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Unit 2A - Course Notes
Unit 2A - Course Notes
C O N T E N T S
THE PLACE OF OCCUPATIONAL HEALTH IN A HEALTH AND SAFETY MANAGEMENT SYSTEM ............................ 7
OCCUPATIONAL HEALTH NEEDS ASSESSMENT ................................................................................................................. 7
PRE-EMPLOYMENT ASSESSMENT AND SCREENING ............................................................................................................ 7
HEALTH SURVEILLANCE (HEALTH CHECKS) .................................................................................................................... 8
IMMUNISATION...................................................................................................................................................... 8
COUNSELLING ....................................................................................................................................................... 9
DRUG AND ALCOHOL SCREENING ................................................................................................................................ 9
TRAINING ............................................................................................................................................................ 9
ERGONOMIC ADVICE ............................................................................................................................................. 11
LIFESTYLE SCREENING/ADVICE AND HEALTH PROMOTION ................................................................................................ 12
RETURN TO WORK PROGRAMMES.............................................................................................................................. 12
DEVELOPING AN OCCUPATIONAL HEALTH POLICY .......................................................................................... 13
RESPONSIBILITIES ................................................................................................................................................ 13
TRIGGERS FOR ACTION .......................................................................................................................................... 13
PROCEDURES ...................................................................................................................................................... 13
NATURE OF THE ORGANISATION ............................................................................................................................... 14
TYPICAL OCCUPATIONAL HEALTH POLICY .................................................................................................................... 14
BSC International Diploma Element 2A | Occupational Health
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.1.4 Explain the place of occupational health in a health and safety management
system
Unit 1:
Effects of Exposure
A substantial number of hazardous exposures in the community environment are derived from
industrial activities or from other occupational systems such as transport. Air emissions
generated by vehicles are not controlled by the workplace boundary, and noise levels produced
by equipment and machinery in the workplace can cause a nuisance in the nearby community.
Additionally, the working population is exposed to the hazards in both the occupational
environment and outside the workplace. Exposure to noise hazards outside the workplace -
traffic and aircraft noise being prime examples (heavy traffic (80 dB(A)), jet engines (140
dB(A)) - increase the duration and level of exposure. The cumulative effects of workplace and
community exposure may increase the risks of hearing damage.
An occupational health hazard may create a public health hazard. For example, a research
institute which handles highly pathogenic agents such as the smallpox virus may, through
inadequate control measures, allow transmission.
Mitigation Techniques
There are occasions when methods to decrease exposure to hazardous substances in the
workplace lead to increased exposure in the environment and the community outside the
workplace. For example, where "end of pipe" solutions such as local exhaust ventilation have
been utilised to control workplace exposure an emission to the external atmosphere still exists
and there is usually a solid waste that requires disposal. The mitigation technique has
therefore moved the hazard from the workplace to the environment and the local community.
However, on the positive side, the shift from the "end of pipe" solutions to primary prevention
effectively reduces not only the exposures in the workplace but also limits the numbers
exposed and the extent of exposure outside the workplace with reasonable costs. For
example, the reduction of noise at source within the workplace will prevent nuisance in the
community. Eliminating a hazardous substance or substituting it with a less hazardous
substance will remove or reduce exposure to both the working population and the public.
Monitoring
Often the techniques of measurement and monitoring are similar in principle, whether they
relate to workplace or public health exposure. Such techniques may include:
Epidemiological studies, which are carried out in both the workplace and in the
community to determine cause and effect relationships. Often the results of studies
carried out in the workplace identify possible concerns in relation to public health. Studies
carried out in both communities are able to provide information for further research and
assist in the identification of preventative measures that may be applicable in both
environments.
Toxicological data, which can be interpreted and applied to a number of situations. For
example, where toxicological data determines a substance to be a possible carcinogen, it
is likely to be a carcinogen whether exposure occurs in the workplace or in the
community. Whilst the risk in each environment is likely to vary according to the level and
duration of exposure, the hazard remains the same.
Measurement instruments and methods are similar, although interpretation of results and their
application may vary slightly. For example, assessment of community noise uses noise level
instruments that operate on the same principles as workplace measurement but results are
interpreted differently and compared to different standards. Methods of collecting air samples,
for example sampling for dusts, will involve a sampling head, pump, filter and flow meter both
in the workplace and the community. The sample head, size and type of filter, the rate of air
flow and therefore pump type may differ, but the principle of operation and measurement will
remain the same.
Many of the techniques and information available to the safety professional in relation to the
workplace can therefore be applied in relation to public health.
