Retrospective Cohort Study

Retrospective Cohort Study Prospective Cohort Study

A retrospective cohort study starts
at a point in the past and follows
cohort forward in order to
Both methods involve looking for
determine past exposure histories
and health outcomes from records
using two cohorts in order to
Reliability may be affected by
factors such as:
Accuracy of diagnosis;
Non-occupational exposure;
and
Prospective Cohort Study
A prospective cohort study starts at
the present time and follows cohort
forward and enables monitoring of
exposure and health outcomes
a link between cause
(exposure) and effect
(disease);
compare those that have been Cohort size;
‘exposed’ against those that
were ‘unexposed’ and looking Accuracy of historical data on
for a dose/response link exposure and health effects;
Long latency periods for the effect;

Frequency of disease in unexposed

cohort;
Lifestyle factors such as alcohol
consumption, diet, smoking etc; Difficulty in following all of cohort for instance
a geographic move, non co-operation

Selection bias (cohort may not be

representative of exposed
population); the ‘healthy worker
effect’ (sick people leave);
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees Non particulate electromagnetic
exposed since effect of exposure is radiation
dose dependant.
Specific doses stated in Ionising
Radiation Regulations for classified
workers.
Artificially generated, normally by the
Likely to receive doses over 6 mSv use of electrical energy and emitted
a year. when a machine is switched on.

Over exposure to be investigated

and reported to enforcement
authority. Can travel a few metres in air, present an
X- Rays external radiation hazard for an
Monitoring of staff overseen by a individual in the same room or space.
Radiation Protection Supervisor,
records kept for fifty years or until
person they refer to has reached
seventy five years of age.

Can penetrate much further into body

Monitored by use of personal
but can be shielded with lead or
devices such as film badges or
concrete.
thermoluminescent dosimeters
(tld’s). These should then be
processed by an approved
dosimetry service and results
checked against specified regs.
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees
exposed since effect of exposure is Type of ionising radiation formed as
dose dependant. a result of radioactive decay.

The source should be shielded or

contained in a sealed unit or
container and where possible the
work undertaken in a glove box or Consists of two protons and neutrons
fume cupboard to minimise chance (ie a Helium nucleus)
of ingestion, inhalation or
absorption.
Alpha Particles
Travel for only a few centimetres
Equipment and surfaces should be
through air
decontaminated following work
with the particles. Can be stopped by skin or paper

Taking of food and drink should not

be allowed in areas where the
particles are likely to be present.

Ensure all wounds cuts and

More hazardous if source is taken into
grazes are covered and
body
protected.

Use of a Radiation protection

adviser / supervisor.
Surveillance
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees
exposed since effect of exposure is Type of ionising radiation formed as
dose dependant. a result of radioactive decay.

The source should be shielded or

contained in a sealed unit or
container and where possible the
work undertaken in a glove box or Consists of two protons and neutrons
fume cupboard to minimise chance (ie a Helium nucleus)
of ingestion, inhalation or
absorption.
Beta Particles
Longer range than Alpha Particles
Equipment and surfaces should be
decontaminated following work Low energy can be stopped by skin
with the particles. High energy can penetrate soft tissue to
a depth of over 1cm.
Taking of food and drink should not
be allowed in areas where the
particles are likely to be present.

Ensure all wounds cuts and

More hazardous if source is taken into
grazes are covered and
body, but not as intense as Alpha
protected.
particles.

Use of a Radiation protection

adviser / supervisor.
Surveillance

Practitioners
• Ergonomists
• Toxicologists
• Epidemiologist
• Occupational Hygienists
• Occupational Health physicians
• Occupational Health nurses
• Occupational Psychologists
• Radiation Protection Advisers /
supervisors / health physicists.
Occupational Health
Information from RIMEC
• EMAS - (Employment Medical • Recognition / Identification
Advisory Service)
• Measurement
• THOR - The Health and
• Evaluation
Occupational Reporting Network
• Control
• Industrial Injuries Disabled Board
• HSE fatality statistics

