OCCUPATIONAL

DISEASE
Dr Harry Dinesh Mahalingam
MD. FRSPH. MSc.PH. OHD. PG.Dip
Diabetology
DEFINITION
• An event or exposure that occurs in the workplace that
causes or contributes to a condition or worsens a
preexisting condition.

• The first recorded observation of an occupational disease

may be a case of severe lead colic suffered by a worker who
extracted metals.
Greek physician of the 4th century BCE

• The Roman scholar Pliny, in the 1st century CE,

described mercury poisoning as a disease of slaves because
mines contaminated by mercury vapour were considered
too unhealthy for Roman citizens and thus were worked
only by slaves.
• Occurrence of scrotal cancer among chimney sweeps to
the soot ingrained into their skin by prolonged exposure to
flue dusts

• Lung diseases caused by dust that commonly afflicted

miners and metal grinders.

• X rays were discovered in 1895, and 20 years later nearly 100

radiologists were estimated to have died as a result of
occupational exposures.

• Asbestos-related disease was first reported in the first half

of the 20th century, and in 1974 hemangiosarcoma

• Malignant tumor of the liver, was discovered among

workers involved in the polymerization of vinyl
chloride monomer
JOB PLACEMENT
Preexisting medical conditions
may be at a disadvantage in
some jobs. A preemployment
health questionnaire or
medical examination can be of
great value in such cases
 SAFETY TRAINING

An occupational health service has a The measures taken to protect

responsibility to keep all employees employee health should be thoroughly
informed about hazards in the explained so that workers understand
workplace. the necessity of complying.
 CONTROL OF RECOGNIZED HAZARD

A complex system of environmental and biological monitoring has been

developed for the control of known hazards at work.

Occupational health practice is concerned with monitoring the

concentration of toxic substances in the environment, determining safe
exposure levels, suggesting procedures to limit worker exposure, and
monitoring workers for signs of overexposure.

Occupational health specialists can also contribute to the prevention of

health risks by assisting in the planning and design of new equipment and
factories.
 IDENTIFICATION OF UNRECOGNIZED HAZARDS
Lung and nasal cancer among
nickel workers
Clinical observation
and study may
reveal a causal Examples
of hazards
relationship Lung cancer in asbestos workers
identified in this
between patterns manner include
of sickness or
mortality in groups
of workers and their Coronary heart disease among
occupational workers exposed to carbon
disulfide
exposure.
 SURVEILLANCE
Employee health surveillance
programs for the
early diagnosis of disease.
 DISORDERS DUE TO CHEMICAL AGENTS

• Hazardous chemicals can act directly on the skin, resulting in

local irritation or an allergic reaction, or they may be absorbed
through the skin, ingested, or inhaled.

• Ingestion of toxic chemicals is usually accidental and most

commonly results from handling contaminated food, drink, or
cigarettes.

• Substances that occur as gases, vapours, aerosols, and dusts

are the most difficult to control, and most hazardous
chemicals are therefore absorbed through the respiratory
tract. If inhaled, airborne contaminants act as irritants to the
respiratory tract or as systemic poisons.

Gases may act as local
irritants to inflame
mucous surfaces.
Common examples
include sulfur dioxide,
chlorine, and fluorine, GASES
which have pungent
odours and can
severely irritate the
eyes and the
respiratory tract.
Some gases, such as
nitrogen oxides and
phosgene, are much
more insidious.
Victims may be
unaware of the danger
of exposure because the
immediate effects of
these gases may be mild
and overlooked.
Several hours after
exposure, however,
breathlessness and fatal
cardiorespiratory failure
due to pulmonary edema
may develop.
 METALS
Mercury poisoning, one of the classic occupational diseases, is a representative
example of metal poisoning. Exposure to mercury can occur in many situations,
including the manufacture of thermometers, explosives, fungicides, drugs, paints,
batteries, and various electrical products. The disorders it can cause vary
depending on the type of mercury compound and the method of exposure.

