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Department Order No.

73-05
Series of 2005
Guidelines for the Implementation of
Policy and Program on Tuberculosis (TB)
Prevention and
Control in the Workplace

The Healthy

A Diseased

TUBERCULOSIS

What is
TB?
152 x 255

Tuberculosis (TB)
- short for tuberculosis / Tubercle Bacillus
Scrofula (swollen neck glands)
Pott's disease of the spine
Miliary TB (x-ray lesions look like millet seeds)
Tabes mesenterica (TB of the abdomen)
Lupus vulgaris (the common wolf - TB of the
skin)
Prosector's wart, also a kind of TB of the skin,
transmitted by contact with contaminated
cadavers to anatomists, pathologists,
veterinarians, surgeons, butchers, etc.

Tuberculosis (TB)
- is a potentially fatal contagious disease
- an infection with the bacterium Mycobacterium
tuberculosis,
-

the bacteria usually invades the lung (pulmonary


TB) (90%), but also invade other parts of the body
such as the central nervous system (meningitis),
lymphatic system, circulatory system (miliary TB),
genitourinary system, bones and joints.

(WHO estimates in 2006)


More than 14M with TB
9.2M new cases of TB worldwide
Approximately 1.7 M died
4.1M diagnosed by lab. Testing

Tuberculosis in Philippines
247,740: Estimated incidence (all new cases) (2006)
287: Estimated incidence (all newcases per 100,000
population) (2006)
129: Estimated incidence (new sputum smear positive
[ss+] per 100,000 population) (2006)
100%: DOTS population coverage (2006)
77%: DOTS detection rate (new ss+)(2006)
89%: DOTS treatment success (new ss+) (2005)

10 most common causes of death:

Most common sickness of Filipinos:

Global rank: 9th largest TB burden

Regional Rank: 3rd among WPR


(Western Pacific Region) countries
Case detection rate: 73%
Cure rate (new smear +): 81%
About 75 Filipinos die of TB everyday

Out of 384,400 new active


cases:
Only 28% are diagnosed (276,768 are
undiagnosed & continue to spread
disease)
20% die without diagnosis
6% of those diagnosed die because of
inadequate treatment

Hemoptys

TB Symptoms

Chest and back pains

TB Symptoms
Occasionally some patients may
have no symptoms. Depending
on the site of the body being
affected, other symptoms may
also occur.

Among those with TB infection,


who is at high risk to develop active TB
disease?
People with HIV infection
People exposed to TB within 2 years
Babies and young children
People who inject illegal drugs
People sick with other diseases that weaken
the immune system

Elderly people
Homeless people
Jailed people in 3rd world
countries
People incorrectly treated
for TB in the past

People with:
- diabetes

mellitus

- malnutrition
- malignant disease
- chronic kidney disease
- alcoholism
- silicosis (dse. Of the lungs)
- impaired immunity due to certain drugs
(e.g., steroids, anti-cancer drugs)

How is the disease


transmitted?

TB is an airborne disease. When a TB patient


coughs, sneezes, speaks, sings, or spits, small
droplets containing the tubercle bacilli are
generated and spread in the air.
When another person breathes in these small air
droplets, he may be infected with the germ .
Prolonged exposure, however, is usually
required for the disease to be transmitted .

Probability of transmission
depends upon:
Number of infectious droplets
expelled by the carrier;
Effectiveness of ventilation;
Duration of exposure;
Level of immunity in the
uninfected person

How can TB be diagnosed?


The usual tests employed by doctors to
diagnose TB include chest x-ray
examination and sputum smear
examination.
Sputum examination is done by direct
smear under microscopy as well as
culture for the germs. Further
investigations may be required, e.g.,
computerized tomography,
bronchoscopy, lung biopsy, etc.

What happens after infection


with the tubercle bacilli?
About 1 in 10 of the infected
persons will develop the disease
If someone does become infected, it
typically takes 3 to 4 weeks before
the newly infected person infectious
enough to transmit the disease
can occur weeks, months, years, or
even decades later.

