e.g. gIoves, saIeIy goggIes, heImeIs, saIeIy shoes, proIecIIve
cIoIhIng and respIraIors. To be eIIecIIve, personaI proIecIIve equIpmenI musI
be IndIvIduaIIy seIecIed, properIy IIIIed and perIodIcaIIy reIIIIed, conscIenIIousIy
and properIy worn, reguIarIy maInIaIned and repIaced as necessary.
6. TASKS lOR TRAlNEES
AcquaInI yourseII wIIh IocaI IndusIrIes, occupaIIons, workers' popuIaIIon and
avaIIabIe occupaIIonaI heaIIh and saIeIy servIces, eIc.
Survey workpIaces (usIng Ihe waIkIhrough meIhod) In IormaI and InIormaI
secIors, agrIcuIIure, smaIIscaIe IndusIrIes and oIher Irades; IamIIIarIze yourseII
and coIIecI daIa on IechnIcaI operaIIons, maIerIaIs processed and handIed,
Iabour; and Iry Io dIscover and deIIne hazards.
ReporI and reIer hazards Io concerned bodIes and IoIIowup on IheIr acIIons.
Assess envIronmenIaI hazards usIng sImpIe, convenIIonaI meIhods and dIrecI
readIng InsIrumenIs; InspecI avaIIabIe conIroI measures and equIpmenI and
IesI IheIr eIIIcIency (e.g. usIng smoke Iubes); and seek advIce Ior InIerpreIaIIon
oI resuIIs and makIng suggesIIons Ior conIroIs.
ParIIcIpaIe In daIa coIIecIIon and anaIysIs on workers' heaIIh.
Be ready Io heIp In an emergency and be abIe Io admInIsIer IIrsI aId.
CoordInaIe wIIh oIher proIessIonaIs In areas such as:
workers' educaIIon
InvesIIgaIIng compIaInIs
vocaIIonaI rehabIIIIaIIon
workers' socIaI weIIare
oIher maIIers reIevanI Io opIImaI work pIace and work envIronmenI and
Io workers' heaIIh.
APPENDlX 1.1 POTENTlALLY HAZARDOUS
OPERATlONS AND ASSOClATED AlR CONTAMlNANTS
1
Frocess types Contnmnnnt type Contnmnnnt exnmpIes
Hot operntons
WeIdIng Cases (g) Chromates (p)
ChemIcaI reactIons PartIcuIates (p) ZInc and compounds (p)
SoIderIng (Dust, Iumes, mIsts) Manganese and compounds (p)
MeItIng
MouIdIng
urnIng
Lqud operntons
PaIntIng Vapours (v) enzene (v)
DegreasIng Cases (g) TrIchIorethyIene (v)
DIppIng MIsts (m) MethyIene chIorIde (v)
SprayIng T,T,TTrIchIoroethyIene (v)
rushIng HydrochIorIc acId (m)
CoatIng SuIIurIc acId (m)
EtchIng Hydrogen chIorIde (g)
CIeanIng CyanIde saIts (m)
Dry cIeanIng ChromIc acId (m)
PIckIIng Hydrogen cyanIde (g)
PIatIng mIxIng TD, MD (v)
CaIvanIzIng Hydrogen suIIIde (g)
ChemIcaI reactIons SuIIur dIoxIde (g)
Carbon tetrachIorIde (v)
5oId operntons
PourIng Dusts Cement
MIxIng Quartz (Iree sIIIca)
SeparatIon FIbrous gIass
ExtractIon
CrushIng
ConveyIng
LoadIng
aggIng
Fressurzed sprnyng
CIeanIng parts Vapours (v) OrganIc soIvents (v)
AppIyIng pestIcIdes Dust (d) ChIordane (m)
DegreasIng MIst (m) ParathIon (m)
Sand bIastIng TrIchIoroethyIene (v)
PaIntIng T,T,TTrIchIoroethane (v)
MethyIene chIorIde (v)
Quartz (Iree sIIIca, d)
5hnpng operntons
CuttIng Dusts Asbestos
CrIndIng eryIIIum
FIIIng UranIum
MIIIIng ZInc
MouIdIng Lead
SawIng
DrIIIIng
1
LeIdeI NA, Busch KA, Lynch |R. Occuntonn cxo:uc :nnng :tntcg) nnnun. CIncInnaII,
OhIo, US DeparImenI oI HeaIIh, LducaIIon and WeIIare, 1977:77-17S.
APPENDlX 1.2 AN OCCUPATlONAL HYGlENE SURVEY
CHECK LlST
1. DeIermIne purpose and scope oI sIudy:
ComprehensIve occupaIIonaI hygIene survey7
LvaIuaIIon oI exposures oI IImIIed group oI workers Io specIIIc agenIs7
DeIermInaIIon oI compIIance wIIh specIIIc recognIzed sIandards7
LvaIuaIIon oI compIIance wIIh specIIIc recognIzed sIandards7
Response Io specIIIc compIaInI7
2. DIscuss purpose oI sIudy wIIh approprIaIe represenIaIIves oI managemenI
and Iabour.
S. IamIIIarIze yourseII wIIh pIanI operaIIons:
ObIaIn and sIudy process IIow sheeIs and pIanI IayouI.
CompIIe an InvenIory oI raw maIerIaIs, InIermedIaIes byproducIs and producIs.
RevIew reIevanI IoxIcoIogIcaI InIormaIIon.
ObIaIn a IIsI oI job cIassIIIcaIIons and Ihe envIronmenIaI sIresses Io whIch
workers are poIenIIaIIy exposed.
Observe Ihe acIIvIIIes assocIaIed wIIh job cIassIIIcaIIon.
RevIew reporIs oI prevIous sIudIes.
DeIermIne subjecIIveIy Ihe poIenIIaI heaIIh hazards assocIaIed wIIh pIanI
operaIIons.
RevIew adequacy oI IabeIIIng and warnIng.
4. Prepare Ior IIeId sIudy:
DeIermIne whIch chemIcaI and physIcaI agenIs are Io be evaIuaIed.
LsIImaIe, II possIbIe, ranges oI conIamInanI concenIraIIons.
RevIew, or deveIop II necessary, sampIIng and anaIyIIc meIhods, payIng
parIIcuIar aIIenIIon Io Ihe IImIIaIIons oI Ihe meIhods.
CaIIbraIe IIeId equIpmenI as necessary.
AssembIe aII IIeId equIpmenI.
ObIaIn personaI proIecIIve equIpmenI as requIred (hard haI, saIeIy gIasses,
hearIng proIecIIon, respIraIory proIecIIon, saIeIy shoes, coveraIIs, gIoves, eIc.).
Prepare a IenIaIIve sampIIng scheduIe.
RevIew occupaIIonaI heaIIh and saIeIy reguIaIIons beIng appIIed by Ihe heaIIh
auIhorIIIes.
S. ConducI IIeId sIudy:
ConIIrm process operaIIng scheduIe wIIh supervIsory personneI.
AdvIse represenIaIIves oI managemenI and Iabour oI your presence In Ihe area.
DepIoy personaI monIIorIng or generaI area sampIIng unIIs.
Ior each sampIe, record Ihe IoIIowIng daIa:
sampIe IdenIIIIcaIIon number
descrIpIIon oI sampIe (as deIaIIed as possIbIe)
IIme sampIIng began
IIow raIe oI sampIed aIr (check IrequenIIy)
IIme sampIIng ended
any oIher InIormaIIon or observaIIon IhaI mIghI be sIgnIIIcanI (e.g.,
process upseIs, venIIIaIIon sysIem noI operaIIng, use oI personaI
proIecIIon)
DIsmanIIe sampIIng unIIs.
SeaI and IabeI adequaIeIy aII sampIes (IIIIers, IIquId soIuIIons, charcoaI or sIIIca
geI Iubes, eIc.) IhaI requIre subsequenI IaboraIory anaIyses.
6. InIerpreI resuIIs oI sampIIng programme:
ObIaIn resuIIs oI aII anaIyses.
DeIermIne IImeweIghIed average exposures oI job cIassIIIcaIIon evaIuaIed.
DeIermIne peak exposures oI workers.
DeIermIne sIaIIsIIcaI reIIabIIIIy oI daIa, e.g. esIImaIe probabIe error In
deIermInaIIon oI average exposures.
Compare sampIIng resuIIs wIIh appIIcabIe IndusIrIaI hygIene sIandards and
reguIaIIons.
7. DIscuss survey resuIIs wIIh approprIaIe represenIaIIves oI managemenI and
Iabour.
8. ImpIemenI correcIIve acIIon comprIsed oI, as approprIaIe:
LngIneerIng conIroIs (IsoIaIIon, venIIIaIIon, eIc.).
AdmInIsIraIIve conIroIs (job roIaIIon, reduced work IIme, eIc.).
PersonaI proIecIIon.
BIoIogIc sampIIng programme.
MedIcaI surveIIIance.
LducaIIon and IraInIng.
9. DeIermIne wheIher oIher heaIIh and saIeIy consIderaIIons warranI IurIher
evaIuaIIon:
AIr poIIuIIon7
WaIer poIIuIIon7
SoIId wasIe dIsposaI7
SaIeIy7
HeaIIh physIcs7
10. ScheduIe reIurn vIsII(s) Io evaIuaIe eIIecIIveness oI conIroIs:
WaIkIhrough and observaIIon.
MeasuremenIs.
MODULE 2
Occupational and other
workrelated diseases
1. OB|ECTlVES
UndersIand Ihe reIaIIonshIp beIween work and heaIIh
UndersIand Ihe InIeracIIon oI man, envIronmenI and work
Know Ihe varIous Iypes oI sIresses or hazards IhaI may be presenI In dIIIerenI
Iypes oI occupaIIons IncIudIng IndusIry, agrIcuIIure eIc.
Know Ihe concepI oI occupaIIonaI and workreIaIed dIseases and Ihe concepI
oI aggravaIIon
RecognIze generaI heaIIh probIems oI workers and wheIher or noI Ihey are
workreIaIed
Survey Ihe workpIace, recognIze sIgns and sympIoms oI earIy ImpaIrmenI oI
heaIIh and carry ouI sImpIe IesIs Io supporI Ihe dIagnosIs oI an occupaIIonaI
and/or workreIaIed dIsease
GIve advIce Io managemenI regardIng Ihe conIroI and prevenIIon oI Ihe
IdenIIIIed hazards
GIve advIce Io workers and educaIe Ihem regardIng Ihe naIure oI hazards Ihey
are exposed Io, conIroI measures, personaI hygIene, earIy sympIoms and IIrsI
aId
ReIer paIIenIs and aIIecIed workers Ior IurIher InvesIIgaIIon and IreaImenI
ConsuII wIIh Ihe reIaIed auIhorIIy on envIronmenIaI monIIorIng oI Ihe workpIace
and on ImpIemenIaIIon and maInIenance oI conIroI measures (especIaIIy
engIneerIng)
Know Ihe Iaws, ruIes and reguIaIIons governIng occupaIIonaI saIeIy and heaIIh
IncIudIng hazard conIroI aI Ihe workpIace, recommended sIandards and
IhreshoId IImII vaIues, prepIacemenI and perIodIc medIcaI examInaIIons,
scheduIe oI occupaIIonaI dIseases (as appIIcabIe), Insurance and compensaIIons
Ior occupaIIonaI dIsease and accIdenIs
Keep medIcaI records IncIudIng personaI medIcaI IIIes, records oI accIdenIs
and occupaIIonaI dIseases, records oI prepIacemenI and perIodIc examInaIIons
Keep records oI envIronmenIaI monIIorIng, saIeIy acIIvIIIes, workpIace surveys
and reporI on heaIIh and saIeIy Irends aI Ihe workpIace.
2.1 OccupaIional and work-relaIed disease
"OccupaIIonaI dIseases . sIand aI one end oI Ihe specIrum oI workreIaIedness
where Ihe reIaIIonshIp Io specIIIc causaIIve IacIors aI work has been IuIIy
esIabIIshed and Ihe IacIors concerned can be IdenIIIIed, measured, and evenIuaIIy
conIroIIed. AI Ihe oIher end |are] dIseases |IhaI] may have a weak, InconsIsIenI,
uncIear reIaIIonshIp Io workIng condIIIons; In Ihe mIddIe oI Ihe specIrum Ihere Is a
possIbIe causaI reIaIIonshIp buI Ihe sIrengIh and magnIIude oI II may vary."
1
2.2 Degree ol work-relaIedness
The degree oI workreIaIedness oI a workconnecIed dIsease condIIIon varIes In
dIIIerenI sIIuaIIons and deIermInes wheIher a dIsease Is consIdered an occupaIIonaI
dIsease, a workreIaIed dIsease or aggravaIIon oI a concurrenI dIsease, e.g.
A specIIIc agenI IIke Iead or sIIIca, whIch Is presenI essenIIaIIy In Ihe workpIace,
causes a dIsease condIIIon whIch cannoI occur due Io oIher causes; IhIs Is an
occupaIIonaI dIsease.
Where InIecIIon can occur aI Ihe workpIace, an occupaIIonaI dIsease can aIso
be caused by a specIIIc agenI, such as IubercuIosIs among heaIIh care workers
In a IubercuIosIs IreaImenI cenIre. OI course InIecIIon can aIso occur In Ihe
generaI popuIaIIon under nonoccupaIIonaI condIIIons.
WorkreIaIed dIseases occur much more IrequenIIy Ihan occupaIIonaI dIseases.
They are caused by Ihe InIeracIIon oI severaI exIrInsIc rIsk IacIors and a
number oI InIrInsIc IacIors each oI whIch may or may noI operaIe In any
IndIvIduaI case. OccupaIIonaI hazards are among Ihe rIsk IacIors whIch can
conIrIbuIe Io Ihe occurrence oI workreIaIed dIseases. LxampIes are many and
IncIude:
- behavIouraI responses
- psychosomaIIc IIIness
- hyperIensIon
- coronary hearI dIsease
- chronIc nonspecIIIc respIraIory dIsease
- IocomoIor dIsorders.
Work condIIIons can aggravaIe preexIsIIng dIsease: hepaIIc dysIuncIIon can
be aggravaIed by exposure Io cerIaIn chIorInaIed hydrocarbons; bronchIaI
asIhma can be aggravaIed by dusI exposure and renaI dIsease can be aggravaIed
by InorganIc mercury, cadmIum and cerIaIn soIvenIs.
1
Idcntcnton nnd conto o \o-cntcd d:cn:c:. ReporI oI a WHO LxperI CommIIIee (WHO
TechnIcaI ReporI SerIes No. 714), Geneva, WorId HeaIIh OrganIzaIIon, 198S.
OccuntonnI nnd other work-reInted dsenses: ModuIe 2 41
Lxposure Io combInaIIons oI occupaIIonaI hazards may resuII In synergIsIIc
eIIecIs whIch are much more pronounced Ihan eIIecIs oI IndIvIduaI exposures
sImpIy added IogeIher.
IndIvIduaI suscepIIbIIIIy Io Ihe eIIecIs oI some occupaIIonaI exposures varIes.
GeneIIc IacIors are ImporIanI deIermInanIs oI IndIvIduaI suscepIIbIIIIy.
3. OCCUPATlONAL DlSEASES
3.1 DeliniIion
OccupaIIonaI dIseases are adverse heaIIh condIIIons In Ihe human beIng, Ihe
occurrence or severIIy oI whIch Is reIaIed Io exposure Io IacIors on Ihe job or In Ihe
work envIronmenI. Such IacIors can be:
PhysIcaI: e.g. heaI, noIse, radIaIIon
ChemIcaI: e.g. soIvenIs, pesIIcIdes, heavy meIaIs, dusI
BIoIogIcaI: e.g. IubercuIosIs, hepaIIIIs B vIrus, HIV
LrgonomIc: e.g. ImproperIy desIgned IooIs or work areas, repeIIIIve moIIons
PsychosocIaI sIressors: e.g. Iack oI conIroI over work, InadequaIe personaI
supporI
MechanIcaI: Ihese maInIy cause work accIdenIs and InjurIes raIher Ihan
occupaIIonaI dIseases.
3.2 CharacIerisIics ol occupaIional diseases
The occupaIIonaI cause oI occupaIIonaI dIsease Is oIIen overIooked by heaIIh care
provIders. ThIs Is due Io severaI specIaI characIerIsIIcs oI occupaIIonaI dIsease IhaI
may obscure IIs occupaIIonaI orIgIn.
The cIInIcaI and paIhoIogIcaI presenIaIIon oI mosI occupaIIonaI dIseases Is
IdenIIcaI Io IhaI oI nonoccupaIIonaI dIseases; e.g. asIhma (excessIve aIrway
narrowIng In Ihe Iungs) due Io aIrborne exposure Io IoIuene dIIsocyanaIe Is
cIInIcaIIy IndIsIInguIshabIe Irom asIhma due Io oIher causes.
OccupaIIonaI dIsease may occur aIIer Ihe IermInaIIon oI exposure. An exIreme
exampIe wouId be asbesIosreIaIed mesoIheIIoma (a cancer aIIecIIng Ihe Iung
and abdomen) whIch can occur S0 or 40 years aIIer Ihe exposure.
The cIInIcaI manIIesIaIIons oI occupaIIonaI dIsease are reIaIed Io Ihe dose and
IImIng oI exposure; e.g. aI very hIgh aIrborne concenIraIIons, eIemenIaI
mercury Is acuIeIy IoxIc Io Ihe Iungs and can cause puImonary IaIIure, whIIe aI
Iower IeveIs oI exposure, eIemenIaI mercury has no paIhoIogIc eIIecI on Ihe
Iungs buI can have chronIc adverse eIIecIs on Ihe cenIraI and perIpheraI
nervous sysIems.
OccupaIIonaI IacIors can acI In combInaIIon wIIh nonoccupaIIonaI IacIors Io
produce dIsease; e.g. exposure Io asbesIos aIone Increases Ihe rIsk oI Iung
cancer IIveIoId; and Ihe IongIerm smokIng oI cIgareIIes Increases Ihe rIsk oI
Iung cancer beIween S0 and 70 IoId.
3.3 PrevenIion ol occupaIional diseases
Inn) c\cnton
PrImary prevenIIon Is accompIIshed by reducIng Ihe rIsk oI dIsease. In Ihe
occupaIIonaI seIIIng, IhIs Is mosI commonIy done by reducIng Ihe magnIIude oI
exposure Io hazardous subsIances. As Ihe dose Is reduced so Is Ihe rIsk oI adverse
heaIIh consequences. Such reducIIons are IypIcaIIy managed by IndusIrIaI hygIene
personneI and are besI accompIIshed by changes In producIIon process or
assocIaIed InIrasIrucIure, e.g. Ihe subsIIIuIIon oI a hazardous subsIance wIIh a
saIer one, or encIosure or specIaI venIIIaIIon oI equIpmenI or processes IhaI
IIberaIe aIrborne hazards. These are known as engIneerIng conIroIs.
OIher meIhods oI exposure reducIIon IncIude use oI personaI proIecIIve equIpmenI
and roIaIIon oI workers Ihrough areas In whIch hazards are presenI Io reduce Ihe
dose Io each worker (NB: IhIs meIhod does, however, Increase Ihe number oI
workers exposed Io Ihe hazard).
5ccondn) c\cnton
ThIs Is accompIIshed by IdenIIIyIng heaIIh probIems beIore Ihey become cIInIcaIIy
apparenI (I.e. beIore workers reporI IeeIIng III) and InIervenIng Io IImII Ihe adverse
eIIecIs oI Ihe probIem. ThIs Is aIso known as occupaIIonaI dIsease surveIIIance. The
underIyIng assumpIIon Is IhaI such earIy IdenIIIIcaIIon wIII resuII In a more
IavourabIe ouIcome.
An exampIe oI secondary prevenIIon Is Ihe measuremenI oI bIood Iead IeveIs In
workers exposed Io Iead. An eIevaIed bIood Iead IeveI IndIcaIes a IaIIure oI prImary
prevenIIon buI can aIIow Ior correcIIve acIIon beIore cIInIcaIIy apparenI Iead
poIsonIng occurs. CorrecIIve acIIon wouId be Io Improve Ihe prImary prevenIIon
acIIvIIIes IIsIed above.
Tctn) c\cnton
ThIs Is accompIIshed by mInImIzIng Ihe adverse cIInIcaI eIIecIs on heaIIh oI a
dIsease or exposure. TypIcaIIy IhIs Is IhoughI oI as cIInIcaI occupaIIonaI medIcIne.
An exampIe oI IerIIary prevenIIon Is Ihe IreaImenI oI Iead poIsonIng (headache,
muscIe and joInI paIn, abdomInaI paIn, anaemIa, kIdney dysIuncIIon) by
admInIsIraIIon oI cheIaIIng medIcaIIon. The goaI Is Io IImII sympIoms or dIscomIorI,
mInImIze Injury Io Ihe body and maxImIze IuncIIonaI capacIIy.
3.4 Physical hazards aI Ihe workplace
TIcnn :tc::
(a) ThermaI envIronmenI
The IemperaIure oI Ihe human body when heaIIhy Is aI a consIanI oI around S7 C
Ihrough a dynamIc baIance beIween heaI producIIon and heaI Ioss. The heaI
reguIaIIng cenIre In Ihe hypoIhaIamus conIroIs IhIs baIance.
HeaI Is produced by Ihe meIaboIIc processes, by muscuIar acIIvIIy and by Iood
consumpIIon. HeaI Is exchanged wIIh Ihe surroundIng envIronmenI by conducIIon,
convecIIon, radIaIIon and evaporaIIon oI sweaI. HeaI exchange Is InIIuenced by aIr
IemperaIure, aIr veIocIIy, reIaIIve humIdIIy and radIaIIon. VarIous combInaIIons oI
Ihese IacIors can cause dIIIerenI degrees oI comIorI and dIscomIorI and severaI
IndIces have been descrIbed Io express Ihe degree oI IhermaI sIress resuIIIng Irom
combInaIIons oI Ihese IacIors, e.g. Ihe eIIecIIve IemperaIure, Ihe correcIed eIIecIIve
IemperaIure and weIbuIbgIobe IemperaIure IndIces.
(b) Types oI IhermaI sIress
CoId sIress:
ThIs exIsIs when Ihe surroundIng IemperaIure IaIIs, as occurs when enIerIng coId
sIorage rooms. A human IrIes Io reduce Ihe exposed skIn surIace (by bendIng Ihe
joInIs II possIbIe or by wearIng IhIck wooIIen cIoIhes). PerIpheraI vasoconsIrIcIIon
oI skIn vesseIs occurs resuIIIng In vascuIar Injury, chIIbIaIns, IrosI bIIe (dry
gangrene) or Irench IooI (weI gangrene). HeaI producIIon Increases Ihrough
Increased muscIe Ione and shIverIng. LxIreme cases resuII In hypoIhermIa, IowerIng
oI Ihe IemperaIure oI core organs and deaIh.
HeaI sIress: Ihe sIages
VasomoIor conIroI: As Ihe heaI sIress Increases, more bIood Is pumped Io Ihe skIn
and Iess Io Ihe vIsceraI organs and braIn. There Is cardIovascuIar sIress and
IachycardIa. MuscuIar work Is reduced sInce II produces more heaI. HeaI exhausIIon
Is manIIesIed by headaches, dIzzIness, sIeepIness, Iack oI concenIraIIon and anorexIa.
LvaporaIIve cooIIng: The body sIarIs Io sweaI wIIh Ihe amounI reIaIed Io Ihe degree
oI sIress and accIImaIIzaIIon. Loss oI sodIum chIorIde Ihrough sweaIIng causes heaI
cramps (paInIuI cramps sIarIIng In Ihe workIng muscIes and spreadIng Io oIher
muscIes) and dehydraIIon whIch aggravaIes cardIovascuIar probIems. The voIume
oI urIne Is reduced. HIgh aIr veIocIIy and Iow reIaIIve humIdIIy heIp cooIIng Ihrough
Ihe evaporaIIon oI sweaI. Dry heaI exposure Is encounIered In IoundrIes, sIeeI mIIIs
and In Ihe gIass IndusIry and moIsI heaI exposure In IexIIIe mIIIs, mInes, Ihe Iood
cannIng IndusIry and IaundrIes.
HeaI sIroke: II sweaIIng Is noI suIIIcIenI Io keep Ihe body IemperaIure wIIhIn Ihe
physIoIogIcaI range, Ihe heaI reguIaIIng cenIre IaIIs, sweaIIng sIops, Ihe skIn Is
IIushed and Ihe paIIenI Is saId Io suIIer Irom heaI sIroke. UnconscIousness and
deaIh may IoIIow. HeaI sIroke occurs In workers In hoI humId envIronmenIs
especIaIIy when exposed Io dIrecI sunIIghI. II Is an emergency sIIuaIIon where rapId
cooIIng, rehydraIIon and repIacemenI oI eIecIroIyIes are IndIcaIed.
(c) PrevenIIon oI heaI sIress
A graduaI exposure Io a hoI envIronmenI resuIIs In accIImaIIzaIIon and beIIer
IoIerance. HeaI sIress Is especIaIIy dangerous Ior chIIdren, Ihe eIderIy and paIIenIs
wIIh cardIovascuIar, renaI and skIn dIseases.
LngIneerIng conIroI measures shouId be used Io prevenI heaI exposure IncIudIng
shIeIdIng, InsuIaIIon and venIIIaIIon. PrepIacemenI and perIodIc medIcaI
examInaIIons are ImporIanI; IosI IIuIds and sodIum chIorIde shouId be repIaced;
personaI proIecIIve cIoIhes can heIp In some sIIuaIIons and workers shouId be gIven
adequaIe resI perIods Io be spenI In a more comIorIabIe envIronmenI.
No:c
NoIse Is unwanIed sound. Workers are exposed Io noIse In:
IexIIIe and gIass IndusIrIes
shIp buIIdIng
aeropIane manuIacIure
engIneerIng IndusIrIes
manuIacIure oI boIIers and pressure vesseIs
power pIanIs.
Sound Is propagaIed In Ihe Iorm oI waves, each oI whIch can be descrIbed In Ierms
oI Irequency or number oI cycIes per second measured In herIz (Hz) and InIensIIy
as expressed In decIbeIs (dB). The human ear can hear sounds rangIng In Irequency
Irom 20 Hz Io 20 000 Hz. The InIensIIy oI very IaInI sounds Is around 0 dB and a jeI
engIne can produce sounds oI 1S0 dB, whIch Is paInIuI Io Ihe ear. The sounds we
normaIIy hear are compIex sounds Iormed Irom many waves oI varyIng IrequencIes
and InIensIIIes. OrdInary speech Is heard aI IrequencIes oI S00 Hz Io 2000 Hz.
In addIIIon Io InIerIerence wIIh Ihe hearIng oI normaI speech, noIse can cause
annoyance and sIress and can Iead Io Increased accIdenI raIes and Iower
producIIvIIy. LxIraaudIIory eIIecIs are observed In dIIIerenI sysIems, IncIudIng
endocrIne, gasIroInIesIInaI and cardIovascuIar sysIems, and InIerIere wIIh sIeep.
The mosI ImporIanI eIIecI oI exposure Io noIse Is noIseInduced hearIng Ioss (NIHL).
HearIng ImpaIrmenI Is aI IIrsI Iemporary; as exposure Io noIse (abouI 8S dB)
conIInues, hearIng ImpaIrmenI becomes permanenI. NIHL usuaIIy Iakes many years
(7-10 years) Io deveIop. The mosI hazardous Is hIgh InIensIIy, hIgh Irequency,
conIInuous noIse. PersonaI suscepIIbIIIIy has a deIInIIe eIIecI.
AudIomeIry reveaIs earIy hearIng ImpaIrmenI aI IrequencIes oI S000-6000 Hz
beIore hearIng oI normaI speech Is aIIecIed. Hence, Ihe ImporIance oI measuremenI
oI hearIng on prepIacemenI and perIodIc hearIng examInaIIons.
Measures Io conIroI noIse In Ihe workpIace IncIude:
desIgn and maInIenance oI machInery
segregaIIon and dIspersIon oI noIse sources
prevenIIon oI propagaIIon and reIIecIIon oI noIse by Ihe use oI sound prooIIng
maIerIaIs Ior IIoors, waIIs and ceIIIngs
roIaIIon oI workers
reducIIon oI work exposure hours
use oI personaI proIecIIve devIces, e.g. ear pIugs, ear muIIs and heImeIs.
Vnton
Workers exposed Io whoIe vIbraIIons IncIude IracIor drIvers, IransporI workers,
workers InvoIved In drIIIIng Ior peIroIeum and Ihose In Ihe IexIIIe IndusIry. WhoIe
body vIbraIIons cause varIous aIImenIs reIaIed Io congesIIon oI peIvIc and
abdomInaI organs.
SegmenIaI vIbraIIons aIIecI workers usIng pneumaIIc or eIecIrIcaI vIbraIIng IooIs In
mInIng, road consIrucIIon, shoe manuIacIure and sawIng. VascuIar changes In Ihe
upper IImbs Iead Io "dead hands" and "whIIe IIngers" and proIonged exposure Ieads
Io rareIacIIon In Ihe smaII bones and wrIsI.
Ioo o dccct\c unnnton
LIghIIng sIandards depend on Ihe Iype oI work perIormed and degree oI precIsIon
requIred. AdequaIe IIghIIng shouId be provIded eIIher by naIuraI or arIIIIcIaI means,
avoIdIng shadows and gIare and observIng approprIaIe coIours and conIrasI.
DeIecIIve IIIumInaIIon Ieads Io eye sIraIn, IaIIgue and Increased accIdenI raIes.
DeIecIIve IIIumInaIIon In mIners Ieads Io mIner's nysIagmus (rapId, InvoIunIary
movemenI oI Ihe eyes).
Kndnton
(a) NonIonIzIng radIaIIon
UIIravIoIeI radIaIIon
Lxposure occurs In weIdIng, meIaI cuIIIng and exposure Io carbon arc and causes
skIn eryIhema, burns and hyperpIgmenIaIIon. Lxposure oI Ihe eyes causes "arc eye"
wIIh conjuncIIvIIIs and severe paIn and may Iead Io corneaI uIceraIIon. Lye
proIecIIon usIng specIaI Iace shIeIds Is necessary. ProIonged exposure causes
aIrophy oI Ihe skIn and epIIheIIomas.
InIrared radIaIIon
Lxposure occurs In IronI oI Iurnaces, In sIeeI mIIIs, In Ihe gIass IndusIry, In
bIacksmIIhs and In chaIn manuIacIure. Lxposure oI Ihe eyes can cause caIaracIs or
corneaI aIIecIIon. SkIn burns can aIso occur. CompIeIe proIecIIon oI Ihe eyes can be
achIeved by wearIng specIaI goggIes.
(b) IonIzIng radIaIIon
Sources oI radIaIIon IncIude radIoacIIve IsoIopes and Xray machInes. IonIzIng
radIaIIon Is used In medIcIne, IndusIry, agrIcuIIure, research and aIomIc warIare.
RadIaIIons are eIIher eIecIromagneIIc waves, IIke Xrays and gammarays, or mInuIe
parIIcIes, IIke aIpha, beIa and neuIrons. BoIh Iypes cause IonIzaIIon or excIIaIIon oI
aIoms whIch Ieads Io IIssue desIrucIIon.
The eIIecI oI IonIzIng IrradIaIIon depends on Ihe dose, Iype oI radIaIIon, wheIher
exposure was conIInuous or InIerrupIed and wheIher II was IoIaI body or IocaIIzed,
as weII as Ihe Iype oI IIssue IrradIaIed. The power oI peneIraIIon oI dIIIerenI Iypes
oI radIaIIon varIes Irom very hIgh, such as Xray and gammaray radIaIIon, Io very
Iow, such as aIpha radIaIIon.
DIIIerenI IIssues vary In IheIr sensIIIvIIy Io radIaIIon, wIIh Ihe IIssues oI Ihe
haemopoIeIIc sysIem and Ihe gasIroInIesIInaI mucosa beIng Ihe mosI sensIIIve and
Ihose oI Ihe bones and muscIes beIng Ihe IeasI sensIIIve.
LIIecIs may vary:
DeaIh occurs wIIhIn hours II Ihe whoIe body Is exposed Io a hIgh dose.
AcuIe radIaIIon syndrome occurs II Ihe dose Is Iess. SIgns and sympIoms
appear wIIhIn 24-48 hours and are due Io aIIecIIon oI Ihe gasIroInIesIInaI
mucosa causIng severe bIoody dIarrhoea and shock oI Ihe haemopoIeIIc
sysIem and oI Ihe skIn. II deaIh occurs II Is due Io haemorrhage (due Io
IhrombocyIopenIa) or InIecIIon (due Io damage oI InIesIInaI mucosa and
IeukopenIa).
BeIaradIaIIon aIIecIs Ihe skIn onIy, causIng skIn burns and aIopecIa.
ChronIc radIaIIon eIIecIs may IoIIow Iong aIIer an acuIe exposure or IoIIow
repeaIed exposure Io doses noI enough Io cause acuIe eIIecIs.
ChronIc eIIecIs IncIude skIn aIrophy, Ioss oI IInger prInIs, aIopecIa, naII
changes, IeIanIecIasIa, pIgmenIaIIon, keraIoses and epIIheIIomas. OIher eIIecIs
IncIude sIerIIIIy, aborIIon, muIagenIc eIIecIs and bIrIh deIecIs.
ConIroI oI exposure Io exIernaI radIaIIon sources resIs on Ihree generaI prIncIpIes:
1. KeepIng suIIIcIenI dIsIance beIween source and worker.
2. ReducIng IIme oI exposure.
S. ConIaInmenI and shIeIdIng.
ConIroI oI exposure Io InIernaI IrradIaIIon (upIake oI radIoacIIve maIerIaIs) IoIIows
more sIrIngenI reguIaIIons.
LaboraIorIes or esIabIIshmenIs In whIch radIoacIIve maIerIaIs are handIed shouId
be consIrucIed In such a way as Io oIIer maxImum conIaInmenI, encIosure and
shIeIdIng oI radIoacIIve maIerIaI, and Io ensure easy and compIeIe cIeanIng In case
oI spIIIs. HandIIng by remoIe conIroI Is very useIuI.
VenIIIaIIon and wasIe dIsposaI sysIems shouId be separaIe Irom Ihose oI oIher areas
and radIoacIIve wasIe shouId noI reach pubIIc wasIe sysIems. RadIoacIIve wasIe
shouId be dIsposed oI In such a way IhaI envIronmenIaI conIamInaIIon Is noI IIkeIy.
LnvIronmenIaI monIIorIng shouId be pracIIsed and aIarm sysIems shouId be
provIded.
OIher measures IncIude:
prepIacemenI and perIodIc medIcaI examInaIIons wIIh specIaI emphasIs on
eyes, skIn and bIood
personaI proIecIIve cIoIhIng
personaI monIIorIng badges
pockeI dosImeIers
whoIe body counIers
monIIorIng oI radIoacIIvIIy In bIoIogIcaI IIuIds.
CInngc: n nonctc c::uc
(a) Increased baromeIrIc pressure
Workers exposed Io Increased baromeIrIc pressure are dIvers, Irogmen, submarIne
crew and workers engaged In underwaIer consIrucIIon oI pIers, brIdges eIc.
BaromeIrIc pressure Increases by 1 aImosphere Ior every 10 meIres descended
underwaIer.
DurIng descenI: II Ihe openIngs IeadIng Io Ihe paranasaI sInuses or Ihe mIddIe ear
are bIocked (e.g. due Io caIarrh and oedema oI a mucous membranes), Ihe pressure
In Ihe cavIIIes cannoI be equaIIzed wIIh Ihe ouIsIde pressure and IhIs resuIIs In
severe paIn, oedema oI Ihe IInIng mucous membrane, haemorrhage and maybe
rupIure oI Ihe ear drum.
DurIng Ihe sIay under waIer, because oI Ihe dIssoIuIIon oI excess amounIs oI gases
In Ihe bIood and IIssues, oxygen poIsonIng and nIIrogen narcosIs may occur wIIh
serIous consequences. DIvers may aIso suIIer asphyxIa and even drownIng.
II rapId ascenI occurs wIIh Ihe gIoIIIs cIosed (e.g. II Ihe worker panIcs) Ihe Iung may
rupIure due Io expansIon oI gases, especIaIIy In Ihe presence oI a weak spoI. RapId
ascenI, noI IoIIowIng Ihe recommendaIIons oI sIandard surIacIng IabIes, resuIIs In
Ihe IormaIIon oI gas bubbIes In Ihe bIood and IIssues due Io IIberaIIon Irom soIuIIon
oI Ihe excess gases IhaI were dIssoIved under pressure. In Ihe bIood sIream, gas
(especIaIIy N
2
) causes aIr emboIIsm and paraIysIs and In Iense IIssues (IIgamenIs
around joInIs) causes severe paIn known as "Ihe bends", aIso reIerred Io as "CaIsson
dIsease" or decompressIon sIckness.
Workers who work under Increased pressure under waIer Ior many years may suIIer
Irom asepIIc bone necrosIs, especIaIIy In Ihe head oI Ihe Iemur. CaIsson dIsease may
manIIesI wIIhIn 24 hours oI ascenI and caIIs Ior urgenI compressIon In a
compressIon chamber unIII sympIoms dIsappear. Pressure Is Ihen reIeased
accordIng Io recommended sIeps.
A worker wIIh an upper respIraIory InIecIIon shouId noI be aIIowed Io dIve Io avoId
compIIcaIIons durIng descenI.
(b) Reduced baromeIrIc pressure
Passenger pIanes are normaIIy pressurIzed buI mIIIIary pIIoIs may be exposed Io
reduced aImospherIc pressure. In IhIs case expansIon oI InIesIInaI gases may cause
respIraIory embarrassmenI buI beIore decompressIon sIckness occurs Ihey wIII have
Ianded.
Workers aI hIgh aIIIIude suIIer Irom eIIecIs oI reduced parIIaI pressure oI oxygen.
The body compensaIes by IncreasIng Ihe puIse raIe, IncreasIng Ihe breaIhIng raIe
and poIycyIhemIa.
3.5 Chemical hazards (occupaIional poisoning)
Workers In dIIIerenI occupaIIons are exposed Io Ihousands oI chemIcaIs, some oI
whIch can cause occupaIIonaI dIseases. Ior Ihe sake oI dIscussIon, Ihese chemIcaIs
are cIassIIIed accordIng Io IheIr physIcaI sIaIe, chemIcaI composIIIon or
physIoIogIcaI acIIon.
Cn:c: nnd \nou:
These can be cIassIIIed accordIng Io IheIr physIoIogIcaI acIIon InIo: asphyxIanIs,
IrrIIanI gases, organomeIaIIIc compounds and anaesIheIIc vapours.
(a) AsphyxIanIs
Can cause asphyxIa eIIher by repIacIng oxygen or by some oIher mechanIsm. They
are cIassIIIed InIo: :nc n:I)xnnt: and cIcncn n:I)xnnt:.
5nc n:I)xnnt:: repIace oxygen, e.g. nIIrogen, meIhane, hydrogen and carbon
dIoxIde.
NiIrogen: a sImpIe asphyxIanI used In Ihe IerIIIIzer IndusIry and presenI In mInes
when O
2
Is consumed. In mInes II can be deIecIed by Ihe saIeIy Iamp whIch Is
exIInguIshed aI O
2
concenIraIIon oI 17. AI 12 O
2
Ihere Is dyspnea, cyanosIs,
unconscIousness, Ioss oI moIor power, convuIsIons and deaIh.
MeIhane (marsh gas): resuIIs Irom decomposIIIon oI organIc maIIer and Is presenI
In marshes, sewers and mInes. II Is a sImpIe asphyxIanI, InIIammabIe and IIghIer
Ihan aIr.
Carbon dioxide (CO
2
): resuIIs Irom combusIIon oI IueIs; II Is a coIourIess gas,
heavIer Ihan aIr. II can be Iound In mInes, weIIs, caves and cIose Io Iurnaces and
brIck kIIns. II Is aIso presenI In Ihe manuIacIure oI soII drInks, beer, In Ihe sugar
IndusIry and Is used as dry Ice. In addIIIon II can be used Io exIInguIsh IIres. CO
2
Is
a sImpIe asphyxIanI buI In Iow concenIraIIons sIImuIaIes rapId respIraIIon.
ResuscIIaIIon caIIs Ior O
2
InhaIaIIon, warmIh, cardIorespIraIory sIImuIanIs and II
respIraIIon sIops, arIIIIcIaI respIraIIon.
CIcncn n:I)xnnt:: InIerIere Ihrough some chemIcaI acIIon wIIh Ihe respIraIory
IuncIIon oI Ihe bIood, IIssue ceIIs or respIraIory cenIre, e.g. carbon monoxIde (CO),
hydrogen suIIIde and hydrocyanIc acId.
Carbon monoxide (CO): a coIourIess, odourIess gas whIch resuIIs Irom IncompIeIe
combusIIon oI IueI. II Is a producI oI coaI dIsIIIIaIIon pIanIs, sIeeI Iurnaces, IueI
boIIers and Iurnaces and home heaIIng appIIances. II Is aIso presenI In vehIcIe
exhausI Iumes.
CO has a greaI aIIInIIy Io haemogIobIn (HbCO) (210 IImes IhaI oI O
2
) and Ihus
InIerIeres wIIh O
2
IransporI. Lxposure causes headaches, dIzzIness, chesI
oppressIon, Ioss oI moIor power, unconscIousness, convuIsIons, cardIovascuIar
eIIecIs, coma and deaIh (dependIng on Ihe percenIage oI HbCO In Ihe bIood).
PrevenIIon oI CO poIsonIng depends on proper desIgn, maInIenance and reguIar
InspecIIon oI home appIIances and IndusIrIaI sources and aIso on conIroI measures
In garages.
