OCCUPATIONAL

HEALTH
WMSU BS MECHANICAL ENGINEERING

1
 Hierarchy of Controls
• Refers to the total removal
of the hazards
• This involves replacing the
hazard by one that presents
a lower risk
• A category of hazard
control that uses
physical/engineering
• methods to eliminate or
minimize the hazard
• A category of hazard control
that uses administrative/
• management involvement
in order to minimize
employee exposure to the
hazard
• Any device worn by a
worker to protect
• against hazards
1. Elimination • Eliminate human interaction in the process
• Eliminate pinch points
2. Substitution • Change in chemicals
3. Engineering • Enclosures, containment, bunding, catch
controls pans, roofing over waste controls
• Drainage system, ventilation, Redesign of
work area, insulation, Attenuation (
mufflers), Wastewater treatment systems
• Scrubber systems, landfill
4. Administrative • Safe work procedures
controls • Safety equipment inspections
• Training
• Lockout
5. Personal • Safety eyewear
Protective • Hearing protection
Equipment • Gloves
Environmental Safety
• Respirators
 MEDICAL
SURVEILLANCE
WMSU
Purpose of Medical Surveillance
PRIMARY
• prevention of illness.
– Aims of Occupational Health (WHO, ILO)

SECONDARY
• early detection of work-related health problems and
determining its cause.
Monitoring
• Systematic continuous, repetitive health-related
activities that should lead to corrective action
• Types of monitoring:
Ambient/environmental - Work Environment Monitoring
Biological – blood, urine
Medical surveillance
• Pre-employment (Entrance)
• Periodic examinations
• Special examinations
• Transfer examinations
• Separation examinations
Monitoring Strategies
Ambient monitoring Biological monitoring Health surveillance

• measurement and assessment of • measurement and assessment of • periodic medico-physiologic

agents at the workplace agents or their metabolites
either in tissues, secreta, excreta,
• evaluates ambient exposure expired air, or any combination
compared to reference
• evaluates exposure compared to
• TLV reference
• BEI
examinations of exposed
workers
• aims to protect health and
prevent occupationally related
disease

Absorption, metabolism,
distribution, elimination
Monitoring Strategies
Monitoring Activity Workplace-Related Events Health Effects
Exposure at the workplace
Environmental - Chemicals
monitoring - Physical agents None

Biologically significant exposure

- Chemicals absorbed
- Early (reversible) changes
Biological monitoring and
Medical surveillance Early
Clinical diagnosis
- measurable health effects

End effects
Treatment and surveillance - diseases Late
(morbidity, mortality) - unfavorable events
(spontaneous abortion)
Monitoring
• Surveillance in occupational health practice covers periodic, systematic
and continuous hazard assessment and medical examination.

• Surveillance data will provide trends or emerging patterns in workplace

hazards and illnesses.

• Surveillance has to be followed by preventive action (appropriate control

measures) and evaluation of the effectiveness of intervention.

• Surveillance is conducted to meet regulatory requirements.

Why do we conduct Medical
Surveillance?

• Worker populations are not homogenous

– Certain members will be particularly vulnerable
or at greater risk than others. (individual
susceptibility)

• Hazard level within safe or acceptable limits

do not guarantee that workers will not be
affected.
 What determines workers health?
Workers health practices
Hazards exposure in the
working environment
• Physical
• Chemical
• Biological
• Ergonomic
Personal-Social factors
• inequities in gender, race,
Access to health services:
age, residence, etc.
• medical history
• family history
• occupational status
• employment conditions
• income
• individual risk-taking
behaviour
• physical exercise,
sedentary work
• diet and nutrition
• unhealthy habits –
smoking, alcohol
• preventive occupational
health services
• specialized curative care
and rehabilitation
• health and accident
insurance
Why do we conduct Medical
Surveillance?
• Monitoring of certain high-risk groups:
– Workers new to a hazardous job
– Workers returning after injury or illness
– Workers with concurrent condition or illness which can be adversely affected by workplace
hazards
– Workers exposed to very hazardous substances or work processes

• When diseases in question are associated

with particular exposure or industry.