Ingestion of mercury salts such as mercuric chloride (corrosive sublimate)

leads to nausea, vomiting, and bloody diarrhea. Kidney damage resulting in
death may follow in extreme cases.

Mercury vapour causes salivation, loosening of the teeth, and tremor; it also
affects the higher centres of the brain, resulting in irritability, loss of
memory, depression, anxiety, and other personality changes.
 ORGANIC COMPOUNDS
Pesticides are used the world over; and, even though precautionary
measures such as using

Protective clothing Respirators

Monitoring Keeping workers Requiring workers

contamination of out of recently to wash
equipment and sprayed areas thoroughly after
clothing exposure
 DUST
• The lung diseases known as the pneumoconioses result when
certain inhaled mineral dusts are deposited in the lungs,
where they cause a chronic fibrotic reaction that leads to
decreasing capacity for exercise and increasing
breathlessness, cough, and respiratory difficulty.
No specific treatment is known.

• Measures for limiting exposure include using water and

exhaust ventilation to lower dust levels and requiring
workers to wear respirators or protective clothing

• Coal worker’s pneumoconiosis, silicosis, and asbestosis are the

most common pneumoconioses.
• Miners and quarry workers are the people most likely to suffer from silicosis.
Because silica is found in many rocks and is used in a variety of industries, workers
involved in stonecutting, grinding, drilling, foundry work, sandblasting, pottery
making, and the manufacture of abrasives and cement are also at risk.

• Silicosis is an aggressive form of pulmonary fibrosis that speeds the progress

of tuberculosis. Routine chest X rays can aid early diagnosis by revealing abnormal
shadowing.

• Asbestosis is more difficult to detect in the early stages because chest X rays usually
reveal little until the disease is advanced. From onset asbestosis progresses more
rapidly than the other pneumoconioses and can result from relatively low exposure.
Asbestos is the general term for a number of fibrous silicates that are used primarily
in various fireproofing, insulation, and cement products. In addition to pulmonary
fibrosis, inhaling asbestos fibers has also been shown to cause lung and other
cancers.
DISORDERS
DUE TO
PHYSICAL
AGENTS
 TEMPERATURE
• Miners who perspired profusely and drank water to relieve
their thirst experienced intense muscular pain—a condition
known as miner’s cramps—as a result of restoring their
water but not their salt balance.

• Heat exhaustion is characterized by thirst, fatigue, giddiness,

and often muscle cramps; fainting can also occur.
Heatstroke, a more serious and sometimes lethal condition,
results when prolonged exposure to heat and high humidity
prevents efficient perspiration.

• Frostbite, or the freezing of tissue, can lead to gangrene and

the loss of fingers or toes. If exposure is prolonged and
conditions (such as wet or tight clothing) encourage heat
loss, hypothermia, a critical fall in body temperature, may
result.
 NOISE

Temporary or Effects on the auditory

permanent hearing loss Acoustic Trauma
System
may also occur.
Characterized by:
• Acoustic Trauma
Depends on: A sudden change in
• Noise-induced hearing
Loudness or intensity hearing loss
of the noise As a result of:
• Temporary A single exposure to a
Pitch or frequency threshold shift (TTS) sudden burst of sound,
such as an explosive
Length and pattern of • Permanent blast.
exposure threshold shift (PTS)
Vulnerability of the
individual

NIHL
Is hearing loss that is a function of
continuous or intermittent noise
exposure and duration, and which
usually develops slowly over several
years.
NOISE INDUCED HEARING LOSS
TTS (Temporary threshold shift)
Is a transitory hearing loss with normal
hearing being restored after cessation
of noise exposure
PTS (Permanent threshold shift)
Irreversible hearing loss that is caused
by prolonged exposure
 DIAGNOSIS

1 2 3 4 5 6

History Clinical NIHL Should be Sensorineural Notching

Examination Audiologic Bilateral
Exposure to noise Excluding other Profile
in the workplace causes of hearing
and not elsewhere loss
• Normal: Hearing thresholds at all
frequencies are less than 25 dB