In a case oI poIsonIng, O
2
InhaIaIIon Is IndIcaIed (wIIh S CO
2
), wIIh warmIh,
sIImuIanIs and arIIIIcIaI respIraIIon provIded II needed; Ihe worker shouId be
removed Irom exposure IIrsI.
Hydrogen sullide (H
2
S): a coIourIess gas, heavIer Ihan aIr; II has Ihe odour oI roIIen
eggs. Lxposure occurs In oII IIeIds and reIInerIes, IannerIes, sewers and In Ihe
manuIacIure oI rayon and arIIIIcIaI rubber. II can be deIecIed by IIs smeII and causes
paraIysIs oI Ihe oIIacIory nerve aIIer a shorI whIIe.
In addIIIon Io beIng a chemIcaI asphyxIanI, II has an IrrIIanI eIIecI on Ihe eyes and
upper respIraIory cenIre; II aIso causes asphyxIa by combInIng wIIh cyIochrome
oxIdase enzyme and prevenIIng IIssue respIraIIon. II respIraIory paraIysIs occurs
arIIIIcIaI respIraIIon Is IndIcaIed. NIIrIIes (subIInguaI and InIravenous) serve Io break
Ihe combInaIIon beIween Ihe gas and cyIochrome oxIdase enzyme by IormIng
meIhaemogIobIn.
Hydrocyanic acid (HCN): a coIourIess gas IhaI has Ihe odour oI bIIIer aImonds. HCN
Is used In IumIgaIIon oI shIps as a pesIIcIde and IIs saIIs are used In phoIography,
meIaI hardenIng, eIecIropIaIIng and In exIracIIon oI goId Irom ore.
The gas can be absorbed Ihrough Ihe skIn and IIs InorganIc saIIs are among Ihe mosI
poIenI poIsons. They produce IheIr eIIecIs Ihrough InhIbIIIng cyIochrome oxIdase
enzyme Ihus InIerIerIng wIIh IIssue respIraIIon. SIgns and sympIoms appear wIIhIn
mInuIes In Ihe Iorm oI dIzzIness, oppressIon oI Ihe chesI, cardIorespIraIory
manIIesIaIIons, unconscIousness and deaIh whIch, In severe cases, occurs wIIhIn
mInuIes. OrganIc saIIs are noI as IoxIc.
IIrsI aId IncIudes Ihe InhaIaIIon oI amyI nIIrIIe and InIravenous InjecIIon oI sodIum
nIIrIIe IoIIowed by sodIum IhIosuIIaIe. CobaII LDTA and hydroxocobaIamIn are aIso
used In Ihe IreaImenI oI cyanIde poIsonIng. CardIorespIraIory sIImuIanIs, warmIh
and arIIIIcIaI respIraIIon may aIso be IndIcaIed.
SInce HCN Is a very rapId poIson, Ihe IIrsI aId equIpmenI shouId be very cIose Io Ihe
work sIIe and a weIIIraIned IIrsI aId aIIendanI avaIIabIe aI aII work shIIIs.
(b) IrrIIanI gases
These can cause IrrIIaIIon or InIIammaIIon oI Ihe mucous membranes wIIh whIch
Ihey come InIo conIacI. ThIs properIy depends on IheIr degree oI soIubIIIIy In waIer.
HIghIy soIubIe gases, IIke ammonIa, aIIecI Ihe upper respIraIory passages. Less
soIubIe gases IIke chIorIne and suIIur dIoxIde aIIecI boIh Ihe upper respIraIory
passages and Ihe Iung IIssues. Gases whIch are even Iess soIubIe, IIke nIIrogen
oxIdes and phosgene, acI essenIIaIIy on Ihe Iungs and In IhIs case Ihe IrrIIanI aIIecI
may be deIayed Ior hours.
Sullur dioxide (SO
2
): one oI Ihe mosI common aIr poIIuIanIs. II resuIIs Irom Ihe
combusIIon oI IueIs conIaInIng suIIur and Is presenI In vehIcIe exhausI Iumes, In
IronI oI Iurnaces and Is aIso produced In Ihe exIracIIon oI meIaIs Irom suIphIde
ores. II Is used In Ihe producIIon oI suIIurIc acId, In Ihe preservaIIon oI IruIIs, In
sugar IndusIry and In Ihe bIeachIng oI wooI.
II Is coIourIess, has a pungenI odour and Is oxIdIzed In aIr InIo suIIur IrIoxIde.
Lxposure causes IrrIIaIIon oI Ihe eyes and upper respIraIory passages. HIgh
concenIraIIons may cause oedema oI Ihe Iarynx, puImonary oedema, pneumonIa
and even deaIh.
Ammonia (NH
S
): a common upper aIrway IracI IrrIIanI. II Is a hIghIy soIubIe aIkaIIne
gas IhaI Is wIdeIy used In IndusIry as a reIrIgeranI and In Ihe manuIacIure oI
IerIIIIzers, expIosIves and pIasIIcs. II aIIacks Ihe skIn, Ihe conjuncIIva and Ihe
mucous membranes oI Ihe upper respIraIory IracI. Oedema oI Ihe Iarynx and
puImonary oedema can occur wIIh exposure Io hIgh concenIraIIons and can cause
deaIh.
ManagemenI consIsIs oI removIng Ihe paIIenI Irom exposure IoIIowed by supporIIve
care wIIh oxygen and aIIenIIon Io IIuId and eIecIroIyIe homeosIasIs. MosI paIIenIs
graduaIIy Improve over IIme and make a IuII recovery wIIhouI parenchymaI Iung
damage excepI Ior bronchIecIasIs.
lormaldehyde (HCHO): a poIenI upper respIraIory IracI IrrIIanI IhaI Is used as a
dIsInIecIanI and IndusIrIaI cIeaner and may reIease gas Irom parIIcIe board. II Is an
anImaI carcInogen and may cause acuIe bronchIaI IrrIIaIIon In humans.
Hydrogen lluoride (HI): a poIenI upper respIraIory IracI acId IrrIIanI IhaI causes
puImonary oedema. II Is used In Ihe mIcroeIecIronIcs IndusIry Ior eIchIng sIIIcon
chIps and Is aIso used Io eIch gIass.
Ozone (O
S
): an ImporIanI IrrIIanI produced by phoIochemIcaI oxIdaIIon oI vehIcIe
exhausI Iumes and whIch Is generaIed In arc weIdIng. Ozone causes nose and eye
IrrIIaIIon and Is aIso a poIenI respIraIory IracI IrrIIanI causIng coughIng, IIghIness
In Ihe chesI and shorIness oI breaIh.
Chlorine (CI
2
): a greenIsh yeIIow gas wIIh a pungenI IrrIIaIIng odour. II aIIecIs Ihe
upper and Iower respIraIory IracI. Lxposure occurs In Ihe producIIon oI sodIum
hydroxIde. The gas Is used In bIeachIng and waIer dIsInIecIIon and exposure can
occur durIng Ihe IransporI oI IIquId chIorIne. Lxposure causes IrrIIaIIon oI Ihe eyes
and upper respIraIory IracI and Iarger concenIraIIons may resuII In puImonary
oedema and deaIh.
Phosgene (COCI
2
): resuIIs Irom decomposIIIon oI chIorInaIed hydrocarbons when
Ihey come InIo conIacI wIIh a hoI surIace (CCI
4
Is used In IIre IIghIIng). Phosgene Is
sparIngIy soIubIe In waIer, IhereIore upper respIraIory IrrIIaIIon Is sIIghI. However,
deIayed puImonary oedema can occur and IhereIore Ihe paIIenI shouId be observed
Ior 48 hours and gIven resI, warmIh sIImuIanIs and O
2
.
NiIrogen oxides (NO
x
): nIIrous oxIde (N
2
O) Is an anaesIheIIc and In Ihe absence oI
O
2
Is a sImpIe asphyxIanI. NIIrogen oxIdes are a mIxIure oI NO
2
and N
2
O
4
and are
brown In coIour. Lxposure occurs In chemIcaI IaboraIorIes, In Ihe expIosIve IndusIry,
In Ihe manuIacIure oI nIIrIc or suIIurIc acIds, IerIIIIzer IndusIry and on sIow
combusIIon oI nIIrogenconIaInIng maIerIaIs. II Is presenI In weIdIng operaIIons and
In soIIs.
Due Io IheIr poor waIer soIubIIIIy, nIIrogen oxIdes can be InhaIed In hIgh
concenIraIIon wIIhouI suIIIcIenI warnIng IrrIIaIIon buI II has a severe IrrIIanI eIIecI
on Ihe Iung IIssue. SympIoms may be deIayed 2-20 hours, aIIer whIch IaIaI
puImonary oedema may occur. ThereIore, regardIess oI Ihe condIIIon oI Ihe paIIenI
when IIrsI seen, he/she shouId be puI under cIose observaIIon, preIerabIy In
hospIIaI, Ior aI IeasI 24 hours.
(c) OrganomeIaIIIc compounds
Arsine (ASH
S
): produced durIng chemIcaI IreaImenI oI meIaIs when arsenIc Is
presenI as an ImpurIIy and nascenI hydrogen Is evoIved. II Is coIourIess and has a
garIIc odour. Lxposure resuIIs In haemoIysIs, anaemIa, jaundIce and anurIa In severe
cases.
Nickel carbonyl |NI(CO)
4
]: a voIaIIIe IIquId produced durIng Ihe exIracIIon oI nIckeI.
InhaIaIIon causes severe puImonary IrrIIaIIon.
(d) AnaesIheIIc vapours
Many oI Ihese have some oIher sysIemIc eIIecI as weII and Iend Io accumuIaIe In
Iow, cIosed, poorIy venIIIaIed pIaces.
The IoIIowIng precauIIons shouId be observed when Ihere Is poIenIIaI exposure Io
noxIous gases.
WorkpIaces shouId be venIIIaIed or sIeamed repeaIedIy.
II Ihere Is IIkeIIhood oI Ihe presence oI noxIous gases or InsuIIIcIenI oxygen,
gas masks shouId be provIded.
Workers shouId be properIy IraIned and shouId aIways work In Ieams wIIh one
Ieam member nomInaIed Io observe Irom a dIsIance, away Irom possIbIe
conIamInaIIon.
IIrsI aId equIpmenI, IncIudIng oxygen, shouId be readIIy avaIIabIe wIIh a
IraIned Ieam oI rescuers.
An aIIecIed worker shouId be removed Irom Ihe exposure and kepI warm and
resIed. II breaIhIng sIops, arIIIIcIaI respIraIIon shouId be conIInued unIII
recovery or deaIh Is ascerIaIned.
Mctn:
In IndusIry, poIsonIng wIIh meIaIs usuaIIy Iakes Ihe chronIc Iorm and resuIIs Irom
Ihe absorpIIon oI smaII amounIs over Iong perIods oI IIme. AcuIe poIsonIng may
resuII Irom accIdenIaI (or suIcIdaI) InIake oI Iarge doses oI some oI Ihe more IoxIc
compounds (IIke arsenIcaIs).
MeIaIs and IheIr compounds gaIn access InIo Ihe body by InhaIaIIon, IngesIIon and,
In a Iew cases, Ihrough Ihe skIn. A Iarge number oI meIaIIIc compounds are used In
IndusIry wIIh Ihe IoIIowIng beIng some oI Ihe more ImporIanI.
(a) Lead
lnorganic lead: Lxposure Io InorganIc Iead compounds occurs In mInIng, exIracIIon,
smeIIIng, meIaI cuIIIng, manuIacIure oI Iead pIpes, Iead paInIs, manuIacIure oI Iead
baIIerIes, crysIaI gIass and hoI meIaI IypeseIIIng.
II Is absorbed as dusI vIa Ihe respIraIory IracI, and vIa Ihe gasIroInIesIInaI IracI wIIh
Iood and drInks. InorganIc Iead Is noI absorbed Ihrough Ihe skIn. The sIgns and
sympIoms oI exposure IncIude a bIue IIne on Ihe gums, InIesIInaI coIIc and
consIIpaIIon, anaemIa, generaI weakness and, In severe cases, IooI drop and wrIsI
drop. LncephaIopaIhy due Io Iead Is now very rare.
LngIneerIng conIroI meIhods Io prevenI exposure are venIIIaIIon, mechanIzaIIon
and housekeepIng. PersonaI cIeanIIness, change oI cIoIhes, washIng IacIIIIIes and
provIsIon oI cIean areas Ior eaIIng and sIorIng Iood wIII reduce upIake oI Iead by
mouIh. PerIodIc medIcaI examInaIIon heIps deIecI earIy aIIecIIon.
Organic lead (IeIraeIhyl lead): OrganIc Iead Is sIIII used as a IueI addIIIve In gasoIIne.
II Is a voIaIIIe IIquId and can be absorbed by InhaIaIIon and Ihrough Ihe skIn.
Lxposure causes excIIaIIon oI Ihe cenIraI nervous sysIem Ihen depressIon and may
end In deaIh.
(b) Mercury
Mercury Is a voIaIIIe IIquId meIaI. Lxposure occurs In mInIng, exIracIIon, chemIcaI
IaboraIorIes, Ihe chemIcaI IndusIry In generaI, Ihe pharmaceuIIcaI IndusIry, Ihe
manuIacIure oI IhermomeIers and baromeIers, Ihe expIosIve IndusIry, Ihe
manuIacIure oI mercury vapour Iamps, Ihe manuIacIure oI pesIIcIdes, mIrrors and
In denIIsIry.
lnorganic mercury compounds: cause sIomaIIIIs, a brown IIne on Ihe gums, Ioose
IeeIh, meIaIIIc IasIe, Iremors and personaIIIy changes. There Is kIdney aIIecIIon and
gasIroInIesIInaI dIsIurbances.
Organic mercury (pesIicides): exerI IheIr eIIecI on Ihe cenIraI nervous sysIem.
Mercury IuImInaIe (an expIosIve) causes skIn uIcers and perIoraIIon oI Ihe nasaI
sepIum.
(c) Manganese
Lxposure occurs In mInIng, exIracIIon, Ihe sIeeI IndusIry, Ihe dry baIIery IndusIry,
Ihe gIass and ceramIcs IndusIry, Ihe manuIacIure oI weIdIng rods and In Ihe
chemIcaI IndusIry. Manganese exposure can cause pneumonIa and can aIIecI Ihe
cenIraI nervous sysIem causIng ParkInson dIsease, Iremors, mask Iace, rIgIdIIy and
personaIIIy change.
(d) ArsenIc
Lxposure occurs In mInIng and exIracIIon. ArsenIc compounds are used In
pesIIcIdes, wood preservaIIves, medIcInes, paInIs and Ihe chemIcaI IndusIry. AcuIe
exposure causes severe gasIroenIerIIIs, shock and even deaIh. ChronIc exposure Io
arsenIc causes aIIecIIon oI Ihe perIpheraI nerves, skIn IesIons, skIn cancer, anaemIa,
perIoraIIon oI Ihe nasaI sepIum and Iung cancer.
Ognnc :o\cnt:
OrganIc soIvenIs are organIc IIquIds In whIch oIher subsIances can be dIssoIved
wIIhouI changIng IheIr chemIcaI composIIIon. They are used In Ihe exIracIIon oI oIIs
and IaIs In Ihe Iood IndusIry, Ihe chemIcaI IndusIry, paInI, varnIshes, enameI, Ihe
degreasIng process, dry cIeanIng, prInIIng and dyIng In Ihe IexIIIe and rayon
IndusIrIes. OrganIc soIvenIs are voIaIIIe: many oI Ihem are InIIammabIe and Ihey
are consIdered IIre hazards.
ChemIcaI groups IncIude:
hydrocarbon soIvenIs
aIcohoIs and eIhers
keIones
esIers
gIycoIs and IheIr compounds.
SoIvenIs are absorbed maInIy Ihrough Ihe Iungs, vIa Ihe gasIroInIesIInaI IracI II
Iaken by mouIh, and many oI Ihem can be absorbed vIa InIacI skIn. As a group,
soIvenIs aIIecI severaI oI Ihe body's sysIems and can cause Ihe IoIIowIng eIIecIs:
nervous sysIem: dIzzIness, unconscIousness and deaIh, perIpheraI neurIIIs,
aIIecIIon oI vIsIon, InsomnIa, headache and easy IaIIgue
gasIroInIesIInaI sysIem: dyspepsIa, anorexIa and nausea and may be secondary
Io IIver aIIecIIon
respIraIory IracI: may show upper respIraIory IrrIIaIIon In some cases
kIdney: aIIecIIon may cause nephrIIIs or renaI IaIIure
bIood IormIng organs: may be aIIecIed causIng anaemIa or even IeukaemIa
skIn: may show conIacI dermaIIIIs or acne.
SpecIIIc exampIes oI poIsonIng by organIc soIvenIs:
PeIroIeum producIs: may cause unconscIousness and when swaIIowed by
accIdenI cause gasIrIIIs or pneumonIa due Io aspIraIIon InIo Iungs.
BenzoI (benzene, C
6
H
6
): Is a producI oI coaI dIsIIIIaIIon and Is used In Ihe paInI
IndusIry, arIIIIcIaI rubber manuIacIurIng, Ihe pharmaceuIIcaI and chemIcaI
IndusIrIes, rubber producIs manuIacIurIng and degreasIng. The cenIraI nervous
sysIem IoxIcIIy Is Ihe mosI ImporIanI aspecI oI acuIe hIgh dose exposure Io
benzoI. ApIasIIc anaemIa Is Ihe cIassIc cause oI deaIh In chronIc benzoI
poIsonIng. BenzoIInduced IeukaemIa may deveIop In some cases In persons
who prevIousIy have had apIasIIc anaemIa. The IoxIc eIIecIs oI benzoI are besI
prevenIed by repIacIng II wIIh Iess IoxIc compounds. There are many soIvenIs
saIer Ihan benzoI.
ChIorInaIed hydrocarbons: Ihe addIIIon oI chIorIne Io carbon and hydrogen
Increases Ihe sIabIIIIy and decreases Ihe IIammabIIIIy oI Ihe resuIIIng
compounds. They have sIIghIIy pungenI odours. SIx chIorInaIed aIIphaIIc
hydrocarbons are commonIy used as soIvenIs:
IrIchIoreIhyIene
perchIoroeIhyIene (IeIrachIoroeIhyIene)
111IrIchIoroeIhane (meIhyI chIoroIorm)
meIhyIene chIorIde (dIchIoromeIhane)
carbon IeIrachIorIde
chIoroIorm.
AcuIe eIIecIs IncIude:
anaesIhesIa: dIzzIness, headache, nausea, vomIIIng, IaIIgue,
"drunkenness", sIurred speech, dIsequIIIbrIum, dIsorIenIaIIon, depressIon,
Ioss oI conscIousness
respIraIory IracI IrrIIaIIon: sore nose, sore IhroaI, cough.
ChronIc eIIecIs IncIude: dermaIIIIs, neurobehavIouraI dysIuncIIon,
hepaIoceIIuIar Injury and renaI IubuIar dysIuncIIon.
Iunonn) du:t d:cn:c:
II Ihe work aImosphere Is dusIy, dusI wIII InevIIabIy be InhaIed. DusI parIIcIes beIow
IIve mIcrons In dIameIer are caIIed respIrabIe sInce Ihey have Ihe chance Io peneIraIe
Io Ihe aIveoII. The respIraIory IracI has cerIaIn deIence mechanIsms agaInsI dusI
buI when Ihe envIronmenI Is very dusIy a sIgnIIIcanI amounI oI dusI can be reIaIned
In Ihe Iungs.
DIIIerenI kInds oI dusI have dIIIerenI eIIecIs:
SoIubIe parIIcIes oI IoxIc compounds reach Ihe bIood and cause poIsonIng, e.g.
Iead.
IrrIIanI dusIs cause IrrIIaIIon oI Ihe upper respIraIory IracI and Ihe Iungs and
cerIaIn meIaI Iumes cause chemIcaI pneumonIa, e.g. cadmIum, beryIIIum and
manganese.
Some oIhers cause sensIIIzaIIon resuIIIng In asIhma or exIrInsIc aIIergIc
aIveoIIIIs, e.g. some organIc dusIs.
MeIaI Iume Iever Is caused by InhaIaIIon oI Iumes oI zInc and copper causIng
Iever, body aches and chIIIs Ior 1-2 days.
PneumonIc anIhrax Is caused by InhaIaIIon oI wooI dusI conIaInIng Ihe spores.
BenIgn pneumoconIosIs whIch causes Xray opacIIIes (noduIaIIon) wIIhouI
sympIoms or dIsabIIIIy Is caused by InhaIaIIon oI Iron, barIum and IIn dusI.
ByssInosIs Is caused by proIonged exposure (7-10 years) Io coIIon dusI In Ihe
IexIIIe IndusIry especIaIIy In Ihe gInnIng, baIe openIng and cardIng. II Is
manIIesIed by chesI IIghIness on Ihe IIrsI day IoIIowIng a weekend. InIIIaIIy, Ihe
paIIenI Is Iree oI sympIoms Ior Ihe resI oI Ihe week. ChronIc bronchIIIs,
emphysema and dIsabIIIIy are common compIIcaIIons.
PneumoconIosIs Is dIsabIIng puImonary IIbrosIs IhaI resuIIs Irom Ihe InhaIaIIon
oI varIous Iypes oI InorganIc dusI, such as sIIIca, asbesIos, coaI, IaIc and chIna
cIay, e.g. sIIIcosIs and asbesIosIs:
Silicosis: sIIIcosIs resuIIs Irom Ihe InhaIaIIon oI respIrabIe parIIcIes oI Iree
crysIaIIIne sIIIca (SIO
2
). Lxposure occurs In mInIng and quarryIng operaIIons, sIone
cuIIIng and shapIng, Ioundry operaIIons, gIass and ceramIcs manuIacIure,
sandbIasIIng and manuIacIure oI abrasIve soaps. II Iakes many years Io deveIop Ihe
dIsease (7-10 years, someIImes Iess) and IhIs depends on Ihe concenIraIIon oI Ihe
dusI aI Ihe workpIace, IIs sIIIca conIenI, Ihe parIIcIe sIze and on IndIvIduaI
suscepIIbIIIIy. The dusI parIIcIes seIIIe In Ihe Iungs and cause smaII noduIes oI
IIbrosIs IhaI progressIveIy become more numerous, enIarge and coaIesce causIng
IIbrosIs and progressIve Ioss oI Iung IuncIIon and dIsabIIIIy. There may be coughIng
and expecIoraIIon. In Ihe earIy sIages Ihere may be sIgns deIecIabIe by Xray buI
IaIer on Ihe worker compIaIns oI IncreasIng dyspnoea on exerIIon. CompIIcaIIons
IncIude puImonary IubercuIosIs and cardIac or respIraIory IaIIure. The dIsease can
be deIecIed even beIore Ihe sympIoms appear by Xray examInaIIon whIch shows
numerous bIIaIeraI noduIar shadows oI dIIIerenI sIzes or Iarge masses oI IIbrosIs.
AsbesIosis: asbesIosIs Is caused by InhaIaIIon oI asbesIos IIbres. II Is a hydraIed
magnesIum sIIIcaIe whIch Is resIsIanI Io heaI and many chemIcaIs. In addIIIon Io
mInIng and exIracIIon, exposure Io asbesIos occurs In IIs use Ior InsuIaIIon, In Ihe
makIng oI asbesIos cIoIh, In Ihe manuIacIure oI asbesIos cemenI pIpes and oIher
producIs, vInyI IIoor IIIes and In brake and cIoIh IInIng. AsbesIos IIbres, when
InhaIed, wIII cause dIIIuse InIersIIIIaI IIbrosIs oI Ihe Iungs, pIeuraI IhIckenIng and
caIcIIIcaIIon. BronchogenIc carcInoma or pIeuraI and perIIoneaI mesoIheIIoma are
known eIIecIs. The earIy sympIoms IncIude progressIve dyspnoea on exerIIon,
cough, expecIoraIIon, chesI paIn, cyanosIs and cIubbIng oI Ihe IIngers. The dIsease
Iakes abouI seven years Io deveIop and depends upon Ihe dusI concenIraIIon aI Ihe
workpIace. LarIy deIecIIon depends on sympIoms and sIgns and Ihe Xray pIcIure.
SmokIng Increases Ihe rIsk oI deveIopIng Iung cancer severaI IoId.
DusI conIroI measures IncIude:
subsIIIuIIon oI harmIuI dusI wIIh a harmIess one
auIomaIIon and mechanIzaIIon oI dusIy processes
segregaIIon oI dusIy jobs
encIosure oI dusIy operaIIons
venIIIaIIon oI generaI and IocaI exhausI Iumes
housekeepIng and generaI cIeanIIness
Ihe use oI waIer In dusI suppressIon
Ior IoxIc dusI: personaI cIeanIIness, washIng IacIIIIIes, changIng work cIoIhes
beIore goIng home, washIng oI work cIoIhes, provIsIon oI separaIe areas Ior
eaIIng, drInkIng and smokIng
heaIIh educaIIon
prepIacemenI medIcaI examInaIIon
personaI proIecIIve equIpmenI.
Ic:tcdc:
PesIIcIdes are a group oI chemIcaIs used Io desIroy varIous kInds oI pesIs IncIudIng
InsecIs, rodenIs, weeds, snaIIs, IungI, eIc. The degree oI IoxIcIIy oI dIIIerenI
pesIIcIdes varIes greaIIy Irom deadIy poIsons Io sIIghIIy harmIuI pesIIcIdes.
Lxposure Io pesIIcIdes occurs In IndusIrIes where Ihe pesIIcIdes are manuIacIured
and IormuIaIed, and durIng IheIr appIIcaIIon In agrIcuIIure or In pubIIc heaIIh.
PesIIcIdes are aIso used aI home.
They are cIassIIIed InIo severaI groups, accordIng Io IheIr chemIcaI composIIIon. The
mosI IrequenIIy used nowadays are organophosphaIes, carbamaIes and
IhIocarbamaIes, pyreIhroIds and organochIorIne pesIIcIdes. OIher groups IncIude
Iead arsenaIe, organIc mercury, IhaIIIum compounds, coumarIn, bromomeIhane,
cresoIs, phenoIs, nIcoIIne, zInc phosphIde, eIc.
PesIIcIdes are absorbed Ihrough Ihe Iungs, Ihe gasIroInIesIInaI IracI and someIImes
Ihrough Ihe InIacI skIn and eyes (organophosphaIes).
(a) OrganochIorIne
LxampIes are DDT, aIdrIn, dIeIdrIn, IoxaIene and gammaxane. They are sIIghIIy Io
moderaIeIy IoxIc, and are noI bIodegradabIe In Ihe envIronmenI or In Ihe human
body. They accumuIaIe In Ihe envIronmenI and Ior IhIs reason have been banned In
many counIrIes.
AcuIe exposure causes IrrIIabIIIIy oI Ihe cenIraI nervous sysIem. SympIoms appear
aIIer S0 mInuIes Io severaI hours (usuaIIy noI more Ihan 12 hours). They IncIude
headache, dIzzIness, nausea, abdomInaI paIn, IrrIIabIIIIy, convuIsIons, coma,
pyrexIa, IachycardIa, shaIIow respIraIIon and deaIh.
II Ihe paIIenI survIves, convuIsIons sIop wIIhIn 24 hours buI weakness, headaches
and anorexIa may conIInue Ior Iwo weeks or more. ChronIc exposure may cause
gasIroInIesIInaI, IIver, kIdney or nervous aIIecIIon.
IIrsI aId IreaImenI:
Remove conIamInaIed cIoIhIng.
Wash skIn wIIh soap and waIer buI do noI rub Ihe skIn.
Induce vomIIIng, sIomach wash and saIIne caIharIIc.
AdmInIsIer sedaIIve Ior convuIsIons.
AdmInIsIer cardIorespIraIory sIImuIanIs.
(b) OrganophosphaIes
These IncIude paraIhIon, meIhyI paraIhIon, maIaIhIon and IeIraeIhyI
pyrophosphaIe. OrganophosphaIes IncIude some exIremeIy IoxIc and some sIIghIIy
IoxIc compounds. They do noI accumuIaIe In Ihe envIronmenI or In Ihe human body.
They are bIodegradabIe wIIhIn a Iew weeks.
OrganophosphaIes cause Ihe InhIbIIIon oI Ihe choIIneesIerase enzyme resuIIIng In
accumuIaIIon oI aceIyI choIIne In Ihe body. SympIoms and sIgns IncIude dyspnoea,
sweaIIng, nausea, abdomInaI coIIc, dIarrhoea, consIrIcIIon oI Ihe pupIIs, muscIe
IwIIches, IrrIIabIIIIy, anxIeIy, headaches, aIaxIa, convuIsIons, respIraIory and
cIrcuIaIory IaIIure, coma and deaIh. In severe cases sympIoms appear wIIhIn
mInuIes and In sIIghI cases aIIer hours buI never exceedIng 24 hours. DeaIh may
occur wIIhIn hours In severe cases. II recovery occurs II Iakes a Iew weeks Ior Ihe
paIIenI Io reIurn Io normaI. BIood examInaIIon reveaIs reducIIon oI choIIneesIerase
acIIvIIy; Ihe IesI Is used In perIodIc medIcaI examInaIIons.
IIrsI aId IreaImenI:
Take paIIenI Io hospIIaI.
Remove conIamInaIed cIoIhIng.
Wash skIn wIIh waIer wIIhouI rubbIng (II avaIIabIe, a soIuIIon oI S
ammonIa or 2 chIoramIne Is more eIIecIIve Ihan waIer). However, II eyes are
conIamInaIed Ihey musI be washed wIIh waIer.
II Ihe pesIIcIde has been swaIIowed, IIrsI gIve Ihe paIIenI waIer Io drInk and
Ihen Induce vomIIIng by puIIIng your IInger down Ihe paIIenI's
IhroaI.
AdmInIsIer aIropIne (Ihe anIIdoIe) InIravenousIy.
AdmInIsIer arIIIIcIaI respIraIIon II requIred.
AdmInIsIer cardIorespIraIory sIImuIanIs.
LaIer, IreaI Ihe paIIenI wIIh oxImes.
(c) CarbamaIes and IhIocarbamaIes
These are moderaIeIy IoxIc (carbaryI) and cause IoxIcIIy Ihrough Ihe same
mechanIsm as organophosphaIes excepI IhaI InhIbIIIon oI choIIneesIerase enzyme
Is Iemporary and recovers sponIaneousIy wIIhIn 48 hours II deaIh does noI occur.
(d) PyreIhroIds
These are synIheIIc pesIIcIdes oI Iow IoxIcIIy used In homes. ToxIc sympIoms Iake
Ihe Iorm oI sensIIIvIIy reacIIons.
5nc Inndng o c:tcdc:
PesIIcIdes are IIcensed Ior use by Ihe governmenI IoIIowIng careIuI consIderaIIon
oI IheIr IoxIcIIy Io humans.
LxIremeIy IoxIc subsIances shouId noI be handIed IreeIy by Ihe pubIIc.
LxIra care shouId be Iaken durIng IransporIaIIon oI chemIcaIs Io ensure IhaI
conIaIners are noI crushed nor IheIr conIenIs spIII. II any spIIIage occurs, II
shouId be reporIed and deconIamInaIIon procedures carrIed ouI.
AII pesIIcIde conIaIners shouId be properIy IabeIIed In Ihe IocaI Ianguage.
SIorage sIIes shouId be properIy cIeaned and venIIIaIed and shouId noI be used
by unauIhorIzed personneI.
BeIore usIng such chemIcaIs appIIcaIIon, workers shouId be weII IraIned and
have receIved heaIIh educaIIon.
PubIIc heaIIh measures shouId be Iaken Io avoId conIamInaIIon oI waIer bodIes
and resIdenIIaI areas by chemIcaIs.
Crops shouId noI be harvesIed beIore Ihe IIme necessary Ior pesIIcIdes Io
bIodegrade.
LmpIy conIaIners and pesIIcIde wasIe shouId be properIy dIsposed oI.
Workers shouId pracIIse good personaI hygIene.
IIrsI aId IreaImenI and anIIdoIes shouId be avaIIabIe.
PrepIacemenI and perIodIc medIcaI examInaIIons shouId be underIaken.
AII concerned, IncIudIng Ihe pubIIc, shouId receIve heaIIh educaIIon regardIng
pesIIcIdes.
PersonaI proIecIIve equIpmenI shouId be suppIIed Io workers.
LngIneerIng conIroI measures shouId be In pIace wIIhIn Ihe chemIcaI IndusIry.
3.6 Biological hazards
Occuntonn nccton:
Human dIseases caused by workassocIaIed exposure Io mIcrobIaI agenIs, e.g.
bacIerIa, vIruses, rIckeIIsIa, IungI and parasIIes (heImInIhs, proIozoa), are caIIed
occupaIIonaI InIecIIons. An InIecIIon Is descrIbed as occupaIIonaI when some aspecI
oI Ihe work InvoIves conIacI wIIh a bIoIogIcaIIy acIIve organIsm.
Lxposure occurs among heaIIh care workers In Iever hospIIaIs, IaboraIorIes and
generaI hospIIaIs; among veIerInarIans and agrIcuIIuraI workers In anImaI
husbandry and daIry Iarms and peI shops; and among sewerage workers, wooI
sorIers and workers In Ihe IeaIher IndusIry.
/Occuntonn) unonn) tuccuo::
HeaIIh care workers In IubercuIosIs IreaImenI cenIres, In IaboraIorIes and In
veIerInary cIInIcs are parIIcuIarIy aIIecIed. The dIsease Is caused by M)conctcun
tuccuo:: (Koch's bacIIIus) and Is IransmIIIed occupaIIonaIIy by dropIeI InIecIIon,
conIacI wIIh InIecIed maIerIaI Irom humans (spuIum) or anImaIs. The organIsm can
survIve In dusI and away Irom dIrecI sunIIghI Ior many days and enIers Ihe body
Ihrough Ihe respIraIory IracI or abraded skIn where II causes a skIn uIcer.
The dIsease usuaIIy aIIecIs Ihe Iungs buI can aIso aIIecI Ihe gasIroInIesIInaI IracI,
bones, kIdneys, menInges, pIeura and perIIoneum. PuImonary IubercuIosIs Is
manIIesIed by coughIng, expecIoraIIon, haemopIysIs, Ioss oI weIghI, Ioss oI appeIIIe,
nIghI sweaIs and nIghI Iever. II can be dIagnosed by chesI Xray and bacIerIoIogIcaI
examInaIIon oI Ihe spuIum.
Workers shouId undergo a prepIacemenI examInaIIon and be IesIed wIIh IubercuIIn
and vaccInaIed wIIh BCG II Ihe IubercuIIn IesI Is negaIIve. PrepIacemenI and
perIodIc Xrays shouId be Iaken. HeaIIh educaIIon Is ImporIanI and proper dIsposaI
oI InIecIed maIerIaI shouId be observed.
ucco::
BruceIIosIs Is caused by an organIsm whIch can InIecI caIIIe, sheep and pIgs. The
dIsease causes recurrenI aborIIon In anImaIs and Is presenI In Ihe pIacenIa, In anImaI
secreIIons, In mIIk and In urIne. Lxposed workers are veIerInarIans, workers In
agrIcuIIure and anImaI husbandry, shepherds and IaboraIory and sIaughIerhouse
workers. MosI occupaIIonaI cases occur Ihrough conIacI wIIh InIecIed anImaIs or
IheIr secreIIons and producIs. The IncubaIIon perIod Is 2-4 weeks.
The acuIe sIage (unduIanI Iever) exIends Ior 2-4 weeks wIIh Iever, enIarged spIeen
and Iymph nodes. In Ihe subacuIe phase Ihe organIsm IocaIIzes In joInIs, InIesIInes,
reproducIIve organs, pIeura or menInges. In Ihe chronIc phase Ihe IocaIIzed dIsease
conIInues wIIh occasIonaI Iever or Ihe onIy sympIom may be generaI weakness.
DurIng IhIs sIage Ihe dIsease Is dIIIIcuII Io dIagnose. ThereIore, perIodIc medIcaI
examInaIIon oI aII exposed workers shouId be carrIed ouI usIng seroIogIcaI IesIs.
ConIroI oI Ihe dIsease In humans depends on conIroI In anImaIs. Workers shouId
wear proIecIIve cIoIhIng and observe proper cookIng oI anImaI producIs and boIIIng
oI mIIk sInce Ihe dIsease can aIso be IransmIIIed Ihrough Iood.
AntInx
AnIhrax Is essenIIaIIy an anImaI dIsease. Lxposed workers are Ihose In agrIcuIIure
and anImaI husbandry, sIaughIer houses, IannerIes and Ihose workIng In Ihe
manuIacIure oI goods Irom wooI, haIr, bones and IeaIher. The dIsease aIIecIs caIIIe,
sheep, horses and pIgs and when Ihe anImaI dIes Ihe anIhrax bacIIIus Iorms spores
whIch are exIremeIy resIsIanI and can survIve Ior years.
InIecIIon can occur Ihrough Ihe skIn, Ihe Iungs or Ihe InIesIIne. InIecIIon Ihrough
Ihe skIn causes a "maIIgnanI pusIuIe". II sIarIs wIIh eryIhema 1-8 days aIIer
InIecIIon whIch Ieads Io a papuIe Ihen pusIuIe wIIh surroundIng sweIIIng and IocaI
Iymph node enIargemenI. InIecIIon Ihrough Ihe Iung occurs In wooI sIores causIng
bU OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
severe IaIaI pneumonIa. InIecIIon Ihrough Ihe InIesIInes causes sepIIcaemIa.
AnImaI producIs InIended Ior use In IndusIry shouId be careIuIIy examIned and
dIsInIecIed.
Vn Icntt: nnd C
HeaIIh care workers who are IIkeIy Io come InIo conIacI wIIh Ihe bIood and body
IIuIds oI InIecIed persons are aI greaI rIsk oI InIecIIon. An acuIe onseI oI hepaIIIIs
Is Ihe excepIIon; more oIIen Ihere are vague generaI sympIoms or none aI aII and
Ihe InIecIIon Is dIscovered on rouIIne seroIogIcaI examInaIIon.
The dIsease may pass InIo chronIc acIIve hepaIIIIs: IIver cIrrhosIs, hepaIIc IaIIure
and IIver carcInoma.
Because oI Ihe exposure Io paIIenIs' body IIuIds vIa conIamInaIed gIassware and
oIher conIamInaIed equIpmenI, such as needIes, whIch may provIde an opporIunIIy
Ior conIacI wIIh mucous membranes or parenIeraI InnocuIaIIon, sIrIcI "InIecIIon
conIroI" procedures shouId be deveIoped Ior sIIuaIIons where Ihere Is poIenIIaI rIsk,
such as phIeboIomy, denIIsIry and haemodIaIysIs.
Workers aI Increased rIsk oI hepaIIIIs B InIecIIon shouId receIve hepaIIIIs B
ImmunIzaIIon.
Acqucd nnunodcccnc) :)ndonc /AII5)
TransmIssIon oI Ihe acquIred ImmunodeIIcIency syndrome (AIDS) agenI, Ihe human
ImmunodeIIcIency vIrus (HIV), occurs onIy Ihrough sexuaI conIacI, perInaIaIIy Irom
an InIecIed moIher and Ihrough conIamInaIed bIood or bIood producIs.
SeroconversIon aIIer a needIesIIck Injury Is esIImaIed Io be Iess Ihan 1, whIch Is
much Iower Ihan Ihe rIsk (6-S0) oI acquIrIng hepaIIIIs B aIIer a needIesIIck Injury.
The vIrus Is noI IransmIIIed Ihrough casuaI, nonInIImaIe workpIace conIacI or
socIaI encounIers, such as eaIIng In resIauranIs or usIng pubIIc IransporIaIIon or
baIhroom IacIIIIIes.
The IoIIowIng groups are aI poIenIIaI rIsk oI conIacI wIIh HIVInIecIed body IIuIds:
bIood bank IechnoIogIsIs
dIaIysIs IechnIcIans
emergency room personneI
morIIcIans
denIIsIs
medIcaI IechnIcIans
surgeons
IaboraIory workers
prosIIIuIes.
OccuntonnI nnd other work-reInted dsenses: ModuIe 2 b1
Ior occupaIIonaI heaIIh proIessIonaIs, empIoyees IraIned In IIrsI aId and pubIIc
saIeIy personneI who may provIde medIcaI servIces Io HIVInIecIed IndIvIduaIs,
reasonabIe sIeps shouId be Iaken Io avoId skIn, parenIeraI or mucous membrane
conIacI wIIh poIenIIaIIy InIecIed bIood, pIasma or secreIIons.
Hands or skIn shouId be washed ImmedIaIeIy and careIuIIy II bIood conIacI
occurs.
Mucous membranes (IncIudIng Ihe eyes and mouIh) shouId be proIecIed by eye
gIasses or masks durIng procedures IhaI couId generaIe spIashes or aerosoIs
oI InIecIed bIood or secreIIons (sucIIonIng, endoscopy).
ConIamInaIed surIaces shouId be dIsInIecIed usIng S sodIum hypochIorIIe.
Workers In Ihe personaI servIce secIor, who work wIIh needIes or oIher InsIrumenIs
IhaI can peneIraIe InIacI skIn, such as IaIIooIsIs and haIrdressers, shouId IoIIow
precauIIons IndIcaIed Ior heaIIh care workers and pracIIse asepIIc IechnIques and
sIerIIIzaIIon oI InsIrumenIs. AII personaI servIce workers shouId be educaIed
concernIng IransmIssIon oI bIoodborne InIecIIons, IncIudIng AIDS and hepaIIIIs B.
3.7 OIher exposures and Iheir healIh ellecIs
Occuntonn dcnnto:c:
OccupaIIonaI dermaIoses are Ihe mosI common occupaIIonaI dIseases and are
aImosI aIways prevenIabIe by a combInaIIon oI envIronmenIaI, personaI and medIcaI
measures.
