Our Lady of Fatima University

College of Medicine
Fatima University Medical Center
Department of Family Medicine and Community Health

Occupational Medicine

Reporters:
Galvez, Earl karyl
Gabatin, Krizza
Jobin, Mathew
Vyas, Akshay
Occupational Health
• The sum of all efforts to prove the health of workers in the community and its industries
(Leavell and Clark)
• The modern definition of Occupational Health (ILO and WHO) is:
– “The promotion and maintenance of the highest degree of physical, mental and
social well-being of workers in all occupations – total health of all at work”
What is Occupational Medicine?
The branch of medicine that deals with:
• Prevention
• Treatment of diseases
• Injuries at work or in specific occupations

FUNCTIONS OF OCCUPATIONAL HEALTH SERVICE

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

FUNCTION OF HEALTH SERVICE

6. Special examination and surveillance of health of women and children
7. Advising the employer or management for improving working conditions, and placement of
hazards.
8. Monitoring of working environment for assessment and control of hazards.
9. Supervision over sanitation, hygiene and canteen facilities.
10. Liaison and cooperation with the safety committees
FUNCTION OF HEALTH SERVICE
10. Liaison and cooperation with the safety committees
11. Maintenance of medical records for medical check-up and follow-up for maintaining health
standards and also for evaluation.
12. To carry out other parallel activities such as nutrition programme, family planning, social
services recreation etc., Concerning the health and welfare of the workers.
THE FACTORS FOR EFFECTIVENESS OF OCCUPATIONAL HEALTH SERVICES:
1. The nature of industry; small, medium or large and its location.
2. Existing infrastructure of health services.
3. Trained manpower.
4. Workers involvement and employers commitment.
5. Surveillance of the working environment by means of epidemiological studies and
testing.
ILO List of Occupational Diseases
Diseases caused by agents
• Chemical, physical, biological
– e.g. Beryllium
Diseases by target organ system
• Respiratory, skin, musculoskeletal
– e.g. Pneumoconioses
Occupational cancer
• Cancer caused by the following agents
– e.g. Asbestos
The Workplace
Spectrum of diseases in the working population
• Occupational disease
• Work-related disease
• General disease
Occupational Disease
• Factors in the work & environment that are
essential in the causation of the disease
• Affects working population EXCLUSIVELY ·
• Cause-specific
Work-related Disease
• Disorders other than/in addition to the recognized occupational diseases
• Multiple causal agents
• Work environment and performance contribute significantl
• Factors in the work environment that causes, aggravate, accelerate, or exacerbate the
condition
• More common than occupational disease
Work-related Disease VS Occupational Disease

Work-related disease Occupational Disease

Accident at work TB & hepatitis for health worker
causing injury
A series of repetitive Pneumoconiosis and silicosis for any
actions resulting to a occupation that involves direct contact
disability with or exposure to coal dust
Pre-existing condition
that has been
aggravated by work
(e.g., asthma)

General Diseases
• Diseases among the general population which workers may be equally or more
susceptible
• Weak or unclear relationship with factors in the work environment

Diseases resulting from physical state of the environment

• Electromagnetic radiation
• Noise
• Extremes in temperature, humidity and air motion
• Abnormal atmospheric or air pressure
 • Repeated motion, vibration and shock
OCCUPATIONAL HEALTH HAZARDS
OCCUPATIONAL HEALTH ( ILO/WHO )
 Promote and maintain the highest degree of physical, mental & social well-being of
workers of all occupations
 Prevent workers from departures due to health caused by their working conditions
 Protect workers in their working environment from hazards and risks usually causing
adverse health effects
 Place & maintain a worker in an occupational environment adapted to his/her
physiological ability
HAZARD AND RISK
CHEMICAL HAZARDS
Routes of excretion
Inhalation, Ingestion, Skin contact
Routes of excretion
Gastro, renal, respiratory and skin
Classification of Toxic Effects
• Local toxicity- occurs at the site of chemical contact
• Systemic toxicity- occurs distant from point of contact, may involve many organ systems
• Acute toxicity- occurs almost immediately (hours/days) after an exposure
• Chronic toxicity- represents cumulative damage to specific organ systems; occurs many
months or years to have recognizable clinical disease