Tests and procedures for pre-employment health screening should relate to the demands of
the work and the potential hazards it presents and may include vision, hearing and lung
function (see below).
Records of pre-employment health screening will provide a base-line measurement of an
individuals health, which can be used as a comparison for any subsequent health testing.
Immunisation
Vaccines consist of dead or live attenuated organisms that, when administered to individuals,
are able to initiate immunity to potentially infectious doses of organisms that could cause ill-
health or disease. Where appropriate vaccines exist, consideration should be given to the
vaccination of staff at risk from exposure to harmful organisms.
In some cases, e.g. clinical work where there is a Hepatitis B risk, vaccination may be a
requirement before work in high risk areas is allowed to commence. However, vaccination can
never be considered to be the principal defence against infection but only as a risk reduction
measure. Protection can never be guaranteed since certain individuals may not develop
immunity after vaccination. A further problem is the possibility of adverse reaction to the
vaccine with some persons. The possible side-effects must be considered before the decision
to vaccinate is taken.
The following vaccinations are recommended for particular categories of staff:
Health care workers: rubella, TB, Hepatitis B.
Sewage workers: tetanus, Hepatitis A.
Agricultural/horticultural workers: tetanus.
Counselling
It is now common for many occupational health workers to be trained counsellors. Following a
traumatic incident at a workplace, these people are on hand to offer one-to-one counselling for
those workers who feel they would benefit from discussing the events.
Other situations where counselling may be used include the following:
Where an employee is suffering from work-related stress.
Where an individual has been subjected to violence from a client/customer in the work
situation.
Training
Health and Safety
In most countries there is a legal requirement for employers to provide health and safety
training, while in others it certainly is good practice to provide employees with health and
safety training. Such training must normally be provided in working hours and not at the
expense of employees.
Training is perhaps one of the key weapons in the management of occupational safety and
health as it can be targeted at developing the necessary understanding and skills in individuals
and groups. Its success depends on identifying training needs and setting outcomes which can
be demonstrated after the training has been received.
The benefits which flow from this includes the following:
New workers, both recruits to the organisation and those changing jobs within it, are able
to assimilate the requirements of the job, including aspects affecting occupational health
and so become effective quickly.
The correct and safe method of doing the task is learnt from the beginning and, as there
is less risk of passing on bad and unsafe practices, machinery and equipment are used
more effectively. This means there is less likelihood of exposure to health hazards
occurring in the early stages of a worker starting a new job.
Well trained employees, who understand the processes in which they are involved and are
skilled in operating them, are more productive and work to higher standards. They also
tend to stay longer with the employer, ensuring future reliability and continuity.
There are a number of key points in the organisation when health and safety training is
specifically required.
Induction Training
As a new recruit could be run down by a fork-lift truck on the first day, or a fire could
break out soon after his/her arrival. Safety training is, therefore, a priority from the
outset.
The induction should also include occupational health hazards and the safe systems of
work that are in place to protect employees. This may be collective protection systems
such as LEV to keep dust levels down or individual protection such as gloves to prevent
dermatitis when working with certain chemicals.
This should precede instruction in the tasks themselves, ensuring that working safety is
given precedence. Later sessions should progress to the joint responsibilities of
management and employees for safe working practices and give more detailed attention
to the causes and prevention of accidents and fire.
Occupational health hazards are often less obvious than typical safety hazards, e.g. the
risk from exposure to X-rays is much less apparent than that from unguarded moving
machinery. It is therefore especially important for workers who are exposed to health
hazards to receive explicit training and instruction on the risks to which they are exposed
and the precautions that should be adopted to reduce the risk of harm.
Changes in Legislation
The area of health and safety is often regulated by the law (although this differs from
country to country) and employers should ensure that they comply with its demands at all
times. This means that, as laws are amended or new legislation is passed, they must set
up procedures for implementing the new requirements.
There are two aspects to this:
A need to monitor developments to ensure that they are aware of impending changes
and can take the necessary action.
A need to provide structured training to all staff management and workers who
will be affected by it.
Manual Handling
To ensure competence in manual handling techniques, appropriate instruction and training
should be provided. This should be closely related to a person's job and include theoretical
and practical supervised sessions using typical loads in working conditions to ensure a
thorough understanding of, for example:
The design of the tasks involved.
Recognition of different types of load, e.g. assessing the likely weights of loads and
deciding which may or may not be handled without assistance.
The need for good housekeeping in and around the work location.
Safe lifting and handling techniques, including the risks from careless and unskilled
handling.
Correct use of personal protective equipment.
Correct use of mechanical aids.