• Mandated by DOLE
 Steps in Surveillance of
Occupational Diseases
1. Hazard and exposure assessment
2. Identification of adverse health outcomes
for each hazard
3. Selection of medical screening tests
4. Interpretation of data and recommendation
5. Communication of results
6. Documentation/recordkeeping
7. Evaluation of control measures.
1. Hazard and Exposure
Assessment
• Types of substances

• Process Involved

• Exposure pathways

• Exposed population

• Estimate intensity, frequency and

duration of exposure to toxic agent
 2. Identification of adverse health
outcomes for each hazard
Industry/Process Hazard Target Organ System
Mining, construction Inorganic dust Lungs
(pneumoconiosis)

Agriculture Chemicals (pesticide) - Eye and skin irritation

malathion Respiratory system (irritant)
Nervous system (nausea,
vomiting, dizziness, convulsions,
coma, death)
Printing Toluene Nervous system (dizziness,
headache, euphoria)
Skin (dermatitis)
Kidney, liver

Stevedoring Lifting Musculoskeletal system

Garments/ sewing Noise Ears
Occupational Health Hazards
Physical
noise, vibration,
radiation,
defective illumination,
temperature extremes

Biological Chemical
viruses, bacteria, fungi, dusts, gases, vapors,
parasites, insects, etc. fumes, mists, etc.

Ergonomic
exhaustive physical exertions, excessive standing,
improper motions, lifting heavy load, job monotony,
workplace stress, etc.
Physical Hazards Adverse Health
Outcomes
Extreme Temperatures
Noise
Heat stroke, Heat exhaustion,
Noise Heat cramps
induced
hearing
loss
(NIHL)

Radiation
Inadequate Illumination Cataract, radiation
Visual fatigue, burns, cancer,
glare, headache congenital birth defects
Vibration
Hand-arm
vibration
syndrome
Chemical Hazards Adverse Health
Outcomes
DGDF
Inhalation, Accidental ingestion, Skin absorption

WORKER EXPOSURE absorption, metabolism,

distribution, elimination

Toxic effects

Molecular level Cellular/

(DNA, RNA, protein) biochemical System/ organ level
(CNS, lung, reproductive systems, etc.)
level
Why the need to measure absorbed
amount?
The dose of an exposure to noxious agent is a strong
predictor of the likelihood and type of disease

Biological monitoring – assessment to overall

systemic exposure to chemicals by measurement of
the chemicals or their metabolites in blood, urine or
breath.

Biological Exposure Indices (BEI) – indicates a

concentration below which nearly all workers should
not experience adverse health effect.
 Blood Lead Concentration (µg/dL)
(Agency for Toxic Substances and Disease Registry)

100 – 120 Encephalopathy;

Chronic nephropathy

80
Frank anemia

Female reproductive effects

60 Reduced hemoglobin production;
50 Neurological symptoms; Altered
Increased urinary ALA; elevated
coproporphyrins and Peripheral nerve testicular function
40
dysfunction (slowed nerve conduction)
30 Increased blood pressure
Increased erythrocyte 25 – 30
protoporphyrin (men) Increased erythrocyte
15 – 20 protoporphyrin (women)
ALA–D inhibition <10
Chemical Hazards Adverse Health
Outcomes As stated in Safety Data Sheet (SDS) Toxicological
Information section

• Neurologic (brain, nerves)

• Cardiovascular (heart, blood vessels)

• Hematologic (blood)

• Respiratory (airway, lungs)

• Renal (kidneys)

• Urologic (bladder)

• Gastrointestinal (stomach, intestines)

• Dermatologic (skin)

• Teratogenic (birth defects)

• Carcinogenic (cancer)
 Nervous system
BRAIN - Solvents (toluene, xylene, etc.)
Eyes
Peripheral nervous system: n-hexane, Methanol
methyl-n-butyl ketone, styrene, Acids, alkali
toluene, inorganic lead
Respiratory System (lungs)
Silica, asbestos, coal
cotton, molds in bagasse,
chromium, arsenic, nickel, metal fumes, chlorine,
ammonia
Blood / Circulatory System Toluene diisocyanate

cyanide, carbon monoxide, Liver

hydrogen sulphide, nitrogen
Vinyl chloride, organic solvents (chlorinated),
dioxide, arsine, benzene, lead
ethanol (alcohols)

Skin
Acids, alkali, epoxy resin,
fiberglass, formaldehyde,
nickel, latex

Kidney
Reproductive System
cyanide, carbon monoxide,
hydrogen sulphide, nitrogen Ethylene oxide, ethylene glycol ethers ,
dioxide, arsine, benzene, lead dibromochlorpropane (DBCP), lead, and 2-
bromopropane
Cytotoxic drugs, Organic mercury
Biological hazards