The skIn can be aIIecIed by many IacIors:
repeaIed mechanIcaI IrrIIaIIon may cause caIIosIIIes and IhIckenIng oI Ihe skIn
varIous kInds oI radIaIIon (see ModuIe 1, S.2, PoIenIIaI heaIIh hazards)
IubercuIosIs and anIhrax
chemIcaIs can cause IrrIIaIIon or sensIIIzaIIon.
Types oI occupaIIonaI dermaIosIs:
acuIe conIacI eczema due Io IrrIIaIIon or sensIIIzaIIon
chronIc conIacI eczema due Io IrrIIaIIon or sensIIIzaIIon
chIoracne (IubrIcaIIng and cuIIIng oIIs, Iar and chIorInaIed naphIhaIenes)
phoIosensIIIzaIIon (chemIcaIs, drugs and pIanIs)
hypopIgmenIaIIon and hyperpIgmenIaIIon (dyes, heavy meIaIs and chIorInaIed
hydrocarbons)
keraIoses (IonIzIng radIaIIon, uIIravIoIeI radIaIIon)
benIgn Iumours and epIIheIIomas (UV, IonIzIng radIaIIon, Iar, sooI, arsenIc)
uIcers (Irauma, burns).
b2 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
Occuntonn cnncc
The cause oI cancer Is sIIII noI compIeIeIy undersIood. II has been observed
however, Ihrough epIdemIoIogIcaI sIudIes and sIaIIsIIcaI daIa IhaI cancer oI cerIaIn
organs has been assocIaIed wIIh cerIaIn exposures.
OccupaIIonaI cancer Is no dIIIerenI Irom ordInary cancer as Iar as sIgns and
sympIoms or hIsIopaIhoIogy are concerned. A posIIIve hIsIory oI exposure Io a
carcInogenIc agenI can be obIaIned In occupaIIonaI cancer. LxampIes oI some
carcInogenIc agenIs and Ihe organs aIIecIed are gIven beIow.
Cnrcnogenc ngent Orgnn n]]ected
ArsenIc SkIn and Iung
ChromIum compounds, hexavaIents Lung
NIckeI Lung and nasaI sInus
PoIycycIIc aromatIc hydrocarbons SkIn
CoaI tars SkIn, scrotum, Iung, bIadder
enzoI Iood (IeukaemIa)
naphthaIamIne Iadder
onIzIng radIatIon SkIn, bone, Iung, bIood (IeukaemIa)
Asbestos Lung, pIeura, perItoneum
Kcoduct\c ccct:
OccupaIIonaI exposure Io cerIaIn chemIcaIs or physIcaI IacIors (IIke IonIzIng
radIaIIon) has been Iound Io have cerIaIn eIIecIs on reproducIIve IuncIIons:
dysIuncIIon In maIes (sIerIIIIy or deIecIIve spermaIozoa) and IemaIes
(anovuIaIIon, ImpIanIaIIon deIecIs In Ihe uIerus)
Increased IncIdence oI mIscarrIage, sIIIIbIrIh and neonaIaI deaIh
InducIIon oI sIrucIuraI and IuncIIonaI deIecIs In newborn babIes
InducIIon oI deIecIs durIng Ihe earIy posInaIaI deveIopmenI sIage.
Lxposure oI eIIher parenI may Iead Io reproducIIve deIecIs.
ChemIcaIs whIch have been suspecIed oI reproducIIve eIIecIs IncIude:
aIcohoIs
anaesIheIIc gases
cadmIum
carbon dIsuIIIde
Iead
manganese
poIyvInyI chIorIde.
Occuntonn n:tInn
AsIhmaIIc paIIenIs suIIer Irom aIIacks oI shorIness oI breaIh. AIIhough bronchIaI
asIhma can be caused by a Iarge number oI subsIances or combInaIIons oI
subsIances ouIsIde Ihe workpIace, many occupaIIonaI exposures can be assocIaIed
wIIh Ihe occurrence oI asIhma. AIIhough In many cases II Is dIIIIcuII Io evaIuaIe
how much oI Ihe probIem Is caused by workpIace exposure, In cerIaIn InsIances II Is
obvIous IhaI asIhmaIIc aIIacks are caused by work exposure onIy and noI by IacIors
ouIsIde work.
LxampIes oI subsIances IhaI may cause occupaIIonaI asIhma:
PIanI orIgIn:
wood dusI
IIour and graIn dusI
IungaI spores
IormaIdehyde
gum arabIc
AnImaI orIgIn:
wooI
haIr
IeaIhers
OIher subsIances:
anIIbIoIIcs (penIcIIIIn)
IoIuene dIIsocyanaIe
pIaIInum saIIs.
4. WORK-RELATED DlSEASES
4.1 CharacIerisIics ol work-relaIed diseases
ThIs caIegory has cerIaIn characIerIsIIcs whIch were IdenIIIIed and sIaIed by a WHO
LxperI CommIIIee as IoIIows:
"MuIIIIacIorIaI dIseases", whIch may IrequenIIy be workreIaIed, aIso occur
among Ihe generaI popuIaIIon, and workIng condIIIons and exposures need noI
be rIsk IacIors In each case oI any one dIsease. However, when such dIseases
aIIecI Ihe worker, Ihey may be workreIaIed In a number oI ways: Ihey may be
parIIaIIy caused by adverse workIng condIIIons; Ihey may be aggravaIed,
acceIeraIed or exacerbaIed by workpIace exposures; and Ihey may ImpaIr
workIng capacIIy. II Is ImporIanI Io remember IhaI personaI characIerIsIIcs,
oIher envIronmenIaI and socIocuIIuraI IacIors usuaIIy pIay a roIe as rIsk IacIors
Ior Ihese dIseases....
MuIIIIacIorIaI "workreIaIed" dIseases are oIIen more common Ihan occupaIIonaI
dIseases and IhereIore deserve adequaIe aIIenIIon by Ihe heaIIh servIce
InIrasIrucIure, whIch IncorporaIes Ihe occupaIIonaI heaIIh servIces.
2
The workreIaIed dIseases whIch deserve parIIcuIar aIIenIIon are:
behavIouraI and psychosomaIIc dIsorders
2
Idcntcnton nnd conto o \o-cntcd d:cn:c:. ReporI oI a WHO LxperI CommIIIee (WHO
TechnIcaI ReporI SerIes No. 714), Geneva, WorId HeaIIh OrganIzaIIon, 198S.
b4 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
hyperIensIon
coronary hearI dIsease
pepIIc uIcers
chronIc nonspecIIIc respIraIory dIsease
IocomoIor dIsorders.
4.2 Behavioural and psychosomaIic disorders
BoIh home and work envIronmenIs can be a major source oI adverse psychosocIaI
IacIors. IndIvIduaIs dIIIer wIdeIy In IheIr responses.
K: ncto: o cIn\oun nnd :)cIo:onntc d:odc:
(a) LnvIronmenIaI psychosocIaI rIsk IacIors
work overIoad and underIoad
boredom and Iack oI conIroI over work sIIuaIIon
shIII work
mIgraIIon (mIgranI workers)
organIzaIIonaI sIrucIure aI Ihe work esIabIIshmenI and Ihe roIe oI Ihe
IndIvIduaI In Ihe organIzaIIon; roIe ambIguIIy and roIe conIIIcI
opporIunIIy Ior career deveIopmenI and promoIIon
physIcaI InsecurIIy (IIres, expIosIons) and responsIbIIIIy Ior oIher peopIe's
saIeIy
job desIgn and degree oI InIeresI
Iow wages
job Iurnover
earIy or InvoIunIary reIIremenI
unempIoymenI.
(b) PhysIcaI sIressors
IhermaI envIronmenI
noIse
vIbraIIon
radIaIIon
poor IIghIIng.
(c) LnvIronmenIaI chemIcaI sIressors
These can Increase Ihe rIsk oI psychosomaIIc IIIness. Some chemIcaI hazards
however, have specIIIc eIIecIs on Ihe cenIraI nervous sysIem, e.g. carbon monoxIde,
carbon dIsuIIIde, aIcohoIs and some oIher soIvenIs.
(d) SocIaI supporI sysIem
ThIs Improves Ihe abIIIIy oI an IndIvIduaI Io adapI Io envIronmenIaI psychosocIaI
sIress. SupporI can be Irom Ihe IamIIy, Ihe work communIIy or Ihe communIIy
ouIsIde oI work.
(e) IndIvIduaI psychosocIaI IacIors
InIerIndIvIduaI reIaIIonshIp aI work
personaIIIy Iype
IndIvIduaI suscepIIbIIIIy
age
sex.
cIn\oun nnd :)cIo:ocn cncton: to :tc::
overeaIIng IeadIng Io obesIIy
smokIng
aIcohoI and drug abuse and drug addIcIIon, any oI whIch can be a rIsk IacIor
Ior psychosomaIIc IIIness
IaIIgue
anxIeIy
depressIon
hosIIIIIy and aggressIon
neurosIs causIng a range oI menIaI and emoIIonaI dIsorders
menIaI dIsorders and psychIaIrIc dIsorders
mass psychogenIc IIIness (mass hysIerIa)
psychosomaIIc dIsease: headache, backache, muscIe cramps, dIsIurbed sIeep,
pepIIc uIcer, dIabeIes meIIIIus, cardIovascuIar dIsorders eIc.
4.3 HyperIension
In over 90 oI paIIenIs wIIh hyperIensIon, Ihe dIsease Is caIIed "essenIIaI
hyperIensIon" and no cause can be IdenIIIIed. GeneIIc predIsposIIIon Is an ImporIanI
rIsk IacIor. Lxposure Io Iead, cadmIum and noIse Is a rIsk IacIor In deveIopIng
hyperIensIon and II has aIso been suggesIed IhaI psychosocIaI sIress Is a IacIor In Ihe
deveIopmenI oI hyperIensIon. OIher rIsk IacIors In Ihe deveIopmenI oI hyperIensIon
IncIude dIeIary habIIs (excess saII and IaIs), obesIIy and physIcaI InacIIvIIy.
bb OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
4.4 Coronary hearI disease (CHD)
NarrowIng oI Ihe coronary arIerIes causes InadequaIe bIood suppIy Io Ihe hearI
muscIe causIng "angIna pecIorIs" or recurrenI brIeI aIIacks oI chesI paIn oIIen
assocIaIed wIIh exercIse. OccIusIon oI any arIery causes myocardIaI InIarcIIon or
necrosIs oI parI oI Ihe hearI muscIe whIch may cause deaIh wIIhIn a shorI IIme or
IaIer on due Io compIIcaIIons.
The IncIdence oI Ihe dIsease Is IncreasIng and more and more younger peopIe are
beIng aIIecIed. II Is more common In men Ihan women beIow 4S years oI age, buI In
oIder age Ihe Iwo sexes may be equaI.
The rIsk oI coronary hearI dIsease Is assocIaIed wIIh hyperIensIon, hIgh dIeIary IaI
InIake, hIgh serum choIesIeroI and beIng overweIghI. In addIIIon Ihere Is a
sIgnIIIcanI IamIIIaI Iendency. A coronaryprone personaIIIy has been descrIbed as
Ihe aggressIve, compeIIIIve person who Iakes on Ioo many jobs, IIghIs deadIInes
and Is obsessed by Iack oI adequaIe IIme Io IInIsh hIs work. OverIoad aI work has
aIso been assocIaIed wIIh coronary hearI dIsease.
PsychosocIaI sIress Increases serum choIesIeroI, causes hyperIensIon and enhances
cIoI IormaIIon. CIgareIIe smokIng Is anoIher rIsk IacIor Ior CHD. OIher occupaIIonaI
IacIors reIaIed Io CHD are sedenIary work, exposure Io carbon dIsuIIIde, carbon
monoxIde and nIIraIes and chronIc exposure Io noIse, heaI and coId. SoIvenIs such
as benzene, IrIchIoreIhyIene, chIoroIorm, eIhyI chIorIde and IIuorocarbon
compounds dIrecIIy aIIecI Ihe myocardIaI IIssue. Lead and mercury cause CHD,
secondary Io hyperIensIon, and cobaII, arsenIc and anIImony produce myocardIaI
damage.
4.5 PepIic ulcer
SeveraI rIsk IacIors have been assocIaIed wIIh Ihe deveIopmenI oI gasIrIc and
duodenaI uIcers. These IncIude heredIIy, cerIaIn medIcInes (anaIgesIcs and non
sIeroIdaI anIIInIIammaIory drugs), cIgareIIe smokIng, medIcaI IIIness, surgIcaI
procedures, Iype oI personaIIIy, IocaI InIecIIon (Hcconctc )o) and occupaIIon.
OccupaIIonaI IacIors assocIaIed wIIh Ihe rIsk oI deveIopIng pepIIc uIcers IncIude
jobs wIIh a hIgh degree oI responsIbIIIIy and IrreguIar shIII work; Ihe hIgher Ihe work
sIress Ihe hIgher Ihe uIcer raIe. AIso pepIIc uIcers are reIaIed Io InhaIed IrrIIanI
gases whIch dIssoIve In spuIum and are IngesIed.
4.6 Chronic nonspecilic respiraIory diseases (CNRD)
CNRD Is a generaI Ierm used Io descrIbe a group oI dIseases In whIch Ihere Is chronIc
cough and spuIum producIIon and/or shorIness oI breaIh aI resI and/or durIng
exercIse. These condIIIons IncIude chronIc bronchIIIs, emphysema, bronchIaI
asIhma and asIhmaIIc bronchIIIs. AII Ihese dIseases may be acuIeIy or chronIcaIIy
exacerbaIed by InIecIIon. CNRD are dIseases oI muIIIpIe eIIoIogy and represenI a
cIassIc exampIe oI dIsorders IhaI may be occupaIIonaI In orIgIn, workreIaIed or
reIaIed Io Ihe socIaI phenomena oI urbanIzaIIon and IndusIrIaIIzaIIon.
When Ihe rIsk oI Ihese dIsorders Is sIrongIy reIaIed Io specIIIc occupaIIonaI
exposure such as nonIIbrogenIc dusIs (e.g. coIIon, rIce and IIax) or IrrIIanIs, Ihey
may easIIy be IhoughI oI as occupaIIonaI dIseases. II Is weII known, however, IhaI
oIher IacIors, such as smokIng, cIImaIIc condIIIons, communIIy aIr poIIuIIon, aIopy,
IamIIIaI geneIIc IacIors, IndIvIduaI suscepIIbIIIIy, bronchIaI hyperreacIIvIIy,
chIIdhood respIraIory InIecIIons, repeaIed respIraIory InIecIIons In aduII IIIe and
socIoeconomIc sIaIus, can pIay a major roIe. In any IndIvIduaI case, II Is dIIIIcuII Io
ascerIaIn how much synergIsm has occurred beIween any combInaIIon oI Iwo or
more. II Is generaIIy beIIeved however, IhaI In smokers who are exposed Io
communIIy or workpIace aIr poIIuIIon, smokIng pIays a more ImporIanI roIe In Ihe
causaIIon oI CNRD Ihan does aIr poIIuIIon.
In dusIy occupaIIons where dusI Is known Io cause specIIIc puImonary dIseases
(sIIIcosIs, asbesIosIs, coaI workers' pneumoconIosIs, byssInosIs, eIc.), dusI
concenIraIIons Iower and duraIIons shorIer Ihan Ihose whIch cause Ihe specIIIc
dIsease may be suIIIcIenI Io conIrIbuIe Io Ihe causaIIon oI CNRD.
LxampIes oI occupaIIons where workreIaIed CNRD may occur are Ihose where dusI
(organIc or InorganIc), IrrIIanI gases or aerosoIs are presenI. These poIIuIanIs may
conIrIbuIe Io Ihe causaIIon oI CNRD by causIng IrrIIaIIon oI Ihe respIraIory mucous
membrane or Ihrough aIIergIc mechanIsms. These occupaIIons IncIude Ihe chemIcaI
IndusIry, mInIng, IoundrIes, IexIIIe mIIIs, sIIos, cemenI IacIorIes, Ihe gIass IndusIry,
Ihe IerIIIIzer IndusIry, sIeeI mIIIs, smeIIers and a muIIIIude oI oIher occupaIIons.
4.7 LocomoIor disorders
Two exampIes oI IocomoIor dIsorder wIII be gIven Ior whIch evIdence oI work
reIaIedness Is avaIIabIe: Iow back paIn syndrome and shouIderneck paIn syndrome.
Io\ nc nn
Low back paIn Is a sympIom oI common occurrence In Ihe generaI popuIaIIon,
aIIecIs maIes and IemaIes aI aII ages, buI Is more common beIween Ihe ages oI 2S
and 64 years. II Is saId Io aIIecI over haII Ihe workIng popuIaIIon aI some IIme durIng
IheIr acIIve workIng IIIe and II Is esIImaIed IhaI 2-S oI IndusIrIaI workers
experIence Iow back paIn each year.
PaIn In Ihe IumbosacraI area can resuII Irom InIIammaIory, degeneraIIve, IraumaIIc,
neopIasIIc or oIher dIsorders. In some InsIances II Is cIaImed Io be psychogenIc In
orIgIn. The mosI common Iype oI occupaIIonaI Iow back paIn Is nonspecIIIc, oI
IndeIermInaIe paIhoIogy and oIIen assocIaIed wIIh posIure, IIIIIng oI heavy objecIs
and InjurIous (IwIsIIng) movemenIs oI occupaIIonaI or nonoccupaIIonaI orIgIn.
The rIsk IacIors Ior Iow back paIn IncIude congenIIaI back deIecIs, weak
muscuIaIure, rheumaIIc aIIecIIon and degeneraIIve condIIIons oI Ihe spIne and
InIerverIebraI dIscs. CerIaIn occupaIIons carry a hIgher rIsk oI deveIopIng Iow back
paIn. These IncIude heavy manuaI work, mInIng, dockIng, maIerIaI handIIng, jobs
requIrIng awkward posIures and posIures IhaI have Io be maInIaIned Ior proIonged
perIods or InvoIve IrequenI bendIng, IwIsIIng or whoIe body vIbraIIon, nursIng and
poIIcIng. These occupaIIons requIre proper seIecIIon, physIcaI IraInIng, proper
pIacemenI and adopIIon oI saIe crIIerIa Ior Ioad IIIIIng.
b OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
5Ioudcncc nn
A varIeIy oI dIseases may resuII In shouIder and neck paIn: exampIes are
InIIammaIory reacIIons In Ihe synovIaI membrane and bursa sysIem and
degeneraIIve dIsorders In Ihe carIIIage, IIgamenIs and Iendons. In addIIIon,
muscuIar, vascuIar and neuromuscuIar dIsorder may resuII In shouIder paIn and
paIn may be reIerred Irom Ihe chesI.
DIsorders assocIaIed wIIh generaI muscIe weakness and generaI maIaIse, such as
InIecIIons, may aIso resuII In an Increased suscepIIbIIIIy Io shouIder and neck
compIaInIs Irom Ioads on Ihe shouIder whIch a worker can normaIIy IoIeraIe. Irom
Ihe occupaIIonaI heaIIh sIandpoInI, IndIvIduaI predIsposIng IacIors such as age,
dIIIIcuIIIes In organIzIng Ihe work Iask and InIIammaIory rheumaIIc predIsposIIIon
pIay a roIe.
II has been Iound IhaI workIng wIIh Ihe hands above shouIder heIghI Is more
IrequenI In workers wIIh boIh acuIe and chronIc shouIder and neck paIn. However,
Increased work Ioads on shouIder and neck muscIes can aIso be produced wIIhouI
IIIIIng Ihe arms above Ihe shouIders.
IurIher prooI oI Ihe workreIaIedness oI shouIder and neck paIn Is presenIed by Ihe
IacI IhaI appIIcaIIon oI ergonomIc prIncIpIes Io Improve meIhods oI work reduces
Ihe paIn.
1. Carry ouI a workpIace survey and make observaIIons.
Look Ior any poIenIIaI and acIuaI hazards (physIcaI, chemIcaI, mechanIcaI,
bIoIogIcaI and psychoIogIcaI)
ConsIder Ihe avaIIabIIIIy or Ihe need Ior conIroI measures
Look Ior any earIy sIgns oI occupaIIonaI dIsease and workreIaIed dIsease
In workers.
2. |oIn and work wIIh members oI Ihe occupaIIonaI heaIIh Ieam; reporI your
observaIIons and consuII wIIh Ihem regardIng conIroI measures, Ihe need Ior
envIronmenIaI and bIoIogIcaI monIIorIng and Ihe managemenI oI cerIaIn
occupaIIonaI heaIIh probIems (where appIIcabIe).
S. Use your skIIIs In doIng sImpIe IesIs; coIIecI bIoIogIcaI sampIes Ior anaIysIs and
advIse on need Ior IurIher InvesIIgaIIons (as appIIcabIe).
4. LducaIe workers on Ihe use and maInIenance oI personaI proIecIIve equIpmenI.
S. DIscuss wIIh workers maIIers reIaIIng Io nuIrIIIon and sanIIaIIon and advIse
Ihem on heaIIhy eaIIng habIIs, good sanIIary measures and personaI hygIene.
6. AdvIse managemenI regardIng Ihe need Ior conIroI measures and Ihe need Io
InvesIIgaIe some occupaIIonaI heaIIh probIems IhaI requIre consuIIaIIon wIIh
oIher members oI Ihe occupaIIonaI heaIIh Ieam.
7. AdvIse managemenI on Ihe ImpIemenIaIIon oI occupaIIonaI heaIIh IegIsIaIIon
In Ihe workpIace.
8. AdvIse workers on Ihe need Io observe Ihe conIroI measures InsIIIuIed Ior a
heaIIhy and saIe workpIace.
9. Keep and updaIe records oI aII occupaIIonaI heaIIh acIIvIIIes underIaken by
you (reporIs on pIanI surveys, reporIs on envIronmenIaI and bIoIogIcaI
monIIorIng and reporIs on heaIIh Irends aI Ihe workpIace).
MODULE 3
Early detection of occupational
diseases
1. OB|ECTlVES
UndersIand Ihe ImporIance oI Ihe earIy deIecIIon oI occupaIIonaI dIseases
Choose Ihe mosI approprIaIe dIagnosIIc means Ior earIy deIecIIon oI
occupaIIonaI dIseases
Know how Io parIIcIpaIe eIIecIIveIy In carryIng ouI perIodIc medIcaI examInaIIons
Ior workers.
OccupaIIonaI dIseases are unIque In Ihe sense IhaI Ihe hazards IhaI cause Ihem are
known even beIore exposure oI Ihe workers Iakes pIace. ThIs IacI characIerIzes
occupaIIonaI dIseases as beIng enIIreIy prevenIabIe; exposure can be conIroIIed or
prevenIed. The IdeaI sIIuaIIon oI compIeIe prevenIIon oI occupaIIonaI dIseases by
conIroIIIng exposures however, does noI occur In pracIIce, and occupaIIonaI
dIseases conIInue Io occur.
To mInImIze Ihe damage caused by occupaIIonaI dIseases, Ihe besI aIIernaIIve Is
earIy deIecIIon oI paIhoIogIcaI changes aI a sIage when Ihey are reversIbIe. CerIaIn
occupaIIonaI exposures cause earIy cIInIcaI, IuncIIonaI, bIochemIcaI, physIoIogIcaI
or morphoIogIcaI changes whIch, when deIecIed earIy enough, are reversIbIe. There
are many cIInIcaI, IaboraIory or oIher IesIs IhaI have been deveIoped Io deIecI Ihese
earIy changes, each exposure havIng IIs specIIIc IesI.
UnIorIunaIeIy, Ihere are oIher occupaIIonaI dIseases whIch cannoI be deIecIed aI a
reversIbIe sIage. These IncIude acuIe reacIIons Io IrrIIanI gases, e.g. ammonIa,
asphyxIanIs, e.g. CO and hydrocyanIc acId, and corrosIve maIerIaIs, e.g. acIds and
aIkaIIs; coIIagenous pneumoconIosIs, e.g. sIIIcosIs and asbesIosIs; occupaIIonaI
cancer, and many oIher condIIIons. AcuIe condIIIons, caused mosIIy by occupaIIonaI
accIdenIs, are amenabIe Io IreaImenI and wIII noI be dIscussed.
The progress oI pneumoconIosIs can be sIowed down consIderabIy II exposure Is
dIsconIInued. AIso, II Is weII known IhaI deIecIIon oI occupaIIonaI cancer aI an earIy
sIage Improves prognosIs. ThereIore, regardIess oI Ihe reversIbIIIIy oI Ihe
paIhoIogIcaI changes caused by occupaIIonaI exposure, earIy deIecIIon oI
occupaIIonaI dIsease Is desIrabIe.
Many IndIces used In earIy deIecIIon oI occupaIIonaI dIseases have very wIde ranges
oI normaI varIabIIIIy. ResuIIs oI such IesIs can move beIween Ihe Iwo ends oI Ihe
normaI range In a gIven IndIvIduaI wIIhouI beIng recognIzed as abnormaI; an
IndIvIduaI wIIh a predIcIed vIIaI capacIIy oI 4 I can deIerIoraIe Irom S I Io S I
wIIhouI beIng recognIzed as abnormaI unIess Ihe preempIoymenI IeveI Is known.
ThereIore, a prepIacemenI record oI varIabIes, as weII as perIodIc examInaIIons, Is
necessary Ior Ihe earIy deIecIIon oI dIsease.
The Ierms "earIy deIecIIon" and "perIodIc examInaIIon" wIII be used In IhIs IexI Io
denoIe examInaIIons carrIed ouI Io deIecI earIy occupaIIonaI dIsease wheIher IhIs
earIy dIsease Is reversIbIe (curabIe) or noI.
ConsIderIng Ihe very Iarge numbers oI workers IhaI have Io be examIned, perIodIc
examInaIIons do noI have Io be comprehensIve checkups. LxamInaIIons usuaIIy
sIarI wIIh sImpIe screenIng IesIs and posIIIve cases Ihen undergo comprehensIve
examInaIIons Io prove or dIsprove Ihe presence oI occupaIIonaI dIseases. ScreenIng
IesIs have Io be sImpIe, sensIIIve, specIIIc, easy, InexpensIve and nonInvasIve.
ScreenIng IesIs IncIude IesIs Io deIecI:
Ihe presence oI a IoxIc maIerIaI In a cerIaIn bIoIogIcaI sampIe, as an Index oI
exposure Io IhaI maIerIaI Ihe presence oI whIch may have been proved by
envIronmenIaI monIIorIng, e.g. monIIorIng Iead In bIood
Ihe presence oI meIaboIIIes oI a IoxIc subsIance In a bIoIogIcaI sampIe, e.g.
monIIorIng organIc suIIaIes In urIne In phenoI exposure.
In both cases biological threshold limit values are recommended concentra-
tions of the substance or its metabolites in the biological fluids or tissues that
should not be exceeded if the disease is to be prevented. Biological threshold
limit values are available for many toxic exposures.
changes In organ IuncIIons as a resuII oI exposure Io subsIances where Ihe
organs are IargeIs Ior Ihe IoxIc acIIon, e.g. kIdney IuncIIons, IIver IuncIIons and
puImonary IuncIIons;
morphoIogIcaI changes In bIood eIemenIs IhaI may IndIcaIe IoxIc acIIon on Ihe
haemopoIeIIc sysIem;
IrreversIbIe IIssue changes, e.g. caIaracI due Io exposure Io InIrared radIaIIon,
IonIzIng radIaIIon or Xray examInaIIon Io deIecI sIIIcosIs and asbesIosIs;
psychomoIor and hIgher cenIraI nervous sysIem IuncIIons, e.g. IesIs have been
used Io evaIuaIe exposure Io subsIances known Io aIIecI nervous IuncIIons,
e.g. manganese, mercury and carbon dIsuIIIde. As screenIng IesIs IheIr specIIIcIIy
Is raIher Iow and Ihey are Ioo eIaboraIe Io be used Ior mass screenIng.
The reguIarIIy oI examInaIIons varIes wIIh Ihe Iype oI exposure. DIseases wIIh
condIIIons whIch progress rapIdIy, e.g. changes In choIIneesIerase acIIvIIy In Ihose
workIng wIIh pesIIcIdes shouId be monIIored aI monIhIy InIervaIs or even more
IrequenIIy.
AIIecIIon oI Ihe bIood pIcIure due Io IonIzIng radIaIIon can be monIIored aI perIods
rangIng Irom 1 Io 6 monIhs dependIng on Ihe exposure dose. Ior dIseases IhaI sIarI
Io appear aIIer many years, e.g. noIseInduced hearIng Ioss and sIIIcosIs, perIodIc
examInaIIon can sIarI aIIer many years oI exposure (S-S years) and sInce progress
Is sIow, examInaIIon can be repeaIed aIIer perIods Irom 1-2 years. Cancer appears
aIIer even Ionger perIods.
nrIy detecton o] occuntonnI dsenses: ModuIe 3 73
3. EARLY DETECTlON Ol OCCUPATlONAL DlSEASES
CAUSED BY PHYSlCAL lACTORS
3.1 HeaI
The severIIy oI heaIIh eIIecIs Irom heaI Increases wIIh Ihe IemperaIure, humIdIIy
and duraIIon oI exposure. In order oI IncreasIng severIIy Ihe heaIIh eIIecIs are:
IassIIude, IrrIIabIIIIy, dIscomIorI
Iowered work perIormance and Iack oI concenIraIIon
heaI rash
heaI exhausIIon
heaI sIroke.
3.2 Noise
NoIseInduced hearIng Ioss can be deIecIed by audIomeIry. LarIy Ioss aIIecIs hIgh
Iones (S000-6000 Hz) Iong beIore hearIng oI every day speech Is aIIecIed. NoIse
Induced hearIng Ioss Is permanenI.
3.3 VibraIion
VIbraIIons cause vascuIar dIsorders oI Ihe arms and bony changes In Ihe smaII bones
oI Ihe wrIsI. VascuIar changes are dIIIIcuII Io deIecI, IesIs are compIIcaIed and non
specIIIc, buI bony changes can be deIecIed by Xray examInaIIon oI Ihe wrIsI. The
mosI common IIndIng Is rareIacIIon oI Ihe IunaIe bone.
3.4 AImospheric pressure
Lxposure Io Increased aImospherIc pressure (under waIer) Ieads Io asepIIc bone
necrosIs around Ihe knee, hIp and shouIder whIch can be deIecIed by Xray
examInaIIon.
3.5 lnlra-red radiaIion
Lxposure Io InIrared radIaIIon causes caIaracI, an opacIIy oI Ihe eye Iens whIch
aIIecIs Ihe posIerIor parI oI Ihe Iens. CaIaracI causes progressIve IaIIure oI vIsIon
and can be deIecIed by sIII Iamp examInaIIon. The aIIecIed Iens has Io be removed.
3.6 lonizing radiaIion
Lxposure Io IonIzIng radIaIIon aIso causes caIaracIs. SInce Ihe bIood IormIng organs
are among Ihe mosI sensIIIve Io IonIzIng radIaIIons, Ihe bIood shouId be examIned
perIodIcaIIy. The IeucocyIIc counI Is IndIcaIIve oI aIIecIIon and Is more useIuI II Ihe
preempIoymenI resuIIs are avaIIabIe. KeraIoses oI Ihe skIn are precancerous
condIIIons.
CAUSED BY BlOLOGlCAL AGENTS
4.1 Pulmonary Iuberculosis
ThIs can be deIecIed by Xray examInaIIon oI Ihe chesI. Mass mInIaIure radIography
Is a useIuI IooI. A ManIoux IesI can be sIrongIy posIIIve and GramnegaIIve, acId
IasI bacIIII may be deIecIabIe on spuIum cuIIure.
4.2 Chronic brucellosis
ChronIc bruceIIosIs Is dIIIIcuII Io dIagnose cIInIcaIIy buI can be deIecIed by
seroIogIcaI examInaIIon (Iube aggIuIInaIIon IesI).
4.3 Viral hepaIiIis B and C
These can be deIecIed by seroIogIcaI examInaIIon and deIermInaIIon oI hepaIIIIs
markers.
CAUSED BY CHEMlCALS
5.1 MeIals
Icnd
(a) LssenIIaIs oI dIagnosIs
Inognnc-ncutc ccct:
abdomInaI paIn (coIIc)
encephaIopaIhy
haemoIysIs
acuIe renaI IaIIure
Inognnc-cIonc ccct:
IaIIgue and asIhenIa
arIhraIgIa and myaIgIas
anaemIa
perIpheraI neuropaIhy (moIor)
neurobehavIouraI dIsIurbances and chronIc encephaIopaIhy
gouI and gouIy nephropaIhy
chronIc renaI IaIIure
A) cnd conound:
IaIIgue and IassIIude
headaches
nausea and vomIIIng
neuropsychIaIrIc compIaInIs (memory Ioss, dIIIIcuIIy In concenIraIIng)
deIIrIum
seIzures
coma
(b) LarIy deIecIIon oI excessIve exposure Io Iead can be deIermIned by:
Ictcnnnton o cnd conccntnton n ood nnd unc
An average normaI vaIue oI Iead In bIood oI S0 g/dI Is noI unusuaI In cIIIes wIIh
heavy IraIIIc. PaIIenIs wIIh Iead poIsonIng have vaIues oI 80 g/dI or hIgher.
Indcc: o ccct
deIIaamInoIevuIInaIe dehydraIase In bIood
deIIaamInoIevuIInIc acId In urIne
coproporphyrIn In urIne
zInc proIoporphyrIn In Ihe eryIhrocyIes
Mccu)
Inognnc nccu)
acuIe respIraIory dIsIress
gIngIvIIIs
Iremor
eryIhIsm (shyness, emoIIonaI IabIIIIy)
proIeInurIa, renaI IaIIure
Ognnc nccu) /n) nccu) conound:)
menIaI dIsIurbances
aIaxIa, spasIIcIIy
paraesIhesIas
vIsuaI and audIIory dIsIurbances
(b) LarIy deIecIIon oI exposure Io mercury (InorganIc and aIkyI organIc mercury)
ThIs Is carrIed ouI by Ihe measuremenI oI mercury In urIne. The normaI vaIue In
nonexposed IndIvIduaIs Is Iess Ihan 20 g/I.
OrganIc aIkyI compounds (meIhyI mercury) can be esIImaIed In pIasma and
eryIhrocyIes.
Mnngnnc:c
Acutc ccct:
Iever
chIIIs
dyspnoea (meIaI Iume Iever)
CIonc ccct:
ParkInsonIIke syndrome
behavIouraI syndrome
pneumonIa
(b) LsIImaIIon
The esIImaIIon oI manganese In bIoIogIcaI IIuIds does noI heIp In earIy dIagnosIs.
DeIecIIon oI Ihe dIsease In Ihe cIInIcaI sIage depends on Ihe neuropsychIaIrIc
manIIesIaIIons.
A:cnc
Acutc ccct:
nausea
vomIIIng
dIarrhoea
InIravascuIar haemoIysIs
jaundIce
oIIgurIa (arsIne)
cardIovascuIar coIIapse
CIonc ccct:
hyperkeraIosIs and hyperpIgmenIaIIon (meIanosIs)
perIpheraI neuropaIhy
anaemIa
cardIac and perIpheraI vascuIar dIsease
(b) ChronIc exposure
ThIs can be evaIuaIed by measuremenI oI arsenIc In urIne. In nonexposed normaI
IndIvIduaIs II does noI exceed S0 g/I. SeaIood raIses Ihe concenIraIIon oI arsenIc
In urIne. LsIImaIIon oI arsenIc In haIr and naIIs can gIve a good Index oI chronIc
exposure, however exIernaI conIamInaIIon shouId be avoIded. HaIr and naIIs shouId
be washed IhoroughIy.
5.2 Organic solvenIs and biological IesIs used lor deIecIion ol
exposure
Orgnnc soIvent nnd ts henIth e]]ects Methods o] evnIunton o] exposure
enzene (benzol)
Acute exposure PerIodIc red and whIte ceII counts oI
AnaesthesIa: dIzzIness, headache, questIonabIe vaIue but may detect earIy
nausea, vomItIng, sIeepIness, haemopoIetIc eIIects
IatIgue, sIurred speech, dIsequIIIbrIum, enzene In bIood (specIIIc, sensItIve,
dIsorIentatIon, depressIon, Ioss oI the best approach avaIIabIe at present)
conscIousness Trans transmuconIc acId In urIne
RespIratory tract IrrItatIon: sore nose (reasonabIy specIIIc, sensItIve)
and throat, cough PhenyImercapturIc acId In urIne
(specIIIc, sensItIve, sophIstIcated
methodoIogy)
Chronc exposure enzene In urIne (specIIIc, sensItIve,
one marrow depressIon wIth a deIayed IImIted experIence)
eIIect, many years In some cases PhenoI In urIne (nonspecIIIc,
EarIy symptoms and sIgns are vague, InsensItIve)
but Iater tIredness and spontaneous enzene In exhaIed breath (specIIIc,
bIeedIng may occur as anaemIa, pancytopenIa sensItIve, IImIted practIcabIIIty)
andJor thrombocytopenIa become more severe
ApIastIc anaemIa, acute myeIobIastIc
IeukaemIa and acute erythroIeukaemIa
are the most Ieared eIIects oI chronIc
exposure
Toluene (methyl benzene)
ToIuene exposure Is rareIy pure and exposure HIppurIc acId In urIne coIIected at the
IrequentIy IncIudes benzene wIth or end oI the work shIIt. (Note: hIppurIc acId
wIthout xyIene Is not a metaboIIte specIIIc to toIuene;
It can be produced Irom dIetary sources,
Acute exposure such as Iood preserved wIth benzoIc
NarcotIc acId).
ConjunctIvaI IrrItatIon and uIceratIon
CardIac arrhythmIa (has caused deaths In
"snIIIers")
Chronc exposure
LIver, kIdney and bone marrow (probabIy
due to benzene as contamInant)
Xylene
Acute exposure MethyI hIppurIc acId In urIne
Mucous membrane IrrItatIon
NarcotIc
Chronc exposure
ApIastIc anaemIa has been postuIated but
may be due to benzene contamInatIon
(wIth toIuene)
Aminobenzene (aniline)
Acute exposure MethaemogIobIn In bIood.
MIId skIn IrrItant ParaamInophenoI In urIne
Moderate exposure may onIy cause some
cyanosIs
Severe poIsonIng resuIts In anoxIa and death,
whIch may be deIayed Ior a Iew hours
aIter exposure
Carbon tetrachloride
Acute exposure CCI
4
In expIred aIr
Nausea, vomItIng, drowsIness, dIzzIness Iood concentratIon Is oI IImIted vaIue
Chronc exposure
Dry, scaIy dermatItIs
CentrIIobuIar necrosIs wIth or wIthout
Iatty degeneratIon oI the IIver
Acute oIIgurIc renaI IaIIure
Polychlorinated biphenyls
Acute exposure PCs In bIood
SkIn rash (chIoracne)
Eye IrrItatIon
Nausea, vomItIng
Chronc exposure
Weakness, weIght Ioss, anorexIa
SkIn rash (chIoracne)
Numbness and tIngIIng oI extremItIes
EIevated serum trIgIycerIdes
EIevated IIver enzymes
Methylene chloride (dichloromethane)
Acute exposure CarboxyhaemogIobIn IeveIs In bIood and
SkIn and mucous membrane IrrItant carbon monoxIde In exhaIed aIr
Acute IntoxIcatIon wIth stupor, numbness SmokIng aIIects bIoIogIcaI monItorIng
and tIngIIng oI IImbs IoIIowIng InhaIatIon resuIts
Chronc exposure
Can precIpItate cardIac InsuIIIcIency due
to Increase In carboxyhaemogIobIn
Chloroform
Acute exposure ChIoroIorm In exhaIed aIr and In bIood
SkIn IrrItant, potent anaesthetIc
Chronc exposure
LIver enIargement and damage potentIated
by aIcohoI abuse (causes hepatIc tumours
In rodents)
OIIgurIc renaI IaIIure
ChronIc dry, scaIy dermatItIs
Trichloroethane
Acute exposure TrIchIoroethane, trIchIoroethanoI and
Mucous membrane and skIn IrrItant trIchIoroacetIc acId In expIred aIr, bIood
NarcotIc and urIne.
CapabIe oI sensItIzIng the myocardIum to
adrenaIIne thereby causIng arrhythmIas
Chronc exposure
Trichloroethylene
Acute exposure ExpIred aIr Ior trIchIoroethyIene and
PowerIuI narcotIc, actIon exacerbated by trIchIoroacetIc acId
ethanoI TrIchIoroethanoI and trIchIoroacetIc acId
MIId respIratory and skIn IrrItant. In bIood or urIne
Chronc exposure
PerIphera; neuropathy has been reported
AddIctIve
Tetrachloroethylene
Acute exposure TetrachIoroethyIene, trIchIoroethanoI and
PowerIuI narcotIc trIchIoroacetIc acId In bIood, aIveoIar aIr
Can cause mucous membrane and skIn and urIne
IrrItatIon as weII as IIver damage
Chronc exposure
CNS depressIon and IIver damage
Rodent carcInogen
Carbon disulfide (CS
2
)
Acute exposure The IodIne azIde reactIon wIth urIne at
Severe skIn and mucous membrane IrrItant the end oI the work day and at the
DIzzIness, headaches, psychosIs, drowsIness begInnIng oI the work day wIII detect
organIc suIIate metaboIItes oI carbon
Chronc exposure dIsuIIIde, but the reactIon Is not
Four dIstInct syndromes: specIIIc Ior CS
2
ParkInsonIIke aIIectIon due to the
corpus strIatum and gIobus paIIIdus
PerIpheraI neuropathy aIIectIng motor
and sensory nerves as weII as ocuIar nerves
PsychotIc condItIons (rareIy seen nowadays,
but Iesser neuropsychIatrIc states are stIII
descrIbed)
CardIovascuIar dIsease, possIbIy due to Increased
bIood choIesteroI and IIpoproteIn IeadIng to
IschaemIc heart dIsease and perIpheraI vascuIar
damage. (Recent research suggests that part oI thIs
cardIovascuIar aIIect may be due to an acute myotoxIc
eIIect on cardIac muscIe IeadIng to IataI arrhythmIas
5.3 PesIicides
Lxposure Io organophosphaIes can be evaIuaIed by deIermInIng Ihe degree oI
InhIbIIIon oI choIIneesIerase acIIvIIy In Ihe bIood. There are IaboraIory meIhods
Ior evaIuaIIon oI choIIneesIerase acIIvIIy whIch are accuraIe and saIIsIacIory. There
are aIso many sImpIer IIeId survey meIhods and kIIs IhaI are noI as accuraIe buI are
quIIe useIuI.