What is the treatment for


TB?
Nowadays,
the
treatment
for TB is
very
effective.

What is the treatment for TB?

-TB

& Chest Service of the Department


of Health provides treatment to
patients free of charge.

- drug treatment lasts 6 months

If the treatment is taken irregularly, there


may be serious consequences:
- the TB germs become resistant to
the
drugs
- the disease cannot be cured
- the disease can be spread to others
- death

MYTHS AND MISCONCEPTIONS


MYTH: TB is inherited
FACT: TB is not inherited
MYTH: TB can be acquired thru: using eating
utensils used by TB patient, sleeping late in the
evening, kissing and sex
FACT: TB can be acquired only when a person
inhales the bacteria from air droplets
MYTH: Only malnourished and poor people can
get TB
FACT: TB can also affect healthy and rich people

Pursuant to Executive Order No. 187


Instituting

a Comprehensive and
Unified Policy for the TB Control
in the Philippines
Signed

by President GMA on
March 21, 2003

Why the Workplace?


Existing organizational structure
Existing resources (manpower, facilities
and equipment, logistics)
Easy to implement health promotion activities and
convenient site for TB-DOTS program
Facilitates monitoring, recording and reporting
Workers spend a significant portion of their day at work
Presence of existing facilities, services, personnel for
health care delivery
Occupational Safety and Health is part of the Social
Corporate Responsibility

Workplace Issues on TB
Transmission

Work Environment factors that enhance the


likelihood of transmission include:

exposure in relatively small, enclosed


spaces;

inadequate local or general ventilation that


results in insufficient dilution and/or
removal of infectious droplet nuclei; and

Re-circulation of air containing infectious


droplet nuclei.

Transmission is most likely to occur


from TB infected workers :

who have unrecognized pulmonary or


laryngeal TB;

who are not on effective anti-TB therapy;


and

who continue to work

Depending on the type of workplace:


the risk may be higher in areas where
patients with TB are provided care before
diagnosis and initiation of TB treatment and
isolation precautions
e.g., in clinic waiting areas and
emergency departments

where diagnostic or treatment procedures


that stimulate coughing are performed
e.g., microscopy centers

Workplace Settings with


Increased TB risk
Health care facilities
Prisons
Workplaces with exposure to silica and other
inorganic dust
Industries with large migrant workforce
Sweatshops(Extreme exploitation, including
the absence of a living wage or long work
hours,
* Poor working conditions, such as health and
safety hazards )

Components of a TB
workplace prevention
and control policy and
program

I. Preventive strategies
Program on TB Advocacy, Education
and Training must be carried out (TB
Awareness Program)
Awareness program shall deal with
the nature, frequency, and
transmission, treatment with the
DOTS, control and management of
TB in the workplace.

Directly Observed Treatment


Short-course

What is DOTS?
A comprehensive strategy
endorsed by the World Health
Organization (WHO) and
International Union Against
Tuberculosis and Lung Disease
(IUATLD) to detect and cure TB
Patients

DOTS: Transferring the Burden of


Curing the Patient to the Health
System
Prime Elements:

Political will

Microscopy-based
diagnosis
Free and
uninterrupted drug
supply
Direct supervision of
treatment
Recording and
monitoring system

Improving
workplace
condition
-

Control of
contamination
Adequate and
appropriate ventilation
Adequate sanitary
facilities for workers
Appropriate worker
density (1 worker /11.5
m3)

Capability Building
TB awareness raising and training
TB Case Finding
TB Case Holding
Reporting and Recording of cases
Implementation of DOTS

Workers must be given


proper information on ways
of
strengthening
their
immune system

STRENGTHENING THE IMMUNE


SYSTEM AGAINST TB INFECTION

STRENGTHENING
the
IMMUNE SYSTEM
against
TB INFECTION

STRENGTHENING
the
IMMUNE SYSTEM
against
TB INFECTION

STRENGTHENING the IMMUNE SYSTEM


against TB INFECTION

Wakeful Rest

Slee

What does sleep


do to us?

Through adequate rest


nerve energy is
restored!