Structure of the Skin
• Epidermis - the outer layer of
the skin.
• Dermis - the layer of the skin
just beneath the epidermis.
• Subcutaneous tissue - fatty
tissue located under the dermis
• blood vessels - Tubes that carry
blood as it circulates. Arteries bring
oxygenated blood from the heart
and lungs; veins return oxygen-
depleted blood back to the heart
and lungs.
Sebaceous gland - a small, sack-
shaped gland that releases oily
(fatty) liquids onto the hair follicle
(the oil lubricated and softens the
skin). These glands are located in
the dermis, usually next to hair
follicles.
• Sweat gland - a tube-shaped
gland that produces perspiration
(sweat). The gland is located in the
epidermis; it releases sweat onto
the skin.
• hair follicle - a tube-shaped
sheath that surrounds the part of
the hair that is under the skin. It is
located in the epidermis and the
dermis. The hair is nourished by
the follicle at its base (this is also
where the hair grows).
• Heat and Cold receptors- Detect
heat and cold and pass info via
nerves to central nervous system.
 The Human Ear
1. Pinna - (also called the
auricle) the visible part of the
outer ear. It collects sound
and directs it into the outer
ear canal.
2. Outer ear canal - the tube 7. Oval Window- link between
through which sound travels stirrup and cochlea.
to the eardrum. 8. Semicircular canals - three loops
of fluid-filled tubes that are
attached to the cochlea in the
inner ear. They help us maintain
our sense of balance.
9. Cochlea - a spiral-shaped, fluid-
filled inner ear structure; it is lined
with cilia (tiny hairs) that move
when vibrated and cause a nerve
impulse to form.
10. Auditory nerve - this carries
electro-chemical signals from the
inner ear (the cochlea) to the
brain.
11. Eustachian tube - a tube that
3. Hammer - (also called the malleus) a tiny connects the middle ear to the
bone that passes vibrations from the eardrum back of the nose; it equalizes the
to the anvil. pressure between the middle ear
and the air outside. When you
4. Anvil - (also called the incus) a tiny bone that "pop" your ears as you change
passes vibrations from the hammer to the altitude (going up a mountain or in
stirrup. an airplane), you are equalizing
5. Stirrup - (also called the stapes) a tiny, U- the air pressure in your middle
shaped bone that passes vibrations from the ear.
stirrup to the cochlea. This is the smallest
bone in the human body.
6. Eardrum - (also called the tympanic
membrane) a thin membrane that vibrates
when sound waves reach it.
 LD50 and LC50

• LC50 (lethal concentration, 50%) or LCt50

• LD50 In toxicology, the median
lethal dose, (abbreviation for
“lethal dose, 50%”), relates to a
single oral dose) of an agent
required to kill half the members of
a tested population.
• Since it is oral dose it is measured
in grams or mg per Kilogram body
weight.
(lethal concentration & time) Inhaled
concentration of an agent required to kill
half the members of a tested population
after a specified test period.
• Measured in ppm (parts per million )or
NOAEL – No Observed Adverse Effect Level
grams / milligrams per cubic metre of air.
• Exposure level at which there are no statistically or
biologically significant increases in the frequency or • No account is taken of bodyweight in this
severity of adverse effects between the exposed measurement.
population and its appropriate control; some effects may
be produced at this level, but they are not considered as
adverse.
LOAEL - Low Observed Adverse Effect Level
• lowest concentration or amount of a substance found by
experiment or observation that causes an adverse
alteration of morphology, function, capacity, growth,
development, or lifespan of a target organism
distinguished from normal organisms of the same species
under defined conditions of exposure.

Limitations
Advantages
• Ethics / Public opinion
• Avoids human exposure.
• Costly and time consuming
• Data can be collected more quickly than for epidemiological
• Dose response varies.
studies.
• May not display synergistic effects that may arise in humans • Animals provide good models due to their close genomic
exposed to other agents at the same time.
relation to humans.
• Difficulty with no observed effects level for carcinogens. • More likely to show carcinogenic potential than in-vitro tests
• There can be wide variability between species as well; what is such as the Ames test.
relatively safe for rats may very well be extremely toxic for humans,
and vice versa.
• For example, chocolate, harmless to humans, is known to be toxic to
many animals.
 Accidents, incidents and emergencies
Reg 13
Requires that employers prepare for
possible accidents, incidents and
emergencies involving hazardous
substances by:
• Preparing emergency procedures,
including provision of First Aid;
• Making available technical information
on possible accidents and hazards
and bringing it to the attention of the
emergency services; and
• Installing alarms and other warnings
and communication systems
Information, instruction and training
Reg 12
• Demands that all employees liable to
exposure to hazardous substances are
provided with suitable and sufficient
information, instruction and training,
Health surveillance Reg 11
Requires that health surveillance of employees
is carried out where:
• An identifiable disease or adverse health
effect may be related to the exposure;
• There is a "reasonable likelihood" that the
disease or health effect may occur under the
particular conditions of work;
• Valid techniques exist for detecting
indications of the disease of health effect; and
The technique presents a low risk to the
employee;
• where there is exposure to certain
substances in specified occupations:
Risk assessment Reg 6
• Requires that an employer not carry out work liable to expose employees and non
Employees to a substance hazardous to health without a risk assessment and
implementation of the steps necessary to comply with the regulations.
• The assessment must include consideration of any information provided by the supplier
of a substance (CHIP)
• Must be reviewed regularly, and also when there is reason to think the assessment is no
longer valid, if the system of work is changed
• Because of the results of health Monitoring. The assessment must also consider any
occupational exposure limit, in particular, those mandated by the HSE.
Prevention or control of exposure Reg 7
COSHH as Requires that an employer prevent
Amended exposure to hazardous substances or, if this
is not reasonably practicable, that he
adequately controls exposure.
Use of control measures Reg 8
Employers must take all reasonable steps to
ensure that control measures, and any
necessary equipment of facilities, are properly
used or applied. Employees must use the
Monitoring Exposure Reg 10 control measures properly, return them after
• Where the risk assessment use and report any defective equipment.
indicates that workplace
monitoring of exposure is
necessary, the employer
must perform such Maintenance and testing of control measures
monitoring Reg 9
• unless he can demonstrate Requires that employers maintain control
another means of preventing measures in efficient working order and in
or controlling exposure good repair
• Monitoring must be at
regular intervals in addition
to when a change occurs
that may affect exposure
6 – Risk assessment