SInce Ihere are wIde varIaIIons In Ihe vaIues oI choIIneesIerase acIIvIIy among
IndIvIduaIs, II Is ImporIanI Io compare IndIvIduaI IIgures wIIh preexposure IeveIs
Ior Ihe same IndIvIduaI, measured by Ihe same meIhod. SympIoms oI poIsonIng wIIh
U OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
organophosphaIes appear when choIIneesIerase acIIvIIy have been reduced by S0-
60 oI preexposure IeveIs. Severe cases may show 7S reducIIon.
MeasuremenI oI choIIneesIerase acIIvIIy Is aIso Ihe IesI Ior deIecIIon oI poIsonIng
or exposure Io carbamaIe and IhIocarbamaIe pesIIcIdes.
5.4 Pulmonary dusI diseases
LarIy dIagnosIs oI byssInosIs Is made usIng a specIaI quesIIonnaIre whIch
demonsIraIes Ihe presence oI chesI IIghIness on Ihe IIrsI day aIIer Ihe weekend
Ieave, In earIy cases. Xray examInaIIon In cases oI byssInosIs yIeIds negaIIve resuIIs
and Ihe demonsIraIIon oI aIrway obsIrucIIon by puImonary IuncIIon IesIIng Is noI
specIIIc.
In Ihe case oI exposure Io IIbrogenIc dusI, aIIer a saIIsIacIory occupaIIonaI hIsIory
has been eIIcIIed, a posIIIve Xray Is Ihe maIn IooI Ior earIy dIagnosIs. ThIs Is
appIIcabIe In Ihe case oI sIIIcosIs, asbesIosIs, IaIc pneumoconIosIs and chIna cIay
pneumoconIosIs. II shouId be noIed, however, IhaI once a posIIIve Xray Is obIaIned,
Ihese dIseases are IrreversIbIe.
In Ihe case oI exIrInsIc aIIergIc aIveoIIIIs (bagassosIs, Iarmers' Iung), Ihe dIagnosIs
oI acuIe, subacuIe and chronIc cases can be conIIrmed by Xray examInaIIon.
SeroIogIcaI examInaIIon may heIp.
1. IamIIIarIze yourseII wIIh Ihe IechnIques and IechnoIogIes used In earIy
deIecIIon oI occupaIIonaI dIseases.
2. Observe how Ihe prepIacemenI/perIodIc medIcaI examInaIIons are carrIed ouI
and record your observaIIons oI Ihe communIcaIIon skIIIs requIred In eIIcIIIng
InIormaIIon Irom Ihe worker.
S. AssocIaIe Ihe resuIIs obIaIned durIng Ihe perIodIc medIcaI examInaIIon wIIh
Ihe resuIIs oI envIronmenIaI monIIorIng oI Ihe workpIace. Prepare a reporI on
your observaIIons.
4. RevIew Ihe medIcaI records aI Ihe workpIace and make your observaIIons
regardIng Ihe hIsIory oI sIgns and sympIoms oI occupaIIonaI dIsease.
S. AcquaInI yourseII wIIh Ihe InIernaIIonaI Labour OrganIsaIIon's (ILO)
InIernaIIonaI CIassIIIcaIIon oI RadIographs oI PneumoconIoses.
6. RevIew Ihe currenI avaIIabIe daIa on bIoIogIcaI monIIorIng oI occupaIIonaI
hazards.
7. AdvIse managemenI on Ihe need Io carry ouI reguIar medIcaI examInaIIons on
IheIr workers.
8. AdvIse workers on Ihe need Io pass a medIcaI examInaIIon on a reguIar basIs.
9. AdvIse workers on Ihe need Io recognIze Ihe earIy sIgns and sympIoms oI
occupaIIonaI dIseases.
MODULE 4
Occupational ergonomics
1. OB|ECTlVES
UndersIand Ihe humanmachIne-envIronmenI reIaIIonshIp
Be aware oI ergonomIcs as a IooI Ior heaIIhIer and saIer workIng condIIIons
Know how Io Iake InIo accounI Ihe workers' dImensIons and Ihe physIcaI/
psychosocIaI capabIIIIIes and IImIIaIIons In order Io avoId harmIuI workIng
condIIIons
CoIIecI InIormaIIon In Ihe work sIIuaIIon abouI boIh Ihe workers and Ihe
naIure oI Ihe work In order Io oIIer correcI and prIorIIIzed advIce
CreaIe awareness as Io why and how Io Improve Ihe work sIIuaIIon and Io gIve
sImpIe suggesIIons In order Io desIgn ergonomIcaIIy eIIIcIenI new work
sIIuaIIons
CommunIcaIe wIIh managemenI and workers abouI ImprovemenIs In Ihe work
sIIuaIIon In order Io beneIII as much as possIbIe.
LrgonomIcs Is Ihe sIudy oI Ihe compIex reIaIIonshIps beIween peopIe, physIcaI and
psychoIogIcaI aspecIs oI Ihe work envIronmenI (e.g. IacIIIIIes, equIpmenI and IooIs),
job demands and work meIhods. II Is a IIeId whIch InIegraIes knowIedge derIved
Irom Ihe human scIences (In parIIcuIar anaIomy, physIoIogy and psychoIogy) Io
maIch jobs, sysIems, producIs and envIronmenIs Io Ihe physIcaI and menIaI abIIIIIes
and IImIIaIIons oI workers. LrgonomIcs sIresses IIIIIng Ihe job Io Ihe worker as
compared Io Ihe more usuaI pracIIce oI obIIgIng Ihe worker Io III Ihe job.
The aIm oI ergonomIcs Is prImarIIy Io opIImIze, IIrsI and IoremosI, Ihe comIorI, as
weII as Ihe heaIIh, saIeIy and eIIIcIency, oI Ihe worker. AppIyIng ergonomIc
prIncIpIes however, Is noI onIy beneIIcIaI Io workers. The beneIIIs Io empIoyers are
equaIIy sIgnIIIcanI and are boIh vIsIbIe and measurabIe In Ierms oI Increased
eIIIcIency, hIgher producIIvIIy, reducIIon In work IIme IosI due Io IIIness or Injury
and decreased Insurance cosIs.
A IundamenIaI prIncIpIe oI ergonomIcs Is IhaI aII work acIIvIIIes cause Ihe worker
Io experIence some IeveI oI physIcaI and menIaI sIress. As Iong as IhIs sIress Is kepI
wIIhIn reasonabIe IImIIs, work perIormance shouId be saIIsIacIory and Ihe worker's
heaIIh and weIIbeIng shouId be maInIaIned.
II sIress Is excessIve, however, undesIrabIe ouIcomes may occur In Ihe Iorm oI
errors, accIdenIs, InjurIes or decreases In physIcaI or menIaI heaIIh. LrgonomIcaIIy
reIaIed InjurIes and IIInesses range Irom eye sIraIn and headaches Io
muscuIoskeIeIaI aIImenIs such as chronIc back, neck and shouIder paIn, cumuIaIIve
Irauma dIsorders (CTDs), repeIIIIve sIraIn InjurIes (RSIs) and repeIIIIve moIIon
InjurIes (RMIs)-Ihree Ierms whIch are used InIerchangeabIy.
PrevenIIng eyesIraIn, headaches and muscuIoskeIeIaI dIsorders and obIaInIng
opIImaI perIormance can be achIeved when equIpmenI, worksIaIIons, producIs and
workIng meIhods are desIgned accordIng Io human capabIIIIIes and IImIIaIIons, I.e.
by appIyIng prIncIpIes oI ergonomIcs.
The cosIs oI IgnorIng Ihese basIc prIncIpIes IncIude:
InjurIes and occupaIIonaI dIseases (IncIudIng RSI, CTD and RMI)
Increased absenIeeIsm
hIgher medIcaI and Insurance cosIs
Increased probabIIIIy oI accIdenIs and errors
hIgher Iurnover oI workers
Iess producIIon ouIpuI
IawsuIIs
IowquaIIIy work
Iess spare capacIIy Io deaI wIIh emergencIes.
The goaI oI an occupaIIonaI ergonomIcs programme Is Io esIabIIsh a saIe work
envIronmenI by desIgnIng IacIIIIIes, IurnIIure, machInes, IooIs and job demands Io
be compaIIbIe wIIh workers' aIIrIbuIes (such as sIze, sIrengIh, aerobIc capacIIy and
InIormaIIon processIng capacIIy) and expecIaIIons. A successIuI ergonomIcs
programme shouId sImuIIaneousIy Improve heaIIh and enhance producIIvIIy.
Examples
Ic\cnton o nccdcnt:
DesIgnIng a machIne guard IhaI wIII aIIow a worker Io operaIe a pIece oI
equIpmenI wIIh smooIh, nonawkward, IImeeIIIcIenI moIIons. ThIs mInImIzes
any InconvenIence InIroduced by Ihe guard and decreases Ihe IIkeIIhood IhaI
II wIII be bypassed or removed.
SIudyIng Ihe bIomechanIcs oI Ihe human waIk Io deIermIne Iorces and Iorques
acIIng aI Ihe InIerIace beIween Ihe IIoor and Ihe soIe oI Ihe shoe. ThIs
InIormaIIon can be used Io Improve Ihe IrIcIIon characIerIsIIcs oI IIoor
surIaces and shoe soIes Io reduce Ihe rIsk oI a sIIp or IaII.
Ic\cnton o ntguc
DesIgnIng a compuIer work sIaIIon (equIpmenI and IurnIIure) so IhaI an
operaIor can use a vIdeo dIspIay unII (VDU) Ior an exIended perIod oI IIme
wIIhouI experIencIng vIsuaI or posIuraI IaIIgue.
LvaIuaIIng Ihe meIaboIIc demands oI a job perIormed In a hoI, humId
envIronmenI Io recommend a work-resI regImen IhaI wIII prevenI heaI sIress.
OccuntonnI ergononcs: ModuIe 4 3
Ic\cnton o nu:cuo:cctn d:odc:
LvaIuaIIng IIIIIng Iasks Io deIermIne bIomechanIcaI sIresses acIIng on Ihe
Iower back and desIgnIng IIIIIng Iasks Io ensure IhaI Ihese sIresses wIII noI
cause back InjurIes.
LvaIuaIIng hIghIy repeIIIIve manuaI assembIy operaIIons and deveIopIng
aIIernaIIve hand IooIs and work meIhods Io reduce Ihe rIsk oI cumuIaIIve
Irauma dIsorders such as IendonIIIs, epIcondyIIIIs, IenosynovIIIs and carpaI
IunneI syndrome.
3. ERGONOMlCS: A MULTlDlSClPLlNARY SClENCE
LrgonomIcs Is a muIIIdIscIpIInary scIence wIIh Iour major areas:
human IacIors engIneerIng
work physIoIogy
occupaIIonaI bIomechanIcs
anIhropomeIry.
3.1 Human lacIors engineering
Human IacIors engIneerIng, someIImes caIIed engIneerIng psychoIogy, Is concerned
wIIh Ihe InIormaIIon processIng aspecIs oI work.
O]cct\c: o Iunnn ncto: cngnccng
BroadIy, Ihe objecIIves are Io desIgn procedures, equIpmenI and Ihe work
envIronmenI Io mInImIze Ihe IIkeIIhood oI an accIdenI caused by human error.
BasIc operaIIonaI objecIIves:
reduce errors
Increase saIeIy
Improve sysIem perIormance
ObjecIIves bearIng on reIIabIIIIy, maInIaInabIIIIy and avaIIabIIIIy (RMA) and
InIegraIed IogIsIIc supporI (ILS):
Increase reIIabIIIIy
Improve maInIaInabIIIIy
reduce personneI requIremenIs
reduce IraInIng requIremenIs
ObjecIIves aIIecIIng users and operaIors:
Improve Ihe workIng envIronmenI
reduce IaIIgue and physIcaI sIress
Increase human comIorI
reduce boredom and monoIony
Increase ease oI use
Increase user accepIance
OIher objecIIves:
reduce Ioss oI IIme and equIpmenI
Increase economy oI producIIon.
Connon cnu:c: o \o nccdcnt: cnu:cd ) Iunnn co
(a) IaIIure Io perceIve or recognIze a hazardous condIIIon or sIIuaIIon
To reacI Io a dangerous sIIuaIIon II Is necessary Io perceIve IhaI Ihe danger exIsIs.
Many workpIace hazards are noI perceIved Ihrough human sensory channeIs, e.g.
excessIve pressure InsIde a boIIer IhaI couId cause an expIosIon
a IorkIIII Iruck approachIng Irom behInd In a noIsy IacIory
unguarded machInery In a poorIy III room
Ihe sudden reIease oI an odourIess IoxIc gas.
In Ihese sIIuaIIons II Is necessary Io suppIemenI Ihe sensory IuncIIons wIIh specIaI
InIormaIIonaI dIspIays, e.g.
a pressure gauge wIIh redIIne marks Io IndIcaIe a dangerous condIIIon InsIde
Ihe boIIer
a horn or beeper on Ihe IorkIIII Iruck IhaI sounds auIomaIIcaIIy whIIe II Is In
moIIon
a weIIIII warnIng sIgn aI Ihe enIrance Io a poorIy III equIpmenI room
an emergency aIarm sysIem IhaI IndIcaIes Ihe reIease oI IoxIc gases.
(b) IaIIure In Ihe InIormaIIon processIng or decIsIonmakIng processes
DecIsIonmakIng InvoIves combInIng new InIormaIIon wIIh exIsIIng knowIedge Io
provIde a basIs Ior acIIon. Lrrors can occur aI IhIs sIage II Ihe InIormaIIon
processIng Ioad Is excessIve, e.g. In Ihe accIdenI aI Ihe Three MIIe IsIand nucIear
power pIanI In Ihe USA In Ihe 1970s, operaIors were requIred Io reacI Io muIIIpIe
sImuIIaneous aIarms.
Lrrors can aIso occur II prevIous IraInIng was IncorrecI or InapproprIaIe Ior handIIng
a specIIIc sIIuaIIon.
(c) IaIIure In moIor acIIons IoIIowIng correcI decIsIons
IoIIowIng a decIsIon, II Is IrequenIIy necessary Ior a worker Io perIorm some moIor
acIIon by usIng a conIroI Io ImpIemenI Ihe desIred change, e.g. IIIppIng a swIIch or
adjusIIng a knob. IaIIures can occur II conIroIs are noI desIgned Io be consIsIenI
wIIh human moIor abIIIIIes, e.g. Ihe Iorce requIred Io adjusI a conIroI vaIve In a
chemIcaI pIanI shouId noI exceed human sIrengIh abIIIIy, or II manIpuIaIIon oI Ihe
conIroI causes an unexpecIed response.
ConIroIs IhaI sIarI poIenIIaIIy dangerous machInery or equIpmenI shouId be
guarded Io prevenI accIdenIaI acIIvaIIon, usuaIIy by coverIng Ihe conIroI or pIacIng
II In a IocaIIon where II cannoI be accIdenIaIIy Iouched.
Tn:: o tnncc:
Look around your envIronmenI and IdenIIIy Ihree IooIs, sysIems, processes or
combInaIIons IhereoI IhaI are IauIIy Irom a human IacIors perspecIIve.
Ior each, descrIbe why you IhInk Ihere Is a probIem and suggesI how Ihe
probIem mIghI be IIxed. LImII your response Io a Iew senIences per probIem.
3.2 Work physiology
Work physIoIogy Is Ihe subdIscIpIIne oI ergonomIcs concerned wIIh sIress IhaI
occurs durIng Ihe meIaboIIc conversIon oI bIochemIcaI energy sources, such as
gIucose, Io mechanIcaI work. II IhIs sIress Is excessIve, Ihe worker wIII experIence
IaIIgue. IaIIgue may be IocaIIzed Io a reIaIIveIy smaII number oI muscIes or may
aIIecI Ihe enIIre body.
5tntc \o nnd ocn nu:cc ntguc
SIaIIc work occurs when a muscIe or muscIe group remaIns In a conIracIed sIaIe Ior
an exIended perIod oI IIme wIIhouI reIaxaIIon. HIgh IeveIs oI sIaIIc work can be
caused by:
susIaIned awkward posIure, e.g. a mechanIc who musI conIInuousIy IwIsI hIs
body Io perIorm repaIrs Io an auIomobIIe engIne
hIgh sIrengIh demands assocIaIed wIIh a specIIIc Iask, e.g. usIng a wrench Io
undo a badIy rusIed wheeInuI when changIng a Iyre.
When a muscIe conIracIs, Ihe bIood vesseIs IhaI suppIy nuIrIenIs and remove
meIaboIIc wasIes are compressed by Ihe adjacenI conIracIIIe IIssue. As a resuII,
vascuIar resIsIance Increases wIIh Ihe IeveI oI muscIe IensIon, and Ihe bIood suppIy
Io Ihe workIng muscIe decreases. II Ihe muscIe Is noI aIIowed Io reIax perIodIcaIIy,
Ihe demand Ior meIaboIIc nuIrIenIs may exceed Ihe suppIy. MeIaboIIc wasIes can
aIso accumuIaIe. The shorIIerm eIIecIs oI IhIs condIIIon IncIude IschaemIc paIn,
Iremor or a reduced capacIIy Io produce IensIon. Any oI Ihese eIIecIs can severeIy
InhIbII work perIormance.
SIaIIc work aIso causes a Iemporary Increase In Ihe perIpheraI resIsIance oI Ihe
cardIovascuIar sysIem. SIgnIIIcanI Increases In hearI raIe and mean arIerIaI bIood
pressure have been observed In conjuncIIon wIIh shorI duraIIon sIaIIc conIracIIons.
CauIIon shouId be exercIsed Io avoId pIacIng a person wIIh a hIsIory oI
cardIovascuIar dIsease on a job IhaI requIres moderaIe Io heavy sIaIIc exerIIons.
In mosI sIIuaIIons, dynamIc acIIvIIIes InvoIvIng cycIIcaI conIracIIon and reIaxaIIon
oI workIng muscIe are preIerabIe Io sIaIIc work. II, however, Ihe job requIres hIghIy
repeIIIIve or IorceIuI exerIIons, a varIeIy oI IocaIIzed cumuIaIIve Irauma InjurIes may
occur Io muscuIoskeIeIaI IIssue or perIpheraI nerves.
b OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
I)nnnc \o nnd \Ioc-od) ntguc
DynamIc, whoIebody work occurs when muIIIpIe groups oI Iarge skeIeIaI muscIes
repeaIedIy conIracI and reIax In conjuncIIon wIIh Ihe perIormance oI a Iask, e.g.
waIkIng on a IeveI surIace, pedaIIIng a bIcycIe, cIImbIng sIaIrs and movIng a Ioad (by
carryIng, pushIng, puIIIng, or shoveIIIng) Irom one IocaIIon Io anoIher.
The InIensIIy oI whoIebody, dynamIc work Is prImarIIy IImIIed by Ihe capacIIy oI
Ihe puImonary and cardIovascuIar sysIems Io deIIver suIIIcIenI oxygen and gIucose
Io workIng muscIes and Io remove producIs oI meIaboIIsm.
WhoIebody IaIIgue occurs when Ihe coIIecIIve meIaboIIc demands oI workIng
muscIes IhroughouI Ihe body exceed IhIs capacIIy. Common sympIoms oI whoIe
body IaIIgue IncIude shorIness oI breaIh, weakness In workIng muscIes and a
generaI IeeIIng oI IIredness. These sympIoms wIII conIInue and may Increase unIII
Ihe work acIIvIIy Is sIopped or decreased In InIensIIy.
Ior exIremeIy shorI duraIIons oI whoIebody dynamIc acIIvIIy (IypIcaIIy 4 mInuIes
or Iess), a person can work aI InIensIIy equaI Io hIs or her aerobIc capacIIy. As Ihe
duraIIon oI Ihe work perIod Increases, Ihe work InIensIIy musI be adjusIed
downward. II a Iask Is Io be perIormed conIInuousIy Ior 1 hour, Ihe average energy
expendIIure Ior IhIs perIod shouId noI exceed S0 oI Ihe worker's aerobIc capacIIy.
Ior a job IhaI Is perIormed Ior an 8 hour shIII, Ihe average energy expendIIure
shouId noI exceed SS oI Ihe worker's aerobIc capacIIy.
AerobIc capacIIy varIes consIderabIy wIIhIn Ihe popuIaIIon. IndIvIduaI IacIors IhaI
deIermIne aerobIc capacIIy IncIude age, sex, weIghI, heredIIy and currenI IeveI oI
physIcaI IIIness.
The prevenIIon oI whoIebody IaIIgue Is besI accompIIshed Ihrough good job desIgn.
The energy expendIIure requIremenIs oI a job shouId be suIIIcIenIIy Iow Io
accommodaIe Ihe aduII workIng popuIaIIon, IncIudIng Ihose IndIvIduaIs wIIh IImIIed
aerobIc capacIIy. These requIremenIs can be meI by desIgnIng Ihe workpIace Io
mInImIze unnecessary body movemenIs (excessIve waIkIng or cIImbIng) and
provIdIng mechanIcaI assIsIs (such as hoIsIs or conveyors) Ior handIIng heavy
maIerIaIs. II Ihese approaches are noI IeasIbIe, II may be necessary Io provIde
addIIIonaI resI aIIowances Io prevenI excessIve IaIIgue, parIIcuIarIy In hoI, humId
work envIronmenIs because oI Ihe meIaboIIc conIrIbuIIon Io heaI sIress.
To assess Ihe poIenIIaI Ior whoIebody IaIIgue, II Is necessary Io measure or esIImaIe
Ihe energy expendIIure raIe Ior a specIIIc job, whIch Is usuaIIy done In one oI Ihree
ways:
1. TabIe reIerence: exIensIve IabIes oI Ihe energy cosIs oI varIous work acIIvIIIes
have been deveIoped.
2. IndIrecI caIorImeIry: energy expendIIure can be esIImaIed by measurIng a
worker's oxygen upIake whIIe perIormIng Ihe job.
S. ModeIIIng: Ihe job Is anaIysed and broken down InIo IundamenIaI Iasks such
as waIkIng, carryIng and IIIIIng. ParameIers descrIbIng each Iask are measured
and subsIIIuIed InIo equaIIons Io predIcI energy expendIIure.
3.3 OccupaIional biomechanics
BIomechanIcs Is Ihe subdIscIpIIne oI ergonomIcs concerned wIIh Ihe mechanIcaI
properIIes oI human IIssue, parIIcuIarIy Ihe resIsIance oI IIssue Io mechanIcaI
sIress. A major Iocus oI occupaIIonaI bIomechanIcs Is Ihe prevenIIon oI Ihe Iower
back and upper exIremIIIes.
MccInncn :tc::
OverI accIdenIs: some oI mechanIcaI sIresses IhaI cause Injury In Ihe work
envIronmenI are assocIaIed wIIh overI accIdenIs, e.g. crushed bones In Ihe IeeI
resuIIIng Irom Ihe ImpacI oI a dropped objecI. The hazards IhaI cause Ihese
InjurIes can usuaIIy be conIroIIed Ihrough saIeIy engIneerIng IechnIques.
CumuIaIIve Irauma InjurIes: oIher InjurIous mechanIcaI sIresses are more
subIIe and can cause cumuIaIIve Irauma InjurIes. Such sIress can be exIernaI,
such as a vIbraIIng chaIn saw IhaI causes Raynaud syndrome, or InIernaI, such
as compressIon oI spInaI dIscs durIng sIrenuous IIIIIng.
Such sIress Is mosI eIIecIIveIy conIroIIed Ihrough ergonomIcs, I.e. desIgnIng job
demands so IhaI resuIIIng mechanIcaI sIress can be IoIeraIed wIIhouI Injury.
onccInnc: o tng, u:Ing nnd ung
(a) PrIncIpIes oI IIIIIng
TesI your personaI sIrengIh IImIIs and make sure Ihe Ioad Io be IIIIed Is beIow
S0 oI IhaI IImII.
AvoId IIIIIng Ioads IhaI exceed Ihe generaI sIrengIh IImIIs caIcuIaIed Ior
varIous Iypes oI IIIIIng.
MInImIze IwIsIIng wIIh a Ioad, and, when II Is necessary Io IwIsI, roIaIe Ihe
peIvIs.
Keep Ihe Ioad cIose Io Ihe body when IIIIIng II.
LxercIse cauIIon when workIng In sIIppery or cIuIIered areas.
(b) PrIncIpIes oI pushIng and puIIIng
Make cerIaIn IhaI Ihe area ahead oI Ihe Ioad Is IeveI and cIear oI obsIacIes; II
II Is noI IeveI, some sysIem oI brakIng shouId be avaIIabIe.
Push Ihe Ioad raIher Ihan puII II; IhIs wIII reduce spInaI sIress, and In mosI cases
wIII Improve Ihe vIsIbIIIIy ahead.
Wear shoes IhaI provIde good IooI IracIIon; Ihe coeIIIcIenI oI IrIcIIon beIween
Ihe IIoor and Ihe soIe oI Ihe shoes shouId be aI IeasI 0.8 wherever heavy Ioads
are moved.
When sIarIIng Io push a Ioad, brace one IooI and use Ihe back, raIher Ihan Ihe
hands and arms, Io appIy Iorce; II Ihe Ioad does noI sIarI Io move when a
reasonabIe amounI oI Iorce Is appIIed, geI heIp Irom a coworker or use a
powered vehIcIe.
OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
PushIng or puIIIng Is easIer when Ihe handIes oI Ihe Ioaded carI are aI abouI hIp
heIghI (91-114 cm Ior men) Ihan Ihey are aI shouIder heIghI or above. HandIes
Iower Ihan Ihe hIps are awkward and unsaIe Io use.
3.4 Use ol anIhropomeIric daIa
One oI Ihe prImary reasons Ior physIcaI sIress on Ihe job Is Ihe mIsmaIch In sIze
beIween Ihe worker and Ihe workpIace, equIpmenI or machInery. ThIs mIsmaIch
may resuII In havIng Io work benI over, havIng Io work wIIh one or boIh arms and
shouIders heId hIgh Ior Iong perIods or havIng Io sII on a sIooI or bench IhaI Is Ioo
Iow or Ioo hIgh.
AnIhropomeIry Is concerned wIIh IIIIIng IooIs and workspaces Io Ihe dImensIons
oI Ihe human body. SInce humans come In a Iremendous range oI shapes and sIzes,
IhIs Is oIIen a dIIIIcuII Iask. KnowIng Ihe dIsIrIbuIIon oI shapes and sIzes Is Ihe IIrsI
sIep In anIhropomeIrIc desIgn. There are Ihousands oI dIIIerenI measuremenIs on
Ihe human body IhaI are reIevanI Io Ihe desIgn oI IooIs, workpIaces and even
cIoIhIng.
AntIoonctc tnc:
AnIhropomeIrIc IabIes IIsI summarIes oI Ihese measuremenIs across dIIIerenI
popuIaIIon groups. Numerous anIhropomeIrIc daIa sources are avaIIabIe, each
represenIaIIve oI Ihe dIIIerenI popuIaIIons measured, e.g. Ihere are anIhropomeIrIc
daIabases avaIIabIe on mIIIIary personneI, AmerIcan IndusIrIaI popuIaIIons and
dIIIerenI counIrIes and regIons oI Ihe worId.
KcncI nnd t
The concepIs oI reach and III are essenIIaI Io anIhropomeIry and Ihey appIy In many
dIIIerenI sIIuaIIons IncIudIng desIgn oI aImosI any producI or IechnoIogy peopIe
use:
chaIrs and seaIIng
baIhs, showers, kIIchens
workpIaces In generaI
compuIer worksIaIIons
cars and oIher vehIcIes
corrIdors, sIaIrways and buIIdIng InIerIors In generaI
IooIs.
A generaI ruIe oI anIhropomeIrIc desIgn Is IhaI IaII peopIe esIabIIsh III requIremenIs,
shorI peopIe esIabIIsh reach requIremenIs.
5tc: n dc:gn
1. DeIInIng who Io desIgn Ior (deIIne Ihe popuIaIIon)
Many companIes and IacIorIes have a dIverse popuIaIIon, boIh wIIhIn and across
workpIaces. ThereIore Ihe popuIaIIon beIng desIgned Ior musI be deIIned Io ensure
IhaI Ihe desIgn IIIs Ihe physIcaI characIerIsIIcs oI Ihe acIuaI workpIace popuIaIIon.
2. DeIermInIng Ihe ImporIanI parIs and dImensIons Io use
Ior desIgn or redesIgn oI equIpmenI, IooIs, worksIaIIons or jobs, body dImensIons
IhaI specIIIcaIIy reIaIe Io Ihe Iasks beIng perIormed shouId be used, e.g.
desIgnIng Ior shorIreach dIsIances Io obIaIn parIs Irom bIns aI a worksIaIIon
aIIows smaIIer empIoyees Io reach wIIhouI IormIng awkward posIures;
Ior a seaIed worksIaIIon, usIng cIearance dImensIons Ior Ihe IargesI maIe
aIIows mosI empIoyees Io pIace IheIr Iegs under Ihe worksIaIIon wIIhouI
IormIng awkward posIures, such as IeanIng or IwIsIIng Ihe back.
Ior Ihe desIgn oI new jobs, empIoyers musI aIso deIermIne:
how Ihe job Is goIng Io be perIormed (IdenIIIIcaIIon oI Ihe Iasks);
how any new equIpmenI or IooIs wIII be used (e.g. IocaIIon oI conIroIs, reach
requIremenIs); and
whaI body dImensIons are ImporIanI Io use Ior Ihe desIgn.
As a mInImum, Ihe dImensIons reIaIed Io work heIghI (Ihe acIuaI heIghI aI whIch
Ihe hands perIorm Ihe work), reach and III (cIearance) shouId be addressed.
S. DesIgnIng Ior adjusIabIIIIy
ThIs sIraIegy accommodaIes nearIy aII Ihe workIorce, e.g. an exIsIIng work surIace
IhaI aIIows a shorIer IndIvIduaI Io sIand and work wIIhouI bendIng over mIghI
requIre IhaI a IaIIer IndIvIduaI bend Iorward Io work on Ihe same work surIace. A
work surIace IhaI Is adjusIabIe In heIghI aIIows Ihe IaIIer IndIvIduaI Io sIand and
work wIIhouI bendIng. AI a compuIer worksIaIIon, adjusIabIIIIy may be consIdered
Ior Ihe chaIr, work surIace and monIIor.
4. DesIgnIng Ior exIremes
An aIIernaIIve approach Io desIgnIng Ior adjusIabIIIIy Is Io desIgn Ior Ihe exIreme
(9SIh percenIIIe maIe or SIh percenIIIe IemaIe) and accommodaIe Ihe resI oI Ihe
popuIaIIon, e.g. desIgn Ihe work surIace heIghI Ior Ihe 9SIh percenIIIe maIe and
accommodaIe shorIer IndIvIduaIs Ihrough work sIands.
1. VIsII IocaI workpIaces Ior dIIIerenI occupaIIons and record your observaIIons
oI ergonomIc probIems.
2. PrIorIIIze your observaIIons and make acIIon pIans In IIghI oI Ihe dIscussIon
In secIIon 2 oI IhIs moduIe.
S. DeveIop, In cIose cooperaIIon wIIh managemenI and workers, correcIIve
measures/advIce/suggesIIons In order Io Improve aI IeasI Ihe mosI harmIuI
aspecIs oI Ihe work sIIuaIIon.
4. Ior probIems whIch cannoI be soIved, IInd ouI where you can reIer Ihem Io,
IncIudIng specIaIIzed cenIres where possIbIe.
S. TraIn managemenI and workers how Io work wIIh Ihe correcIIons InIroduced
and encourage IoIIowup.
6. Check up on exacIIy how your suggesIed correcIIve measures have been
ImpIemenIed.
7. LducaIe managemenI and workers on whaI Io do In order Io avoId physIcaIIy
and psychosocIaIIy harmIuI work sIIuaIIons.
8. DocumenI Iasks 1-7.
MODULE 5
Stress and adverse
psychological factors at work
1. OB|ECTlVES
Learn how Io IdenIIIy workers wIIh psychoIogIcaI probIems
Learn how Io encourage workers wIIh psychoIogIcaI probIems Io manage IheIr
sIress by seekIng Ihe heIp oI IheIr reIaIIves and IrIends
Know how Io keep records and wrIIe reporIs
AssIsI In sImpIe psychomeIrIc IesIs
SpoI sIressors.
2.1 DeliniIions
SIress: a (perceIved) subsIanIIaI ImbaIance beIween demand and response capabIIIIy
under condIIIons where IaIIure Io meeI demand has ImporIanI (perceIved)
consequences. SIress Is aIso deIIned as Ihe sequence Irom sIressors Io sIress
reacIIons and IongIerm consequences.
SIressor: envIronmenIaI evenI or condIIIon IhaI resuIIs In sIress.
SIresslul: perIaInIng Io an envIronmenI IhaI has many sIressors.
SIrain (or sIress reacIion): shorIIerm physIoIogIcaI, psychoIogIcaI or behavIouraI
manIIesIaIIons oI sIress.
Modilier: IndIvIduaI characIerIsIIc or envIronmenIaI IacIor IhaI may acI on each
sIage oI Ihe sIress response Io produce IndIvIduaI varIaIIon.
Psychosocial lacIors: IacIors InIIuencIng heaIIh, heaIIh servIces and communIIy
weIIbeIng sIemmIng Irom Ihe psychoIogy oI Ihe IndIvIduaI and Ihe sIrucIure and
IuncIIon oI socIaI groups. They IncIude socIaI characIerIsIIcs such as paIIerns oI
InIeracIIon wIIhIn IamIIy or occupaIIonaI groups, cuIIuraI characIerIsIIcs such as
IradIIIonaI ways oI soIvIng conIIIcIs, and psychoIogIcaI characIerIsIIcs such as
aIIIIudes, beIIeIs and personaIIIy IacIors.
2.2 Common workplace sIressors
Ognnzntonn
change
InadequaIe communIcaIIon
InIerpersonaI conIIIcI
conIIIcI wIIh organIzaIIonaI goaIs
Cncc dc\concnt
Iack oI promoIIonaI opporIunIIy
new responsIbIIIIIes beyond IeveI
unempIoymenI
Koc
roIe conIIIcI
roIe ambIguIIy
InadequaIe resources Io accompIIsh job
InadequaIe auIhorIIy Io accompIIsh job
Tn:
quanIIIaIIve and quaIIIaIIve overIoad
quanIIIaIIve and quaIIIaIIve underIoad
responsIbIIIIy Ior Ihe IIves and weIIbeIng oI oIhers
Iow decIsIon makIng IaIIIude
Wo cn\onncnt
poor aesIheIIcs
physIcaI exposures
ergonomIc probIems
noIse
odours
saIeIy hazards
5tress nnd ndverse sychoIogcnI ]nctors nt work: ModuIe 5 93
5It \o
2.3 ComponenIs ol Ihe sIress process
5tc::o:
|ob sIrucIure
overIIme
shIII work
machIne pacIng
pIecework
|ob conIenI
quanIIIaIIve overIoad
quaIIIaIIve underIoad
Iack oI conIroI
PhysIcaI condIIIons
unpIeasanI
IhreaI oI physIcaI or IoxIc hazard
OrganIzaIIon
roIe conIIIcI
compeIIIIon
rIvaIry
LxIraorganIzaIIonaI
job InsecurIIy
career deveIopmenI
commuIIng
OIher sources
personaI
IamIIy
communIIy
Outconc:
PhysIoIogIcaI
ShorIIerm
caIechoIamInes
corIIsoI
bIood pressure Increases
LongIerm
hyperIensIon
hearI dIsease
uIcers
asIhma
PsychoIogIcaI (cognIIIve and aIIecIIve)
ShorIIerm
anxIeIy
dIssaIIsIacIIon
mass psychogenIc IIIness
LongIerm
depressIon
burnouI
menIaI dIsorders
BehavIouraI
ShorIIerm
job: absenIeeIsm, reduced producIIvIIy and parIIcIpaIIon
communIIy: decreased IrIendshIps and parIIcIpaIIon
personaI: excessIve use oI aIcohoI and drugs, smokIng
LongIerm
"Iearned heIpIessness"
Modc:
IndIvIduaI
behavIouraI sIyIe
personaI resources
SocIaI supporI
emoIIonaI
vaIue or seIIesIeem
InIormaIIonaI
3. PREVENTlON AND CONTROL Ol STRESS
Tcnt tIc nd\dun
MedIcaI IreaImenI
hyperIensIon
backache
depressIon
CounseIIIng servIce
LmpIoyee assIsIance programmes
smokIng
aIcohoI
drugs
5tress nnd ndverse sychoIogcnI ]nctors nt work: ModuIe 5 95
Kcducc nd\dun \uncnt)
CounseIIIng
IndIvIduaI
group programmes
TraInIng programmes
reIaxaIIon
medIcaIIon
bIoIeedback
GeneraI supporI
exercIse programmes
recreaIIonaI acIIvIIIes
Tcnt tIc ognnznton
DIagnosIs
aIIIIude survey
rap sessIons
DeveIop IIexIbIe and responsIve managemenI sIyIe
Improve InIernaI communIcaIIons
Kcducc ognnzntonn :tc::
VarIabIe work scheduIes
|ob resIrucIurIng
enIargemenI
enrIchmenI
Increased conIroI
SupervIsor IraInIng and managemenI deveIopmenI
4. PRlNClPLES Ol |OB DESlGN
Wo :cIcduc
A work scheduIe shouId be desIgned Io avoId conIIIcIs wIIh demands and
responsIbIIIIIes ouIsIde Ihe job. When roIaIIng shIII scheduIes are used, Ihe raIe oI
roIaIIon shouId be sIabIe and predIcIabIe.
Intcnton,conto
Workers shouId be abIe Io provIde InpuI InIo decIsIons or acIIons aIIecIIng IheIr
jobs and Ihe perIormance oI IheIr Iasks.
Woond
Demands shouId noI exceed Ihe capabIIIIIes oI IndIvIduaIs. Work shouId be desIgned
Io aIIow recovery Irom demandIng physIcaI or menIaI Iasks.
Contcnt
Work Iasks shouId be desIgned Io provIde meanIng, sIImuIaIIon, a sense oI
compIeIeness and an opporIunIIy Ior Ihe use oI skIIIs.
Wo oc:
RoIes and responsIbIIIIIes aI work shouId be weII deIIned.
5ocn cn\onncnt
OpporIunIIIes shouId be avaIIabIe Ior socIaI InIeracIIon, IncIudIng emoIIonaI
supporI and acIuaI heIp as needed In accompIIshIng Iasks.
]o utuc
AmbIguIIy shouId be avoIded In maIIers oI job securIIy and career deveIopmenI
opporIunIIIes.
1. Survey workpIaces usIng sImpIe meIhods and IechnIques and IdenIIIy possIbIe
and poIenIIaI sIressors In Ihe area.
2. CoIIecI bIoIogIcaI and envIronmenIaI sampIes concernIng physIcaI, chemIcaI,
bIoIogIcaI and ergonomIc sIressors.
S. Keep sImpIe records oI IndIvIduaI workers as weII as oI workIng groups and
surveys.
4. In coIIaboraIIon wIIh Ihe sIIe physIcIan, IdenIIIy and documenI workers wIIh
psychoIogIcaI probIems In Ihe workpIace wIIh Ihe heIp oI socIaI workers where
avaIIabIe.
S. AssIsI In sImpIe psychomeIrIc anaIyses and IechnIques.
6. PracIIse heaIIh educaIIon oI Ihe workers concernIng heaIIh probIems reIaIed
Io work condIIIons, personaI IIIesIyIes, and menIaI and psychoIogIcaI sIaIes.
7. Try Io heIp peopIe wIIh drug or subsIance addIcIIons.
MODULE 6
Occupational safety and
accident prevention
1. OB|ECTlVES
UndersIand Ihe ImporIance oI prevenIIng accIdenIs In Ihe workpIace and
supporI saIeIy proIessIonaIs' eIIorIs In IhIs regard
ParIIcIpaIe In educaIIng and IraInIng workers
Keep records and anaIyse Ihe daIa obIaIned
ConIrIbuIe Io Ihe daIIy work oI Ihe occupaIIonaI saIeIy commIIIee
GIve advIce on reducIng morbIdIIy, dIsabIIIIy and morIaIIIy due Io occupaIIonaI
accIdenIs and Irauma.
2.1 DeliniIions
AccidenI: a sudden evenI IhaI resuIIs In an undesIred ouIcome such as properIy
damage, bodIIy Injury or deaIh.
OccupaIional accidenI: accIdenI occurrIng aI Ihe workpIace whIch may cause
damage Io machInery, IooIs or peopIe.
lnjury: physIcaI damage Io body IIssues caused by an accIdenI or by exposure Io
envIronmenIaI sIressors. ThIs Injury may Iead Io deaIh and Is Ihen caIIed a "IaIaI
accIdenI" or may cause parIIaI dIsabIIIIy or Iead Io sIck Ieave Ior a perIod oI IIme.
Hazard: any exIsIIng or poIenIIaI condIIIon In Ihe workpIace whIch, by IIseII or by
InIeracIIng wIIh oIher varIabIes, can resuII In deaIh, Injury, properIy damage or oIher
Ioss. SImpIy, hazard Is a poIenIIaI source oI harm.
Risk: Ihe IIkeIIhood oI harm (In deIIned cIrcumsIances).