Effects Chemical Agent Industry/Process

Renal Diseases: acute/chronic Mercury, cadmium, Battery, chemical industries, pesticide

renal failure chloroform

Respiratory Diseases: Solvents, ammonia Chemical industries

Irritation, inflammation

Pneumoconiosis Inorganic dust Mining, construction, sandblasting, coal

Cancer Chromium Plating, metal refining

Blood Diseases: Lead Battery mfg., lead smelting

Anemia
 Aplastic anemia Benzene Solvent & soap mfg.

Skin Diseases: Plastic epoxides Plastic, varnish

Allergic/contact
dermatitis

Acne Cutting oils, grease Machine-tool operators

Skin Cancer Arsenic, tar Petroleum refinery

BIOLOGICAL HAZARDS

Agent / Disease Occupation

Colds, influenza, scarlet fever, May be contacted anywhere

diphtheria, smallpox

Tuberculosis Silica workers, people exposed to heat

and organic dusts, and medical
personnel

Anthrax Animal handlers and handlers of

carcasses, skins, or hair of infected
animals, including wool carpet
processors and handlers.

Agent / Disease Occupation

Ringworm (in horses, cattle, deer, Pet shop salesmen, stockmen,

pigs, cats, dogs, birds) breeders of cats and dogs, and other
animal handlers

Tetanus Farmers (spores in soil) or anyone in

contact with manure.

PRINCIPLES OF OCCUPATIONAL HEALTH

WORK ENVIRONMENTAL CONTROL

EXPOSURE MEASUREMENT
emissions from industrial processes, contaminated food or water, consumer products containing
hazardous chemicals, etc

SOURCES OF EXPOSURE

inhalation, absorption, and ingestion. Inhalation is the most common route of entry of health hazards.
Skin absorption is the second major route of exposure. Those areas of the skin that come into contact
with contaminants are the most impacted.

WORK CONTROL

PERSONAL PROTECTION EQUIPMENT

• Eg . gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls,
vests and full body suits.

• ENGINEERING CONTROL

• Design of building

• Good housekeeping

• Enclosure

• Isolation

• Environmental monitoring

ERGONOMICS

• the study of people's efficiency in their working environment.

• Eg . Chair is too low for Desk.

HEALTH CONTROL

• HEALTH PROMOTION

• HEALTH SURVEILLANCE

• Pre-placement examination

• Pre-assignment examination

• Periodic examination

• Termination examination

• Special purpose examination

WALK THROUGH OCCUPATIONAL SURVEY

The premises permits observation of all operations.

Carried out to make a preliminary assessment of potential hazards.

An important opportunity to meet plant personnel and to interact with engineers, foremen and other
workers who know the process problems and are aware of complaints or symptoms among workers.
General principles

• Hazards present in the work place

• Estimated /likely scale of the identified hazards

• Monitoring required

SURVEY METHODS

• Surveys are usually carried out without the use of measuring instruments.

• Much of the information required can be assembled in advance of the survey

• The following aids are required

• Survey report forms

• Notepad or dictation machine

• Plan of premises

• Camera

• Smoke tubes

Sources of information

• Workers involved in their daily tasks

• Sense of smell hearing and touch for detection of odours heat and noise

• Photography for documenting the general visual appearance of each environment

• Smoke tube test for exhaust ventilation

• Observation the key of an effective survey

• Eg.poorly designed lighting

Reports

• Introduction

• Summary of hazards requiring further monitoring

• Proposed occupational hygiene work plan

OCCUPATIONAL HEALTH PROGRAMS

• Policies / Guidelines / Standards Development

• Capacity Building

• Technical Assistance

• Research

• Communication and Promotion

• Advocacy and Lobbying

 • Monitoring and Evaluation

• Human Resource Development

• Information Management

Target Population/Client

• Informal Sector Workers (ISW) consisting of Agricultural Workers, Small-scale Miners, and
Transport Group

• Public Health Workers (PHW)