First-Aid
First-aid is the immediate and temporary care given to the victim of an accident or illness until
the services of a qualified medical practitioner can be obtained. It can save lives and
minimises the consequences of an injury until medical help is obtained, so every workplace
should have sufficient trained personnel and suitable facilities to deal with any cases which
occur. It also has another function - the treatment of minor injuries which would not receive
or do not need medical attention.
Ergonomic Advice
The ergonomic design of tools, equipment and workplaces can contribute to the reduction of
risk relating to occupational health and safety.
Appropriate design can reduce the levels of force required for a task, the number of highly
repetitive movements, and improve posture. Mechanisation and automation and reducing
machine pace can also have a major impact on the risk.
Responsibilities
The roles, responsibilities and authority of those people who manage or perform occupational
health functions should be defined, documented and communicated. Ultimate responsibility
for occupational health lies with top management but the responsibilities of all employees,
including line managers and lower-levels of employees, need to be clearly defined. Specialist
areas should not overlap and boundaries should be clear.
Every person should understand their responsibilities and be competent to perform them.
Procedures
A major part of occupational health will be to look at all the factors of new working practices,
equipment and materials. Procedures will need to be in place to identify changes in operations
and to assess the risks they present to enable the occupational health service to adjust
according to changing needs. Consideration should be given at the planning stage to the
design of jobs and the application of ergonomic and human factor principles.
Depending on the type and level of service provided procedures will need to be in place for a
number of issues including:
The identification of workplace hazards that present risks to the health of employees.
Accessibility of the service, for both employees and for manager referrals.
Reporting and investigation of complaints and incidents.
Confidentiality of employee records.
Sickness absence management including self-certification, absence review and long-term
absence management.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.2.3 Describe the roles and responsibilities of members of an occupational health team
Unit 2:
Punitive - where the criminal courts impose fines and imprisonment for breaches of legal
duties. These punishments can be given to the company or to individuals within the
company.
Compensatory - where employees are able to sue for compensation.
The provision of occupational health services will reduce the risk of ill-health occurring
amongst employees, and thus reduce the chances of legal action being taken by employees
against the employer.
When determining the type and level of Occupational Health provision an organisation should
first carry out a needs assessment to ensure the service will meet their needs. The needs
assessment can be carried out by the organisation itself or by an external provider and should
consider such factors as:
The size of the organisation.
The geographical spread of the workforce.
The variety of occupational health hazards within the organisation.
The availability of facilities.
Available resources.
Internal Provision
The most effective occupational health provision will be achieved where the occupational
health team has a true understanding of the organisation's activities, priorities and values.
An internal team is often in a better position to become an integral part of the
organisation, gaining both an operational and strategic understanding which allows the
service to become more tailored to the needs of the organisation.
An internal team is in a position to establish relationships within the organisation and gain
best use of the internal resources available from within other areas of the business. They
become familiar with organisational structures, both formal and informal, and can make
effective use of working relationships.
The organisation is in a position to select occupational health professionals with
personalities that meet the needs of the organisation and in-house teams can be trained
and developed to the specific needs of the organisation.
An in-house occupational health team generally allows employers and employees easy
access to health advice. There is also no requirement for employees to leave the
workplace, reducing time away from work. However, where occupational health provision
is through just one or two individuals, there is always the risk of health professionals not
being available when they are needed due to absence.
Assuming staff turnover is low, an in-house team can achieve continuity as the
occupational health team is likely to remain stable.
When offered internally the type or level of service is generally more flexible and is able
to change frequently and with little cost when the needs of the organisation change.
An equivalent service is likely to be cheaper if provided internally, but the availability of a
whole range of services from externally-sourced providers may outweigh that benefit.
External Provision
Occupational health is a specialised area which may be difficult to manage internally;
outsourcing the service removes the need to manage the service leaving only the
requirement to manage the contract.
An outsourced service is likely to have access to a broader range of professionals and
specialist services, with professional development likely to be an ongoing part for each
professional ensuring that access to up-to-date advice is constantly available.
Where an employer uses an external company, the need to provide, maintain and equip
premises are removed. In terms of financial resources this can be cost effective. In
addition where an organisation is geographically spread, with employees in different parts
of the company, an external provider is likely to be able to provide facilities in a number of
more accessible locations.
Generally, access to an outside service will always be available. Whilst the individual
health professional seen may vary, the outsourced company usually has the resources to
cover for absence.
The levels and type of service provided by external companies are extremely varied and
can be selected according to the needs of the organisation. The experience and
knowledge of the external provider are likely to be of real benefit when establishing the
service required.