Harm: Ihe Ioss Io a person (or peopIe) as a consequence oI damage.
Damage: Ihe Ioss oI InherenI quaIIIy suIIered by an enIIIy (physIcaI or bIoIogIcaI).
Danger: Ihe degree oI exposure Io a hazard.
SaleIy: Ihe absence oI danger.
OccupaIional saleIy: rIsk IdenIIIIcaIIon aI Ihe workpIace and prevenIIve measures
Iaken Io reduce or eIImInaIe Ihe hazard whIch may Iead Io accIdenIs.
Sale behaviour: acIIng In such a way IhaI no rIsk oI Injury Is caused by one's
behavIour.
SaleIy prolessional: a person whose basIc job IuncIIon and responsIbIIIIy Is Io
prevenI accIdenIs and oIher harmIuI exposures and Ihe personaI Injury, dIsease or
properIy damage IhaI may ensue.
2.2 Aim ol occupaIional saleIy
The occupaIIonaI saIeIy phIIosophy has been deveIoped In order Io:
prevenI needIess desIrucIIon oI heaIIh and wasIe oI human and oIher resources
raIse Ihe moraIe oI workers
prevenI IneIIIcIency In Ihe workpIace due Io Ihe eIIecIs oI accIdenIs
prevenI socIaI harm caused by accIdenIs
promoIe accIdenI prevenIIon.
2.3 ClassilicaIion ol Iypes ol occupaIional accidenI
T)c o nccdcnt
IaIIs or beIng sIruck by maIerIaIs
sIrIkIng agaInsI objecIs
beIng caughI In, under or beIween objecIs
overexerIIon or sIrenuous movemenIs
exposure Io or conIacI wIIh exIreme IemperaIures
exposure Io or conIacI wIIh eIecIrIc currenI
exposure Io or conIacI wIIh harmIuI subsIances or radIaIIon
oIher Iypes oI accIdenI.
Agcnc)
machInes
means oI IransporI and IIIIIng equIpmenI
oIher equIpmenI
maIerIaIs, subsIances and radIaIIon
work envIronmenI
oIher agencIes noI eIsewhere cIassIIIed
agencIes noI cIassIIIed Ior Iack oI suIIIcIenI daIa.
OccuntonnI sn]ety nnd nccdent reventon: ModuIe b 99
Nntuc o n]u)
wounds, IracIures, dIsIocaIIons
burns, poIsonIngs
dIseases.
od) ocnton o tIc n]u)
head
Irunk
upper exIremIIIes
Iower exIremIIIes
body sysIem.
Occunton o nccdcnt \ctn/:)
Icononc nct\t) n tIc cou:c o \IcI tIc nccdcnt occucd
2.4 Causes ol occupaIional accidenIs and injuries
Hunnn ncto:
There are many varyIng human IacIors IhaI have an eIIecI on Ihe accIdenIrIsk oI
Ihe IndIvIduaI aI cerIaIn IImes and In cerIaIn sIIuaIIons. Some oI Ihese IacIors are:
age, experIence, use oI medIcInes or drugs, moIIvaIIon, eIc. BuI mosI human acIIvIIy
requIres avoIdance oI errors IhaI couId resuII In InjurIes or maIerIaI damage. To
avoId an accIdenI an IndIvIduaI musI observe and recognIze danger, decIde on a
course oI acIIon and acI suIIIcIenIIy vIgorousIy Io avoId Ihe danger.
The accIdenI may occur II a hazard Is noI seen, recognIzed or undersIood as
dangerous, or II one does noI Iake responsIbIIIIy Ior personaI acIIon, or II one does
noI know how Io acI or Ior oIher reasons does noI decIde Io acI. Lven II Ihe rIghI
decIsIon Is made, Ihe muscuIar response may be IncorrecI, IneIIecIuaI or Ioo sIow.
In\onncntn ncto:
These IncIude boIh Ihe ouIsIde agenI oI Injury and oIher IacIors oI Ihe physIcaI
workIng envIronmenI: IIghIIng, noIse, IemperaIure, eIc.
A necessary cause oI Injury Is conIacI wIIh a harmIuI objecI, subsIance or energy.
An Injury may aIso be caused by a Iack oI energy, e.g. Iack oI oxygen In Ihe
envIronmenI. These Injury agenIs are caIIed hazards. II Ihere Is a hazard In Ihe
workIng envIronmenI Ihere Is aIways some possIbIIIIy oI an accIdenI. ThIs Is Ihe
reason why saIeIy IechnoIogy has Ihe IIrsI prIorIIy In accIdenI prevenIIon. Hazards
shouId be eIImInaIed or IsoIaIed so IhaI Ihere Is no rIsk oI accIdenI.
The Injury agenI, Ihe kInd and amounI oI hazardous energy, Is Ihe maIn deIermInanI
oI Ihe severIIy oI Injury. The IoIIowIng IabIe IIIusIraIes some exampIes.
1UU OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
Selected examples of overt and cumulative trauma commonly
affecting occupational groups
Cnuse Inury or dsorder A]]ected occupnton
Overt trauma
MechanIcaI energy LaceratIons Sheet metaI workers,
butchers, press operators,
sawyers, IabrIc cutters
Fractures MaterIaIs handIers, mIners,
constructIon workers
ContusIons MaterIaIs handIers, any worker
exposed to Iow energy Impacts
AmputatIons Press operators, butchers,
machIne operators
CrushIng InjurIes MaterIaIs handIers, press
operators, constructIon
workers, rubber workers
Eye InjurIes MIners, grInders, saw mIII
(struck by IoreIgn objects) operators, machIne shop
empIoyees
StraIns or spraIns (overt) MaterIaIs handIers, mIners,
baggage handIers, maII
handIers, constructIon
workers
ThermaI energy urns Foundry workers, smeIter
workers, weIders, gIass
workers, Iaundry workers
Heat straIn FIreIIghters, steeIworkers,
smeIter workers
CoId straIn UtIIIty workers, Iumberjacks,
butchers
ChemIcaI energy urns Masons, process workers,
(IncIudIng acute toxIcIty) hazardous waste workers
AsphyxIatIon, acute toxIcIty FIreIIghters, conIIned
space workers, hazard
ous waste workers
EIectrIcaI energy EIectrocutIon, shocks, burns UtIIIty workers, constructIon
workers, eIectrIcIans, users oI
eIectrIc hand tooIs or machInes
NucIear energy RadIatIon burns, IIIness HospItaI workers, IndustrIaI
radIographers, nucIear workers
Cumulative trauma
Heavy IIItIng, proIonged ack paIn MaterIaIs handIers, sIttIng,
awkward posture nurses, truck drIvers,
sewIng machIne operators
Frequent or repetItIve Upper extremIty AssembIy IIne workers; IorceIuI
hand motIons cumuIatIve trauma dIsorders garment workers;
wIth awkward posture (tendonItIs, carpaI tunneI pouItry, meat, or IIsh
syndrome, epIcondyIItIs, processors; cIerIcaI
degeneratIve joInt dIsease) workers; press operators;
IruIt pIckers; musIcIans
VIbratIon Raynaud syndrome Lumberjacks, grIndIng
machIne operators,
jackhammer operators
OccuntonnI sn]ety nnd nccdent reventon: ModuIe b 1U1
Ognnzntonn ncto:
The socIaI envIronmenI has a greaI eIIecI on human perIormance. The saIeIy
managemenI approach Io accIdenIs Is IhaI Ihe ImmedIaIe causes (unsaIe condIIIons
and unsaIe acIs) are onIy sympIoms oI rooI causes IhaI exIsI In Ihe managemenI
IuncIIon. These may be errors In Ihe area oI managemenI poIIcy, conIusIon oI goaIs,
sIaIIIng, housekeepIng, responsIbIIIIy, use oI auIhorIIy, IIne and sIaII reIaIIonshIps,
accounIabIIIIy, ruIes, InIIIaIIve, eIc.
ConIroIIIng Ihe Irequency and severIIy oI accIdenI occurrence and conIroIIIng Ihe
quaIIIy and quanIIIy oI producI have much In common. In many cases Ihe same
IauIIy pracIIce Is InvoIved, IeadIng Io boIh accIdenI occurrence and unsaIIsIacIory
producIIon.
3. RECORDlNG AND lNVESTlGATlNG ACClDENTS
CompanIes and communIIy heaIIh workers need Io record and InvesIIgaIe
occupaIIonaI accIdenIs In order Io:
IdenIIIy Ihe reaI causes oI Injury, properIy damage and nearmIsses
deveIop eIIecIIve meIhods oI prevenIIng IuIure sImIIar accIdenIs
meeI IegIsIaIIve requIremenIs.
The accIdenI or Injury reporI shouId IncIude Ihe IoIIowIng InIormaIIon:
cIrcumsIances oI Ihe accIdenI
cause oI Ihe accIdenI
avaIIabIe daIa Ior assessIng Ihe cause oI Ihe accIdenI and IheIr eIIecIs on Ihe
person and Ihe envIronmenI
emergency measures Iaken
sIeps Io be Iaken In Ihe IuIure Io prevenI IurIher accIdenIs.
AccIdenIs may be reporIed accordIng Io:
cause oI accIdenI
pIace oI Ihe accIdenI
Iype oI Injury
personaI characIerIsIIcs such as age, sex and Ihe IeveI oI educaIIon oI Ihe
Injured
IIme oI Ihe accIdenI.
The IoIIowIng poInIs shouId be consIdered when deveIopIng an accIdenI recordIng
and InvesIIgaIIng sysIem:
WhaI reporIs are requIred7
Who Is responsIbIe Ior conducIIng Ihe InvesIIgaIIon7
1U2 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
Who do reporIs go Io7
WhaI IImeIrame shouId be aIIowed Io compIeIe InvesIIgaIIons7
Are Ihere IoIIowup procedures Io ensure IhaI reporI recommendaIIons are
ImpIemenIed7
Have Ihe approprIaIe auIhorIIIes been noIIIIed7
WhaI accIdenIs wIII be recorded and InvesIIgaIed7
Is a cusIomdesIgned Iorm needed7
Are aII InjurIes recorded In Ihe recordIng sysIem7
WhaI IraInIng wIII InvesIIgaIors need7
Where wIII records oI accIdenIs and InvesIIgaIIons be kepI7
Does reguIar anaIysIs IdenIIIy sImIIar accIdenIs recurrIng or oIher Irends7
4. ACClDENT RATES
ComparIson oI accIdenIs beIween IImeperIods, IndusIrIes, occupaIIons and
counIrIes can be made onIy II Ihe IndusIrIaI accIdenI sIaIIsIIcs are consIdered In
conjuncIIon wIIh daIa, IncIudIng empIoymenI, work hours, producIIon, eIc. Ior such
purposes II Is useIuI Io caIcuIaIe reIaIIve measures such as Irequency, IncIdence,
and severIIy raIes.
Irequency raIe = IoIaI number oI accIdenIs 10
S
- IoIaI number oI workhours
worked
IncIdence raIe = IoIaI number oI accIdenIs 10
S
- IoIaI number oI workers
exposed.
Two dIIIerenI severIIy IndIcaIors are recommended:
Ihe average number oI days IosI per accIdenI
Ihe number oI days IosI per day worked by persons exposed Io rIsk, or, IaIIIng
IhaI, per person exposed Io rIsk.
In some counIrIes Ihe severIIy raIe Is deIIned as Ihe number oI days IosI per 1000
workhours.
DeaIh and permanenIIy dIsabIIng InjurIes are deaII wIIh separaIeIy Irom oIher
accIdenIs In sIaIIsIIcs. II Is aIso possIbIe Io converI Ihem InIo IosI workIng days, Ior
exampIe, so IhaI deaIh and IoIaIIy dIsabIIng permanenI Injury are equaI Io 6000 IosI
days.
5. PREVENTlON AND CONTROL Ol OCCUPATlONAL
ACClDENTS
The basIc accIdenI prevenIIon acIIvIIIes are as IoIIows:
LIImInaIe Ihe hazard Irom Ihe machIne, meIhod, maIerIaI or IacIIIIy sIrucIure.
ConIroI or conIaIn Ihe hazard by encIosIng or guardIng II aI IIs source or
aIIachIng an exhausI pIpe Io remove aIrborne hazards Irom Ihe operaIor.
TraIn operaIIng personneI Io be aware oI Ihe hazard and Io IoIIow saIe job
procedures Io avoId II.
PrescrIbe personaI proIecIIve equIpmenI Ior personneI Io shIeId Ihem Irom Ihe
hazard.
ProvIde advIsory servIces on saIeIy and heaIIh probIems and oIher maIIers
reIaIed Io accIdenI prevenIIon.
DeveIop a cenIraIIzed programme Io conIroI accIdenI and IIre hazards.
Keep InIormed oI changes In IegIsIaIIon and saIeIy codes and communIcaIe
such InIormaIIon Io managemenI.
DeveIop and appIy saIeIy sIandards boIh Ior producIIon IacIIIIIes (equIpmenI,
IooIs, work meIhods and saIeguardIng) and Ior producIs, based on appIIcabIe
IegaI and voIunIary codes, ruIes and sIandards.
Work cIoseIy wIIh Ihe engIneerIng, IndusIrIaI hygIene, medIcaI, and purchasIng
deparImenIs Io ensure IhaI onIy saIe IooIs, equIpmenI and suppIIes are
purchased.
DeveIop, pIan and ImpIemenI a saIeIy and heaIIh InspecIIon programme Io be
carrIed ouI by Ihe operaIIng supervIsors and IIeId saIeIy personneI Io IdenIIIy
poIenIIaI hazards, boIh In Ihe workpIace and In Ihe use oI Ihe company's
producIs.
AIong wIIh represenIaIIves Irom engIneerIng, operaIIng and personneI, InspecI
aII new equIpmenI Io ensure adequaIe heaIIh and saIeIy saIeguards.
GuIde operaIIng supervIsIon In accIdenI InvesIIgaIIon Io deIermIne Ihe accIdenI's
cause and Io prevenI recurrence.
RevIew nondIsabIIngInjury accIdenI reporIs on a sampIe basIs Io check Ihe
Ihoroughness oI Ihe accIdenI InvesIIgaIIon and correcIIve acIIons Iaken.
CoIIecI and anaIyse daIa on IIIness and accIdenIs Ior Ihe purpose oI InsIIIuIIng
correcIIve acIIon and Io deIermIne accIdenI Irends and provIde IargeIs Ior
correcIIve acIIon.
Lnsure educaIIon and IraInIng oI empIoyees In generaI as weII as specIIIc heaIIh
and saIeIy prIncIpIes and IechnIques.
MaInIaIn supervIsory conIacIs Ior new InsIrucIIons, IoIIowup and generaI
heaIIh and saIeIy moIIvaIIon.
1U4 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
CooperaIe wIIh IndusIrIaI hygIene or envIronmenIaI quaIIIy conIroI personneI
on IndusIrIaI hygIene probIems.
6.1 EducaIion
The aIm oI saIeIy educaIIon Is Io do work In a saIe way unIII II becomes a habII.
AudIovIsuaI aIds, e.g. IecIures, posIers, IIIms, vIdeos, sIIdes, radIo and IeIevIsIon
programmes, are very ImporIanI In saIeIy educaIIon.
U:c nnd,o dc\co nudo\:un nd: o cducntng tnncc: nccodng to :nct)
ncc: nnd ocn:.
6.2 Training
A IraInIng programme Is needed Ior new empIoyees when new equIpmenI or
processes are InIroduced, when procedures have been revIsed or updaIed, when new
InIormaIIon musI be made avaIIabIe and when perIormance oI empIoyees needs Io
be Improved.
ReIraInIng Is IndIcaIed In Ihe IoIIowIng sIIuaIIons:
hIgh accIdenI or Injury raIe
hIgh Iabour Iurnover
excessIve wasIe and scrap
company expansIon (pIanIs or equIpmenI).
Ic:gn nnd,o n) n tnnng cou:c o nc\ cno)cc: n n cctnn ndu:t) n
coocnton \tI tIc :nct) c:onnc \ong n tIc tngctcd nct).
6.3 EvaluaIion ol saleIy legislaIion
OccupaIIonaI saIeIy Iaws, reguIaIIons and codes oI pracIIce are needed Ior Ihe
workers' saIeIy IakIng InIo consIderaIIon Ihe responsIbIIIIy oI managemenI and
workers wIIh cIarIIIcaIIon oI responsIbIIIIIes and job anaIysIs. These Iaws shouId
IncIude measures Io be Iaken Io prevenI occupaIIonaI accIdenIs. SaIeIy IegIsIaIIon
wouId be IneIIecIIve unIess some means couId be Iound Io enIorce II.
I\nuntc ocn o nntonn :nct) cg:nton nnd t: cnoccncnt n tIc gIt o
nnnngcncnt nnd \oc c:on:tc:.
6.4 Personal proIecIion devices
PersonaI proIecIIon devIces are Ihe second IIne oI deIence and musI be used when
engIneerIng conIroIs cannoI be used or are InadequaIe. These IncIude: masks,
goggIes, saIeIy shoes, heImeIs, ear pIugs, ear muIIs, gIoves and aprons.
CIcc on tIc n\nnt) o c:onn otccton dc\cc: n cctnn ndu:tc: nnd
c\nuntc tIc nnnngcncnt': nnd tIc \oc:' no\cdgc, ntttudc: nnd nctcc:
conccnng tIc oc o tIc:c ncnn: n c\cntng occuntonn nccdcnt: nnd n]uc:.
6.5 ConIrol ol elecIrical hazards
Many accIdenIs occur due Io deIecIIve eIecIrIcaI apparaIus, especIaIIy porIabIe
eIecIrIcaI apparaIus, e.g. sockeIs, pIugs and IIexIbIe cabIe. AII swIIches musI have
approved voIIage and amperage raIIng compaIIbIe wIIh InIended use. CIrcuII
breakers shouId be used when needed. AII eIecIrIcaI equIpmenI musI be InspecIed
and maInIaIned reguIarIy.
Innnzc )ou:c \tI tIc conto :):tcn: o ccctcn Inznd: n n cctnn
ndu:t) nnd cnc n cot c\nuntng tInt :):tcn.
6.6 ConIrol ol lire hazards
OrdInary IIre resuIIs Irom Ihe combInaIIon oI IueI, heaI and oxygen. Common IIre
hazards IncIude smokIng, IIammabIe IIquIds, naked IIames, poorIy maInIaIned and
overheaIIng machInes, eIecIrIcaI wIrIng, sIaIIc eIecIrIcIIy, weIdIng and soIderIng
equIpmenI.
The prIncIpIes oI IIre conIroI are Io:
prevenI IgnIIIon
sIore chemIcaIs and expIosIve maIerIaIs properIy
InsIaII and use IIre aIarms
provIde IIre exIInguIshIng equIpmenI and reguIarIy InspecI and maInIaIn II
IraIn every worker Io use Ihe avaIIabIe IIre conIroI equIpmenI
InspecI Ihe workpIace aI reguIar InIervaIs Ior IIre rIsks
conducI reguIar IIre drIIIs
cooperaIe wIIh Ihe IocaI IIre brIgade.
Innnzc )ou:c \tI tIc c Inznd conto :):tcn n n cctnn ndu:t) nnd
cnc n cot c\nuntng tInt :):tcn.
6.7 Purposes ol occupaIional accidenI invesIigaIion
InvesIIgaIIon and anaIysIs are used Io prevenI accIdenIs, boIh Ihose IhaI resuII In
Injury Io personneI and Ihose IhaI do noI. The InvesIIgaIIon or anaIysIs oI an
accIdenI can produce InIormaIIon IhaI Ieads Io counIermeasures Io prevenI
accIdenIs or reduce IheIr number and IheIr severIIy. An InvesIIgaIIon oI every
accIdenI IhaI causes dIsabIIIIy or IIIness shouId be carrIed ouI. IncIdenIs resuIIIng
In nondIsabIIng InjurIes or no InjurIes and "near accIdenIs" shouId aIso be
InvesIIgaIed Io evaIuaIe IheIr causes In reIaIIon Io InjuryproducIng accIdenIs or
1Ub OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
breakdowns. Ior purposes oI accIdenI prevenIIon, InvesIIgaIIons musI be IacI
IIndIng, noI IauII IIndIng.
I:cu:: tIc no\c ncntoncd :tntcncnt n tIc gIt o tIc nctun occuntonn
nccdcnt ccodng nnd n\c:tgntng :):tcn nt tIc ocn nnd nntonn c\c:.
6.8 Types ol occupaIional accidenI invesIigaIion
These are severaI accIdenI InvesIIgaIIon and anaIysIs IechnIques avaIIabIe. The
choIce oI a parIIcuIar meIhod depends on Ihe purpose and orIenIaIIon oI Ihe
InvesIIgaIIon. The accIdenI InvesIIgaIIon and anaIysIs procedure Iocuses prImarIIy
on unsaIe cIrcumsIances surroundIng Ihe occurrence oI an accIdenI and Is Ihe mosI
oIIen used IechnIque. OIher sImIIar IechnIques InvoIve InvesIIgaIIon wIIhIn Ihe
Iramework oI deIecIs In Ihe Iour Ms: man, machIne, medIa and managemenI, or Ihe
Ihree Ls oI saIeIy: educaIIon, enIorcemenI and engIneerIng.
Connc nnd c\nuntc tIc cx:tng t)c: o occuntonn nccdcnt n\c:tgnton n
tIc gIt o tIc t)c: ncntoncd no\c.
MODULE 7
First aid and its practice
1. OB|ECTlVES
Become acquaInIed wIIh IIrsI aId IechnIques
Be abIe Io provIde emergency care In Ihe workpIace
Know how Io decIde Io reIer cases Io a hospIIaI or a specIaIIzed heaIIh cenIre
Know how Io perIorm and pracIIse heaIIh educaIIon
Learn how Io keep records and wrIIe reporIs.
2. lMPORTANCE Ol llRST AlD
IIrsI aId Is Ihe ImmedIaIe care gIven Io vIcIIms oI accIdenIs beIore IraIned medIcaI
workers arrIve. IIs goaI Is Io sIop and, II possIbIe, reverse harm. II InvoIves rapId
and sImpIe measures such as cIearIng Ihe aIr passageway, appIyIng pressure Io
bIeedIng wounds or dousIng chemIcaI burns Io eyes or skIn. The crIIIcaI IacIors
whIch shape IIrsI aId IacIIIIIes In a workpIace are workspecIIIc rIsk and avaIIabIIIIy
oI deIInIIIve medIcaI care, e.g. Ihe care oI a hIghpowered saw Injury Is obvIousIy
radIcaIIy dIIIerenI Irom IhaI oI a chemIcaI InhaIaIIon.
IIrsI aId Is a IIuId concepI noI onIy In whaI musI be done (how Iong, how compIex)
buI In who can do II. AIIhough a very careIuI aIIIIude Is requIred, every worker can
be IraIned In Ihe Iop 10 crucIaI sIeps oI IIrsI aId. In some sIIuaIIons ImmedIaIe acIIon
can save IIIe, IImb or eyesIghI. Coworkers oI vIcIIms shouId noI remaIn paraIysed
whIIe waIIIng Ior IraIned personneI Io arrIve. The Iop 10 crucIaI sIeps wIII vary wIIh
each workpIace and musI be IaughI accordIngIy.
IIrsI aId personneI are persons on Ihe spoI, generaIIy workers who are IamIIIar wIIh
Ihe specIIIc condIIIons oI work. They mIghI noI be medIcaIIy quaIIIIed buI Ihey musI
be IraIned and prepared Io perIorm very specIIIc Iasks. IIrsI aId personneI shouId
be seIecIed careIuIIy, IakIng InIo accounI aIIrIbuIes such as reIIabIIIIy, moIIvaIIon
and Ihe abIIIIy Io cope wIIh peopIe In a crIsIs sIIuaIIon.
3. lN|URlES
3.1 DeliniIions
lnjury: a physIcaI damage Io body IIssues caused by an accIdenI or by exposure Io
envIronmenIaI sIressors.
Wound: a break In Ihe conIInuIIy oI body IIssue or openIng In Ihe skIn. A wound
may be an Injury buI noI aII InjurIes are wounds.
3.2 Head injuries
Cucn :tc:
1. MaInIaIn an aIrway.
2. ConIroI bIeedIng.
S. ProIecI agaInsI InIecIIon.
4. PrevenI IurIher Injury.
Then:
In cases oI shock, Iook Ior oIher InjurIes whIch may be causIng bIood Ioss.
In case oI cIosed braIn InjurIes, Iook Ior sympIoms such as unusuaI behavIour,
Ioss oI memory, drowsIness, excIIabIIIIy or deIIrIum.
Be aware IhaI bruIsIng Io Ihe braIn may cause convuIsIon, drowsIness or Ioss
oI conscIousness.
Be aware IhaI bIeedIng Irom Ihe ears, nose and IhroaI Is a resuII oI a IracIure
aI Ihe base oI Ihe skuII.
Do noI aIIempI Io remove IoreIgn objecIs embedded In Ihe head as IhIs may
cause unconIroIIabIe bIeedIng.
AppIy head dressIngs In such a manner IhaI Ihey wIII noI sIIp oII durIng
IransporIaIIon Io hospIIaI.
PIace Ihe paIIenI on hIs/her sIde Io aIIow proper draInage.
In cases oI respIraIory cenIre damage, appIy mouIhIomouIh resuscIIaIIon Io
ensure an adequaIe suppIy oI oxygen.
3.3 lacial injuries
Cucn :tc:
1. Check Ior obsIrucIed aIrway as IacIaI InjurIes may cause exIernaI bIeedIng
resuIIIng In bIockage oI aIrway. The bIeedIng Irom Ihe oraI cavIIy can be
parIIcuIarIy heavy.
2. ConIroI bIeedIng by reaIIgnIng Ihe jaw, I.e. by graspIng Ihe chIn and puIIIng II
sIraIghI ouI.
S. MaInIaIn Ihe aIrway by IurnIng Ihe vIcIIm on hIs/her sIde.
3.4 ChesI injuries
Cucn :tc:
1. SeaI Ihe chesI wound Irom Ihe ouIsIde as quIckIy as possIbIe.
2. Never exIracI IoreIgn objecIs Irom Ihe chesI wound.
Irst nd nnd ts rnctce: ModuIe 7 1U9
S. MaInIaIn aIrway.
4. AdmInIsIer oxygen.
S. AppIy mouIhIomouIh resuscIIaIIon and exIernaI hearI massage II necessary.
6. TransporI Ihe paIIenI In a sIIIIng posIIIon unIess he/she Is In shock.
3.5 Abdominal injuries
Cucn :tc:
1. Cover Ihe wound wIIh a sIerIIe dressIng; appIy a compressIon bInder Io conIroI
haemorrhagIng.
2. Look Ior any peneIraIIng wounds and oIher sympIoms such as vomIIIng,
abdomInaI paIn and Ienderness.
S. Never aIIempI Io repIace proIrudIng organs, cover Ihem wIIh sIerIIe gauze and
keep Ihe cIoIh moIsI.
4. PIace Ihe paIIenI In a semIsIIIIng posIIIon unIess he/she Is In shock.
S. Keep Ihe paIIenI warm wIIh bIankeIs.
6. Never gIve Ihe paIIenI anyIhIng Io drInk or eaI.
3.6 Eye injuries
Do noI InIerIere wIIh eye InjurIes excepI In mInor cases. ReIer Ihe vIcIIm Io
hospIIaI ImmedIaIeIy.
SympIoms oI serIous eye Injury are:
bIurred vIsIon IhaI does noI cIear wIIh bIInkIng
Ioss oI aII or parI oI Ihe vIsuaI IIeId oI an eye
sharp sIabbIng or deep IhrobbIng paIn
doubIe vIsIon.
SIgns oI eye Injury IhaI requIre ophIhaImoIogIcaI evaIuaIIon are:
bIack eye
red eye
an objecI on Ihe cornea
one eye IhaI does noI move as compIeIeIy as Ihe oIher
one eye proIrudIng more Ihan Ihe oIher
one eye wIIh an abnormaI pupII sIze, shape or reacIIon Io IIghI
a Iayer oI bIood beIween Ihe cornea and Ihe IrIs (hyphaema)
IaceraIIon oI Ihe eyeIId, especIaIIy II II InvoIves Ihe IId margIn
IaceraIIon or perIoraIIon oI Ihe eye.
Cucn :tc:
1. Any chemIcaI spIashed InIo Ihe eye(s) musI be consIdered a vIsIonIhreaIenIng
emergency. IorcIbIy keep Ihe paIIenI's eyeIIds open whIIe IrrIgaIIng wIIh waIer
Ior aI IeasI IIve mInuIes, Ihen reIer Ihe paIIenI Io an ophIhaImoIogIsI. InIorm Ihe
ophIhaImoIogIsI oI Ihe naIure oI Ihe chemIcaI conIamInanI.
2. PaIch Ihe Injured eye IIghIIy wIIh a dry, sIerIIe eye pad. II IaceraIIon oI Ihe eye
Is suspecIed, add a proIecIIve shIeId over Ihe sIerIIe eye pad. InsIrucI Ihe
paIIenI noI Io squeeze Ihe eye IIghIIy shuI because II greaIIy eIevaIes Ihe
InIraocuIar pressure. CaImIy IransporI Ihe paIIenI Io Ihe ophIhaImoIogIsI.
3. ConjuncIIvIIIs, wIIh normaI vIsIon and a cIear cornea, may be IreaIed wIIh an
anIIbIoIIc eye oInImenI Ior severaI days. II Ihere Is no ImprovemenI, reIerraI Io
Ihe ophIhaImoIogIsI Is IndIcaIed.
4. Never puI eye oInImenI In an eye abouI Io be seen by Ihe ophIhaImoIogIsI. The
oInImenI makes cIear vIsuaIIzaIIons oI Ihe reIIna very dIIIIcuII.
5. Never gIve a paIIenI a IopIcaI anaesIheIIc Io reIIeve paIn, such as Irom a IIash
burn. The proIonged use oI IopIcaI anaesIheIIc can resuII In bIIndness Irom
corneaI breakdown.
6. Never IreaI a paIIenI wIIh a IopIcaI sIeroId unIess dIrecIed by Ihe ophIhaImoIogIsI.
TopIcaI sIeroIds can make severaI condIIIons much worse, such as herpes
sImpIex, keraIIIIs, IungaI InIecIIons and some bacIerIaI InIecIIons.
7. II In doubI as Io how severe an ocuIar sympIom sIgn Is, aIways err on Ihe sIde
oI cauIIon and reIer Ihe empIoyee Io an ophIhaImoIogIsI Ior dIagnosIs and
IreaImenI.
4. lRACTURES
4.1 DeliniIions
lracIure: any break In a bone.
Simple lracIure (cIosed IracIure): Ihe skIn covers Ihe IracIure.
Compound lracIure (open IracIure): Ihe skIn Is broken and Ihe bone has dIrecI
conIacI wIIh Ihe open aIr.
II Is essenIIaI Io remember Ihe IoIIowIng:
1. Do noI harm. UnwIse aIIempIs by Ihe paIIenI Io conIInue Io use a IracIured
exIremIIy may cause IaceraIIon oI Ihe soII IIssues and may Iead Io Ihe broken
bone peneIraIIng Ihe skIn or Io Ihe onseI oI shock.
2. ProIecI and ImmobIIIze. AppIy a spIInI Io Ihe IracIure so Ihe vIcIIm can be
moved more comIorIabIy and wIIhouI causIng any IurIher InjurIes.
4.2 lracIures ol Ihe exIremiIies
Cucn :tc:
1. PIace Ihe Injured IImb In as naIuraI a posIIIon as possIbIe beIore paddIng and
spIInIIng.
Irst nd nnd ts rnctce: ModuIe 7 111
2. II Ihe broken bone Is noI proIrudIng above Ihe skIn, appIy IracIIon Io overcome
Ihe muscIe and Io sIraIghIen Ihe IImb wIIh mInImum paIn. II Ihe broken bone
Is proIrudIng above Ihe skIn, do noI appIy IracIIon Io avoId conIamInaIIng deep
IIssues.
S. To conIroI bIeedIng, appIy genIIe pressure by coverIng Ihe wound wIIh a sIerIIe
dressIng and wrappIng wIIh an eIasIIc bandage.
4. Never aIIempI Io seI an open IracIure. AppIy Ihe proper spIInI beIore movIng
Ihe paIIenI.
4.3 lracIure ol Ihe spine and pelvis
A spInaI IracIure may occur In Ihe neck and upper or Iower spIne and may aIIecI Ihe
spInaI cord. SympIoms oI IracIure Io Ihe spIne IncIude severe back paIn and numbness
and IIngIIng In Ihe arms and Iegs. PeIvIc IracIures are common buI hard Io spoI. They
are usuaIIy assocIaIed wIIh oIher InjurIes whIch may be severe and cause shock. A
IracIured peIvIc bone may pIerce Ihe bIadder and may cause InIesIInaI obsIrucIIon.
Cucn :tc:
Unc:: )ou In\c ccn tnncd n tIc cocct \n) to no\c n :u:cctcd :nn nctuc,
do not nttcnt to no\c tIc \ctn unc:: cn\ng In \oud cxo:c In to utIc
dnngc.
1. Lnsure IhaI Ihe vIcIIm has an adequaIe aIrway.
2. TransporI a paIIenI wIIh a (suspecIed) broken neck on hIs/her back on a rIgId
supporI.
S. The paIIenI musI be moved as a unII by S-S men, one oI whom musI IIrmIy hoId
Ihe paIIenI's head.
4. To prevenI unnecessary movemenI, pIace bIankeI roIIs or pIIIows aIong Ihe sIde
oI Ihe paIIenI.
S. PIace a paIIenI wIIh a (suspecIed) IracIured peIvIs genIIy on hIs/her back on a
IIrm sIreIcher.
6. ImmobIIIze Ihe peIvIc regIon by bandagIng Ihe knee and ankIe IogeIher IIrmIy
wIIh paddIng pIaced beIween Ihe knees Ior comIorI.
7. Wrap a broad bandage or IoIded bIankeI around Ihe paIIenI's hIps Irom jusI
above Ihe hIp bone Io approxImaIeIy S cm down on Ihe IhIghs.
8. PrevenI shock.
5. THERMAL lN|URlES
5.1 Burns
There are Ihree maIn Iypes oI burn: IhermaI, eIecIrIcaI and chemIcaI.
LsIImaIe Ihe serIousness oI Ihe burns by usIng Ihe RuIe oI NIne: Ihe head and
neck comprIse 9 oI Ihe skIn area; Ihe chesI, 18; Ihe back, 18; each arm, 9;
and each Ieg 18 (Ior Ihe sake oI compIeIeness Ihe genIIaIs/perIneum comprIse
1).
IIrsI degree burns are superIIcIaI wIIh reddenIng oI Ihe skIn.
Second degree burns exIend deepIy InIo Ihe skIn wIIh redness.
ThIrd degree burns InvoIve Ihe enIIre IhIckness oI Ihe skIn.
Cucn :tc:
1. PrevenI shock.
2. Do noI aIIempI Io remove paIIenI's cIoIhes excepI In case oI a chemIcaI burn.
S. Wrap Ihe paIIenI In a cIean sheeI Io prevenI InIecIIon.
4. MaInIaIn body IemperaIure.
S. NeuIraIIze Ihe chemIcaI agenI II a neuIraIIzer Is avaIIabIe.
6. DeIermIne whaI chemIcaI agenIs have been Ihe cause oI Ihe burns beIore
IransIerrIng Ihe paIIenI Io hospIIaI.
5.2 Cold
Long exposure Io exIreme coId resuIIs In hypoIhermIa and coma. The InIIIaI
sympIoms oI IrosIbIIe are IIngIIng, numbness, paIn, vIoIaIed red skIn IoIIowed by a
consIanI burnIng and IIchIng sensaIIon and Ihen Ioss oI aII sensaIIon In Ihe aIIecIed
area. ProIonged exposure Io exIreme coId resuIIs In Ihe onseI oI hypoIhermIa and
uIIImaIeIy, Ihe vIcIIm wIII Iapse InIo a coma.
Cucn :tc:
1. Immerse Ihe aIIecIed parI In waIer heaIed Io beIween 40 C and 42 C.
2. Do noI aIIempI Io Ihaw Ihe aIIecIed area.
S. Do noI pIace Ihe vIcIIm cIose Io IIre.
4. Do noI massage Ihe aIIecIed area.
5.3 HeaI sIroke
IacIors conIrIbuIIng Io heaI sIroke are: workIoad, IhermaI envIronmenI, sIress, non
accIImaIIzaIIon, poor work condIIIons, overweIghI, unsuIIabIe cIoIhIng, poor
venIIIaIIon, dehydraIIon or shorIage oI waIer, aIcohoI consumpIIon, hIsIory oI
cardIovascuIar dIseases or recenI prIckIy heaI.
Cucn :tc:
1. ConIIrm suspecIed cases oI heaI sIroke by measurIng Ihe body IemperaIure.
A person wIIh a IemperaIure beIween 40 C and 4S C wouId be consIdered a
vIcIIm oI heaI sIroke.
Irst nd nnd ts rnctce: ModuIe 7 113
2. Sponge wIIh cooI waIer, wrap In cooI sheeIs or IoweIs or bIow cooI aIr over
paIIenI.
6. POlSONlNG
Cucn :tc:
1. Induce vomIIIng as quIckIy as possIbIe by admInIsIerIng a IabIespoon oI Ipecac
syrup excepI In InsIances oI IngesIIon oI acIds, aIkaIIs and peIroIeum producIs.
AdmInIsIer waIer, mIIk or unIversaI anIIdoIes; waIer shouId be used II Ihere Is
noIhIng eIse avaIIabIe. Do noI gIve IIuId Io an unconscIous person.
2. In InsIances oI IngesIIon oI acIds, aIkaIIs, peIroIeum producIs and oIher
causIIcs: aIIempI Io IdenIIIy Ihe specIIIc producI, Ihe concenIraIIon oI Ihe
acIIve IngredIenIs and Ihe esIImaIed voIume IngesIed. The producI conIaIner
or IabeIs may be avaIIabIe. A dIIuIenI may be beneIIcIaI II gIven wIIhIn S0
mInuIes oI a soIId or granuIar aIkaIIne IngesIIon. WaIer or mIIk may be
admInIsIered, dosages oI 2S0 mI In aduIIs and 1S mI/kg In chIIdren. lnduced
emesis and aIIempIs aI neuIralizing Ihe subsIance by using a weak acid or
alkali are absoluIely conIraindicaIed.
S. AdmInIsIer mouIhIomouIh or mechanIcaI resuscIIaIIon II Ihere Is dIIIIcuIIy
In breaIhIng.
4. II poIson Is In conIacI wIIh Ihe skIn, remove aII conIamInaIed cIoIhIng and IIood
Ihe aIIecIed area wIIh waIer.
S. II poIson Is In conIacI wIIh Ihe eyes, IrrIgaIe boIh eyes wIIh Iarge quanIIIIes oI
waIer.
6. IdenIIIy Ihe poIsonIng maIerIaI or coIIecI aII vomIIed maIerIaI In a conIaIner and
IransporI II Io Ihe hospIIaI wIIh Ihe paIIenI Ior IaboraIory anaIysIs.
7. HAEMORRHAGE
Haemorrhage may be arIerIaI, venous or capIIIary.
Cucn :tc:
1. AppIy pressure wIIh IIngerIIps Io Ihe pressure poInIs and a bandage as
necessary.
2. AppIy IournIqueI only when oIher meIhods IaII and In Ihe case oI a IIIe
IhreaIenIng haemorrhage.
S. A IournIqueI shouId consIsI oI a IIaI band aI IeasI one Inch wIde such as a IIe,
handkerchIeI, IoweI, scarI or beII. Never use rope or wIre. II shouId onIy be
appIIed In Iwo pIaces dependIng on Ihe sIIe oI Ihe Injury:
Ihe arm, a hand's wIdIh beIow Ihe eIbow; or
Ihe Ieg, a hand's wIdIh beIow Ihe groIn.
8. SHOCK
Shock means Ihere Is noI enough bIood cIrcuIaIIng Ihrough Ihe body. SympIoms oI
shock IncIude: paIe, coId and moIsI skIn, shaIIow breaIhIng, bIuIsh IIngernaIIs and
IIps, IhIrsI and resIIessness.
Cucn :tc:
1. TreaI shock by removIng Ihe cause: sIop Ihe bIeedIng, reIIeve Ihe paIn, spIInI
Ihe IracIure.
2. PrevenI InIecIIon and maInIaIn body heaI.
S. Lay Ihe paIIenI IIaI.
4. Burn vIcIIms suIIerIng Irom shock shouId be gIven IIquIds In smaII amounIs.
9. lMPAlRED BREATHlNG
MoutI-to-noutI c:u:ctnton
1. CIear Ihe mouIh and Ihe IhroaI oI any denIures, mucus, Iood, bIood or oIher
obsIrucIIons.
2. TIII Ihe head back as Iar as possIbIe and sIreIch Ihe neck.
S. LIII Ihe Iower jaw Iorward.
4. PInch Ihe nose.
S. Open your mouIh wIde seaIIng your IIps over Ihose oI Ihe vIcIIm, Iake deep
breaIh and bIow IorceIuIIy unIII you see Ihe vIcIIm's chesI rIse.
6. Remove your mouIh when you see Ihe vIcIIm's chesI rIse; IIsIen Ior exhaIaIIon.
7. ConIInue Ihe same procedure 12-20 IImes per mInuIe.
1. IamIIIarIze yourseII wIIh Ihe Iheory oI IIrsI aId.
2. PracIIse IIrsI aId procedures wIIh Ihe workers.
S. Know how Io perIorm IIrsI aId IechnIques and arIIIIcIaI respIraIIon.
4. Know how Io decIde Io reIer cases Io Ihe hospIIaIs or emergency heaIIh cenIres
when requIred.