7 – Prevention or control of Schedule 2 of Reg 7

Exposure. (Adequate control)
Principles of good practice

8 – Use of control measures

Design process to minimise ex.
9 – Maintenance and testing Route of exposure.
of control measures Controls proportionate to risk
COSHH amended L5 Escape of substance minimised
PPE in addition
10 – Monitoring exposure Review effectiveness
Info., training and instruction
11 – Health Surveillance - Higher risk – do not introduce.
Schedule 6 - Benzene –
Manufacturing process

12 – Information, instruction
and training

13 – Accidents, incidents and

emergencies
 Controls Zoonoses are animal infections which may be
transmitted to people in the course of their • Anthrax is an acute infectious disease of
work. Common examples include: farm animals caused by a bacterium
First stage of control strategy is to • Anthrax • Transmitted to man by contact with
assess those people at risk Factors to • Brucellosis infected hair, hides, excrement or
consider include: • Orf products such as bonemeal
• Work being carried out • Glanders • Fatal without treatment
• Susceptibility to infection of the • Initial lesion rapidly becomes ulcerated
workers • Treatment is by penicillin
• How infections might occur • Inhaling the pathogen causes pulmonary
• How likely exposure to infection is. anthrax which is usually fatal in 3 or 4
days
• Most common route of entry is via
the skin, by way of open cuts, sores • Brucellosis caused by the bacterium
or abrasions which provide direct Brucella abortus, which may infect
entry to blood stream, people handling cattle or pigs or their
• inhalation of contaminated dusts, carcasses in abattoirs
• Contact with conjunctiva of eyes, Zoonoses • Not very severe but involves loss of
• Direct injection by cuts from infected appetite, headache, insomnia and slight
animals or animal bites fever
• Direct ingestion via hands • In the UK a policy of eradication has
been pursued since the 60’s by
destroying any infected cattle
• Where animal products likely to emit infected dust are
handled (e.g. wool, skin, hides, pelts), LEV and possibly
RPE should be provided to prevent airborne infection • Orf is a contagious pustular dermatitis of viral
• Specific immunisation of workers may be necessary origin, mainly affecting farm workers, shepherds,
• Clean & hygienic animal living conditions and disinfection sheep shearers, butchers and abattoir workers
of stalls will also ensure better hygiene in factory • Lesion enlarges and often becomes ulcerated,
premises and will reduce probability of infection exuding fluid and pus
• Complete recovery occurs in about 3 weeks

