Evaluation of the

Occupational Hazards

1
Section A

Introduction

2
What is Occupational Health ?

The joint international labor

organization committee on
Occupational health, 1950
defined occupational health as
“The highest degree of physical,
mental and social well-being of
workers in all occupations.”
3
 GOALS

 To reduce industrial accidents.

 To prevent occupational hazards/
diseases.
 To achieve maximum human
efficiency and machine efficiency.
 To reduce sick absenteeism.

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

It represents a dynamic
equilibrium between
the worker and his
occupational environment.

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GENERAL ASPECTS OF
OCCUPATIONAL HEALTH

 what types of agent might represent

an occupational health risk in the
workplace?

 how do we go about evaluating the

severity of the risk?
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PRINCIPLES OF
OCCUPATIONAL HEALTH
 Recognition/identification of
occupational health hazards
 Measurement of level or
concentration
 Evaluation of likelihood and severity
of harm
 Control strategies available to
reduce or eliminate risk
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RECOGNITION
 chemical
◼ liquids, fumes, mists vapours, gases,
dusts
 physical
◼ radiation, noise, vibrations, temperature,
humidity
 biological
◼ bacteria, viruses, fungi
 ergonomic
◼ body position, repetitive actions, work
pressure
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CHEMICAL HAZARDS

 absorption then attack on organs or

metabolic processes
◼ toxic response
◼ carcinogenic response
 contact then attack on the surface of
the body
◼ irritant response
◼ sensitisation response

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PHYSICAL HAZARDS

 harmful energy absorbed by the

body’s structure
 energy derived from
◼ mechanical sources
 noise, vibration
◼ radiation sources
 ionising, non-ionising
◼ thermal sources

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BIOLOGICAL HAZARDS

 exposure to biological agents

resulting in illness
 types of biological agent
◼ bacteria
◼ viruses
◼ fungi

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ERGONOMIC HAZARDS
 concerns the physical, physiological
and psychological relationships
between people and work
 specific areas:
◼ perceptual responses
◼ work rates and fatigue
◼ man-machine interface
◼ anthropometrics

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MEASUREMENT
 continuously
◼ control strategy where the risk is high
 intermittently
◼ initial determination of hazard
◼ spot measurement in an established
process
◼ routine check measurement

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EVALUATION
 harmful characteristics of the
substance, energy or condition
involved
 concentration, intensity or level of
the exposure to the harmful agent
 time duration of the exposure

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CONTROL
 elimination
 substitution
 change of work method/ pattern
 isolation and segregation
 engineering controls
 personal protective equipment

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ROUTES OF ATTACK ON THE
HUMAN BODY

 route of entry
(reach an area of penetration
of the body)
 process of entry
(penetrate the outer cover of
the body)
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ROUTES OF ENTRY
 inhalation
 ingestion
 skin pervasion
 injection
 implantation
 Aspiration

Inhalation is most common in workplace

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PROCESS OF ENTRY
absorption
◼ epidermis
◼ lungs
◼ gastro-intestinal tract
direct entry into the body

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TOXICOLOGY
- the study of poisonous materials and
their effects on living organisms

 toxic substances  toxicity

◼ systemic ◼ LD50 to quantify the
 travel through effects of a toxic
the system agent
◼ local
◼ Acute Toxicity
 act only at the
point of contact  harmful effect occurs
quickly (seconds,
◼ cumulative minutes, hours)
 not readily
excreted from the ◼ Chronic Toxicity
body  harmful effect takes a
 accumulated over long time to appear
a period of time (months, years)
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LOCAL AND SYSTEMIC
EFFECTS
 local effects  systemic effects
(confined to (occur at organs
specific area distant from
where contact contact site)
occurs) ◼ liver
◼ skin ◼ nervous system
◼ eye ◼ bone
◼ respiratory tract ◼ blood-forming
organs

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DEFENCE MECHANISMS OF
THE BODY
 respiratory defence
◼ physical filtration
◼ Phagocytosis
 immune response
 inflammatory response
 fibrotic response

22
 Section B

Exposure Assessment

2021/7/4 23
What is Exposure?
 Contact between the outer boundary of the
human body (skin, nose, lungs, gastro-
intestinal tract) and a contaminant
 Requires the simultaneous presence of a
contaminant and the contact between the
person and medium
 Quantified by concentration of
contaminant and time and frequency of contact
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 What is exposure assessment?