S. Keep heaIIh records oI IndIvIduaI workers.
MODULE 8
Health education in
occupational health
1. OB|ECTlVES
DescrIbe paIIerns oI occupaIIonaI dIseases and accIdenIs
DescrIbe how dIIIerenI condIIIons wIIhIn work envIronmenIs may be reIaIed Io
occupaIIonaI dIseases and how Io reduce Ihe rIsk
IdenIIIy causes oI work accIdenIs and meIhods oI prevenIIon
DescrIbe how dIIIerenI sIyIes oI work pracIIces mIghI aIIecI Ihe heaIIh oI Ihe
worker, coIIeagues and oIhers
DIscuss rIsk reducIIon oI occupaIIonaI dIseases and accIdenIs wIIh workers
and managers In Ihe workpIace and IdenIIIy suIIabIe procedures Io maInIaIn
a heaIIhy work envIronmenI
DIscuss how IIIesIyIe and behavIour mIghI aIIecI heaIIh
DescrIbe varIous new meIhods oI heaIIh educaIIon and how, when and where
Io appIy Ihem as weII as ways oI moIIvaIIon
DescrIbe Ihe heaIIh educaIIon Iasks Ihe heaIIh worker Is goIng Io appIy and
perIorm In dIIIerenI heaIIh probIem sIIuaIIons In Ihe workpIace
IdenIIIy psychoIogIcaI, cuIIuraI, reIIgIous and eIhIcaI vaIues whIch mIghI aIIecI
Ihe communIIy heaIIh worker's abIIIIy Io educaIe workers or workpIace
managers on Ihe work envIronmenI and prevenIIon and conIroI oI occupaIIonaI
dIseases and accIdenIs.
2. OCCUPATlONAL DlSEASES
2.1 lirsI sIeps
LxpIaIn Io Ihe IraInees Ihe deIInIIIon oI occupaIIonaI dIsease and IIs causes:
chemIcaI agenIs: gases, vapours, mIsIs, pesIIcIdes, eIc.
physIcaI agenIs: noIse, vIbraIIon, heaI and coId sIress, radIaIIon, IIghI,
eIc.
bIoIogIcaI agenIs: bacIerIa, parasIIes, IungI, aIIergens, eIc.
psychoIogIcaI IacIors: InIerpersonaI and socIaI eIIecIs, reIaIIonshIp
wIIh managemenI, shIIIwork, eIc.
ergonomIc IacIors.
DIscuss Ihe rouIes oI enIry oI noxIous agenIs (skIn, InhaIaIIon, IngesIIon) and
IheIr Iorms (dusIs, gases, vapours, IIuIds eIc.).
ReIer Io Ihe ImporIance oI Ihe earIy deIecIIon oI heaIIh ImpaIrmenI and Ihe
maIn sIgns and sympIoms oI some common occupaIIonaI dIseases In Ihe
IocaIIIy.
DIscuss Ihe Iypes oI medIcaI examInaIIons (prepIacemenI, perIodIc and
rouIIne), IheIr ImporIance and meIhods oI ImpIemenIaIIon.
2.2 MeIhodology
Ask Ihe IraInees Io paIr up wIIh someone In Ihe group. Then dIrecI Ihem (In Ihe
paIrs) Io dIscuss Ihe IoIIowIng quesIIons. One member oI each paIr shouId wrIIe
down IheIr answers.
QuesIIons:
1. In your opInIon, whaI are Ihe occupaIIonaI dIseases you wouId expecI Io IInd
In your dIsIrIcI and why7
2. Do you IhInk IhaI II Is ImporIanI Io prevenI occupaIIonaI dIseases7
S. WheIher you answer yes or no, expIaIn why.
NexI, ask each paIr Io joIn up wIIh anoIher paIr In Ihe room. Any IeIIover paIr can
joIn any oI Ihe groups oI Iour. GIve Ihem some IurIher IIme Io conIInue IheIr
dIscussIon In Ihe smaII groups. Then ask Ior Ieedback Io Ihe cIass concernIng:
1. The occupaIIonaI dIseases Ihey expecI Io be Iound In IheIr dIsIrIcIs and why.
2. The socIaI and economIc eIIecIs oI occupaIIonaI dIseases.
3. OCCUPATlONAL ACClDENTS
3.1 lirsI sIeps
LxpIaIn Ihe deIInIIIon and Ihe causes oI occupaIIonaI accIdenIs, e.g. sIIppIng,
IrIppIng up, IaIIs oI maIerIaI and peopIe, machInery, IransporI, eIecIrIcIIy aI
work, conIIned spaces, IIres and expIosIons, personaI IacIors.
LxpIaIn IhaI Ihere are ways oI mInImIzIng Ihe rIsk oI accIdenIs. DIscuss saIe
and unsaIe worker behavIour. SIress Ihe ImporIance oI IIdIness and hygIene In
Ihe workpIace In accIdenI prevenIIon.
LxpIaIn prImary IIrsI aId sIeps In Ihe case oI work accIdenIs and how Io reIer
cases urgenIIy Ior medIcaI supporI.
DIscuss rehabIIIIaIIon, compensaIIon and economIc Ioss due Io accIdenIs.
DIscuss Ihe roIes oI Ihe empIoyer, workers and governmenI In accIdenI
reducIIon.
HenIth educnton n occuntonnI henIth: ModuIe 117
3.2 MeIhodology
1. SIIck sIgns readIng "Dangerous" and "SaIe" on Ihe board some dIsIance aparI.
Prepare In advance a Iarge number oI cards or sIrIps oI paper. On each card
wrIIe or draw a parIIcuIar sIIuaIIon, eIIher dangerous or saIe, e.g.
oII spIIIs on Ihe workpIace IIoor
covered machInery
exposed eIecIrIcaI wIres
heavy boxes whIch are precarIousIy pIaced on a movIng IorkIIII
wearIng oI Ioose cIoIhIng wIIh Ioose beIIs or sIrIps oI IabrIc near
revoIvIng machIne wheeIs
oIher sIIuaIIons whIch may be reIevanI Io your group oI IraInees.
2. Hand ouI Ihe cards aI random Io members oI Ihe groups and ask Ihem Io sIIck
IheIr cards on Ihe board aI a poInI under Ihe sIgn Io whIch Ihey IeeI II beIongs.
You can heIp II Ihe group cannoI decIde where Io III a cerIaIn card. Lach person
who goes up Io Ihe board Is encouraged Io say wheIher he dIsagrees wIIh Ihe
posIIIon oI any cards IhaI are aIready Ihere.
S. IInaIIy, move any cards IhaI are IncorrecIIy pIaced and expIaIn your reasons Ior
doIng so.
3.3 Case hisIory
TIcc nc \c \oc: n n cn cn \o:Io n )ou to\n. Onc o tIc:c \oc:
Ind nn nccdcnt \Ic tc:tng tIc c\o\ng nt: o n tuc cngnc. Hc Ind n dcc cut
n I: ct Innd, \n: o:ng n ot o ood nnd \n: n :c\cc nn.
3.4 MeIhodology
DIvIde Ihe cIass InIo groups oI IIve wIIh an eIecIed Ieader and a reporIer and
acquaInI Ihem wIIh Ihe case hIsIory.
Ask Ihe cIass Io dIscuss Ihe necessary sIeps IhaI Ihe coIIeagues oI Ihe Injured
worker shouId Iake In order Io heIp hIm.
GIve enough IIme Ior group dIscussIon and joIIIng down oI commenIs, Ihen ask
Ihe reporIers Io gIve Ieedback Io Ihe cIass.
IoIIowIng Ihe Ieedback Irom Ihe groups, Iead Ihe cIass In a generaI dIscussIon
on Ihe IopIc. ConIIrm IhaI onIy essenIIaI IIrsI aId shouId be gIven, I.e. Io sIop
bIeedIng by wrappIng Ihe hand wIIh a pIece oI cIean cIoIh above Ihe wound sIIe.
Then, eIIher an ambuIance shouId have been caIIed or Ihe vIcIIm shouId have
been IransporIed as quIckIy as possIbIe Io Ihe nearesI cIInIc or hospIIaI Ior
IurIher medIcaI IreaImenI.
4. WORK ENVlRONMENT AND CONTROL MEASURES
lN THE WORKPLACE
4.1 lirsI sIeps
LxpIaIn Io Ihe IraInees Ihe deIInIIIon oI Ihe work envIronmenI and Ihe IacIors
whIch aIIecI II: physIcaI, chemIcaI, bIoIogIcaI and ergonomIc.
DIscuss Ihe rIsks InvoIved when Ihere are unconIroIIed condIIIons.
DescrIbe Ihe meIhods oI evaIuaIIon oI Ihe work envIronmenI (measuremenIs
and InIerpreIaIIon oI resuIIs) Ior noIse, heaI and coId, IIIumInaIIon, radIaIIon,
aIr poIIuIanIs, gases, vapours and parIIcIes (aIr sampIIng).
DIscuss ways oI mInImIzIng Ihe heaIIh rIsks In aII Iypes oI envIronmenI
Ihrough conIroI measures (anIIcIpaIIon, recognIIIon, evaIuaIIon and conIroI)
and accIdenI prevenIIon. PoInI ouI IhaI IhreshoId vaIues shouId be IoIIowed.
DIscuss Ihe ImporIance oI perIodIc InspecIIon oI Ihe workpIace. Use oI
sIandard Iorms and quesIIonnaIres shouId be hIghIIghIed.
4.2 MeIhodology
V:t to nn occuntonn I)gcnc nonto)
The hygIenIsI or responsIbIe IechnIcIan aI Ihe IaboraIory shouId brIeI Ihe
IraInees on Ihe equIpmenI used Ior work envIronmenI measuremenIs, e.g.
noIse IeveI meIers, IIghI IeveI meIers, dusI sampIers, gas sampIers, eIc.
V:t to nctoc:,\oncc:
SeIecI Ihree or Iour IacIorIes/workpIaces whIch have dIIIerenI IndusIrIaI
acIIvIIIes and work envIronmenI hazards.
ObIaIn permIssIon Irom Ihe IacIory managemenI Io brIng Ihe IraInees on a vIsII
and IIx Ihe daIe and IIme.
Prepare a Iorm Ior Ihe IacIory/workpIace InspecIIon usIng Ihe IacIory InspecIIon
GuIdeIInes beIow.
On Ihe vIsII day, dIsIrIbuIe a copy oI Ihe Iorm Io each group oI IraInees.
InsIrucI each group Io nomInaIe a Ieader and a reporIer.
On arrIvaI aI Ihe IacIory, InsIrucI Ihe group Io quesIIon Ihe desIgnaIed IacIory
conIacI person usIng Ihe prepared Iorm.
The groups Ihen Iour Ihrough Ihe dIIIerenI parIs oI Ihe IacIory, IIIIIng In Ihe
resI oI Ihe Iorm as Ihey go.
AII groups reIurn Io Ihe cIassroom and Ihe reporIers Irom each group provIde
Ieedback on IheIr IIndIngs.
Lead a cIass dIscussIon emphasIzIng Ihe IoIIowIng poInIs:
Ihe work envIronmenI
workpIace hygIene
workIng condIIIons
use oI proIecIIve equIpmenI
need Ior heaIIh educaIIon programmes
Ieedback Io managemenI
4.3 lacIory,workplace inspecIion guidelines
Name and address oI Ihe IacIory/workpIace
IndusIrIaI acIIvIIy
Raw maIerIaIs used
IInaI producIs
Number oI workers
GeneraI hygIene oI Ihe workpIace
SaIepIace approach
equIpmenI
machInery "guardIng encIosure"
venIIIaIIon
oIhers
Lxposure hazards and rIsks
physIcaI
chemIcaI
bIoIogIcaI
ergonomIcaI
SaIeperson approach
sysIems oI work
onIhejob IraInIng
personaI proIecIIon
PrepIacemenI and perIodIc medIcaI examInaIIons
AppIIed heaIIh educaIIon programmes
Need Ior heaIIh educaIIon programmes
OIher poInIs.
5. PREVENTlON Ol OCCUPATlONAL DlSEASES AND
ACClDENTS
5.1 lirsI sIeps
DIscuss wIIh Ihe IraInees Ihe ImporIance oI Ihe workpIace sIIe, Ihe buIIdIng
engIneerIng pIan and Ihe IayouI oI machInery (saIepIace approach).
Ask Ihe IraInees whIch meIhods wouId be suIIabIe Io maInIaIn heaIIh sIandards
In Ihe workpIace.
DIscuss Ihe ImporIance oI work pracIIces educaIIon and job IraInIng Ior
workers (saIeperson approach).
LmphasIze Ihe ImporIance oI maInIaInIng good workpIace hygIene and personaI
hygIene.
SIaIe Ihe beneIIIs oI prepIacemenI and perIodIc medIcaI examInaIIons.
DIscuss Ihe roIes oI empIoyer, worker and governmenI.
LxpIaIn Ihe vIIaI roIe oI heaIIh educaIIon In occupaIIonaI dIsease and accIdenI
prevenIIon.
5.2 MeIhodology
Iquncnt
BrIng Io cIass a coIIecIIon oI personaI proIecIIve equIpmenI, e.g. gIoves, masks,
goggIes, heImeIs, booIs, aprons, eIc., and dIscuss wIIh Ihe IraInees Ihe varIous Iypes
oI equIpmenI and IheIr beneIIIs In prevenIIon oI occupaIIonaI dIsease and accIdenI.
InvIIe Ihe IraInees Io Iry on Ihe equIpmenI In order Ior Ihem Io undersIand how
Ihey are used.
Io:tc:
Prepare and dIspIay posIers showIng workers IoIIowIng saIe work pracIIces: correcI
meIhod oI weIghI IIIIIng, wearIng masks, goggIes and gIoves, eIc., and poor work
pracIIces: workers sIandIng In IronI oI unproIecIed revoIvIng machInery parIs,
workers wIIhouI proIecIIve equIpmenI whIIe exposed Io gases, dusIs, noIse eIc.
I:cu::on
Lead Ihe cIass In dIscussIon oI Ihese posIers. Lncourage Ihe IraInees Io commenI
on each posIer and wheIher or noI Ihey agree wIIh Ihe work pracIIce IndIcaIed by
Ihe educaIIonaI message. II Ihey don'I agree wIIh Ihe work pracIIce, InvIIe Ihem Io
suggesI ImprovemenIs.
6. LEGlSLATlON
6.1 lirsI sIeps
InIorm IraInees oI Ihe Iaws governIng work envIronmenI and work pracIIces
wrIIIen by Ihe mInIsIry oI Iabour, mInIsIry oI heaIIh, mInIsIry oI IndusIry,
mInIsIry oI socIaI securIIy, eIc.
DIscuss work accIdenIs and occupaIIonaI dIsease compensaIIon and
rehabIIIIaIIon IegIsIaIIon.
MenIIon Ihe roIe oI Ihe worker, empIoyer and Ihe governmenI In Ihe seIIIemenI
oI Ihese Issues.
6.2 Case hisIory
M A : n \oc n nn on \o:Io. Hc Ind n \o nccdcnt n \IcI Ic dnnngcd
t\o onc: n I: gIt ndcx ngc. Hc Ind to c tcntcd n tIc d:tct Io:tn.
6.3 MeIhodology
DIvIde Ihe cIass InIo smaII groups wIIh an eIecIed Ieader and a reporIer.
AcquaInI Ihe IraInees wIIh Ihe case hIsIory ouIIIned above.
InsIrucI IraInees Io dIscuss Ihe advIce Ihey wouId gIve Mr A on any admInIsIraIIve
or IegIsIaIIve sIeps he shouId Iake.
Ask Ihe groups Ior Ieedback.
The IraInees shouId concIude IhaI aIIer Mr A has compIeIed hIs IreaImenI, he
shouId Iorward documenIaIIon ouIIInIng hIs Injury Io Ihe Iabour oIIIce or Ihe
socIaI Insurance deparImenI In order Io cIaIm compensaIIon and/or
rehabIIIIaIIon IreaImenI.
7. EllECTS Ol LllESTYLE AND BEHAVlOUR ON
HEALTH
7.1 lirsI sIeps
TeII Ihe cIass IhaI In IhIs sessIon Ihey are goIng Io Iearn abouI Ihe eIIecIs oI
IndIvIduaI/communIIy IIIesIyIes and behavIour on heaIIh condIIIons. In many
InsIances, wheIher aI home or aI work, peopIe can become III or remaIn heaIIhy
as a resuII oI IheIr behavIour and aIIIIudes.
Lncourage IraInees Io gIve exampIes oI correcI heaIIh behavIour, e.g. washIng
oI hands and uIensIIs wIIh soap; sIorIng oI InIIammabIe maIerIaIs away Irom
worksIIes, wearIng proIecIIve cIoIhIng when requIred and coverIng Iood
agaInsI IIIes.
Ask Ihe IraInees Io dIscuss whaI makes peopIe behave In cerIaIn ways. Ask
Ihem Io gIve exampIes oI Ihe causes oI such behavIour and suggesI possIbIe
reasons behInd Ihe causes. MenIIon Ihe maIn IacIors IhaI InIIuence and dIrecI
peopIe's behavIour: knowIedge, beIIeIs, aIIIIudes and vaIues.
TeII Ihe cIass IhaI II Is essenIIaI Io undersIand Ihe reasons behInd a communIIy
adopIIng a parIIcuIar behavIour whIch may proIecI II Irom or cause dIsease, In
order Io eIIecIIveIy use heaIIh educaIIon Io encourage changes In behavIouraI
paIIerns.
Ask Ihe IraInees Io name a currenI heaIIh probIem In IheIr workpIace or
communIIy and Ihen consIder, In a cIass dIscussIon, Ihe mosI suIIabIe
educaIIonaI meIhods Io deaI wIIh IhIs probIem mosI eIIecIIveIy.
7.2 Case hisIory
In n gn:: nnnunctung ncto) cncd X tIcc : n o\cu ccctct) gcncnto
\IcI :uc: tIc ncto) \tI ccctct) n cn:c o nn]o o\c cut: o nccd o
noc o\c :u). TIc tIcc ocnto: o tIc gcncnto Ind n cou:c n IcntI
cducnton co\cng no:c Icnng o:: nnd no:c conto ncn:uc:. Iung \o :It:
tIc) cgun) u:c cnnu: nnd :cIcduc tIc no:c cxo:uc tnc.
AnotIc ncto) Y n:o In: n gcncnto o tIc :nnc :zc \IcI : u:cd o tIc :nnc
uo:c:. ut tIc tIcc gcncnto ocnto: In\c not Ind n cou:c n IcntI
cducnton nout no:c Icnng o:: nnd no:c conto ncn:uc:. TIc) do not u:c
cnnu: cgun) no do tIc) :cIcduc tIc no:c cxo:uc tnc.
Atc 5 )cn: tIc gou n ncto) Y In\c :tntcd In\ng Icnng ocn: nnd
dccct:.
7.3 MeIhodology
DIvIde Ihe cIass InIo smaII groups wIIh an eIecIed Ieader/reporIer.
AcquaInI each group wIIh Ihe case hIsIory ouIIIned above.
InsIrucI Ihe groups Io dIscuss Ihe IoIIowIng:
Ihe behavIour oI boIh groups oI IacIory workers and IheIr hearIng
probIems
Ihe personaI behavIour In boIh sIIuaIIons
Ihe IInk, II any, beIween Ihe behavIour oI each group and Ihe condIIIons
In Ihe IacIory.
8. HEALTH EDUCATlON lN THE WORKPLACE
8.1 lirsI sIeps
RemInd Ihe IraInees IhaI Ihe work envIronmenI can aIIecI workers' heaIIh
Ihrough exposure Io chemIcaI, physIcaI, bIoIogIcaI and ergonomIc hazards.
LxpIaIn IhaI a successIuI heaIIh educaIor:
IaIks Io managers and workers and IIsIens careIuIIy Io IheIr probIems
IhInks abouI aIIIIudes whIch can cause such probIems or soIve Ihem or
proIecI Ihem
dIscovers Ihe reasons Ior peopIe's behavIour and heaIIh probIems
InvIIes workers Io gIve IheIr Ideas on soIvIng Ihe probIems
In conjuncIIon wIIh Ihe workers, Iooks aI Ihese Ideas and decIdes whIch
ones are beneIIcIaI, pracIIcaI and easy Io appIy
encourages IacIory managers and workers Io seIecI Ideas approprIaIe
Io IheIr cIrcumsIances.
DIscuss Ihe IoIIowIng poInIs whIch are ImporIanI when esIabIIshIng a heaIIh
educaIIon programme:
esIabIIshIng good workIng reIaIIonshIps: how Io encourage cooperaIIon
and parIIcIpaIIon
heaIIh educaIIon pIannIng In PHC: InIormaIIon coIIecIIon, probIem
IdenIIIIcaIIon and undersIandIng, prIorIIIzaIIon, objecIIves and
procedures Io be IoIIowed, resource IdenIIIIcaIIon and mobIIIzaIIon,
encouragIng proper acIIon and IoIIowup, seIecIIon oI suIIabIe heaIIh
educaIIon meIhods, resuIIs evaIuaIIon and revIsIon oI pIannIng
procedures
IndIvIduaI heaIIh educaIIon: counseIIIng
group heaIIh educaIIon
communIIy heaIIh educaIIon
Ihe ImporIance oI conveyIng Ihe educaIIonaI message aI Ihe rIghI IIme
and pIace wIIh worker parIIcIpaIIon and good subjecI preparaIIon and
Ihe need Io IesI II In smaII groups beIore generaI appIIcaIIon.
TeII Ihe cIass abouI Ihe prIncIpIes on whIch PHC and heaIIh educaIIon In Ihe
workpIace can be organIzed.
LmphasIze IhaI Ihe aIms oI workers' educaIIon shouId be Io deveIop Ihe
capacIIy Io consIrucI an operaIIonaI sysIem capabIe oI reducIng occupaIIonaI
hazards. The eIIecIIveness oI such a sysIem shouId be assessed by deIermInIng
Io whaI exIenI Ihe IncIdence oI heaIIh InjurIes, dIsease or dIsorders Is
dImInIshed.
LxpIaIn IhaI Io eIIecI IhIs a number oI sIeps shouId be Iaken:
provIde Ihe necessary documenIaIIon
make use oI Ihe workers' experIence
deIIne prIorIIy hazards
draw up Ihe crIIerIa Ior workpIace ImprovemenIs
seI Ihe specIIIc objecIIves Io be achIeved
IesI Ihe eIIecIIveness oI conIroI measures.
InIroduce Ihe Idea IhaI heaIIh educaIIon saIeIy courses shouId be specIIIcaIIy
desIgned and heId Ior Ioremen and group Ieaders. PerIodIc meeIIngs shouId be
heId by Ihem wIIh IacIory managers, IacIory heaIIh personneI and saIeIy
oIIIcers Io sIudy Ihe preparaIIon made Ior saIeIy campaIgns and Io consIder
accIdenI sIaIIsIIcs, Ihe causes oI accIdenIs, rIsks Io heaIIh and how Io eIImInaIe
Ihem.
RevIew Ihe brIeIIng IhaI workers shouId receIve when Ihey joIn Ihe workpIace,
IncIudIng an InIormaIIon IeaIIeI InIormIng Ihem oI:
InIernaI IraIIIc rouIes (II appIIcabIe)
deIaIIed descrIpIIons oI Ihe work Ihey wIII be doIng and Ihe IooIs and
raw maIerIaIs Ihey wIII be handIIng, as weII as IheIr dangers and Ihe
precauIIons IhaI need Io be Iaken
generaI saIeIy reguIaIIons
specIaI saIeIy ruIes Ior dIIIerenI Iypes oI work
IndIvIduaI and group saIeIy equIpmenI
Ihe need Io caII Ior IIrsI aId aI once In Ihe evenI oI an accIdenI and
where such heIp can be Iound
a baIanced dIeI and saIe sanIIaIIon.
ThIs InIormaIIon IeaIIeI shouId be revIewed Irom IIme Io IIme and commenIed on
by Ihe shop IIoor. Any reIevanI IncIdenIs shouId be used by Ihe IraIner as a basIs Ior
a saIeIy Iesson, reInIorcIng Ihe saIeIy and heaIIh InsIrucIIons.
8.2 Case hisIory
TIcc nc 2 \oc: n n ccncnt ncto) n )ou d:tct. Iung tIc :unnc
nontI: \oc: connn o nu:cc nn /cnn:), IcndncIc: nnd ntguc. In tIc n:t
nontI o tIc :unnc, ou \oc: nc dngno:cd ) tIc d:tct I):cnn n:
:ucng on Icnt cxInu:ton.
8.2 MeIhodology
DIvIde Ihe cIass InIo smaII groups wIIh an eIecIed Ieader/reporIer.
AcquaInI Ihe cIass wIIh Ihe case sIudy above.
InsIrucI Ihe groups Io sIudy Ihe case hIsIory and pIan a heaIIh educaIIon
programme Ior Ihe workers oI Ihe IacIory. RemInd Ihem Io menIIon aII Ihe
necessary sIeps Ihey Iook In order Io ImpIemenI a successIuI programme.
AIIer suIIIcIenI dIscussIon IIme, Ihe reporIers shouId provIde Ieedback Io Ihe
group and generaI dIscussIon shouId IoIIow.
9. HEALTH EDUCATlON METHODS AND AlDS
9.1 lirsI sIeps
LxpIaIn Ihe Iwo meIhods oI heaIIh educaIIon-dIrecI and IndIrecI-and dIscuss
Ihe merIIs and drawbacks oI boIh.
DIrecI meIhod: a person gIvIng InIormaIIon Io IndIvIduaIs or groups
who are presenI In Ihe same pIace.
IndIrecI meIhod: Ihe person conveyIng Ihe message Is remoIe Irom
Ihose who are receIvIng II, e.g. IeIevIsIon, broadcasIIng, InIerneI
magazInes, books.
DIscuss Ihe InIeracIIve IeachIng sIraIegIes requIred In order Io aIIow InsIrucIIon,
pracIIce, Ieedback and moIIvaIIon Io Iake pIace:
presenIaIIon
Iarge group dIscussIons
smaII group dIscussIons
roIe pIay
case sIudIes
IacI IIndIng
projecI work
quesIIons.
DIscuss Ihe dIIIerenI aIds by whIch a heaIIh educaIIon message can be
conveyed:
VIsuaI aIds: boards or Iarge sheeIs oI paper or IIIpcharIs, phoIographs,
posIers, pubIIcaIIons, newspapers, magazInes, IransparencIes used on
an overhead projecIor, sIIdes and sIIde projecIors, reaI objecIs, modeIs.
AudIo aIds: recorded Iapes.
AudIovIsuaI aIds: vIdeo Iapes, cInema IIIms, roIe pIay, exhIbIIIons,
dummIes.
9.2 Case hisIory
TIc nn:t) o ngcutuc In: nn ngcutun :cIcnc n )ou d:tct ncn. TIc
:cIcnc u:c: dccnt gou: o c:tcdc: n odc to conto n:cct: tInt nc Innu
to tIc nnt:. TIc cIcncn: nc n:o u:cd ngnn:t c:t: :ucI n: nt:, d: ctc.
In:t \cc tIc :n)ng tcnn:, con::tng o 15 \oc: c tcnn, :tntcd nn
ognnoIo:Intc n:cctcdc nnt :n)ng cnnngn. TIc) \cc o\dcd \tI
otcct\c cotIng ut :onc \oc: dd not \cn t. TIc) Ind cnn:t nnd uncI
cn: dung tIc cou:c o tIc dn). WIcn tIc \o \n: conctc :onc o tIcn \cnt
Ionc :t \cnng tIc cotIc: tIc) Ind \on \Ic :n)ng.
T\o dn): ngo, ou o tIc:c \oc: cotcd to tIc nu:c o tIc ocn o]cct cnc
\tI c:nto) ocn: nnd IcndncIc:. TIc o\:onn dngno:: \n: n:cctcdc
ntoxcnton. TIcc \cc no nntdotc: to ognnoIo:Intc n:cctcdc n tIc cnc. TIc
ncctcd \oc: \cc cccd to tIc d:tct Io:tn, 5 onctc: n\n), o utIc
oo\-u nnd tcntncnt.
9.3 MeIhodology
HoId a pracIIcaI cIass sessIon demonsIraIIng Ihe use oI IeachIng aIds.
AIIernaIIveIy arrange a vIsII Io Ihe nearesI heaIIh educaIIon cenIre where Ihe
IraInees can see Ihe educaIIonaI aIds In use.
AcquaInI Ihe IraInees wIIh Ihe case sIudy above and dIvIde Ihem InIo Ihree
groups wIIh a Ieader/reporIer. Ask each group Io deveIop a heaIIh educaIIon
programme Ior IhIs sIIuaIIon.
The IraInees musI use aI IeasI one aId (more II desIred) Irom each oI Ihe
educaIIonaI aId caIegorIes: vIsuaI, audIo, audIovIsuaI.
Ask Ihe IraInees Io consIder Ihe IoIIowIng:
WhaI InIormaIIon are you conveyIng Ihrough Ihese aIds7
To whIch groups7
How are you pIannIng Io use Ihese aIds7
GIve Ihe groups suIIIcIenI IIme Io deveIop IheIr programmes and Io prepare
IheIr aIds. Move beIween Ihe groups oIIerIng dIrecIIon and advIce.
Ask Ihe groups Io presenI IheIr heaIIh educaIIon programmes usIng Ihe Ihree
Iypes oI aIds as requIred.
IoIIowIng IhIs, hoId a cIass dIscussIon on how weII each group arranged and
presenIed Ihe requIred programme and how weII Ihey made use oI Ihe avaIIabIe
educaIIonaI aIds.
10. COMMUNlCATlON SKlLLS lN HEALTH EDUCATlON
10.1 The communicaIion process
LxpIaIn Io Ihe cIass IhaI when we wanI Io convey a heaIIh message Io a person
or a group oI persons, we need a communIcaIIon process. When Ihe IargeI
audIence undersIands Ihe message In Ihe way we wanI, Ihen Ihe communIcaIIon
process has been successIuI. LducaIIon Is prImarIIy a maIIer oI communIcaIIon.
The mosI ImporIanI communIcaIIon skIIIs are:
esIabIIshIng good reIaIIonshIps wIIh peopIe
speakIng cIearIy and makIng use oI reIevanI vocabuIary
IIsIenIng aIIenIIveIy
ensurIng IhaI Ihe message has been cIearIy undersIood and expIaInIng
IurIher II necessary
usIng nonverbaI communIcaIIon IooIs eIIIcIenIIy
reIraInIng Irom bIas and prejudIce
reIraInIng Irom dIrecI crIIIcIsm oI oIhers and hurIIuI commenIs
maInIaInIng conIIdenIIaIIIy II necessary
beIng IuIIy prepared when communIcaIIng Ihe message
adjusIIng Ihe IeveI oI IeachIng Io suII Ihe recIpIenIs
usIng suIIabIe educaIIonaI aIds
IeadIng meeIIngs compeIenIIy.
10.2 MeIhodology
WrIIe Iwo sIgns on Ihe bIackboard: "CorrecI" and "Wrong".
Prepare cards, each namIng a Iype oI behavIour In communIcaIIon skIIIs, and
perhaps a Iew words oI expIanaIIon (see IIsI beIow).
Hand Ihe cards ouI randomIy Io Ihe IraInees.
Ask Ihe IraInees Io pIace IheIr card on Ihe bIackboard under Ihe reIevanI sIgn.
II Ihey are unsure Ihey can pass IheIr card on Io someone eIse. The IraInees are
Iree Io dIsagree wIIh each oIher.
IInaIIy, remove any cards whIch are cIearIy IncorrecIIy pIaced and hoId a
generaI dIscussIon on Ihe dIIIerenI sIIuaIIons and Ihe correcI opIIons.
10.3 LisI ol communicaIion skills and behaviour
1. SpeakIng In a posIIIve manner when addressIng a Iarge group.
2. ShouIIng angrIIy aI an audIence.
S. IaIIIng Io respond when asked a vaIId quesIIon abouI a work envIronmenI.
4. TakIng sIdes wIIh one or Iwo persons In a group even when Ihey are noI gIvIng
suIIabIe answers.
S. OpenIy crIIIcIzIng sIudenIs who gIve IncorrecI answers.
6. GIvIng correcI InIormaIIon In a IogIcaI caIm manner aIIer a sIudenI's IncorrecI
answer.
7. DIscussIng openIy conIIdenIIaI maIIers made known Io Ihe IraIner durIng a
personaI counseIIIng sessIon wIIh a sIudenI.
8. Thorough preparaIIon oI Iessons beIore Ihe cIass begIns.
9. UsIng unusuaI Ierms In a Iarmers' heaIIh educaIIon sessIon.
10. SpeakIng above Ihe educaIIonaI and comprehensIon IeveI oI Ihe IargeI group.
11. LIecIIng a weII InIormed sIudenI Io Iead a group dIscussIon.
12. UsIng roIepIay as a IooI Io educaIe IIIIIeraIe Iarmers on Ihe conIroI oI bIoIogIcaI
work hazards.
1. Show skIIIs In gIvIng heaIIh educaIIon Io workers In a workpIace.
2. Know Ihe Iypes oI occupaIIonaI dIseases and accIdenIs IhaI occur In your
dIsIrIcI.
S. Show skIIIs In desIgnIng posIers and preparaIIon oI handouIs Io workers.
4. Show skIIIs In group dIscussIons.
S. Show good communIcaIIon skIIIs wIIh workers, managers and empIoyers.
6. Know how Io use and appIy suIIabIe aIds Ior use In heaIIh educaIIon programmes.
7. Know how Io gIve and dIscuss Ihe maIn poInIs Iound In work IegIsIaIIon wIIh
regards Io work reIaIIons, occupaIIonaI dIseases and accIdenIs, rehabIIIIaIIon,
compensaIIon, workpIace InspecIIon, eIc.
MODULE 9
Epidemiology and biostatistics
in occupational health
1. OB|ECTlVES
UndersIand Ihe purpose and accepI Ihe ImporIance oI occupaIIonaI
epIdemIoIogy and bIosIaIIsIIcs In dIscoverIng causes, measurIng rIsks and
deIermInIng prIorIIIes In InIervenIIon and evaIuaIIon;
SIaIe Ihe characIerIsIIcs oI epIdemIoIogy whIch dIsIInguIshes II Irom oIher
perspecIIves;
DIscuss Ihe appIIcaIIon oI bIosIaIIsIIcs In epIdemIoIogIcaI sIudIes;
DescrIbe Ihe maIn Iypes oI sIudy desIgn used In occupaIIonaI epIdemIoIogy.
2. DEllNlTlONS
OccupaIIonaI heaIIh may be consIdered Io be a componenI oI pubIIc heaIIh.
LpIdemIoIogy and bIosIaIIsIIcs are key dIscIpIInes In pubIIc heaIIh. Whereas cIInIcaI
medIcIne Iends Io be concerned wIIh Ihe InvesIIgaIIon and managemenI oI an
IndIvIduaI paIIenI's probIem, popuIaIIonbased sIudIes are an InIegraI parI oI
occupaIIonaI heaIIh pracIIce.
Epidemiology: Ihe sIudy oI Ihe dIsIrIbuIIon and deIermInanIs oI heaIIhreIaIed
sIaIes and evenIs In popuIaIIons and Ihe appIIcaIIon oI IhIs sIudy Io Ihe conIroI oI
heaIIh probIems.
1
The IundamenIaI goaI oI Ihese InvesIIgaIIons Is Io obIaIn a vaIId
and reasonabIy precIse esIImaIe oI exposure-dIsease assocIaIIon In groups. "As
appIIed Io occupaIIonaI heaIIh, epIdemIoIogy Ihus has Ihe duaI Iask oI descrIbIng
Ihe dIsIrIbuIIon oI deaIhs, accIdenIs, IIInesses and IheIr precursors . In Ihe
workIorce . and oI searchIng Ior Ihe deIermInanIs oI heaIIh, Injury and dIsease In
Ihe occupaIIonaI envIronmenI."
1
OccupaIional epidemiology: Ihe sIudy oI Ihe occurrence oI dIsease In reIaIIon Io
workreIaIed deIermInanIs. II IoIIows IhaI, In revIewIng any IndIvIduaI wIIh a heaIIh
reIaIed probIem or any workpIace wIIh a hazardous envIronmenI, Ihe InvesIIgaIor
musI ask Ihe IoIIowIng quesIIons:
Who Is aI rIsk7
Where7
1
Idcnoog) o \o-cntcd d:cn:c: nnd nccdcnt:. TcntI cot o tIc ]ont IIO,WHO
Connttcc on Occuntonn HcntI. Geneva, WorId HeaIIh OrganIzaIIon, 1989 (WHO TechnIcaI
ReporI SerIes No.777).
When7
How7
BiosIaIisIics: Ihe dIscIpIIne oI sIaIIsIIcs concerned wIIh Ihe descrIpIIon,
summarIzaIIon and InIerpreIaIIon oI daIa as weII as Ihe deveIopmenI oI procedures
Io accompIIsh Ihese objecIIves.
OccupaIional biosIaIisIics: an ImporIanI IooI In Ihe quanIIIaIIve sIudy oI morbIdIIy
and morIaIIIy In humans, reIaIIve Io exposure In Ihe workpIace.
Random sample: a sampIe oI sIze n seIecIed Irom a Iarger popuIaIIon Is random II
each IndIvIduaI wIIhIn Ihe popuIaIIon has equaI probabIIIIy oI beIng seIecIed. When
a sampIe Is noI random, Ihe occurrence oI Ihe characIerIsIIc beIng InvesIIgaIed may
be reIaIed Io Ihe IIkeIIhood IhaI an IndIvIduaI was seIecIed Ior Ihe sampIe. ThereIore,
II Is necessary Io assess bIas and seIecIIon IacIors careIuIIy beIore generaIIzIng Irom
Ihe resuIIs oI a sIudy based on nonrandom sampIes.
AriIhmeIic mean: usuaIIy denoIed as x
-
, Ihe arIIhmeIIc mean Is a measure oI Ihe
cenIraI Iendency oI Ihe daIa. II Is gIven by Ihe IormuIa:
n
x x x
x
n
+ + +
=
...
2 1
II Ihe sampIe Is randomIy seIecIed Irom a Iarge popuIaIIon, x
-
esIImaIes a popuIaIIon
mean usuaIIy desIgnaIed as .
The arIIhmeIIc mean Is sIrongIy aIIecIed by exIreme vaIues In Ihe daIa. II a varIabIe
has a IaIrIy symmeIrIc dIsIrIbuIIon, Ihe mean Is used as Ihe approprIaIe measure oI
cenIraI Iendency.
Median: Ihe "mIddIe" observaIIon, or S0Ih percenIIIe, I.e. haII oI Ihe observaIIons
IIe above Ihe medIan and haII beIow.
Mode: Ihe mosI IrequenIIy occurrIng observaIIon. II Is rareIy used excepI when Ihere
are a IImIIed number oI possIbIe ouIcomes.
SIandard deviaIion: usuaIIy denoIed as 5, Ihe sIandard devIaIIon Is a measure oI
Ihe "spread" oI Ihe daIa abouI x. II Is gIven by Ihe IormuIa:
1
) (
2
n
x x
The square oI Ihe sIandard devIaIIon, :

2
, Is Ihe varIance. II Ihe sampIe Is randomIy
seIecIed Irom a Iarger popuIaIIon, : and :
2
esIImaIe Ihe popuIaIIon parameIers
and
2
.
Bias or sysIemaIic error: usuaIIy a resuII oI IIaws In Ihe sIudy desIgn or daIa
coIIecIIon.
Conlounding: Ihe eIIecI oI an exIraneous varIabIe IhaI may parIIaIIy or compIeIeIy
accounI Ior an apparenI assocIaIIon beIween a sIudy exposure and dIsease.
denoIogy nnd bostntstcs n occuntonnI henIth: ModuIe 9 131
3. BlOSTATlSTlCAL DATA
3.1 Types ol daIa
DaIa coIIecIed In medIcaI research can be dIvIded InIo Ihree Iypes: nomInaI
(caIegorIcaI), ordInaI and InIervaI (conIInuous).
Nominal (caIegorical) daIa: daIa IhaI can be dIvIded InIo Iwo or more unordered
caIegorIes, e.g. sex, race, reIIgIon. In occupaIIonaI heaIIh, many ouIcome measures
such as cancer raIes are consIdered separaIeIy Ior dIIIerenI sex and race caIegorIes.
Ordinal daIa: one sIep up Irom nomInaI daIa, Ihe dIIIerence beIng a predeIermIned
orderIng underIyIng Ihe caIegorIes. LxampIes oI ordInaI daIa are cIInIcaI severIIy,
socIoeconomIc sIaIus and ILO proIusIon caIegory Ior pneumoconIosIs on chesI
Xray.
BoIh nomInaI and ordInaI daIa are exampIes oI dIscreIe daIa.
lnIerval daIa: AIso caIIed conIInuous daIa, InIervaI daIa are measured on an
arIIhmeIIc scaIe. LxampIes IncIude heIghI, weIghI, bIood Iead and Iorced expIraIory
voIume. The accuracy oI Ihe number recorded depends on Ihe measurIng
InsIrumenI and Ihe varIabIe can Iake on an InIInIIe number oI vaIues wIIhIn a
deIIned range.
3.2 Sample size
The number oI subjecIs needed Io assess Ihe poIenIIaI exposure-dIsease
reIaIIonshIp Is a IundamenIaI Issue when pIannIng a sIudy. The Iarger Ihe sampIe
sIze, Ihe greaIer Ihe power Io deIecI a specIIIed dIIIerence In magnIIude beIween an
exposure and a dIsease when II exIsIs.
3.3 Chance variaIion
ThIs reIers Io Ihe naIuraI varIaIIon In heaIIh ouIcomes observed among sImIIarIy
exposed IndIvIduaIs. Two sIaIIsIIcaI IooIs used Ior assessIng Ihe roIe oI chance are
Ihe I vaIue and Ihe conIIdence InIervaI.