With adequate rest


the body revitalizes,
repairs, restores,
renews & rejuvenates!

Sleep provides us with


these 2 primary needs:
1. Revitalization of the nervous
system.
2. Repair of organic damages &
rebalancing of body chemistry.

SLEEP DEPRIVATION CAN CAUSE


THE FOLLOWING:

Significant decrease in the


metabolic activity of the brain after
24
hours
of
sustained
wakefulness.

Reduction in body temperature,


a slowing down of immune system
function and an inadequate
release of growth hormone.

Continued sleep deprivation may


cause
hallucinations and mood
swings.
(Essential hormones that
effect the breakdown of proteins,
maintain
optimal
emotional
functioning and that fight invaders
like viruses
and bacteria are
released in sleep.)

Increased heart rate and nervous


system malfunction.

Memory and physical performance


impairment; reduction in the ability to
carry out mathematical calculations.

STRENGTHENING THE IMMUNE


SYSTEM AGAINST TB INFECTION

When you smoke you inhale up


to 4000 chemicals including
these
Poisons:

Causes

causes BLINDNESS

II. MEDICAL MANAGEMENT


1. Adopt DOTS in management of TB in
workers and dependents
2. Refer workers and family members with TB
to private or public DOTS centers
3. TB Benefits Policy of ECC, SSS, and
PhilHealth shall be followed

III. RECORDING, REPORTING AND

SETTING-UP A DATABASE

1. Companies shall report all diagnosed cases


of TB to the Department of Labor and
Employment
Use appropriate form, i.e., the Annual
Medical Report (OSHS RULE 1965.01 (4)
and Rule 1053.01 (1)).
2. SSS will report to Philippine Coalition
Against Tuberculosis (PhilCAT)

IV. SOCIAL POLICY

1. Non-discrimination:
Workers who have or had TB shall not be
discriminated against
a. Support for adequate diagnosis and treatment
b. Ensure continuing employment for as long as
they are certified by the companys accredited
health provider as medically fit
c. Restoration to work as soon as their illness is
controlled

2. Work Accommodation
- Based on agreements between the
management and workers
Measures to accommodate and
support workers through
flexible leave arrangements
rescheduling of working times
arrangements for return to work

3. Restoration to Work
- The worker may be allowed to return to

work with reasonable working


arrangements as determined by the
company Health Care Provider and/or the
DOTS provider.

V. ROLES AND RESPONSIBILITIES OF


WORKERS WITH TB OR AT RISK FOR TB
Workers who have symptoms of TB shall seek
immediate assistance from their health service
provider
Also those at risk, i.e., those with family members
with TB, shall do the same
Once diagnosed, they shall avail of the DOTS and
adhere to the prescribed course of treatment

VI. ROLES AND RESPONSIBILITIES OF


EMPLOYERS
Any contact in the workplace shall be traced
and the contacts shall be clinically assessed.
In the context of their Corporate Social
Responsibility and OSH and related programs,
employers are encouraged to extend the TB
program to their workers families and their
respective communities.

VII. IMPLEMENTATION AND


MONITORING
The Occupational Safety and Health Center
(OSHC) shall provide preventive and technical
assistance in the implementation of the
Workplace TB program at the enterprise level.
The BWC and DOLE Regional Offices through
their labor inspectors shall enforce these
guidelines.
All employers shall disseminate these
guidelines in their respective workplaces.

EFFECTIVITY
All concerned shall comply
with all the provisions of this
Department Order within 30
days from its publication in a
newspaper of general
circulation.

March 30, 2005

Wakeful rest restorative and


intentional inactivity.

Sleep

a period of complete
unconsciousness of the individual and
a function of the nervous system
exclusively:
it
shuts
down
consciousness.

Even if you do not feel sleepy,


the sleep debt can have a
powerful negative effect on
your daytime performance,
thinking, and mood, and cause
you to fall asleep at
inappropriate and even
dangerous times.

When we get less sleep (even


1 hour less) than we need
each night, we develop a
"sleep debt.