 To decide whether and how to use resources for reducing

workplace exposures, and to define exposure-response
relationships in epidemiologic studies.

 Rapid, inexpensive measurement tools and improved data analysis

methods are needed for the collection of adequate exposure data
and for effective intervention.

2021/7/4 25
 Advancements of exposure assessment

(1) better identification of at-risk workers；

(2) better identification of the most cost-effective control and

intervention strategies；

(3) better understanding of exposure-response relationships；

(4) improved baseline data for standard setting and risk

assessment.

2021/7/4 26
Methods of exposure assessment

 field survey
 environmental monitoring
 biological monitoring
 health surveillance

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 Field survey

 Know specific characteristics of occupational

hazards
 Estimate exposure levels, duration, frequency,
spatial distribution
 Assess whether working condition accord
with labor hygiene standard
 Check preventive strategies
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Occupational environment monitoring
Need to be remember:
- diversity: many types, combination
- variability: intensity change, variation of time and
space distribution
- Discontinuity of exposure

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Occupational environment monitoring

 Air sampling
○ Area sampling
○ Personal sampling
 Concentration
○ Short term concentration
○ Time weighted average concentration, TWA

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Personal sampling

 Workers carry the sample machine, sample

collection is in the breathing zone
 Represent actual exposure levels well
 Unsuitable to sample the very low
concentration of chemicals

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Personal sampling

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Area sampling

•Fix the sample machine in the workplace. It is used

to assess the quality of work environment
•Select the representative monitoring site, which
should be near the workers
•The sample collection should be in the breathing
zone.

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Area sampling

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Types of Air Sampling: Time

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Measurement of physical hazards

Noise measurement Radiation detection 36

Biological monitoring

 Measurement of chemical compounds and

metabolites in specimen to assess exposure
and health effects on body

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Biomarker
 Biomarker is a substance used as an indicator of a
biological state.

 It is objectively measured and evaluated as an indicator

of normal biological processes OR pathogenic
processes

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Exposure biomarkers

 the actual chemicals, or chemical metabolites, that

can be measured in the body or after excretion
from the body to determine different characteristics
of an organism’s exposure.

 For example: a person ’s blood can be tested to see

the levels of lead and therefore determine the
exposure
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 Effect biomarkers

 the quantifiable changes that an individual endures,

which indicates an exposure to a compound and may
indicate a resulting health effect.

◼ Intermediate endpoint or early outcome predictor:

public health
◼ Surrogate biomarker: clinical diagnosis and curative
effect assessment

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Susceptibility biomarkers

indicators of the characteristics of workers that make it more

susceptible to the effects of an exposure to a chemical
Innate: genetic
Toxicant
Acquired: environment induction
exposure

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 Ideal biomarkers

 Relevant to the biological phenomena

 Sensitivity and specificity
 Practicability and accuracy

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Characteristics of biomarkers
Biomarker type Characteristics of validity
Consistently linked with exposure at relevant levels of exposure
Exposure with confounding and background exposures assessed (cross-
sectional study) a
Consistently linked with increased risk with confounding and
Effect effect modifying factors assessed (attributable proportion and
predictive value in only cohort studyb)

Can distinguish subgroups at risk given specific exposure

Susceptibility
(cross-sectional study, case-control study and cohort study)
a Biomarkers of exposure may also be validated by establishing a constant link to an
adverse health effect (only cohort study) or to the concentration of the
chemical in the target organ (cross-sectional study) .
b including prospective, retrospective cohort studies and nested case-control study
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Characteristics of biological monitoring

 reflect the total exposure of body and exposure load,

while environmental monitoring only reflect the
external exposure
 directly measure internal dose or biological effective
dose
 consider the individual susceptibility and variations of
toxico-kinetic process of body

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Health surveillance

 Any activity which involves obtaining

information about employees' health and which
helps protect employees from health risks at
work
 Secondary prevention

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Health surveillance

For pre-employment or periodic evaluations,

should it include a questionnaire and/or
a physical?