The I vaIue Is Ihe probabIIIIy oI obIaInIng by chance aIone a dIIIerence In dIsease
raIes beIween Ihe exposed and unexposed as Iarge as or more exIreme Ihan whaI
was observed. A I vaIue oI 0.00S means IhaI Ihe probabIIIIy oI obIaInIng by chance
aIone an exposure eIIecI as Iarge as or more exIreme Ihan whaI was observed Is
onIy S per 1000. SmaII I vaIues (beIow 0.0S) are someIImes reIerred Io as sIaIIsIIcaIIy
sIgnIIIcanI.
The conIIdence InIervaI (CI) gIves Ihe pIausIbIe vaIues Ior Ihe acIuaI eIIecI oI
exposure wIIh a desIred degree oI conIIdence, e.g. Ihe 9S conIIdence InIervaI Ior
Ihe rIsk assocIaIed wIIh an occupaIIonaI exposure Is an InIervaI In whIch Ihe Irue
reIaIIve rIsk wIII be IncIuded 9S oI Ihe IIme. A 9S conIIdence InIervaI IhaI IncIudes
1.0 ImpIIes IhaI a vaIue oI 1.0 Ior Ihe reIaIIve rIsk Is pIausIbIe and Ihus Ihe nuII
hypoIhesIs oI no exposure eIIecI Is consIsIenI wIIh Ihe daIa.
3.4 2 2 Iable
The sImpIesI sIaIIsIIcaI IechnIque, Ihe 2 2 IabIe, Is useIuI when occupaIIonaIIy
exposed and unexposed IndIvIduaIs are IoIIowed Ior equaI amounIs oI IIme Ior
dIsease IncIdence.
4. TYPES Ol EPlDEMlOLOGlCAL STUDY
LpIdemIoIogIcaI sIudIes measure Ihe rIsk oI dIsease dIrecIIy In human popuIaIIons.
There Is no need Io reIy on quesIIonabIe exIrapoIaIIons across anImaI specIes Io
esIImaIe Ihe ImpacI oI an exposure In humans. II Is possIbIe In epIdemIoIogy Io
examIne Ihe consequences oI an occupaIIonaI and envIronmenIaI exposure In Ihe
manner In whIch II acIuaIIy occurs In humans, noI Ihe arIIIIcIaI manner In whIch
IaboraIory sIudIes oI anImaIs are done. The Issue oI dose, rouIe oI exposure,
concomIIanI exposures and hosI IacIors are aIso dIrecIIy assessed.
In essence Ihere are Ihree Iypes oI epIdemIoIogIcaI sIudy aIIhough, In pracIIce, Ihe
IhIrd Is underIaken rareIy, Ior eIhIcaI reasons.
DescripIive sIudies: Ihese descrIbe evenIs based on observaIIon and shouId
Iead Io Ihe deveIopmenI oI causaI hypoIheses, whIch can be IesIed.
AnalyIical sIudies: Ihese InvoIve Ihe IesIIng oI hypoIheses. II a hypoIhesIs
seems Io be supporIed, aIIempIs shouId be made Io reIuIe II In IurIher sIudIes
and/or Io underIake InIervenIIon sIudIes.
lnIervenIion sIudies: Ihese are underIaken Io see wheIher an aIIeraIIon oI
exposure produces a change In Ihe heaIIh ouIcome oI Ihe exposed popuIaIIon.
The cohorI sIudy Is Ihe mosI common Iype oI sIudy In occupaIIonaI epIdemIoIogy.
InIormaIIon on a IacIor (or IacIors) Is coIIecIed In a deIIned popuIaIIon IhaI Is IoIIowed
over IIme Ior Ihe occurrence oI a dIsease (or dIseases). The dIsease raIe among Ihose
exposed Is compared Io Ihe raIe among Ihe nonexposed Io assess II Ihere Is an
assocIaIIon beIween Ihe sIudy IacIor and dIsease. ThIs sIudy Iakes a Iong IIme Io
compIeIe as InvesIIgaIors have Io waII someIImes years beIore acquIrIng enough cases
oI dIsease (or deaIh). A reIrospecIIve cohorI sIudy may be used Io eIImInaIe IhIs Iong
IoIIowup perIod. PasI records oI IndIvIduaIs are used Io characIerIze Ihe exposure
sIaIus oI Ihe sIudy objecIs and Ihe dIsease sIaIus Is deIermIned unIII a parIIcuIar daIe.
The major meIhodoIogIcaI advanIage oI Ihe cohorI sIudy Is IhaI InIormaIIon on
exposure Is recorded beIore Ihe deveIopmenI oI dIsease. ThIs eIImInaIes recaII bIas.
The case-conIrol sIudy examInes Iwo groups. One group consIsIs oI peopIe wIIh a
parIIcuIar dIsease and Ihe oIher consIsIs oI Ihose Irom Ihe source popuIaIIon or
sIudy base wIIhouI Ihe dIsease. InIormaIIon regardIng pasI exposures and habIIs Is
obIaIned Irom each person In Ihe Iwo groups. II Ihe exposure oI InIeresI Is reporIed
by a Iarger proporIIon oI cases Ihan conIroIs, an assocIaIIon beIween Ihe exposure
and dIsease can be saId Io exIsI. Case-conIroI sIudIes are more eIIIcIenI and suIIabIe
Ior Ihe sIudy oI rare dIseases and dIseases wIIh Iong IaIency perIods.
In Ihe cross-secIional sIudy peopIe are seIecIed regardIess oI exposure or dIsease
sIaIus. ThIs sIudy desIgn Is oIIen caIIed a survey or prevaIence sIudy.
5. COMMON MEASURES Ol DlSEASE lREQUENCY
5.1 lnIroducIion
The number oI IndIvIduaIs wIIh a dIagnosed dIsease or wIIh abnormaI IesI resuIIs,
In generaI, cannoI be InIerpreIed wIIhouI some addIIIonaI InIormaIIon. An excepIIon
Io IhIs ruIe Is Ihe occurrence oI a dIsease IhaI Is so rare IhaI any case Is unusuaI, e.g.
Ihree cases oI hepaIIc angIosarcoma dIagnosed among abouI 270 workers durIng a
Ihreeyear perIod were suIIIcIenI Io make a pIanI physIcIan suspecI IhaI Ihe vInyI
chIorIde Ihey were exposed Io was a carcInogen.
5.2 Crude raIes
A raIe Is Ihe Irequency oI a dIsease per unII sIze oI Ihe group (or popuIaIIon) beIng
sIudIed.
PoinI prevalence raIe: Ihe sImpIesI raIe based on Ihe number oI cases presenI aI
one poInI In IIme.
PrevaIence raIe = Ihe number oI cases presenI aI a gIven poInI In IIme Ihe IoIaI
popuIaIIon aI rIsk aI IhaI gIven poInI In IIme
ThIs raIe can be compared wIIh a generaI popuIaIIon raIe or raIe Irom an approprIaIe
conIroI group Io deIermIne II II Is excessIve. A IImIIaIIon oI prevaIence raIe aIone,
however, Is IhaI II counIs aII cases oI Ihe dIsease wIIhouI dIIIerenIIaIIng beIween
oId and new cases.
lncidence raIe: a raIe IhaI removes Ihe background cases and Iocuses more cIearIy
on new or recenI evenIs. II Is based on Ihe number oI new cases occurrIng over a
specIIIed perIod oI IIme.
IncIdence raIe = Ihe number oI new cases oI dIsease durIng a gIven perIod oI IIme
Ihe IoIaI popuIaIIon aI rIsk durIng IhaI IIme
Person-years: When Ihe IncIdence raIe Is InIended Io measure dIsease onseI
occurrIng In Ihe group aI rIsk over Ihe course more Ihan 1 year Ihe approprIaIe
denomInaIor Is person-years. ThIs vaIue sImuIIaneousIy Iakes InIo consIderaIIon
Ihe number oI IndIvIduaIs and Ihe IIme perIod over whIch Ihey were observed and
consIdered aI rIsk oI deveIopIng Ihe dIsease. II IhereIore permIIs Ihe IncIusIon oI
IndIvIduaIs who were noI aI rIsk Ior Ihe whoIe IIme perIod. ThIs Is parIIcuIarIy
ImporIanI when new empIoyees or IermInaIIons oI conIracI are counIed or when
rIsk In a specIIIc IIme perIod Is evaIuaIed.
5.3 Specilic raIes
In some InsIances, a crude or adjusIed raIe Ior Ihe enIIre popuIaIIon may obscure
an ImporIanI assocIaIIon. When opposIIe Irends exIsI In dIIIerenI parIs oI Ihe age
specIrum, Ihese Irends may oIIseI each oIher and be masked by a summary raIe.
5.4 Comparison ol raIes
IndependenI oI wheIher raIes are represenIed by homogeneous subgroups or
adjusIed Ior approprIaIe varIabIes In Ihe enIIre group, Ihe raIes musI be IransIaIed
InIo rIsks Io evaIuaIe Ihe eIIecIs oI exposure.
The Iwo major Iypes oI rIsk esIImaIes based on comparIsons oI raIes are Ihe raIIo
oI raIes (reIaIIve rIsk) and Ihe dIIIerence beIween raIes (aIIrIbuIabIe rIsk).
The relaIive risk, or raIe raIIo, Is desIgned Io communIcaIe Ihe reIaIIve ImporIance
oI an exposure by comparIng raIes Irom an exposed popuIaIIon Io an unexposed or
normaI popuIaIIon. In IIs sImpIesI Iorm, II Is Ihe raIIo oI Iwo raIes.
The aIIribuIable risk, or rIsk dIIIerence, Is desIgned Io communIcaIe Ihe amounI oI
dIsease IhaI can be aIIrIbuIed Io Ihe exposure under sIudy. ThIs concepI Is
parIIcuIarIy useIuI and necessary In occupaIIonaI dIsease sIudIes because Iew
dIseases can be aIIrIbuIed soIeIy Io an occupaIIonaI exposure. The aIIrIbuIabIe rIsk
Is caIcuIaIed by subIracIIng Ihe raIe oI parIIcuIar dIsease In Ihe normaI or unexposed
popuIaIIon Irom IhaI In Ihe exposed popuIaIIon.
6.1 QuesIion 1
The daIa In Ihe IabIe beIow show Ihe dIsIrIbuIIon oI days absenI Irom work among
workers In Iour seIecIed IndusIrIes. CaIcuIaIe Ihe mean, medIan and mode duraIIon
oI absence In each IndusIry. CommenI on Ihe dIIIerence beIween IndusIrIes.
Ferod o]
nbsence
(dnys) U 1 2 3 4 5 b 7 9 1U TotnI
Industry
A - - T6 TT3 36 5 4 2 T - T T78
- T T 2 2 - 27 - - - - 33
C - - T2 33 20 28 35 7 T 4 6 T46
D - 97 6 2 6 28 TT 27 2 T 4 T84
6.2 QuesIion 2
A survey oI IemaIe IexIIIe workers showed IhaI 8 had bacIerIa In IheIr urIne.
IormuIaIe Ihe sIudy quesIIon.
SpecIIy addIIIonaI InIormaIIon you need Io deIermIne II a heaIIh probIem
exIsIs.
IdenIIIy wheIher or noI Ihe sIudy quesIIons are epIdemIoIogIcaI Issues.
6.3 Answer Io quesIion 1
6.4 Answer Io quesIion 2
WhaI Is Ihe prevaIence raIe oI bacIerIurIa In IemaIe IexIIIe workers7
The expecIed prevaIence raIe Ior a comparabIe group oI women Is needed.
II Is an epIdemIoIogIcaI probIem.
Industry Menn Mednn Mode
A 3.35 3 3
5.42 6 6
C 4.84 5 6
D 3.26 T T
MODULE 10
Record keeping
1. OB|ECTlVES
Be aware oI Ihe ImporIance oI record keepIng and reporIIng In occupaIIonaI
heaIIh;
Keep records on workers' heaIIh and reporI Ihe resuIIs oI InvesIIgaIIons as
requIred;
Be acquaInIed wIIh Ihe codIng sysIems used In record keepIng.
2. PURPOSE AND TYPES Ol RECORD
2.1 Purpose
No maIIer how smaII an occupaIIonaI heaIIh servIce Is, record keepIng Is a necessary
parI oI IIs acIIvIIIes. Records are never an end In IhemseIves; Ihey are IooIs IhaI IIII
a need. In an occupaIIonaI heaIIh servIce, records are used Ior:
documenIaIIon oI an empIoyee's exposure Io hazards
empIoyee heaIIh daIa Ior job pIacemenI
documenIaIIon oI empIoyee heaIIh overIIme
provIsIon oI empIoyee heaIIh overIIme
IuIIIImenI oI reguIaIory requIremenIs.
2.2 Types
There are seven Iypes oI basIc record on workers' heaIIh. The keepIng oI some oI
Ihese records may be requIred by Iaw In some counIrIes. PHC workers musI be IoId
Ihe sIaIuIory requIremenIs wIIh respecI Io keepIng records on workers' heaIIh.
HcntI nnd :nct) n:ccton
These records musI conIaIn Ihe daIe, Ihe person carryIng ouI Ihe InspecIIon and
Ihe IIndIngs oI Ihe InspecIIon. In desIgnIng Ihe InspecIIon record Iorm, II Is advIsabIe
Io consuII wIIh Ihe dIsIrIcI heaIIh cenIre as II may be InIeresIed In producIng a Iorm
Ior aII workpIaces In Ihe area.
In\onncntn nontong
ThIs Is onIy appIIcabIe Io pIaces whIch requIre envIronmenIaI monIIorIng on a
rouIIne basIs. The scheme oI monIIorIng Is devIsed by eIIher Ihe occupaIIonaI heaIIh
and saIeIy commIIIee In Ihe workpIace or by Ihe dIsIrIcI heaIIh cenIre. ThIs IncIudes
Ihe Iorm Ior keepIng records. The PHC workers are IraIned Io Iake readIngs wIIh
sImpIe InsIrumenIs and record Ihem sysIemaIIcaIIy. The records are handed over
perIodIcaIIy Io experIs Ior InIerpreIaIIon.
HcntI nontong
ThIs Is onIy appIIcabIe Io cerIaIn groups oI workers In some workpIaces. The PHC
workers are IraIned eIIher Io coIIecI specImens perIodIcaIIy and send Ihem Io Ihe
desIgnaIed IaboraIorIes Ior anaIysIs, or Io arrange Ior Ihe workers Io have IheIr
specImens Iaken and examInaIIons done perIodIcaIIy In desIgnaIed IaboraIorIes. The
PHC workers are responsIbIe Ior keepIng Ihe records suppIIed by Ihe desIgnaIed
IaboraIorIes sysIemaIIcaIIy and Ior submIIIIng Ihem Io Ihe occupaIIonaI heaIIh and
saIeIy commIIIee In Ihe workpIace or Ihe dIsIrIcI heaIIh cenIre Ior InIormaIIon and
any acIIon whIch may be requIred.
I:t nd o\dcd n tIc \oncc
IIrsI aId IreaImenI records are oIIen kepI aI Ihe IIrsI aId sIaIIon aI each work sIIe
raIher Ihan aI a cenIraI occupaIIonaI heaIIh cIInIc In a pIanI or In Ihe dIsIrIcI PHC
cenIre. ThIs permIIs accIdenIaI InjurIes Io be recorded aI Ihe work sIIes where Ihey
occur, eIImInaIIng Ihe need Ior an empIoyee wIIh a IrIvIaI Injury Io Ieave work and
go Io Ihe cIInIc sImpIy Io record Ihe occurrence. The occupaIIonaI heaIIh cIInIc/
dIsIrIcI PHC cenIre shouId receIve and keep copIes oI Ihese records and a record oI
aII IIrsI aId IreaImenI whIch II has IIseII provIded. ThIs record Is caIIed Ihe acuIe
care regIsIer.
IIrsI aId records are someIImes mandaIed by governmenI reguIaIIon and are aIways
ImporIanI Io Ihe assessmenI oI compensaIIon cIaIms. They aIso provIde daIa vIIaI
Io Ihe assessmenI oI Ihe accIdenI prevenIIon programmes.
Accdcnt n\c:tgnton:
There are Ihree reasons why companIes need Io record and InvesIIgaIe occupaIIonaI
accIdenIs:
Io IdenIIIy Ihe reaI causes oI Injury and IIIness, properIy damage and near
mIsses (accIdenIs IhaI mIghI have happened)
Io deveIop eIIecIIve meIhods oI prevenIIng IuIure sImIIar accIdenIs
Io meeI IegIsIaIIve requIremenIs.
ThIs Is usuaIIy done by an experI on Ihe occupaIIonaI heaIIh and saIeIy commIIIee
In Ihe workpIace or a Iabour InspecIor. These records musI be kepI sysIemaIIcaIIy.
The PHC workers musI read Ihe records IhoroughIy so IhaI Ihe knowIedge on Ihe
IIndIngs can be appIIed.
5cnc:: cctcnton
ThIs recordIng Is usuaIIy done by medIcaI pracIIIIoners and kepI by Ihe
managemenI. The PHC workers musI be suppIIed wIIh absIracIs oI Ihese records on
a perIodIc basIs. ThIs wIII enabIe Ihe PHC workers Io reIaIe any common sIcknesses
among workers Io Ihe IIndIngs oI Ihe heaIIh and saIeIy InspecIIon and Ihe heaIIh
educaIIon programme.
Record keeng: ModuIe 1U 139
Ic:onn IcntI ccod:
ThIs seI oI records concerns Ihe heaIIh sIaIus oI each IndIvIduaI worker. II InevIIabIy
conIaIns personaI, prIvIIeged InIormaIIon whIch has specIaI sIgnIIIcance In Iaw.
PersonaI heaIIh records shouId be kepI In IheIr orIgInaI handwrIIIen Iorm even II
Iyped or compuIerIzed versIons aIso exIsI.
A worker's personaI heaIIh record shouId onIy reIIecI hIs/her heaIIh sIaIus InsoIar
as II appIIes Io Ihe job. The conIenI may IhereIore vary a greaI deaI. The InIormaIIon
whIch Is usuaIIy Iound In Ihe record IncIudes:
resuIIs oI physIcaI examInaIIons
Xray and IaboraIory reporIs IncIudIng LCG puImonary IuncIIon resuIIs and
audIograms
ImmunIzaIIons
occupaIIonaI and medIcaI hIsIory
parIIcIpaIIon In heaIIh programmes
workers' compensaIIon and medIcaI Insurance
InIormed consenI Iorms and auIhorIzaIIons Ior reIease oI InIormaIIon
documenIaIIon oI reIusaIs Io undergo examInaIIon, IesIIng and programme
parIIcIpaIIon
progress noIes Ior rehabIIIIaIIon
consuIIanI reporIs.
3. RECORD KEEPlNG
The besI way Io keep records Is Ihe sImpIesI manner consIsIenI wIIh convenIenI,
economIcaI and eIIIcIenI buI conIroIIed access. DedIcaIed Iorms are parIIcuIarIy
useIuI buI a IrIaI In use shouId aIways be carrIed ouI beIore Ihey are InIroduced InIo
IuII servIce. II codIng sysIems are used Ihey shouId be compaIIbIe wIIh exIsIIng,
wIdeIy recognIzed sysIems, e.g. codIng oI IIIness and Injury shouId be In accordance
wIIh Ihe InIernaIIonaI SIaIIsIIcaI CIassIIIcaIIon oI DIseases and ReIaIed HeaIIh
ProbIems oI Ihe WorId HeaIIh OrganIzaIIon.
II Is recommended (In some counIrIes II Is mandaIed by Iaw) IhaI records be reIaIned
Ior aI IeasI S0 years. ThIs Is In Ihe evenI oI subsequenI heaIIh probIems beIng
IdenIIIIed. These records musI be IransIerred Io a responsIbIe recIpIenI or a
governmenI agency II Ihe empIoyer, cIInIc or dIsIrIcI cenIre goes ouI oI busIness.
CompuIer sIorage permIIs auIomaIIc and very rapId reIrIevaI oI daIa In any
combInaIIon and desIred sequence. ThIs Is InvaIuabIe noI onIy Ior worker heaIIh
evaIuaIIon buI Ior heaIIh programme operaIIons and audII.
When consIderIng Ihe possIbIIIIy oI recordIng specIIIc InIormaIIon or ceasIng Io
record II, Ihe IoIIowIng quesIIons shouId be asked:
Is IhIs InIormaIIon requIred by reguIaIIon7
WIII IhIs InIormaIIon be used7
WIII IIs use jusIIIy Ihe cosI oI maInIaInIng II7
Can Ihe InIormaIIon be obIaIned easIIy and wIIh accuracy7
WIII Ihe process oI obIaInIng Ihe InIormaIIon conIravene or compromIse
IegIsIaIed human rIghIs7
Are secure IacIIIIIes avaIIabIe Io sIore Ihe record Ior Ihe requIred reIenIIon
perIod7
In generaI, a good occupaIIonaI heaIIh record aIIows a reader Io pIece IogeIher a
cIear and coherenI pIcIure oI workers' exposure on Ihe job, heaIIh sIaIus, IreaImenIs
and job assIgnmenIs Ior a perIod oI aI IeasI S0 years. Many assocIaIIons beIween
chronIc dIsease and occupaIIonaI exposures have been made usIng such records,
and Ihey are aIways ImporIanI IegaI documenIs.
1. VIsII Ihe medIcaI poInI aI Ihe workpIace: check Ihe records avaIIabIe and
evaIuaIe Ihe quaIIIy oI Ihe recordIng.
2. IamIIIarIze yourseII wIIh Ihe Iorms used by Ihe dIsIrIcI heaIIh care cenIre Io
coIIecI InIormaIIon on workers' heaIIh.
S. RevIew Ihe naIIonaI reguIaIIons regardIng Ihe recordIng sysIem oI occupaIIonaI
accIdenIs and IIInesses.
4. DesIgn a Iorm Ior coIIecIIng InIormaIIon Ior each Iype oI proposed record In
Ihe moduIe.
S. IamIIIarIze yourseII wIIh Ihe soIIware used Ior recordIng occupaIIonaI accIdenIs
and IIInesses.
6. IamIIIarIze yourseII wIIh Ihe InIernaIIonaI SIaIIsIIcaI CIassIIIcaIIon oI DIseases
and ReIaIed HeaIIh ProbIems oI Ihe WorId HeaIIh OrganIzaIIon.
MODULE 11
Occupational health in special
areas
1. MlNlNG
1.1 ObjecIives
Be aware oI and be abIe Io descrIbe Ihe specIaI probIems oI mInes: physIcaIIy,
chemIcaIIy, bIoIogIcaIIy and socIaIIy
Learn how Io seI prIorIIIes In order Io rank workreIaIed acIIons and acIIons
reIaIed Io sanIIary servIces
Be IamIIIar wIIh IypIcaI sIIuaIIons and IheIr probIems: specIIIcaIIy, overIoadIng,
unheaIIhy condIIIons and dusI exposure
Learn where and Io whom Io reIer Ior envIronmenIaI monIIorIng consuIIaIIons
Have IIrsIaId knowIedge
Know Ihe heaIIh sysIem, socIaI weIIare and heaIIh IegIsIaIIon
Learn Io use approprIaIe IIIeraIure, checkIIsIs and daIa sheeIs
IInd ways Io promoIe Ihe heaIIh oI Ihe worker, Io creaIe awareness and Io
Improve Ihe workIng envIronmenI
Learn accIdenI reporIIng, accIdenI InvesIIgaIIon and sImpIe accIdenI prevenIIon.
1.2 lnIroducIion
MIneraIs and mIneraI producIs are Ihe backbone oI mosI IndusIrIes. Ior many
counIrIes mInIng accounIs Ior a sIgnIIIcanI proporIIon oI Ihe gross domesIIc
producI and Ior Ihe buIk oI IoreIgn exchange earnIngs and IoreIgn InvesImenI.
MIneworkers Iace a consIanIIy changIng combInaIIon oI workpIace cIrcumsIances,
boIh daIIy and IhroughouI Ihe work shIII. Some work In an aImosphere IhaI Is
wIIhouI naIuraI IIghI or venIIIaIIon. DespIIe Ihe consIderabIe eIIorIs In many
deveIopIng counIrIes, Ihe IoII oI deaIh, Injury and dIsease among mIneworkers
means IhaI, In mosI counIrIes, mInIng remaIns Ihe mosI hazardous occupaIIon
when Ihe number oI peopIe exposed Io rIsk Is Iaken InIo accounI.
1.3 RecogniIion, evaluaIion and simple conIrol ol harmlul
lacIors in mines
II):cn Inznd:
(a) NoIse
deIInIIIon
eIIecI on humans, e.g. deaIness, hearIng Ioss and psychoIogIcaI InconvenIence
prevenIIon and conIroI measures, e.g. InsIrumenI InspecIIon, encIosIng oI
source oI noIse, acousIIc barrIers Ior noIsy IooIs and ear proIecIIon devIces.
(b) VIbraIIon
deIInIIIon and exampIes oI vIbraIIng InsIrumenIs
Iypes oI vIbraIIon: nuIsance, segmenIaI and whoIe body vIbraIIon, hand-arm
vIbraIIon syndrome
basIs oI prevenIIon and conIroI measures: repaIrIng, ImprovIng or changIng
IooIs and machInery, use oI personaI proIecIIve devIces and deIermInIng oI
work and resI IIme.
(c) HeaI and humIdIIy
deIInIIIon and heaI sources
eIIecIs on humans: IaIIgue, heaI rashes, heaI exhausIIon, heaI cramps
prevenIIon and conIroI measures: use oI cooI and saIIy IIquIds, deIermInIng oI
work and resI IIme.
(d) HarmIuI radIaIIon
deIInIIIon oI IonIzIng radIaIIon
nonIonIzIng radIaIIon eIIecIs on human organs, eyes and skIn
prevenIIon and conIroI measures: suIIabIe cIoIhIng, personaI proIecIIve
equIpmenI
monIIorIng oI exIernaI radIaIIon by IIIm dosImeIers.
CIcncn Inznd:
deIInIIIon and characIerIsIIcs oI dusIs, Iumes and gases
dusIs whIch cause pneumoconIosIs, sIIIcosIs, sIIIcoIubercuIosIs
chemIcaIs whIch may mIx wIIh oxygen Io cause expIosIon
hazards oI smokIng among mIners
Ihe eIIecIs oI carbon dIoxIde, meIhane and hydrogen suIIIde on heaIIh (carbon
monoxIde, nIIrogen oxIdes)
OccuntonnI henIth n secnI nrens: ModuIe 11 143
dIeseI exhausI gases: nIIrogen oxIdes, IIne parIIcuIaIes, suIIur oxIdes, poIycycIIc
aromaIIc hydrocarbons
prevenIIon and conIroI measures: weI processes, Iess dusI producIIon, personaI
proIecIIve equIpmenI
deIermInIng oI work and resI IImes
adequaIe venIIIaIIon Ior mIners
IdenIIIIcaIIon and monIIorIng oI Ihe conIamInanIs by deIecIIon Iubes
bIoIogIcaI hazards, occupaIIonaI InIecIIons, IubercuIosIs.
Accdcnt:
causes oI accIdenIs In mInes, e.g. IIre, expIosIon
unsaIe mechanIcaI and physIcaI condIIIons
unsaIe acIs
unsaIe personaI IacIors
rIsk assessmenI and appraIsIng saIeIy perIormance
prIncIpIes oI accIdenI prevenIIon.
Igononc:
bIomechanIcaI background
physIoIogIcaI background
posIure (sIIIIng, sIandIng)
change oI posIure
hand and arm posIures
movemenIs
IIIIIng, carryIng, puIIIng, pushIng
psychosocIaI (urbanIzaIIon oI ruraI areas, nIghI shIII, conIInuous work).
HcntI nctc: n nnc:
hygIenIc IavaIory
baIh
resIauranI
dressIngroom
saIe drInkIng waIer
wasIe and sewage managemenI.
HcntI :u\cnncc
preempIoymenI examInaIIon, perIodIc examInaIIon
IesIs Ior assessmenI oI heaIIh ImpaIrmenI, e.g. Iorced vIIaI capacIIy, Iorced
expIraIory voIume, peak expIraIory IIow raIe, bIood pressure, body IemperaIure,
puIse raIe, weIghI and heIghI measuremenI.
1.4 Tasks lor Irainees
1. VIsII Ihe workpIace, coIIecI daIa abouI Ihe workers, Ihe work and work
envIronmenI.
2. SeI prIorIIIes based on observaIIons, measuremenIs, dIscussIons, eIc.
S. OIIer advIce on some sImpIe prevenIIon and conIroI measures.
4. ReIer probIems Io Ihe reIerraI sysIem whIch cannoI be soIved by Ihe communIIy
heaIIh care workers.
S. LducaIe workers on heaIIh and saIeIy.
6. AppIy IIrsI aId.
2. SMALL-SCALE lNDUSTRY
2.1 ObjecIives
Be aware oI aII heaIIh and saIeIyreIaIed hazards; Iearn how Io deIIne probIems
and specIaI needs
DescrIbe Ihe physIcaI hazards and IheIr conIroI (see 1.S)
Learn how Io seI prIorIIIes In order Io rank acIIons
IamIIIarIze yourseII wIIh Ihe IypIcaI probIems assocIaIed wIIh smaIIscaIe
IndusIry, e.g. Iong workIng hours, absence oI hoIIdays, Iack oI medIcaI care and
socIaI Insurance
Know Ihe heaIIh sysIem, socIaI weIIare and IegIsIaIIon
Have IIrsI aId knowIedge
Learn how Io use approprIaIe IIIeraIure, checkIIsIs and daIa sheeIs
IInd ways Io promoIe Ihe heaIIh oI Ihe worker, Io creaIe awareness and Io
Improve Ihe workIng envIronmenI.
2.2 DeliniIion
There Is no InIernaIIonaIIy agreed deIInIIIon oI a smaIIscaIe IndusIry. VarIous
parameIers can be used Io deIIne II, e.g.
number oI empIoyees
amounI oI capIIaI InvesIed
annuaI Iurnover or saIes
amounI oI raw maIerIaIs used
degree oI mechanIzaIIon and auIomaIIon.
2.3 Working condiIions
In mosI InsIances, workIng condIIIons In smaIIscaIe enIerprIses do noI compare
IavourabIy wIIh Ihe Iarger and more aIIIuenI IndusIrIes: Iow wages, poor workIng
pracIIces, Iack oI resources and a reIaIIveIy hazardous work envIronmenI are Ihe
major IacIors aIIecIIng condIIIons In Ihe IndusIrIaI secIor.
The hours oI work are Iong. A 12hour work shIII and a 7day week are common.
Young chIIdren may be empIoyed, even In heavy work. MachInery used may be
obsoIeIe In desIgn and noI properIy maInIaIned, IncreasIng Ihe possIbIIIIy oI
accIdenIs and exposure Io hazards. Work sIIes may be sIIuaIed In IamIIy dweIIIngs,
posIng hazards noI onIy Io Ihe workers buI Io Ihe oIher IamIIy members as weII, or
In sIum areas where overcrowdIng, heaI, dusI and poor venIIIaIIon are consIanI
probIems.
The sIandards oI sanIIaIIon, hygIene, IIre saIeIy, proIecIIve equIpmenI and IIrsI aId
are generaIIy Iow. Workers who suIIer accIdenIs may noI be covered by
compensaIIon and workers may noI even be paId on IIme. These condIIIons
conIrIbuIe Io Ihe generaIIy poor workIng envIronmenI oI Ihese IndusIrIes.
The IypIcaI worker In a smaIIscaIe enIerprIse In deveIopIng counIrIes has a Iow IeveI
oI educaIIon and comes Irom Ihe IowesI economIc IeveI oI socIeIy. HIs/her
nuIrIIIonaI IeveI and generaI sIaIe oI heaIIh are usuaIIy beIow IdeaI. ThIs, combIned
wIIh a work envIronmenI IhaI Is oIIen hoI, humId, overcrowded and where
hazardous subsIances are oIIen handIed and processed wIIhouI even eIemenIary
saIeIy precauIIons, creaIes a sIIuaIIon wIIh an overwheImIng need Ior occupaIIonaI
heaIIh servIces.
2.4 HealIh condiIions ol workers
Incto: ncctng tIc IcntI o \oc:
sIaIe oI Ihe heaIIh oI Ihe worker beIore he/she sIarIed workIng
workIng condIIIons prevaIIIng In Ihe workpIace
avaIIabIIIIy and accessIbIIIIy oI heaIIh and saIeIy servIces aI Ihe workpIace,
IncIudIng provIsIons Ior perIodIc medIcaI examInaIIons
awareness oI Ihe worker and hIs/her manager oI Ihe hazards InherenI In Ihe
work envIronmenI
degree oI enIorcemenI and compIIance wIIh Ihe IegaI provIsIons Ior occupaIIonaI
heaIIh and saIeIy servIces.
Innnctc: n tIc n::c::ncnt o tIc IcntI condton: o \oc:
AIIer IIndIng Ihese IacIors Io be adverse and unIavourabIe In many smaIIscaIe
IacIorIes, one can expecI IhaI Ihe heaIIh oI workers In Ihese IacIorIes wIII be graveIy
aIIecIed. VarIous parameIers have been used Io assess workers' heaIIh:
IncIdence oI accIdenIs and InjurIes
sympIoms reIaIed Io occupaIIons
Iung IuncIIon IesIs
audIomeIry
urIne and bIoodIead examInaIIons.
2.5 MeIhods ol prevenIion and inIervenIion
Increase awareness In occupaIIonaI heaIIh and saIeIy among managers oI
smaIIscaIe IndusIrIes as weII as Ihe workers IhemseIves
IInd IowcosI aIIernaIIves Io heaIIh care deIIvery In Ihe IndusIrIaI secIor
LnacI enIorceabIe Iaws appIIcabIe Io IhIs probIem where none exIsI as yeI
ProvIde IncenIIves and moIIvaIIon Io compIy wIIh such Iaws and enIorce Ihem
wIIh penaI provIsIons II necessary.
2.6 Tasks lor Irainees
1. VIsII a workpIace, coIIecI daIa abouI workers, Ihe work and Ihe work envIronmenI.
2. SeI prIorIIIes based on observaIIons, measuremenIs, dIscussIons, eIc.
S. OIIer advIce on some sImpIe prevenIIve and conIroI measures.
4. IInd ouI where Io reIer probIems IhaI cannoI be soIved by Ihe communIIy
heaIIh worker.
S. LducaIe workers on heaIIh and saIeIy.
6. AppIy IIrsI aId.
3. AGRlCULTURAL AND RURAL AREAS
3.1 ObjecIives
Have an Idea abouI generaI work condIIIons, envIronmenIaI hazards and Ihe
maIn heaIIh probIems In Ihe agrIcuIIure and ruraI areas
Know how Io survey workpIaces usIng sImpIe meIhods
Know how Io decIde Io reIer cases Io Ihe hospIIaI or heaIIh cenIre II requIred
Know how Io recognIze generaI heaIIh probIems oI workers wheIher or noI Ihey
are workreIaIed
Know how Io keep records and wrIIe reporIs.
3.2 General condiIions and problems ol lile in rural areas
IcnognIc
hIgh proporIIon oI chIIdren
dIsproporIIonaIe Iow number oI young aduII maIes
women and chIIdren parIIcIpaIe Io a greaI exIenI In Ihe workIorce.
5ococcononc
decrease In Ihe agrIcuIIuraI Iand avaIIabIe wIIh Ihe conIInuous and progressIve
Increase In Ihe sIze oI Ihe popuIaIIon
soII Ioss
deserIIIIcaIIon
mIgraIIon oI Iarmers.
Hou:ng
poor buIIdIng maIerIaIs
Iack oI InIernaI pIannIng and sanIIary prIncIpIes
poIenIIaI Ior ouIbreak oI IIre and IgnIIIon sources
IIvesIock and pouIIry housed In Ihe same dweIIIng as Ihe Iarmer.
Wntc
prevaIence oI waIerborne dIseases
Iack oI ruraI waIer suppIy sysIem.
5c\ngc nnd \n:tc d:o:n
dung mIxed wIIh garbage as manure
poor baIhIng and washIng IacIIIIIes
use oI rIvers and canaIs as dIsposaI IacIIIIIes.
Nutton
undernuIrIIIon due Io overpopuIaIIon/Iand area
poor nuIrIIIonaI habIIs
mIcronuIrIenI deIIcIency
prevaIence oI endemIc parasIIIc dIsease
hIgh meIaboIIc requIremenIs due Io hIgh meIaboIIc expendIIure In agrIcuIIuraI
acIIvIIIes.
Iducnton
poor and InadequaIe educaIIon
scarce IeachIng IacIIIIIes
hIgh absenIee raIes oI ruraI chIIdren
Iack oI IransporIaIIon IacIIIIIes and bad weaIher.
Tnn:otnton nnd connuncnton
poor sIaIe oI counIry roads and IeIephone servIces
Iack oI markeIIng and medIcaI care.
CotIng
poor quaIIIy
Iack oI personaI proIecIIon equIpmenI.
3.3 CharacIerisIics ol agriculIural work
Iype oI work
pIace oI work
Ihe agrIcuIIuraI worker:
sharecropper
seIIempIoyed
paIdworker
mobIIe Iemporary worker.
3.4 OccupaIional hazards in agriculIure
II):cn Inznd:
heaI and humIdIIy
coId
soIar rays
noIse
vIbraIIon (segmenIaI or whoIe body).
CIcncn Inznd:
pesIIcIdes
IerIIIIzers
anImaI Ieed addIIIves.
oogcn Inznd:
zoonoses
snakebIIes and InsecI and scorpIon sIIngs
major communIcabIe occupaIIonaI dIseases.
Iu:t Inznd:
Irom soII, pIanIs or anImaIs
may conIaIn sIIIca, IungaI maIIer, anImaI maIIer, IncIudIng InsecIs and excreIa,
sIorage mIIes, graIn dusI and IIour dusI
aIso may conIaIn agrIcuIIuraI chemIcaIs such as IerIIIIzers and pesIIcIdes.
Igononc Inznd:
heavy work
repeIIIIve Iasks
poor ergonomIc desIgn oI IooIs and equIpmenI
IncorrecI workIng habIIs.
Occuntonn nccdcnt: nnd Inznd:
The raIe oI accIdenIaI deaIh In agrIcuIIure Is one oI Ihe hIghesI compared wIIh
oIher branches oI producIIon.
The raIe oI serIous as weII as mInor accIdenIs Is, on average, hIgher In
agrIcuIIure Ihan In aII oIher occupaIIons.
IaIaIIIIes are caused mosI oIIen by machInes, especIaIIy IracIors; anImaIs, e.g.
buIIs, horses; IaIIs; snakebIIes; IIre and chemIcaIs, e.g. pesIIcIdes.
NonIaIaI InjurIes are oIIen caused by Iarm machInes, hand IooIs, physIcaI
sIraIn, anImaIs, sIIppIng and IaIIs.
MuscuIoskeIeIaI dIsorders due Io ergonomIc hazards are common.
3.5 PrevenIion
envIronmenIaI conIroI
heaIIh educaIIon
personaI proIecIIon equIpmenI.
3.6. Tasks lor Irainees
1. AssIsI In perIormIng sImpIe dIagnosIIc IesIs Ior zoonoIIc dIseases.
2. AssIsI IaboraIory IechnIcIans In sIooI and urIne anaIysIs Ior parasIIIc and
endemIc dIseases.
S. HeIp In assessmenI oI pesIIcIdes or IheIr end producIs and meIaboIIIes In
bIoIogIcaI sampIes.
4. RecognIze specIIIc anIIdoIes Ior pesIIcIdes and cerIaIn oIher agrochemIcaIs.
S. Carry ouI IIrsI aId IreaImenI Ior cases InIoxIcaIed by chemIcaIs or pesIIcIdes.
6. Survey workpIaces usIng sImpIe meIhods and IechnIques.
7. CoIIecI bIoIogIcaI and envIronmenIaI sampIes.
8. IdenIIIy possIbIe and poIenIIaI sources oI Injury In Ihe agrIcuIIuraI workpIace.
9. RecognIze generaI heaIIh probIems oI agrIcuIIuraI workers and wheIher or noI
Ihey are workreIaIed.
10. ReIer paIIenIs when necessary Io Ihe approprIaIe unII In Ihe heaIIh servIce
sysIem.
11. LducaIe and advIse workers on heaIIh and saIeIy probIems In agrIcuIIure.
12. Keep records oI IndIvIduaI workers as weII as records oI workIng groups and
surveys.
1S. AssocIaIe wIIh members oI Ihe occupaIIonaI heaIIh Ieam, reporI IheIr
observaIIons and consuII wIIh Ihem regardIng conIroI measures, Ihe need Ior
envIronmenIaI and bIoIogIcaI monIIorIng and Ihe managemenI oI cerIaIn work
reIaIed or occupaIIonaI heaIIh probIems where appIIcabIe.
14. AssIsI In sanIIaIIon oI Ihe workpIace wIIh regard Io waIer, wasIe, Iood, eIc.
1S. DeIecI and reporI on communIcabIe, endemIc, parasIIIc, occupaIIonaI and
workreIaIed dIseases In Ihe workpIace.
16. MaInIaIn consIanI surveIIIance and checkIng oI proper usage oI personaI
proIecIIve equIpmenI and measurIng devIces.
17. ParIIcIpaIe wIIh Ihe managers and saIeIy personneI In ImpIemenIaIIon oI
occupaIIonaI heaIIh programmes.
18. RecognIze earIy sIgns oI poIsonIng and respond approprIaIeIy.
19. Check anImaIs In Ihe area daIIy In order Io deIecI any dIseased anImaIs as earIy
as possIbIe.
20. Be capabIe oI exIracIIng an Injured worker Irom agrIcuIIuraI equIpmenI
wIIhouI IurIher Injury.