• Hearing Loss: There is 25 dB loss or more at

any one frequency

• Early NIHL: 25dB loss or more in the 4kHz

region (including 3 and 6 kHz) plus a
recovery pattern at 8 kHz

• Early NIHL: Average increase of 10dB or

more in the frequencies 2, 3, and 4 kHz
(Standard threshold shifts)
 Severity of Hearing Loss

Normal ± 20 Dbhl
Mild 21 – 40 dBHL
Moderate 41 – 70 dBHL
Severe 71 – 90 dBHL
Profound > 90 dBHL

DIAGNOSIS

Hearing Impairment:
Average loss of 25dB or more affecting
the frequencies 0.5, 1, 2,3 kHz

Disability:
Average loss of 50 dB or more affecting
the frequencies 0.5, 1, 2, and 3 kHz
HEARING CONSERVATION PROGRAM
Required when workers are exposed to levels beyond
85dB

Noise level Assessment

Sound level meter
Noise dosimeter

Noise Control Measures

Engineering
Administrative
PPE
Audiometric Monitoring
Baseline
Periodic
End of employment
 Education and Training

Engineering Control

Substitution of machines

Reduce noise through its transmission in air

Maintenance of machines

Isolate the operator by providing a relatively soundproof

booth for the operator or attendant
 PERSONAL
ADMINISTRATIVE
HEARING
CONTROL
HOW
PROTECTION

TO
CONTROL Ear plugs
NOISE
Job rotation
Job transfer Ear muffs
Provide education Provides a 15-30 dB
and training reduction
 VIBRATION

Whole-body vibration is experienced in surface and air transport,

with motion sickness its most familiar effect.
A more serious disorder, known as Raynaud’s syndrome or vibration white
finger (VWF), can result from the extensive use of vibratory hand tools,
especially in cold weather.
The condition is seen most frequently among workers who handle chain
saws, grinders, pneumatic drills, hammers, and chisels
 OCCUPATIONAL DERMATOSES

• Pathological condition of the skin which results from exposure

to an occupational agent.

• It includes all skin diseases induced or aggravated by

exposure to agents in the work environment

• Chemical, mechanical, physical and biological

 Contact Dermatitis
• (>90% of cases)
• Irritant contact dermatitis
• Acute irritant dermatitis
• Cumulative contact dermatitis

Allergic Contact Dermatitis

• Contact Urticaria

CLASSIFICATION Non Eczematous Dermatosis

Mechanical Injury

Localized Vibration

Temperature

Ultraviolet Light

Ionizing radiation

Skin infections
Hierarchy of Controls
HIRAC
Hazard Identification, Risk Assessment and Control (HIRAC) is the process for managing
hazards in the work or operational environment. It is the fundamental mechanism for
ensuring a safe workplace, and underlies the basis of modern health and safety legislation.
 WORK-RELATED MUSCULOSKELETAL
DISORDERS & ERGONOMICS
• Work-related musculoskeletal disorders are conditions in which
➢ The work environment and performance of work
contribute significantly to the condition; and/or
➢ The condition is made worse or persists longer due to work
conditions

• Examples of work conditions that may lead to WMSD include

➢ Routine lifting of heavy objects,
➢ Daily exposure to whole body vibration,
➢ Routine overhead work,
➢ Work with the neck in chronic flexion position
➢ Performing repetitive forceful tasks.
• Musculoskeletal Disorders (MSD) are associated with high costs to
employers such as absenteeism, lost productivity, and increased health care,
disability, and worker’s compensation costs.