Partner Institutions

• Inter-Agency Committee on Environmental Health (IACEH)

• - Occupational Health Sector

• - Toxic and Hazardous Substances Sector

• Department of Labor and Employment (DOLE)

• - Occupational Safety and Health Center (OSHC)

• - Bureau of Working Conditions (BWC)

• Department of Environment and Natural Resources (DENR)

• - Environmental Management Bureau (EMB)

• - Mines and Geoscience Bureau (MGB)

• Department of Transportation and Communications (DOTC)

• Department of Energy (DOE)

• - Energy Utilization Management Bureau (EUMB)

• Civil Service Commission (CSC)

• UP College of Public Health

• UP-PGH National Poison Management Control Center

• Philippine College of Occupational Medicine

• Occupational Health Nurses Association of the Phils.

ERGONOMICS Derived from two Greek words:

 “Nomoi” meaning natural laws

 “Ergon” meaning work

 Hence, ergonomists study human capabilities in relationship to workdemands

What two elements are at work?

1) Static work: musculoskeletal effort required to hold a certain position, even a comfortable one.

Example: sit & work at computers; keeping head and torso upright requires small or great amounts of
static work depending on the efficiency of the body positions we chose.

2. Force: amount of tension our muscles generate

Example: tilting your head forward or backward from a neutral, vertical position quadruples the amount
of force acting on your lower neck vertebrae

• Increased force is d/t increase in muscular tension needed to support head in a tilted position

3 Main Ergonomic Principles:

1. Work activities should permit worker to adopt several different healthy and safe postures.

2. Muscle forces should be done by the largest appropriate muscle groups available

3. Work activities s/b performed with joints at about mid-point of their ROM (esp. head,trunk,UE)

What causes Nerve Compression or Entrapment?

1) Repeated motions

2) Tight muscles

• Inflammation of surrounding tissues

• Misalignment of the nerve

Modify Tasks: Alternate activities frequently; rotate heavy &/or repetitive tasks w/ lighter less repetitive
ones.

a) If sx become worse REASSESS task setup & look for alternative methods

b) Avoid repetitive or prolonged grip activities

c) Avoid pinching w/ wrist in flexion or wrist deviation (bending to side)

d) Take frequent breaks to stretch & rest hands

Body Mechanics

• Use the largest joints & muscles to do the job

• Use 2 hands to lift rather than one, even with light objects and tasks.

• Avoid lifting w/ the forearm in full pronation (palm down) or supination (palm up)

• Slide or push & pull objects instead of lifting

• Keep reaching to a minimum

• Carry objects close to body at waist level

Occupational Noise Exposure

 • Sound/Noise Vibration that travel through the air or another medium and can be heard when
reach a person’s ear

– The pitch ranges between 20 to 20,000 Hz.

– The volume ranges between 0 to 140 dB.

– Noise is a type of unwanted sound.

– It carries no information.

– It is random.

• Types of Hearing Loss Middle ear hearing loss results from lack of

conduction.

– Accumulation of ear wax

– Broken ear drum

– Inner ear hearing loss results from lack of

neural connections.

– Naturally due to aging

– Loud noise and disease

Occupational Hearing Loss

• OHL is damage to the inner ear from the noise and vibration due to certain types of jobs.

• CAUSES- Over time, repeated exposure to loud noise and music can cause hearing loss

>70 dB – for prolonged period of time may start damaging your hearing

>120 dB- can cause immediate harm to your ears

Noise Measuring Equipment

• Sound level meters(dB meter)

– Basic instrument to measure sound pressure variations in air

• Noise dosimeter

– Measure the noise exposure of a person over a period of time

• Octave band analyzer- Diagnostic tool to help find appropriate engineering controls to reduce
noise levels

• Noise action limit No employee shall be exposed above the permissible exposure level(PEL)

• PEL= 90 dBA for a 8 hour time weighted average

• Hearing protection is required to protect the employee to the permissible exposure level.

Hearing Protectors
• Provided at no cost to the employee

• Selected from a variety of types and brands

• Properly fitted

• Replaced as needed