21. SIudy and consIder Ihe possIbIIIIy oI Ihe human IacIor In any occupaIIonaI
accIdenI.
22. LducaIe agrIcuIIuraI workers abouI Ihe causes oI heaI sIroke.
2S. SpoI cases oI heaI sIroke and Ihen conIIrm by IakIng body IemperaIure and
observIng physIcaI sympIoms.
24. Know how Io admInIsIer ImmedIaIe IIrsI aId IreaImenI Ior cases wIIh heaI
sIroke.
2S. HeIp wIIh Ihe appIIcaIIon oI research projecIs accordIng Io esIabIIshed prIorIIIes
usIng Ihe sImpIesI meIhods and IechnIques.
26. Make a heaIIh map oI an area, hIghIIghIIng rIsk areas and IdenIIIyIng rIsk
IacIors In order Io ImpIemenI approprIaIe meIhods Io conIroI and soIve
probIems.
MODULE 12
Occupational health for women
and children
1. WORKlNG WOMEN
1.2 ObjecIives
Know Ihe ImpacI oI occupaIIonaI hazards on workIng women's heaIIh
Have approprIaIe IraInIng on prImary heaIIh care Ior workIng women
ApprecIaIe Ihe ImporIance oI Ihe exIensIon oI maIernaI and chIId heaIIh as
componenIs oI prImary heaIIh care InIo Ihe workpIace
Be acquaInIed wIIh Ihe reproducIIve heaIIh probIems oI workIng women In
varIous occupaIIons
Know Ihe prevenIIve heaIIh measures IhaI wIII have an ImpacI on workIng
women's heaIIh.
1.2 OccupaIional hazards
The number oI women joInIng Ihe workIorce has sIeadIIy Increased aII over Ihe
worId durIng Ihe IasI Iew decades.
ThroughouI hIsIory, women In deveIopIng counIrIes have aIways worked hard, noI
onIy as wIves and moIhers buI aIso as workers In dIIIerenI secIors. OIIen encumbered
wIIh many chIIdren and weakened by excessIve and IrequenI pregnancIes, workIng
women are subjecI Io numerous rIsks e.g. IaIIgue, maInuIrIIIon, undue menIaI sIress
and exposure Io varIous hazards aI IheIr workpIaces.
DomesIIc work exposes women Io many hazards whIch may undermIne IheIr heaIIh,
e.g. accIdenIs, burns, backache Irom bendIng, and chemIcaI exposure Irom
deIergenIs, resuIIIng In skIn probIems such as dermaIIIIs.
In many counIrIes, IndusIrIaI expansIon has occurred wIIhouI suIIIcIenI proIecIIve
measures Ior workers. Women are under specIaI pressure sInce, In many InsIances,
IheIr jobs are consIdered by managemenI Io be oI secondary ImporIance and
medIcaI IacIIIIIes are consequenIIy InadequaIe.
IemaIe workers dIIIer Irom maIe workers In IhaI Ihey are generaIIy physIcaIIy
smaIIer and are subjecI Io specIIIc sIressIuI condIIIons pecuIIar Io Ihem, e.g.
mensIruaIIon, pregnancy and IacIaIIon. PHC workers carIng Ior workIng women
shouId be aware oI such condIIIons and IheIr possIbIe eIIecIs on work perIormance,
and Ihe eIIecI oI Ihe work envIronmenI on Ihe heaIIh oI women aI Ihese IImes, e.g.
Ihere Is a progressIve Increase In respIraIory venIIIaIIon durIng pregnancy whIch
may Iead Io Increased upIake oI InhaIed chemIcaIs Irom Ihe aIr.
I:)cIo:ocn ocn:
SIressreIaIed Issues are encounIered In nearIy aII jobs heId by workIng women. The
majorIIy oI women are sIIII empIoyed In IowpayIng jobs. Ior a sIngIe moIher, a Iow
wage and Ihe home obIIgaIIons oI carIng Ior chIIdren and doIng Ihe housework can
be parIIcuIarIy serIous causes oI sIress.
SIress aI work can come Irom many sources, e.g.:
oIIIce workers and assembIy IIne workers In IacIorIes have demandIng and
repeIIIIve jobs, whIch cause sIress
nurses oIIen experIence sIress because IheIr work Is physIcaIIy heavy and
hecIIc.
CIcncn ngcnt:
Due Io Ihe hIgher conIenI oI body IaI In women Ihan men, IoxIc subsIances such as
organIc soIvenIs are reIaIned more easIIy by women. Some sIudIes suggesI IhaI
exposure Io organIc soIvenIs causes mensIruaI dIsIurbances. Some meIaIs, e.g. Iead,
can cause sponIaneous aborIIon. AIso some chemIcaIs used In hospIIaIs, e.g.
eIhyIene oxIde, are known Io cause aborIIon.
Many women are engaged In agrIcuIIuraI acIIvIIIes whIch means Ihey are exposed Io
pesIIcIdes and IerIIIIzers. Some oI Ihe pesIIcIdes used In agrIcuIIure are suspecIed
Io cause reproducIIve damage In women. Women workIng In IexIIIe mIIIs are
exposed Io organIc dusIs, e.g. coIIon, whIch causes byssInosIs.
II):cn ngcnt:
Women workIng In Ihe IexIIIe IndusIry are exposed Io noIse, vIbraIIon and heaI
sIress, parIIcuIarIy In Ihe spInnIng and weavIng secIIons. NoIse causes
vasoconsIrIcIIon whIch may Iead Io Iow bIrIh weIghI oI babIes. SIudIes have shown
IhaI women are more suscepIIbIe Io whoIe body vIbraIIon and heaI sIress. WhoIe
body vIbraIIon may damage Ihe reproducIIve sysIem. RadIaIIon may aIso cause a
probIem. In addIIIon poor IIghIIng Is noI uncommon In many jobs IeadIng Io eye
damage.
oogcn ngcnt:
Nurses may be exposed Io IubercuIosIs, hepaIIIIs B, rubeIIa vIrus, Toxon:nn gond,
AIDS, eIc. Women empIoyed In agrIcuIIure are exposed Io snake bIIes, schIsIosoma,
worm InIesIaIIon, IeIanus, eIc.
Igononc ocn:
BodIIy dImensIons are an ImporIanI consIderaIIon In physIcaI work perIormance and
machIne desIgn and operaIIon. Many IndusIrIaI and agrIcuIIuraI processes and
machInery are desIgned Ior maIe workers makIng many machInes dIIIIcuII Ior
IemaIe workers Io operaIe.
OccuntonnI henIth ]or wonen nnd chIdren: ModuIe 12 155
1.3 OccupaIional healIh services lor working women
OccupaIIonaI heaIIh servIces shouId be esIabIIshed aI aII workpIaces Io ensure IhaI
Ihe IoIaI heaIIh and saIeIy needs oI workIng women are meI. UnIorIunaIeIy, In many
counIrIes Ihey are noI accessIbIe Io Iarge numbers oI workers, especIaIIy In
agrIcuIIure and smaIIscaIe IndusIrIes. In Ihese cases, PHC servIces shouId caIer Io
Ihe specIIIc needs oI workIng women.
GeneraIIy, Ihe IoIIowIng poInIs are oI parIIcuIar reIevance Io occupaIIonaI heaIIh
care programmes Ior workIng women.
5ccn IcntI cducnton
HeaIIh and saIeIy InspecIors, occupaIIonaI heaIIh InspecIors, empIoyers and heaIIh
poIIcy makers shouId receIve specIaI IraInIng In heaIIh educaIIon Ior IemaIe workers.
LducaIIon concernIng heaIIh rIsks, IncIudIng reproducIIve rIsks Ior men and women
as weII as poIenIIaI eIIecIs on Ihe IoeIus, and IraInIng In Ihe saIe use oI chemIcaIs,
musI be prIorIIIzed.
Kcgunton: to :ncgund \ong \oncn
ReguIaIIons and sIandards appIyIng Io Ihe enIIre Iabour Iorce shouId be revIewed
conIInuousIy Ior IheIr reIevance and adequacy Io IemaIe workers. II Is oI specIaI
ImporIance IhaI saIe workIng condIIIons are ensured Ior IemaIe workers, and
pregnanI workers In parIIcuIar. II Is ImporIanI Io prevenI occupaIIonaI hazards IhaI
are parIIcuIarIy harmIuI Io women. MInImum sIandards shouId be seI up Ior
anIhropomeIrIc parameIers and physIcaI capacIIy Io be used In preempIoymenI
examInaIIons.
In\onncntn nontong
The roIe oI Ihe IndusIrIaI hygIenIsI Is Io monIIor Ihe workIng envIronmenI Ior
poIenIIaI hazards. LnvIronmenIaI monIIorIng shouId be carrIed ouI reguIarIy Io
IdenIIIy probIems whIch couId aIIecI Ihe heaIIh oI workIng women. OccupaIIonaI
hygIene sIandards shouId be recommended Ior varIous Iypes oI exposure, e.g. Iead,
soIvenIs, pesIIcIdes, eIc.
Ic-nccncnt ncdcn cxnnnnton
These shouId be used Io heIp In Ihe proper pIacemenI oI women In jobs approprIaIe
Io IheIr physIcaI, physIoIogIcaI and psychoIogIcaI capabIIIIIes.
Icodcn ncdcn cxnnnnton:
WorkIng women shouId undergo reguIar medIcaI examInaIIon, especIaIIy Ihose aI
parIIcuIar rIsk.
Iquncnt dc:gn
The desIgn oI IooIs, machInes and equIpmenI shouId Iake InIo accounI Ihe
anaIomIcaI IeaIures and physIoIogIcaI capabIIIIIes oI women.
InIn:: on undc:c\cd \ong \oncn
PHC shouId Iocus on underserved workIng women, especIaIIy Ihose empIoyed In
agrIcuIIure and smaIIscaIe IndusIrIes. In addIIIon, maIernaI and chIId heaIIh
servIces shouId be avaIIabIe Io such women.
Kc:cncI nnd :u\c):
Research shouId be carrIed ouI on Ihe eIIecIs on IemaIe workers oI specIIIc hazards
assocIaIed wIIh a wIde varIeIy oI exposure condIIIons.
Woncn': gIt:
In addIIIon Io receIvIng InIormaIIon on occupaIIonaI heaIIh and saIeIy, workIng
women shouId aIso be InIormed oI IheIr rIghIs In connecIIon wIIh heaIIh, maIernIIy
and chIId care. II shouId aIso be ensured IhaI women have suIIIcIenI resI In Ihe IasI
IrImesIer oI pregnancy and durIng breasIIeedIng.
Woncn': ::uc:
In pIannIng PHC servIces Ior workIng women II Is essenIIaI Io consIder Issues
specIIIc Io Ihem and Io IncIude Ihe basIc eIemenIs oI maIernIIy proIecIIon, IamIIy
pIannIng (Ihe responsIbIIIIy oI men and women) and counseIIIng.
1.4 Work exposure and pregnancy
The poIenIIaI Ior reproducIIve hazards Induced by workpIace exposure Is wIdeIy
recognIzed. These IncIude:
InIerIIIIIy
sponIaneous aborIIon
maIIormaIIon
perInaIaI morIaIIIy
Iow bIrIh weIghI
deveIopmenIaI ImpaIrmenI
chIIdhood cancer.
OI Ihese, sponIaneous aborIIon and maIIormaIIon In Ihe oIIsprIng have aIIracIed
mosI aIIenIIon In Ihe occupaIIonaI seIIIng. Ior many ouIcomes II has been
suspecIed IhaI boIh IemaIe and maIe exposure may be Ihe underIyIng cause.
However, mosI sIudIes and Ihe besI evIdence reIaIe ouIcome Io Ihe exposure oI Ihe
woman durIng pregnancy.
1.5 Risk lacIors ldenIilied in cerIain occupaIions and indusIries
HeaIIh care occupaIIons may InvoIve exposure Io many kInds oI reproducIIve IoxIns.
OccupaIIonaI IacIors whIch may carry a rIsk oI sponIaneous aborIIon IncIude:
anaesIheIIc gases
eIhyIene oxIde (sIerIIIzIng gases)
anIIneopIasIIc agenIs
organIc soIvenIs
meIhyIene chIorIde
IeIrachIoroeIhyIene
aIIphaIIc hydrocarbons
conIacI wIIh IurbearIng anImaIs
IIIIIng heavy burdens
Xrays.
AnaesIheIIc gases were Ihe IIrsI gases suspecIed oI causIng harm Io Ihe IoeIus.
Lxposure has been eIIecIIveIy reduced In many counIrIes. RecenI sIudIes have noI
Iound a sIgnIIIcanIIy Increased rIsk Ior sponIaneous aborIIon and congenIIaI
maIIormaIIon. Lxposure Io eIhyIene oxIde, a gas used Ior sIerIIIzIng, Increased Ihe
rIsk oI sponIaneous aborIIons. HandIIng oI anIIneopIasIIc drugs In hospIIaIs
Increases Ihe rIsk oI sponIaneous aborIIon and maIIormaIIon In Ihe oIIsprIng.
OccupaIIonaI IacIors appearIng Io carry a rIsk oI maIIormaIIons or IuncIIonaI
deIecIs:
(a) MaIIormaIIon
organIc soIvenIs
anIIneopIasIIc agenIs
IonIzIng radIaIIon (Xrays, radIoacIIve IsoIopes)
(b) IuncIIonaI deIecI
Iead (decreased cognIIIve capacIIy)
noIse (hearIng Ioss).
The harmIuI eIIecIs oI IonIzIng radIaIIon are known, and exposure In medIcaI
occupaIIons Is conIroIIed. HeaIIh care work predIsposes personneI Io conIagIous
dIseases, among whIch HIV Is a promInenI probIem.
AccordIng Io severaI sIudIes, exposure Io organIc soIvenIs and/or IaboraIory work
durIng pregnancy may Increase Ihe rIsk oI sponIaneous aborIIon and congenIIaI
maIIormaIIon. AIIhough exposure Io soIvenIs Is common In numerous IndusIrIes
and occupaIIons, II has been dIIIIcuII Io esIabIIsh wheIher specIIIc soIvenIs, or IheIr
combInaIIons, or soIvenIs In generaI are responsIbIe.
Lxposure Io heavy meIaIs such as Iead Is suspecIed oI causIng reproducIIve IoxIcIIy.
QuIIe Iow exposure durIng pregnancy may harm Ihe cognIIIve deveIopmenI oI Ihe
chIId.
OIher occupaIIonaI IacIors whIch shouId especIaIIy be conIroIIed Ior durIng
pregnancy IncIude:
heavy meIaIs
PCBs (poIychIorInaIed bIphenyIs)
pesIIcIdes
carbon monoxIde
carcInogens.
IngesIIon oI Iood oII conIaInIng PCBs has caused dIsIurbances In chIIdren, wIIh some
newborns oI exposed moIhers exhIbIIIng smaII sIze, dIscoIoraIIon oI skIn and naIIs
and premaIure erupIIon oI IeeIh. ThIs sIgnaIs concern Ior occupaIIonaI exposures
Ioo.
Carbon monoxIde Is a known asphyxIanI Ior Ihe IoeIus. OccupaIIonaI exposure
durIng pregnancy shouId be avoIded; neverIheIess, exposure occurs mosIIy vIa Ihe
moIher smokIng.
There are pIenIy oI oIher chemIcaIs whIch are suspecIed Io be reproducIIve IoxIns
and numerous IndusIrIes are hazardous Irom Ihe poInI oI vIew oI reproducIIon. In
generaI, exposure Io known carcInogenIc and muIagenIc agenIs shouId be avoIded
durIng pregnancy because Ihey are poIenIIaIIy harmIuI Io Ihe IoeIus. Damage by
Ihese agenIs Io Ihe gameIes Is aIso possIbIe prIor Io concepIIon.
CongenIIaI maIIormaIIons and sponIaneous aborIIons are Ihe ouIcomes mosI wIdeIy
InvesIIgaIed so Iar. ReporIed epIsodes oI breasI mIIk conIamInaIIon have been
mosIIy due Io envIronmenIaI poIIuIIon, buI II shouId noI be overIooked In
occupaIIons where exposure Io subsIances IhaI may accumuIaIe In Ihe body, e.g.
PCBs and Iead, Is possIbIe. AIIenIIon shouId aIso be paId Io oIher exposures (e.g.
soIvenIs) when Ihe moIher Is workIng durIng Ihe breasI IeedIng perIod.
The producIIon and IabrIcaIIon oI pIasIIcs may IncIude exposure Io Ihe monomers
or Io Ihe IhermodegradaIIon producIs oI Ihe pIasIIcs. The IexIIIe IndusIry has many
possIbIe reproducIIve IoxIns. HaIrdressers use many chemIcaIs oI poIenIIaI IoxIcIIy
and IIIghI sIewardesses suIIer more IrequenIIy Irom mensIruaI dIsorders.
The agrIcuIIuraI secIor Is oIIen IhoughI oI as a saIe workpIace buI II Ioo can pose
IhreaIs Io women's heaIIh. In agrIcuIIure, IIIIIe dIsIIncIIon Is made beIween
workpIace envIronmenI and IIvIng envIronmenI, and Iarm workers are whoIIy
dependenI on Ihe Iarmer Ior subsIsIence, IeIsure IIme and housIng. WorkIng women
In agrIcuIIure Iace Ihe rIsks oI InadequaIe proIecIIon Irom IoxIc subsIances, such
as pesIIcIdes, herbIcIdes, dIppIng chemIcaIs, paInI, IerIIIIzers and IueI. IarmIng aIso
InvoIves exposure Io bIoIogIcaI agenIs, such as mIcrobes, mIcrobIaI IoxIns and
mycoIoxIns. BIoIogIcaI exposures In agrIcuIIure Is sIgnIIIcanI and may become
probIemaIIc wIIh new bIoIechnoIogy.
PhysIcaI and psychophysIoIogIcaI IacIors may pIay a roIe In reproducIIve hazards.
The IeraIogenIc and oIher harmIuI eIIecIs oI IonIzIng radIaIIon (e.g. Xrays,
radIoIsoIopes) on Ihe IoeIus are known. ThIs InIormaIIon Is Iaken InIo accounI In
many counIrIes where Ihe exposure oI pregnanI women Is resIrIcIed by Iaw. The
eIIecIs oI nIghI work, heavy IIIIIng, hIgh IemperaIures and whoIe body vIbraIIon, as
weII as work wIIh vIsuaI dIspIay IermInaIs, need Io be sIudIed IurIher.
1.6 Tasks lor Ihe Irainees
1. DescrIbe Ihe maIn occupaIIons In whIch women In your area work.
2. CharacIerIze Ihe adverse heaIIh rIsks whIch workIng women are exposed Io In
Ihese occupaIIons.
S. LIsI Ihe mosI ImporIanI PHC servIces In your IacIIIIy whIch may be beneIIcIaI
Io workIng women.
4. PrIorIIIze Ihe heaIIh educaIIon IopIcs you recommend Io educaIe workIng
women wIIhIn cerIaIn occupaIIons.
2. CHlLD LABOUR
2.1 ObjecIives
Know Ihe ImpacI oI occupaIIonaI hazards on Ihe growIh oI workIng chIIdren
Be aware oI Ihe consequences oI chIId Iabour on Ihe communIIy In generaI
Know II a chIId's Injury or IIIness Is workreIaIed
Know how Io Ieach heaIIh educaIIon Io workIng chIIdren, IheIr empIoyers,
parenIs, Ieachers and Ihe communIIy.
2.2 DeliniIions and basic concepIs
ChIId Iabour Is deIIned as Ihe paId empIoymenI oI chIIdren younger Ihan 18 years
oI age.
1
The IegaI mInImum age IImIIs Ior work dIIIer Irom counIry Io counIry and
Irom acIIvIIy Io acIIvIIy. Many counIrIes make a dIsIIncIIon beIween IIghI and
hazardous work wIIh Ihe mInImum age Ior Ihe Iormer generaIIy beIng 12, Ior Ihe
IaIIer usuaIIy varyIng beIween 16 and 18. The InIernaIIonaI Labour OrganIsaIIon
MInImum Age ConvenIIon (No. 1S8, 197S) aIso broadIy adopIs IhIs approach,
aIIowIng IIghI work aI age 12 or 1S buI hazardous work noI beIore 18. NeverIheIess,
Ihe ILO aIso esIabIIshes a generaI mInImum age oI 1S years, provIdIng 1S Is noI Iess
Ihan Ihe age oI compIeIIon oI compuIsory schooIIng.
ChIId Iabour can be broken down InIo seven maIn Iypes, none oI whIch Is unIque Io
any counIry or regIon oI Ihe worId:
domesIIc servIce
Iorced and bonded Iabour
commercIaI sexuaI expIoIIaIIon
IndusIrIaI and pIanIaIIon work
sIreeI work
work Ior Ihe IamIIy
gIrIs' work.
1
LandrIgan P| eI aI. ChIId Iabor. Icdntc nnnn:, 199S, 24:6S7-62.
1bU OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
MosI chIIdren who work do noI have Ihe power oI Iree choIce. ChIId Iabour Is
assocIaIed wIIh poverIy, InadequaIe educaIIonaI opporIunIIIes and IaIIure Io enIorce
reIevanI Iaws and sIandards. ParIIcuIarIy severe chIId abuses have been documenIed
In socaIIed Iree enIerprIse zones, I.e. specIaI IndusIrIaI areas where Iabour and
envIronmenIaI Iaws are noI enIorced.
IIIegaI chIId Iabour Is wIdespread and hundreds oI mIIIIons oI chIIdren aII over Ihe
worId are empIoyed under unIawIuI condIIIons. AccordIng Io Ihe ILO aI IeasI 200
mIIIIon chIIdren under Ihe age oI 14 are empIoyed worIdwIde.
IIIegaI empIoymenI oI chIIdren occurs In aII IndusIrIaI secIors and oIIen under
sweaIshop condIIIons. A sweaIshop Is deIIned as an esIabIIshmenI IhaI vIoIaIes
wage, hour and chIId Iabour Iaws as weII as Ihe Iaws proIecIIng occupaIIonaI saIeIy
and heaIIh.
2
HeaIIh and saIeIy condIIIons In sweaIshops are oIIen dangerous.
A decade ago, UNICLI deIermIned IhaI chIId Iabour was expIoIIaIIve II II InvoIved:
IuIIIIme work aI Ioo earIy an age
Ioo many hours spenI workIng
work IhaI exerIs undue physIcaI, socIaI or psychoIogIcaI sIress
work and IIIe on Ihe sIreeIs In bad condIIIons
InadequaIe pay
Ioo much responsIbIIIIy
work IhaI hampers access Io educaIIon
work IhaI undermInes chIIdren's dIgnIIy and seIIesIeem, such as sIavery or
bonded Iabour and sexuaI expIoIIaIIon
work IhaI Is deIrImenIaI Io IuII socIaI and psychoIogIcaI deveIopmenI.
2.3 Why children work
PoverIy (poor economIc and socIaI envIronmenI) has aIways been Ihe reason
IhaI chIIdren work. ChIIdren oI IandIess peasanIs or oI underempIoyed parenIs
are aI greaIer rIsk sInce, by workIng, Ihey can conIrIbuIe subsIanIIaIIy Io Ihe
IamIIy Income.
ChIIdren workIng In expIoIIaIIve, harmIuI condIIIons oIIen come Irom
dIsadvanIaged and economIcaIIy vuInerabIe popuIaIIon groups, IncIudIng
IemaIeheaded househoIds, Iower casIes, IndIgenous or IrIbaI peopIe and
mIgranI IamIIIes.
ChIIdren In IradIIIonaI socIeIIes, usuaIIy In IheIr cIoseIy knII IamIIy sIIuaIIons,
are senI Io work by parenIs who consIder work an essenIIaI parI oI deveIopmenI
and socIaIIzaIIon.
2
US GeneraI AccounIIng OIIIce. 5\cnt:Io: nnd cId nou \onton:: n go\ng ocn n
tIc Untcd 5tntc:. WashIngIon DC, GovernmenI PrInIIng OIIIce, 1989.
OccuntonnI henIth ]or wonen nnd chIdren: ModuIe 12 1b1
ChIId Iabour Is aIso generaIed by deIIcIencIes In educaIIonaI sysIems. SchooIs
may noI represenI a possIbIe way Io geI ouI oI poverIy. GIven Ihe Iow quaIIIy
and ImpIIed cosIs oI Ihe educaIIon servIces avaIIabIe Io Ihe poor, many parenIs,
havIng IhemseIves worked as chIIdren, Iend Io consIder an earIy enIry InIo Ihe
Iabour markeI, raIher Ihan schooIIng, as Ihe besI way Io equIp IheIr chIIdren
wIIh skIIIs useIuI Ior IheIr IuIure as aduIIs.
2.4 Work and healIh ol a child
Many oI Ihose who supporI Ihe argumenI IhaI chIIdren have Io work Io survIve In
some sIIuaIIons sIrongIy beIIeve IhaI work has someIhIng Io do wIIh promoIIon oI
a chIId's heaIIh. TheIr reasonIng: when a chIId earns an Income, such Income wIII be
used Io buy Iood, cIoIhIng and, aI IImes, sheIIer. And, such a chIId wouId be
proIecIed Irom aII Iorms oI IroubIe, e.g. roamIng Ihe sIreeIs. In a sIIuaIIon where
Ihe chIId Is Ihe onIy wage earner, Ihe chIId's IamIIy Is supposed Io beneIII and be
abIe Io supporI oIher IamIIy members more eIIecIIveIy. They reason IhaI work In
IhIs conIexI may enhance boIh Ihe chIId's and Ihe IamIIy's capabIIIIy Iowards good
heaIIh.
S
Con:cqucncc: o Inzndou: \o o cIdcn': IcntI
WhIIe Ihe above may be Irue In an IdeaI sIIuaIIon, unIorIunaIeIy sIudIes show IhaI
many chIIdren are deprIved oI opporIunIIIes Ior opIImaI educaIIon, socIaI
InIervenIIon and physIcaI growIh. A revIew oI Ihe IIIeraIure and reporIs reveaI Ihe
IoIIowIng as consequences oI hazardous work Ior chIIdren's heaIIh:
workIng chIIdren have poorer heaIIh sIaIus Ihan nonworkIng chIIdren
maInuIrIIIon Is quIIe common among workIng chIIdren
ImpaIred psychosocIaI deveIopmenI oI workIng chIIdren has a IongIerm eIIecI
accIdenIs among workIng chIIdren are IrequenI
workIng chIIdren are noI ergonomIcaIIy compaIIbIe wIIh Ihe equIpmenI and
IooIs provIded by Ihe workpIace
workpIaces provIde ampIe opporIunIIy Ior acuIe and chronIc poIsonIngs.
Incto: contutng to dnngc: to cIdcn
ChIIdren are empIoyed In a varIeIy oI occupaIIons where dangers are noI as
apparenI. These dangers couId aIIecI a chIId's heaIIh and saIeIy. IacIors IhaI
conIrIbuIe Io dangers Ior chIIdren IncIude:
cerIaIn work arrangemenIs (e.g. separaIIon Irom IamIIIes, IIvIng InsIde
workpIaces)
exposure Io specIIIc hazardous processes and Iasks (e.g. IIIIIng heavy weIghIs,
workIng underground)
S
GusILsIreIIa DP. Case sIudIes In hazardous chIId Iabour. Intcnntonn cId IcntI: n dgc:t
o cucnt nonnton. Geneva, UNICLI, 199S.
1b2 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
exposure Io hazardous maIerIaIs such as chemIcaIs (boIh In IndusIry and
agrIcuIIure), dangerous machInery and dangerous IooIs
exposure Io hazards In Ihe physIcaI envIronmenI, IncIudIng noIse IeveIs,
radIaIIon exposure, exIreme IemperaIure oI Ihe workIng envIronmenI,
poor IIghIIng, chemIcaI and bIoIogIcaI hazardous agenIs, workIng posIure and
dusI
generaI workIng condIIIons, IncIudIng workIng hours, wages, number oI work
days (per week or per monIh), amounI oI resI and recreaIIon
absence oI heaIIh and saIeIy measures IncIudIng personaI proIecIIve equIpmenI,
weIIare and heaIIh IacIIIIIes, ergonomIc consIderaIIons, IIrsI aId, reguIar
medIcaI IacIIIIIes, a sysIem oI reIerraIs
absence oI envIronmenIaI saIeIy measures (such as saIe waIer suppIIes and
IoIIeIs) and poor access Io Iood
Iack oI IegIsIaIIve proIecIIon (In Ihe InIormaI secIor, In domesIIc work, eIc.)
InadequaIe supervIsIon
InadequaIe Iabour InspecIIon servIces.
2.5 Risks ol child labour
K:: to dc\concnt
Work IhaI Is harmIess Io aduIIs can be exIremeIy harmIuI Io chIIdren. Among Ihe
aspecIs oI a chIId's deveIopmenI IhaI can be endangered by work are:
PhysIcaI deveIopmenI: IncIudIng overaII heaIIh, coordInaIIon, sIrengIh, vIsIon
and hearIng. CarryIng heavy Ioads or sIIIIng Ior Iong perIods In unnaIuraI
posIIIons can permanenIIy dIsabIe growIng bodIes. Hard physIcaI Iabour over
a perIod oI years can sIunI chIIdren's physIcaI sIaIure by up Io S0 per cenI oI
IheIr bIoIogIcaI poIenIIaI, as Ihey expend sIores oI sIamIna IhaI shouId IasI InIo
aduIIhood.
4
CognIIIve deveIopmenI: IncIudIng IIIeracy, numeracy and Ihe acquIsIIIon oI
knowIedge necessary Io a normaI IIIe.
LmoIIonaI deveIopmenI: IncIudIng adequaIe seIIesIeem, IeeIIng Iove and
accepIance.
SocIaI and moraI deveIopmenI: IncIudIng a sense oI group IdenIIIy, Ihe abIIIIy
Io cooperaIe wIIh oIhers and Ihe capacIIy Io dIsIInguIsh rIghI Irom wrong.
ChIId Iabour aIso InIerIeres wIIh pIay, whIch Is ImporIanI Ior normaI
deveIopmenI; reIaxaIIon and Ireedom Irom IaIIgue are necessary Ior chIIdren
Io grow and Iearn.
4
AIIsebrook A, SwIII A. ocn on:c. London, Hodder and SIoughIon, 1989:91.
K:: o n]u) nnd dcntI
The rIsk oI Injury Is aImosI 10 IImes greaIer among chIIdren empIoyed under IIIegaI
condIIIons Ihan among Ihose workIng In compIIance wIIh Ihe Iaws. LxampIes are:
IaceraIIons
ampuIaIIons and crush InjurIes Irom machInery
moIor vehIcIe accIdenIs InvoIvIng Iarm vehIcIes on pubIIc roads
suIIocaIIon In graIn eIevaIors and sIIos
bIunI Irauma Irom Iarge anImaIs, e.g. as a resuII oI beIng kIcked by a cow.
K:: o occuntonn d:cn:c: nnd o:onng:
ChIIdren are parIIcuIarIy vuInerabIe Io cerIaIn probIems and dIseases and are aI
greaIer rIsk In IheIr occupaIIonaI envIronmenI due Io IheIr Iack oI experIence.
The occupaIIonaI envIronmenI conIaIns a varIeIy oI chemIcaI, physIcaI, bIoIogIcaI
and ergonomIc hazards, e.g. exposure Io cerIaIn dusIs can Iead Io chronIc Iung
dIsease. AIso, workIng chIIdren may experIence a varIeIy oI IoxIc exposures aI work,
e.g. IormaIdehyde and dyes In Ihe garmenI IndusIry, soIvenIs In paInI shops,
pesIIcIdes In agrIcuIIure, asbesIos In buIIdIng abaIemenI and benzene In peIroI
IIIIIng sIaIIons. Young peopIe may noI have InIormaIIon or knowIedge abouI Ihese
hazards and someIImes, even II Ihey have Ihe InIormaIIon, Ihey may noI be wIIIIng
or abIe Io Iake Ihe necessary sIeps Io proIecI IhemseIves.
K:: to cducnton
LducaIIon heIps a chIId deveIop cognIIIveIy, emoIIonaIIy and socIaIIy. InIerIerence
wIIh schooI perIormance Is a serIous consequence oI chIId Iabour. WorkIng chIIdren
rIsk havIng Ioo IIIIIe IIme Ior IheIr homework and beIng overIIred on schooI days.
The socIaI envIronmenI oI work someIImes undermInes Ihe vaIue chIIdren pIace on
educaIIon.
Lack oI educaIIon condemns chIIdren Io Ihe worsI empIoymenI prospecIs and, In
Iurn, Ihe sheer pressure oI survIvaI wIII resuII In Ihese chIIdren joInIng Ihe Iow wage
earners.
2.6 PrevenIion and proIecIion measures
Any eIIecIIve measure Io proIecI workIng chIIdren Irom workpIace hazards musI
begIn by hIghIIghIIng boIh Ihe chIIdren and Ihe dangers Ihey Iace. RecognIIIon oI
Ihe sIIuaIIon Is Ihe IIrsI vIIaI sIep. NexI, Ihe presence oI sIrong and deIermIned
poIIIIcaI wIII Is needed In order Io IormuIaIe poIIcIes and reaIIsIIc programmes
Iowards Ihe eIIecIIve IermInaIIon oI Ihe pracIIce oI chIId Iabour.
However, cerIaIn heaIIh probIems oI IegaIIy workIng chIIdren can be avoIded In Ihe
IIrsI pIace II Ihere Is approprIaIe job pIacemenI, I.e. a maIchIng oI Ihe needs oI Ihe
job wIIh Ihe abIIIIIes and poIenIIaI oI Ihe IndIvIduaI. A prepIacemenI examInaIIon
can aIso averI cerIaIn dIIIIcuIIIes, e.g. when prospecIIve empIoyees are aIIergIc Io
varIous subsIances.
1b4 OccuntonnI henIth trnnng nnnunI ]or rnnry henIth cnre workers
WorkIng young peopIe shouId be proIecIed, as Iar as possIbIe, Irom dangerous
workIng envIronmenIs, e.g. areas where Ihere Is IasImovIng machInery.
Where Ihere are IoxIc subsIances, such as Iead dusI, Ihe monIIorIng oI Ihe
concenIraIIons oI Ihese subsIances In Ihe aIr, as weII as In bIood and urIne, becomes
ImporIanI. Record keepIng can be used Io IndIcaIe sIckness and absenIeeIsm IhaI
mIghI poInI Io specIIIc dIIIIcuIIIes.
HeaIIh promoIIon In workpIaces shouId InvoIve educaIIon on Ihe broader Issues oI
accIdenI prevenIIon, nuIrIIIon, heaIIhy IIIesIyIes, eIc.
The earIy IreaImenI and subsequenI rehabIIIIaIIon oI young peopIe wIIh InjurIes and
IIInesses, wheIher physIcaI or psychoIogIcaI, shouId be ensured.
However, prevenIIon oI Injury and IIIness among workIng chIIdren, IncIudIng IIIegaI
Iypes oI work, requIres a coordInaIed serIes oI acIIons In severaI areas:
BeIIer educaIIon oI chIIdren, parenIs, Ieachers, physIcIans and Ihe busIness
communIIy on Ihe hazards oI chIId Iabour.
BeIIer meIhods oI dIagnosIs: occupaIIonaI hIsIory shouId be rouIIne In Ihe
evaIuaIIon oI acuIe Irauma and shouId be used when assessIng chIIdren wIIh
poIenIIaI workreIaIed condIIIons, such as repeIIIIve moIIon Injury or
organophosphaIe poIsonIng.
DeveIopmenI oI beIIer daIa Io deIIne Ihe exIenI and paIIerns oI chIId Iabour:
beIIer sysIems are needed Io monIIor Ihe workIng paIIerns (IegaI and IIIegaI)
oI chIIdren and young adoIescenIs: IheIr number, age, empIoymenI paIIerns by
IndusIry and occupaIIon and Ihe number oI hours and days worked. ThIs
InIormaIIon wouId heIp Iocus enIorcemenI eIIorIs and Irack Irends In chIIdhood
empIoymenI.
DeveIopmenI oI beIIer daIa on workreIaIed InjurIes In chIIdren and adoIescenIs:
empIoyers shouId be IegaIIy requIred Io reporI aII InjurIes oI workIng chIIdren
and adoIescenIs Io Ihe heaIIh and Iabour auIhorIIIes.
SIrengIhenIng and ImprovIng IegIsIaIIon and enIorcemenI measures oI chIId
Iabour Iaws.
LnsurIng IhaI Ihe maIn pIaces where chIIdren work and Ihe worsI Iorms oI chIId
Iabour are encompassed by naIIonaI IegIsIaIIon.
LnsurIng IhaI naIIonaI Iabour and educaIIon Iaws are consIsIenI so as Io
eIImInaIe Ihe dIscrepancIes whIch may exIsI beIween Ihe mInImum age
requIred by Ihe Iaw Io work and Ihe mInImum age permIIIed Io Ieave schooI.
ImprovIng schooIIng Ior Ihe poor: Ihe sIngIe mosI eIIecIIve way Io sIem Ihe IIow
oI schooIage chIIdren InIo abusIve Iorms oI empIoymenI or work Is Io exIend
and Improve schooIIng so IhaI II wIII aIIracI and reIaIn Ihem.
2.7 Tasks lor Ihe Irainees
1. DescrIbe Ihe maIn Iypes oI empIoymenI and occupaIIons In whIch chIIdren In
your area work.
2. CharacIerIze Ihe knowIedge and aIIIIudes oI IheIr IamIIIes Iowards Ihe
probIem oI chIId Iabour In generaI.
S. RevIew Ihe avaIIabIe daIa on workIng chIIdren aI Ihe naIIonaI IeveI and deIIne
Ihe shorIcomIngs. DIscuss ways oI broadenIng Ihe sources and sIrengIhenIng
Ihe vaIIdIIy oI daIa on chIId Iabour.
4. DesIgn an occupaIIonaI hIsIory quesIIonnaIre Ior approachIng chIIdren's
InjurIes and IIInesses suspecIed Io be workreIaIed.
S. DIscuss Ihe naIIonaI IegIsIaIIon and sIandards reIaIed Io chIId Iabour. SuggesI
ways Io Improve IheIr quaIIIy and enIorcemenI.
6. DIscuss Ihe prevenIIon and proIecIIon measures IhaI can be appIIed Io cerIaIn
occupaIIons where chIIdren may be workIng IegaIIy.
7. DIscuss Ihe roIe IhaI schooIs may pIay In conIronIIng Ihe chIId Iabour probIem;
aIso Ihe roIe oI Ihe communIIy In generaI.
lURTHER READlNG
CenIers Ior DIsease ConIroI and PrevenIIon, NaIIonaI CenIer Ior OccupaIIonaI SaIeIy
and HeaIIh, Iocct gudc to cIcncn Inznd:. IIasca, IIIInoIs, NaIIonaI SaIeIy CouncII
Press, 2000.
CIdcn nt \o: :ccn IcntI ::. Kcot o n WHO 5tud) Cou. Geneva, WorId
HeaIIh OrganIzaIIon, 1987 (TechnIcaI ReporI SerIes No. 7S6).
Icononcn) nct\c ounton 15-21. 4Ih ed. on dIskeIIe. Geneva, InIernaIIonaI
Labour OrganIsaIIon, 1996.
HarrIngIon |M eI aI. Occuntonn IcntI, 4Ih ed. OxIord, BIackweII ScIence, 1998.
HcntI onoton o \ong ounton:. Kcot o n WHO Ixct Connttcc,
Geneva, WorId HeaIIh OrganIzaIIon, 1988 (TechnIcaI ReporI SerIes No. 76S).
|eyaraInam |, Koh D. Tcxtoo o occuntonn ncdcnc nctcc. SIngapore, WorId
ScIenIIIIc PubIIshIng, 1996.
|eyaraInam |. Occuntonn IcntI n dc\cong countc:. OxIord, OxIord MedIcaI
PubIIcaIIons, 1992.
KIIunga L|. WorkIng women. In:t Acnn nc\:cttc on occuntonn IcntI nnd
:nct), 1989, 2:8-10.
LaDou |. Occuntonn ncdcnc. New York, AppIeIon & Lange, 1990.
LasI PA. HeaIIh proIecIIon and promoIIon. Women's heaIIh. In: SIeIIman |M, ed.
Inc)concdn o occuntonn IcntI nnd :nct), 4Ih ed. Geneva, InIernaIIonaI
Labour OrganIsaIIon, 1998.
Levy BS, Wegman DH. Occuntonn IcntI, ccognzng nnd c\cntng \o-cntcd
d:cn:c, 2nd ed. New York, LIIIIe, Brown & Company, 1988.
McCunney R|, RounIree PP. Occuntonn nnd cn\onncntn ncdcnc. 5c-
n::c::ncnt c\c\. PhIIadeIphIa, LIppIncoII WIIIIams & WIIkIns, 1998.
OccupaIIonaI heaIIh Ior aII. In: oogcn nontong o cIcncn cxo:uc n tIc
\oncc, VoI. 2, Geneva, WorId HeaIIh OrganIzaIIon, 1996.
PIog BA, NIIand |, QuInIan P|. Iundnncntn: o ndu:tn I)gcnc, 4Ih ed. IIasca,
IIIInoIs, NaIIonaI SaIeIy CouncII Press, 1996.
Rom WN, ed. In\onncntn nnd occuntonn ncdcnc, Srd ed. PhIIadeIphIa,
LIppIncoII WIIIIams & WIIkIns, 1998.
Wod o \o. TIc nngnznc o tIc IIO. Geneva, InIernaIIonaI Labour OrganIsaIIon,
1996, 16.
1997, 19.
1997, 20.
Young coc': IcntI: n cIncngc o :occt). Kcot o n WHO 5tud) Cou on )oung
coc nnd "HcntI o A ) tIc Ycn 2. Geneva, WorId HeaIIh OrganIzaIIon,
1986 (TechnIcaI ReporI SerIes No. 7S1).

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