• Examples of MSDs include

➢ Sprains, strains, and tears
➢ Back pain
➢ Carpal tunnel syndrome
➢ Hernia
 DEVELOPING AND IMPLEMENTING
WORKPLACE CONTROLS
Engineering controls, administrative controls and use of personal protective
• A three-tier hierarchy of controls is widely accepted as an intervention strategy for
reducing, eliminating, or controlling workplace hazards, including ergonomic hazards. The
three tiers are:

Use of engineering controls

• The preferred approach to prevent and control WMSDs is to design the job to take account
of the capabilities and limitations of the workforce using engineering controls.

➢ Some examples include:

❑ Changing the way materials, parts, and products can be transported.
For example, using mechanical assist devices to relieve heavy load lifting and
carrying tasks or using handles or slotted hand holes in packages requiring manual
handling
❑ Changing workstation layout, which might include using height-adjustable
workbenches or locating tools and materials within short reaching distances
 USE OF ADMINISTRATIVE CONTROLS
(changes in work practices and management policies)
Administrative control strategies are policies and practices that reduce WMSD risk but they
do not eliminate workplace hazards.

Although engineering controls are preferred, administrative controls can be helpful as

temporary measures until engineering controls can be implemented or when engineering
controls are not technically feasible.

Some examples include:

• Reducing shift length or limiting the amount of overtime
• Changes in job rules and procedures such as scheduling more breaks to allow for rest and
recovery
• Rotating workers through jobs that are physically tiring
• Training in the recognition of risk factors for WMSDs and instructions in work practices and
techniques that can ease the task demands or burden (e.g., stress and strain)
 USE OF PERSONAL PROTECTIVE EQUIPMENT
(PPE)

• PPE generally provides a barrier between the worker and hazard source.

• Respirators, ear plugs, safety goggles, chemical aprons, safety shoes, and
hard hats are all examples of PPE

• Whether braces, wrist splints, back belts, and similar devices can be
regarded as offering personal protection against ergonomic hazards
remains an open question. Although these devices may, in some
situations, reduce the duration, frequency or intensity of exposure,
evidence of their effectiveness in injury reduction is inconclusive. In some
instances, these devices may decrease one exposure but increase another
because the worker has to “fight” the device to perform the work. An
example is the use of wrist splints while engaging in work that requires
wrist bending
 ERGONOMICS
Ergonomics is the science of fitting
workplace conditions and job
demands to the capability of the
working population.
ERGONOMICS
The goal of ergonomics is
➢ to reduce stress and eliminate injuries and
disorders associated with the overuse of
muscles, bad posture, and repeated tasks.

A workplace ergonomics program can aim to

prevent or control injuries and illnesses by
eliminating or reducing worker exposure to
WMSD risk factors using engineering and
administrative controls.

PPE is also used in some instances but it is the

least effective workplace control to address
ergonomic hazards.
 RISK FACTORS

Awkward Material Mechanical

Repitition Force
Postures Handling Compression

Temperature Inadequate Duration of

Vibration Glare Exposure
extremes Lighting

Eg: employees who spend many

hours at a workstation may develop
ergonomic-related problems resulting
in musculoskeletal disorders.
INORGANIC
DUST
DISEASES
 ASBESTOSIS
Asbestosis is caused by the inhalation of microscopic fibers of asbestos.
The disease is progressive, resulting in scarring of the lungs with fibrous tissue.

Examples of products that may have previously contained asbestos include:

• Insulation blankets or tape around steam pipes, boilers, and furnace ducts
• Resilient floor tiles
• Vinyl sheet flooring backing
• Adhesives used to install floor tiles
• Insulation made of cement sheet, millboard, and paper used around furnaces and wood-
burning stoves
• Door gaskets in furnaces, wood stoves, and coal stoves
• Sprayed soundproofing or decorative material on walls and ceilings
• Patching and joint compounds for walls and ceilings
• Cement roofing, shingles, and siding

If the asbestos-containing materials are in good condition, they are generally safe if left alone.
Removal of asbestos-containing material should be undertaken by a specially-trained
contractor.
 Coal Worker’s
Pneumoconiosis Silicosis
(Black Lung Disease)
Inhaling free crystalline silica, a
dust found in the air of mines,
CAUSED BY Inhaling coal dust foundries, blasting operations, and
stone, clay, and glass
manufacturing facilities

Scarring of the lungs, silicosis itself

Scarring on the lungs
CHARACTERIZED (which often permanently
can increase the risk for other lung
diseases, including tuberculosis
BY damages the lungs and may
(a chronic, bacterial infection that
lead to shortness of breath).
usually infects the lungs).