• Automation to reduce human contact and enclosure of
aerosol-producing activities will reduce exposure to
infection
• Finally, medical checks, training and information,
procedures, instruction and records will give added
protection to workers
• Glanders is an infectious disease of horses, donkeys and
mules caused by the pathogen Pseudomonas mallei
• Transmitted to humans by nasal or mouth secretions from
the infected animal
• Abscesses appear on hands, arms or face
• Lasts up to 4 months but is treatable with modern
antibiotics
 Aids
• Acquired Immune Deficiency
Hepatitis
Syndrome Caused by Human
• Those at risk include doctors,
Immunodeficiency Virus (HIV), which
surgeons, nurses and porters
attacks the immune system
• Infection amongst health workers
• Virus is found in most body fluids but is
is a result of contact with blood
delicate and relatively easy to kill with
or excreta of patients suffering
heat and chemicals
• It has low infectivity and transmission is from viral hepatitis or in whom
Aids and Hepatitis the disease is still in its
thought to be more likely with repeated
incubation stage
exposure to infection rather than to a
• Porters and refuse disposal are
single contact
• Occupational risk comes from at risk from carelessly discarded
syringes and other sharps - the
accidental inoculation or contamination
problem is becoming worse with
of a cut or abrasion with blood or body
the increase in drug addiction
fluids of an infected person
• Doctors, nurses, dentists, laboratory
and hospital staff are at some risk,
since they may come into close contact
with body fluids
• Other workers possibly at risk might
• Course of disease is similar to
include community, welfare, custodial
Weil’s Disease, but is usually much
and emergency service workers and
less severe and normally self-
first aiders
limiting with recovery in about 6
weeks
Many of the precautions taken against other • In about 5% of cases, chronic
infections, especially Hepatitis B, will be equally infectious hepatitis follows, leading
effective against HIV. They include: to cirrhosis and possibly death
• Prevention of puncture wounds, cuts and • Persons exposed to risk can be
abrasions in the presence of blood and body protected with injections of
fluids; gammaglobulin
• Protection of existing wounds and skin lesions • In all cases, protective disposable
• Control of surface contamination by gloves should be worn and hands
containment and disinfection and arms washed regularly with
• Safe disposal of contaminated waste, disinfectant
especially sharps
 Support – this includes the
encouragement,
sponsorship and resources
Demands – this includes provided by the
issues such as workload, organisation, line
work patterns and the management and
work environment. colleagues.

HSE Stress Relationships – this includes

Control– how much say promoting positive working
the person has in the way Management Hazards
to avoid conflict and dealing
they do their work. with unacceptable behaviour.

Role – whether people

Change– how organisational understand their role within
change(large or small) is the organisation and
managed and communicated in whether the organisation
the organisation ensures that they do not
have conflicting roles.
 Cold Stress – Difficulty in Pre-employment screening
controlling core body And on-going surveillance
temp.

Provision and wearing of

Reduction in heart rate thermal clothing, footwear
undergarment ,high CLO
rating

Persistent shivering with blue Monitor activity level, to

fingers and lips generate some heat but not
Cold Stress to sweat. Breaks with warm
rest area.
Mental impairment with
stress No possibility of being locked
in, ability to open from inside
Regular maintenance and
alarm to detect leaking
Hypothermia and frost bite
refrigerant
which is inflammation of the
skin and tissue damage.

Training on hazards involved

Chillblains causing redness, with cold working
tingling and pain in the
affected area.
Physiological Effects Controls in Garage

Carbon monoxide
absorbed via the lungs Minimising duration of engine
into bloodstream, running time.
displaces Oxygen by
chemically bonding to the
Haemoglobin. Reducing
oxygen carrying capacity Local exhaust ventilation
of blood and therefore attached to hose pipes as well
supply to tissues. as good ventilation to
Carbon Monoxide
workshop and pits.
CO only slowly displaced
from body. Regular maintenance of LEV
system and fitting CO alarms

Causes drowsiness,
headaches, skin colour Specific CO hazard training to
changes (blue lips), dizziness employees .
breathlessness,
unconsciousness and death
above 5% Segregating area from
customers
Regulations
Regulation 3
• Duty of employer to make
provision for first aid.
• Assessment of need
• First –aid materials, eqpt and
facilities
• First-aid personnel
Regulation 4
• Duty of employer to
provide information to
employees on first-aid
Regulation 5
• Self employed duty to
provide first-aid eqpt
• Duties of self employed
Main Function and factors
to consider
Preservation of life and
minimisation of the
consequences of injury until
medical help is obtained, and
treatment of minor injuries.
Health and Safety
Number, composition and
(First-Aid) distribution of workforce.
Regulations 1981
Hazard and level of risk
present and past accidents.
Distance from medical
facilities
Number of first-aiders and
level of training as well as
cover for shifts, leave and
sickness
Health effects Factors to consider and
Control of Asbestos at Work regs control measures
Mesothelioma 2012
A form of cancer that affects the
external lining of the lung or RA – to contain
the peritoneum. Long latency • Type of asbestos
period and almost always • Likely to become airborne
terminal and in what concentration.