Ideal- questionnaire + physical

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Missions of Health surveillance

 Health examination：
--pre-employment examination
--periodical examination
 Establish health surveillance archives
 Assess health status of workers
 Identify work ability

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 Pre-employment examination

 Know the employee’s original health status and

baseline health data, find occupational
contraindication
Benzene exposure: blood count

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 Periodical examination

 Find high risk population and occupational

diseases
 Adopt preventive strategies to protect the worker’s
health
For example:
Noise exposure, hearing impartment
examination

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 Quality and Quantity
Exposure assessment

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Exposure Assessment
1. Assessment of hazard
2. Determine acceptability
3. Decision on appropriate action
4. Periodically re-evaluate

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Exposure Assessment

1.Assessment of Hazard

 Process description with emphasis on:

–Raw materials
–Contaminant chemicals
–Intermediates
–By-products
–Decomposition products
–Additives

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Exposure Assessment

1. Assessment of Hazard
 Preliminary inspection and observations
–Worker and management interviews
–Evaluate work practices
–Note personal protective equipment
–Note ventilation/other controls

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Exposure Assessment

1.Assessment of Hazard

 Exposure modeling
–Use a mathematical construct to quantitatively
estimate exposures
–Models will typically include
•Source term
•Transport in time and space
•Receptor factors (time activity information)

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Exposure Profile

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Exposure Assessment

2. Determine Acceptability

 Role of air sampling

–Used as a tool for estimating risk or hazard
–Other observations, calculations, discussions
with workers, medical data, etc.
 Comparison with measure of safe or
acceptable
 Professional judgment and other factors
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Exposure Assessment

3. Decision on Appropriate Action

 Develop workplace control plan

–Short term
• Personal Protective equipment
• Administrative
• Work practices
–Long term
• Engineering controls

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 Personal Protective equipment (PPE)

Protective glasses Protective mask Protective cloth

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Personal Protective equipment (PPE)

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 PPE

Dust mask 60
4. Periodically Re-Evaluate

 Whenever significant process or workforce

change occurs
 Develop schedule for routine periodic re-
evaluation
–Basic workplace characterization
–Exposure assessment program
–Workplace control plan

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 Exposure Assessment
Exposure to occupational Health effects on people
hazards
Early
Exposure internal target dose
dose dose
biological disease death
effect

Environmental
monitoring Biological monitoring Health surveillance
Exposure monitoring Ask and survey

Exposure assessment

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OCCUPATIONAL EXPOSURE
LIMITS (I)
 designed to control the absorption of airborne
contaminants into the body
 measured in:
◼ ppm (parts of vapour/gas per million parts
of air)
◼ mg/m3 (milligrams of substance per cubic
metre of air)
 expressed as the concentration of an airborne
substance averaged over a reference period
◼ 15 minutes short term limit
◼ 8 hours long term limit

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 OCCUPATIONAL EXPOSURE
LIMITS (II)
 Maximum Exposure  Occupational
Limit (MEL) Exposure Standard
◼ maximum permissible (OES)
concentration ◼ concentration at which
◼ has legal status no evidence of harm
◼ must not be exceeded ◼ represents good
practice
◼ reduce exposure to as
far below the MEL as ◼ if exceeded, take steps
possible to reduce down to OES
◼ OES represents
adequate control
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OCCUPATIONAL EXPOSURE
LIMITS (III)
 long term limits  short term limits
◼ time-weighted ◼ time-weighted
average average
concentration concentration
◼ conc. x exposure ◼ conc. x exposure
time averaged over time averaged over
8 hours 15 mins
◼ designed to control ◼ designed to control
chronic effects acute effects

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Section C

Occupational health risk assessment

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Objectives of occupational health risk
assessment
 Estimate the type and characteristics of adverse
health effects from occupational hazards
 Estimate probability of adverse health effects
 Estimate and deduce the dose and condition for
occupational hazards having adverse health effects
on human body
 Set generally acceptable level
 Advance preventive strategies
67
Process of occupational health risk
assessment

 Hazard identification
 Dose-response assessment
 Exposure assessment
 Risk characterization

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Hazard identification
 Identify hazards .
To find the hazards (If the factors have adverse
health effects on human body when exposure?)
Yes or no
 Quality risk assessment
 Using multiple methods (toxicology,
epidemiology, experimental research, field
measurement etc) to assess whether there is causal
relationship between occupational exposure and
health effect
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Hazard identification based on…
 Occupational epidemiology data