Snoring
Breathing Pauses during sleep
Problems with sleeping at night
Difficulty staying awake during
the day
Unexplained decrease in Daytime
Performance

How much
SLEEP is
enough?

0 2 months old 10 to 18
hours including naps

2 12 months old 14 to 15 hours


including naps

12 to 18 months old 13 to 15 hours


including naps

18 months to 3 years old 12


to 14 hours including naps

3 to 5 years old 11 to 13
hours including naps

5 to 12 years old
9 to 11 hours

5 to 12 years old

9 to

8 to 9 hours

at least 7 to 9
hours

9 11 PM (evening)
time for eliminating unnecessary/toxic chemicals
(DETOXIFICATION) from the antibody system (lymphnodes.)
this time duration should be
spent by RELAXING
or LISTENING to music

9 11 PM
If during this time a housewife is still in an unrelaxed state such as
WASHING the DISHES or MONITORING CHILDREN doing their
homework,
this will have a

NEGATIVE IMPACT ON HEALTH.

11 PM 1 AM
is the DETOXIFICATION process
in the liver, and ideally should be
done in a deep sleep state.

1 3 AM

DETOXIFICATION process
in the GALL, also ideally
done in a deep sleep state.

3 5 am
DETOXIFICATION process in the LUNGS.
there will be severe cough for cough sufferers during this time.
Since the detoxification process had reached the respiratory tract, there is no
need to take cough medicine so as not to interfere with toxin removal
process.

5 7 AM
DETOXIFICATION process in the
COLON, you should empty your
bowel.

7 9 AM
absorption of nutrient in the small
intestine, you should be having
breakfast at this time

Breakfast should be earlier, before 6:30 AM, for those who are sick.
Breakfast before 7:30 AM is very beneficial to those wanting to stay fit
Those who always skip breakfast, they should change their habits, & better
to eat breakfast late until 9 10AM than no meal at all

Sleeping so late and waking up too late


will disrupt the process of removing unnecessary chemicals.
Therefore, have a good sleep and dont sleep late.

Whats
your
POISON?

The cigarette is the most common method of


smoking tobacco.

Hydrogen Cyanide

Phenol
DDT (Insecticide)

Toluene

(Poison used in gas chambers)

(Industrial solvent)

* Toluidine

Arsenic

Ammonia (White Ant Poison)

* Dibenzacridine

(Floor Cleaner)

* Urethane

Acetone
(Paint stripper)
* Naphthylamine

* Polonium - 210

Butane
(Lighter fuel)

Dimethylnitrosamine

Carbon Monoxide

Napthalene

(Poisonous gas in
car exhausts)

(Mothballs)

Methanol

(Rocket fuel) * Pyrene


* KNOWN CANCER CAUSING SUBSTANCE

* Cadmium
(used in car
batteries)

* Benzopyrene
* Vinyl Chloride

The Healthy

A Diseased

Cancerous Human Lung


This dissection of human lung
tissue shows light-colored
cancerous tissue in the center of
the photograph. At bottom center
lies the heart. While normal lung
tissue is light pink in color, the
tissue surrounding the cancer is
black and airless, the result of a
tarlike residue left by cigarette
smoke. Most lung cancer begins in
the cells lining the main air
passages, or bronchi. In their
cancerous state, these cells lack
the cilia that normally catch and
eliminate foreign particles inhaled
into the lung. Mucous ordinarily
cleared by bronchial cilia becomes
trapped, blocking air passages.
Lung cancer accounts for the
largest percentage of cancer
deaths in the United States, and
cigarette smoking is directly
responsible for the majority of
these cases.
Microsoft Encarta
Reference

Preventive Strategies
Members of the Health and Safety Committee
Penalty / Sanction to violators on
Non discrimination of TB Patient employees
Penalty / Sanctions on Smoking and Drinking

Preventive Strategies
Medical Management
Recording, Reporting and Setting up a database
Social Policy (no discrimination/
work accommodation)
Roles and Responsibilities of workers and
employers with TB or at risk for TB
Implementation and monitoring