About 2.8 percent of coal

Over one million workers per year
miners have coal worker's
are exposed to silica
pneumoconiosis.
 asbestos; mesothelioma
(Asbestos chrysotile fibres are responsible for the lung diseases known as asbestosis and mesothelioma)
ORGANIC
DUST
DISEASES
 Byssinosis Hypersensitivity
(Brown Lung Disease) pneumonitis
Inhalation of fungus spores
Dust from hemp, flax, from moldy hay, bird
CAUSED BY and cotton processing. droppings, and other organic
dusts.
Inflamed air sacs in the lungs,
CHARACTERIZED Chest tightness and leading to fibrous scar tissue
BY shortness of breath. in the lungs and abnormal
breathing.
There are variations of
Affects textile workers--
hypersensitivity pneumonitis
both former and current-
depending on the
-and almost exclusively
occupation, including cork
those who work with
worker's lung, farmer's lung,
unprocessed cotton.
and mushroom worker's lung.
Occupational asthma
(most common)
Inhaling certain irritants
in the workplace, such as
dusts, gases, fumes, and
vapors.
Common asthma
symptoms (such as a
chronic cough and
wheezing), occupational
asthma is a reversible
condition when
diagnosed at an early
stage.
Often work in
manufacturing and
processing operations,
farming, animal care,
food processing, cotton
and textile industries, and
refining operations.
 OCCUPATIONAL RENAL DISEASE
Exposure to chemical substances can cause adverse effects on the kidney, ureter, or bladder
(Kidney Toxicity). The kidney is vulnerable because of its role in filtering the blood. Some
chemicals and heavy metals cause severe injury to the kidney, while others produce chronic
changes that can lead to kidney failure and cancer.

In the workplace, the most common route of exposure to occupational renal disease is by
inhalation (breathing a substance into the lungs), skin absorption, and swallowing.

Some people are at higher risk of kidney disease than others. The two most common causes of
kidney disease are diabetes and high blood pressure. it is very important that you familiarize
yourself with the hazards in your workplace, as you are already at high risk for developing
kidney disease.
detergent
Some examples of occupational products that can contribute to kidney damage and failure
are benzene, organic solvents such as fuels, paints, and[degreasing agents. 7 Agrochemicals
such as fertilizers and pesticides can also cause kidney illness. Workplace exposures to heavy
metals such as cadmium and lead are also known to cause toxic injury to the kidneys.
 OCCUPATIONAL NEUROLOGY
1. The nervous system is vulnerable to the effects of certain chemicals and physical
conditions found in the work environment. When one is making a differential diagnosis in
patients with neurological disorders, the possibility of toxic exposure or encounters with
physical factors in the workplace must not be overlooked. Central to an accurate clinical
diagnosis is the patient's history. A diagnosis of an occupational or environmental
neurological problem requires a careful assessment of the clinical abnormalities.

2. On the basis of information about hazards in the workplace, safety standards and
environmental and biological monitoring can be implemented in the workplace to
reduce the risks of undue injury. Clinical manifestations of headache, memory
disturbance, and peripheral neuropathy are commonly encountered presentations of the
effects of occupational hazards. Physicians in everyday clinical practice must be aware of
the signs and symptoms associated with exposure to possible neurotoxins and work
methods. Occupational and environmental circumstances must be explored when
evaluating patients with neurologic disorders.
OCCUPATIONAL LIVER DISEASE
 THANKS!
CREDITS: This presentation template was created by
Slidesgo, including icons by Flaticon, and infographics &
images by Freepik and illustrations