Asbestosis
Form of pneumoconiosis –lung
fibrosis. Limit number of people
Asbestos exposed
Scarring and inflammation of
the lung tissue.
Irreversible, chest pain, fatigue
laboured breathing Limit contamination spread.
Limit fibre emission at source
Diffuse pleural thickening (work methods)
Non- Cancerous
Causes thickening of the tissue Licencing and Training on
which makes it less able to removal
expand during breathing

Cancer of the bronchus

Malignant growth within Use of specific PPE
bronchus of lung, terminal

Information to gather
Review of previous surveys
Assessment of current controls
Legal requirements and limits
Site layout and location of
machines.
Number and location of
workers and audiometry
records
Shift times and patterns with
likely duration of exposure
Identify noisy machines and
review maintenance records
for identification purposes.
Manufacturers data
Exposure limit value – 87dB
Upper exposure action value – 85dB Noise survey and Eqpt.
Lower exposure action value – 80dB
L108 - Controlling noise at work
Personal noise monitoring and
frequency analysis
Basic survey followed by a
more detailed survey Competent assessor
Consultation eqpt calibrated before and
after measurements
Use results to plot noise map
for area.
Control of Basic Survey
Noise at Work Simple sound level meter for
spot checks and integrating
R. 2005 sound level meters.
Measure at planned points to
ID exposures at action levels.
Noting machinery in operation
at time.
Detailed Survey
• Integrating sound level meters
• Appropriate sample times to measure Leq (equivalent continuous sound
level), use nonogram to calculate exposure LEPw, LEPd
• Measurement of peak noise levels and plotted on noise map.
• Use of frequency analysis useful to decide on controls such as enclosure
• Personal noise exposure using dosimeter or microphone close to ear
• Selection of hearing PPE with suitable SNR (Single Number Rating)
 Signs
Sudden mood changes
Becoming confused
Abnormal fluctuations in
concentration and energy
levels
Impaired job performance /
more accidents
Poor time keeping and more
short term sickness
Deterioration in relationship
with colleagues
Dishonesty or theft
of alcohol or presence of drugs
paraphernalia
Change in appearance, scruffy
or needle marks, slurred
speech.
Reasons for Introduction
and Difficulties
Safety critical posts.
Following accident or incident.
Part of rehabilitation stage
following discovery of use.
Pre-employment.
General statement of aims.
Responsibilities.
Definition of drug misuse.
Drug and Alcohol Rules that will apply.
Abuse Notification of prescribed drugs.
Reporting suspicions.
Procedure following failed test.
Support and help available.
How to return following
Treatment.
Union agreement – staff trust
Data protection
Cost – lab, competent tester
False positives / Unexpected results
Measuring Instruments

Black globe thermometer - Radiant Temperature
Dry bulb thermometer– Normal air temp.
Wet bulb thermometer - covered in muslin sleeve
(found in psychrometer. )
Wet bulb Thermomter Index Used for heat stress.
Sorbent tube – full of adsorbent e.g. charcoal.
Cellulose filter paper, Acetone bath. Cowl
Dry weight filter paper – Cyclone head - Respirable

Simple sound level meter

Measuring Instruments Integrated sound level meter
Octave band frequency analysis
Humidity – Hygrometer (psychrometer)
Combination of wet and dry bulb
thermometers. Vane anemometer – Wind speed
Kata Thermometer – low wind speed

Wet bulb globe temperature index

To measure heat stress.
Accelerometer – Measures vibration
Smoke tube
Manometer –Pressure differentials
Pitot Tube – Static pressure or velocity by using calculation
Thermal or hot wire anemometer – air velocity
Regulations
Control of Noise at Work Regs 2005
Health and Safety (First-Aid) Regulations 1981 Exposure limit value – 87dB
Management of Health and Safety at Work regs 1999 Upper exposure action value – 85dB
Workplace Health safety and Welfare regs 1992 Lower exposure action value – 80dB
Manual Handling Operations regs 1992 L23 L108 - Controlling noise at work
Personal Protective Eqpt regs 1992
Health and Safety (DSE) regs 1992
PUWER 1998

Control of Artificial Optical Radiation at Work regs 2010

Ionising Radiation regs 1999 COSHH 2002 as Amended L5
Radiation Protection Adviser Legionella L8
Radiation Protection Supervisor Control of Lead at Work Regs 2002 L132
Control of Asbestos at Work Regs 2012

Control of Vibration at Work Regs 2005 (L140 HAVs)

Exposure action value of 2.5 m/s2 A(8) at which level employers should
introduce technical and organisational measures to reduce exposure.
Exposure limit value of 5.0 m/s2 A(8) which should not be exceeded