 Animal testing

 In vitro test

 Property of occupational hazards

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Dose-response assessment
 Key process of risk assessment.
 Quantitative risk assessment
 To establish the relationship of occupational exposure
dose and human response
 According to the different type of chemical toxicant, it
is classified into two types
1. Chemical dose-response assessment with threshold
value
2. Chemical dose-response assessment without
threshold value

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 Chemical dose-response assessment with
threshold value
① Select suitable index with critical effect
② Lowest observed adverse effect level, LOAEL
no observed adverse effect level, NOAEL
(Occupational epidemiology and animal testing)
③ Select uncertainty factor (UF) (Animal testing,
species difference)
④ Establish dose-response effect ,calculate reference
dose (RfD)
RfD=NOAEL OR LOAEL/UF
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 Chemical dose-response assessment
without threshold value

 carcinogen or mutagen with genetic toxicity, no

biological threshold value
 Two models:
Probability distribution models
Mechanistic models

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Exposure assessment

 The key process of risk assessment.

 Quantitative risk assessment
 Identify occupational hazards, concentrations of
hazards, route of exposure, duration,
constitute, characteristics, and sample size of
exposed population etc.

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Risk characterization

 The last step of risk assessment

 Based on the qualitative and quantitative risk
assessment, reasonable analyses and judgment
to get the risk characterization

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Uncertainty in occupational health risk
assessment

①From animal to human

species difference and individual difference
②From high dose in animal to low dose in human
③Short time, small sample size in animal testing to
long exposure in human

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Risk management
 During decision-making，besides risk assessment,
also considering social sense of worth，technical
feasibility and economical factors
 There is no zero risk.
Compromising
generally acceptable level,
Generally regarded as safe, GRAS
Virtually safe dose, VSD

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Risk assessment and risk management

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Section D

occupational health service

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 What is occupational
health service?
The objective is a healthy and safe
working environment, a well-functioning
working community, prevention of work-
related diseases as well as the
maintenance of employees’ working
ability and functional capacity, and
promotion of their health.

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PREVENTING EXPOSURE
 change the process or activity
◼ the hazardous substance is not required
or generated
 replace the hazardous substance with
a safer alternative
 use the hazardous substance in a
safer form

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CONTROLLING EXPOSURE
 totally enclose the process
 partially enclose the process and use
local exhaust ventilation
 use general ventilation
 use systems of work and handling
procedures that minimise spills and
leaks
 reduce the duration of exposure
82
 MONITORING EXPOSURE
HEALTH SURVEILLANCE
 monitoring  health
exposure surveillance
◼ where serious risks if ◼ where exposure is
controls fail linked to a disease
◼ to confirm exposure which could occur
limits are not and can be detected
exceeded ◼ where employees are
◼ to confirm that working and
controls are working exposure could be
properly significant
◼ keep records
83
 RECORDING AND REVIEWING
THE ASSESMENT

 record enough  review the

information: assessment:
◼ to show how ◼ at no less than 5-
decisions on risks yearly intervals
and precautions ◼ whenever it is
were made thought that the
assessment might
◼ to clearly show the not be valid
responsibilities for
◼ where there has
implementing the been a significant
precautions change in the work
84
INFORMATION, INSTRUCTION
AND TRAINING
 inform, instruct and train employees about:
◼ the nature of the substances and the risks
arising from exposure
◼ the precautions that should be taken
 give information and instruction on:
◼ the purpose and use of control measures
◼ use of personal protective equipment
◼ results of any monitoring or health
surveillance
◼ emergency procedures

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 FUNCTIONS OF OCCUPATIONAL
HEALTH SERVICE - CONT..

1. Pre-employment medical examination.

2. First Aid and emergency service.

3. Supervision of the work environment for the

control of dangerous substances.

4. Special periodic medical examination particularly

for the workers in dangerous operations.

86
 FUNCTION OF HEALTH
SERVICE - CONT..
5. Health education for disseminating information
on specific hazards and risks in the work
environment.

6. Advising the employer or management for

improving working conditions, and placement of
hazards.

7. Monitoring of working environment for

assessment and control of hazards.

87
 FUNCTION OF HEALTH
SERVICE - CONT..
8. Maintenance of medical records for
medical check-up and follow-up for
maintaining health standards and also for
evaluation.
9. To carry out other parallel activities such
as nutrition programme, family planning,
social services recreation etc., Concerning
the health and welfare of the workers.

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The end
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