MICROORGANISMS
 Bacteria
 Fungi
 Parasites
 Viruses

MACROORGANISMS
 Pest
 Plants
Biological Hazards

SOURCES:
• soil
• insects
• plants
• birds
• animals
• humans
Biological Hazards Adverse Health
Outcomes

Healthcare
Miners
Tuberculosis

Other animal handlers

Pet shop owners,
Research and
Laboratory Rabies, micro organisms,
parasites, etc.
workers
Agriculture, fishing
and animal husbandry
Tetanus, hookworm, fungal infections,
micro organisms from animals
 Tuberculosis
WMSU
 MORTALITY: TOP TEN LEADING CAUSES, 2013
BOTH SEXES
CAUSE OF DEATH
Number Rate
1. Diseases of the Heart 118,740 121.1
2. Diseases of the Vascular System 68,325 69.7
3. Malignant Neoplasms 53,601 54.7
4. Pneumonia 53,101 54.2
5. Accidents 40,071 40.9
6. Diabetes mellitus 27,064 27.6
7. Chronic lower respiratory diseases 23,867 24.4
8. Tuberculosis, all forms 23,216 23.7
9. Nephritis, nephrotic syndrome, and nephrosis 14,954 15.3

10. Certain conditions originating in the perinatal period 10,436 10.6

Tuberculosis
• Caused by the bacteria Mycobacterium tuberculosis
• Transmitted by droplet nuclei released when
sneezing and coughing
• Symptoms:
– weight loss
– low grade afternoon fever
– persistent cough &, sometimes, blood-streaked
expectoration or hemoptysis
• 90% cure rate with DOTS
Mode of Transmission

Inhalation of droplets
sprayed into the air from a
cough or sneeze by
someone infected
 Human
Immunodeficiency
Virus (HIV)
WMSU
HIV & AIDS
HIV - Human immunodeficiency virus
- virus which causes AIDS

AIDS - Acquired immune deficiency syndrome

- serious & usually fatal condition in which the body’s
immune system is severely weakened & cannot fight off
infection
Quick facts (DOH-EB, December 2018)
Modes of transmission
 HEPATITIS B
WMSU
 Hepatitis B
• most common cause of liver cancer and
liver cirrhosis among Filipinos.
• Mode of transmission:
1. Sexual contact
2. Mother to child
(during pregnancy or childbirth)
 Hepatitis B
3. Exposure to contaminated blood or infected
body fluids (semen, vaginal secretions, etc)

unscreened blood unscreened organ cut on skin or needle stick and sharps
for transfusion donors for transplant mucosa injury

unsterilized needles unsterilized needles unsterilized needles

used in body piercing inadequately sterilized dental
used in acupuncture used in body tattooing or surgical instruments
 ERGONOMIC
HAZARDS
WMSU
Ergonomics
“The scientific discipline concerned with the
understanding of the interactions among human
& other elements of a system, & the profession
that applies theory, principles, data, & methods
to design in order to optimize human well-being
& over-all system performance.”

International Ergonomics Association Council, 2000

Ergonomics

task
(job content &
context)

environment tool

organization workstation
Ergonomics
Risk Factors:

Static posture
Forceful exertion
Repetitive movement
Extreme range of motion
Awkward posture
Ergonomic Hazards Adverse Health
Outcomes
WORK-RELATED MUSCULOSKELETAL DISORDERS
– Low back pain
– De Quervain’s disease
– Carpal Tunnel Syndrome
– Hand-arm vibration syndrome
– and others
 Effects
of
Stress
to
the
Body
(www.mentalhealthamerica.net)
Impacts of Alcohol and Drugs at Work
PHYSICAL SAFETY
• liver / kidney
• impaired judgment
damage
• cancer • decrease coordination

• heart diseases • loss of concentration

• brain damage • increase accidents
• HIV / AIDS

MENTAL PRODUCTIVITY
• impair performance
• altered perceptions
• increase absenteeism
• personality changes
• decrease productivity
• paranoia
• increase healthcare costs
• irritability
• Increase replacement costs
• depression
 3. Selection of Medical Screening
Tests
Hazard Health Risk Test
Noise Noise-induced hearing loss Audiometry

Toluene Nervous system Neuro examination

Liver Liver profile
Biological monitoring
(urinary toluene)

Silica Silicosis (lung disease) Chest X-ray

Pulmonary function tests (PFT)
Asbestos Asbestosis (lung disease) Chest X-ray
Pulmonary function tests (PFT)
Lead Anemia, nephropathy Neuro examination
Biological monitoring
(Lead in blood)
 Biological Monitoring - Selected
Substances (adopted from ACGIH, 2018)
Assay
Substance Parameter Sampling Time
material
Benzene urine S-Phenylmercapturic End of shift
acid/g creatinine or
t,t-Muconic acid/g creatinine

Hexane urine 2,5-Hexanedione End of shift at end of

workweek

Lead and compounds blood Lead Not critical

(except alkyl lead
compounds)

Mercury, elemental urine Mercury Prior to shift

Toluene urine o-cresol/g creatinine End of shift

urine Toluene End of shift

Biological Monitoring - Selected
Substances (adopted from ACGIH, 2018)

Assay
Substance Parameter Sampling Time
material
Acetone urine acetone/L urine End of shift

Styrene urine mandelic acid End of shift

Xylene urine methylhippuric End of shift
acids/g creatinine
Trichloroethylene urine TCA/L urine By the end of the
last shift of a
workweek/
shift period
Cadmium and its blood Cd/g creatinine Not critical
inorganic
compounds
 4. Interpretation of Data and
Recommendation

Periodic Exam Periodic Exam Periodic Exam Periodic Exam Periodic Exam

Course of Employment

MEDICAL SURVEILLANCE DATA

Basis of having Occupational Health Policies and Programs
Pre-Employment Exit/Separation
(baseline) Exam
Are workers still healthy?
What control measures would you recommend based on these results?
Do workers get sick in spite of control measures being implemented?
Are your control measures effective in keeping your workers healthy?
 5. Communication of Results
Medical surveillance
• Feedback of group results

• Ensure medical confidentiality

– Use codes instead of actual names of
the employees.

Communicate to the Health and Safety Committee

– Facilitates continuous review of preventive programs
– Provides a mechanism for continuously improving health and safety performance
– Occupational Health Policies and Programs based on the results (e.g. top illnesses of the company)
 6. Recordkeeping
• Medical recordkeeping
– Test results, interpretation, record of
notifications, AMR

• Exposure evaluations
– WEM, Biological monitoring

• Resulting environmental modifications

– Control measures implemented

• Requirements, procedures, and interpretation of findings

for health surveillance as specified by national legislation
DOLE/BWC/HSD/OH-47-A (AMR)
DOLE/BWC/HSD/OH-47-A
 6. Recordkeeping

• Medical History of workers

– personal illnesses
– family health problems
– reproductive history
– lifestyle (e.g., smoking, drug use, etc.)
• Occupational History
• descriptions of all jobs held
• work exposures
• symptoms or illnesses at previous jobs
• personal protective equipment used
 6. Recordkeeping

• Physical Examination
– complete system review
• cardiovascular, pulmonary, and musculoskeletal
• eyes, ears, nasopharynx, abdomen

– evaluation of susceptibility (obesity, smoking)

to exposures and physical problems (heat
stress, noise)
7. Evaluation of Control Measures
Do workers get sick in spite of control measures being implemented?
Are your control measures effective in keeping your workers healthy?

60 60
55 55
50 50
45 45
40 40
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
1995 96 97 98 99 2000
asthma Low back pain

Figure 1. Cases of asthma and low back pain in Company X, 1995-2000 (HCD, 2019)
Biological Exposure Indices (BEI) and Work Environment Measurement (WEM) of lead
among workers in Electro Inc., 2016-2019
BEI
2016 2017 2018 2019
(ug/dL)

Zeero 48.0 46.8 26.5 21.8

Reesa 45.2 43.2 41.2 40.9
Achy 15.3 19.7 15.3 13.6

Visio 21.7 15.7 13.7 11.9

Milly 19.6 16.3 11.6 9.4

Oshy 49.2 47.6 45.4 44.8

WEM (mg/m3) 0.21 0.18 0.15 0.01
Reference values:
Threshold Limit Value (TLV) for 8-hour exposure is 0.15 mg/m3
Biological Exposure Index (BEI) = 40ug/dL
• The purpose of medical surveillance in occupational health is
prevention of illness.

• When illness arises from a particular exposure, medical

surveillance is necessary.

• There are various health effects for every health hazards

present in my workplace.

• We can refer to Safety Data Sheet on the health effects of

chemicals used in my workplace.
• Medical surveillance and biological monitoring are strategies
done to check for any abnormalities in the body at
physiological and cellular levels.

• Safety Officer must classify the risk of the health hazards

before implementing appropriate control measures to address
them.

• Medical surveillance has to be followed by preventive action

and evaluation of the effectiveness of intervention .
QUESTION ?