Statutory Medicals
Certain workers are required by specific regulations to be examined periodically for
occupational health reasons. Examples include ionising radiation, lead and asbestos workers.
Health Surveillance
Best practice requires health surveillance in given circumstances to facilitate the early detection
of disease or adverse health effects, and to assist in the evaluation of control measures. The
process may involve examination of possible exposure to carcinogens, pathogens and
sensitisers. Where exposure to such substances exists, the role of the occupational health
physician will be to decide if health surveillance is necessary and whether a method of health
surveillance is available which is capable of identifying adverse health effects related to the
working environment, and which has a useful predictive value.
complex case, the occupational health physician will carry out a pre-employment medical
examination.
Counsellors
Trained counsellors can be of benefit to those who have been involved in traumatic situations,
ranging from involvement in a major accident to suffering stress due to pressures in the work
situation. Counsellors do not give advice; rather, they encourage individuals to talk about their
thoughts and feelings knowing that they will not be exposed to any criticism or judgment.
Counselling can give significant mental relief to individuals suffering in various ways.
Physiotherapists
The role of the occupational health physiotherapist includes the assessment, diagnosis,
treatment, evaluation and follow-up of work-related injuries and diseases. The physiotherapist
provides rehabilitation in order to help injured employees back to work or to assist them to
remain at work.
Activities and responsibilities undertaken by an occupational health physiotherapist may include
any of the following tasks:
Workplace assessments and making recommendations for alterations.
Analysing tasks and suggesting changes in order to avoid injuries.
Education/training relating to injury prevention in the workplace, e.g. back care, manual
handling techniques, etc.
Testing a person's capacity for work.
Treatment of work-related injuries.
Planning return-to-work timetables for injured employees.
Implementing stress management and relaxation techniques.
Pain management.
Ergonomists
The work of the ergonomist can have important implications for the smooth running of the
workplace, with regard to efficiency, productivity, safety and health. It is the ergonomist who
aims to ensure that the individual and the technological setting in which he/she works combine
to get the best performance available from both resources.
The ergonomist is concerned with:
The design of equipment and systems so that they are easier to use.
The design of jobs and tasks so that they take account of human factors.
The design of equipment and the work situation in order to improve posture and strain on
the body to avoid repetitive strain injury and work related upper limb disorder.
The design of work environments to ensure that elements such as lighting and heating
suit the requirements of the individual whilst carrying out the necessary work.
The ergonomist works in multi-disciplinary teams which may include design engineers,
industrial designers, production engineers, health and safety specialists and psychologists.
Occupational Hygienists
Hygiene is generally considered to be the maintenance of health and the prevention of disease.
Occupational hygiene applies this definition to the place of employment and the principal aim
is to prevent occupational ill-health.
The work of the occupational hygienist follows the stages used in the study of occupational
health and hygiene generally:
Identification of the hazard.
Recognition of Hazards
Avoidance of ill-health at work is achieved primarily by identifying the many visible and hidden
environmental hazards, present or emanating from the workplace. Key categories of such
hazards are:
Chemical (dust, fumes, gases, vapours; also those harmful by skin contact).
Physical (extreme temperatures, light, noise, vibrations, ionising and non-ionising
radiation and humidity).
Microbiological (bacteria, viruses).
Behavioural or psychosocial misfit (stress caused by excessive work demands beyond a
person's ability to cope, violence and bullying).
Ergonomics, or physical misfit (factors affecting posture and motion, manual handling).
Hygienists need to be aware of the legal requirements and standards. They should also be
aware of the environmental impact of their activities, and integrate occupational health
practice with environmental protection.
Evaluation of Risks
Occupational hygienists understand how hazards might affect health, and can measure how
serious the effects may be. The hygienist must understand the routes of entry into the body
of various agents, as well as the effects on health.
The evaluation of risks typically comprises a study of existing plant, equipment, materials used,
products and by-products, production and general working conditions.
Atmospheric monitoring may be passive, i.e. using a static monitoring position, or personal,
where the worker wears a detection/collection device whilst carrying out normal work
practices.
Risks to persons outside the workplace may also be relevant.
Control of Risks
Occupational hygienists specialise in eliminating the risks to health or controlling them in
practical and cost-effective ways by the application of scientific, technological and managerial
principles. Any problems identified should be rectified, following a hierarchy of the most
practicable controls or isolation of the hazardous agent. They should endeavour to develop
strategies, if necessary working together with professionals from other disciplines, which will
contain the harmful agents near to their source. Organisational measures, and education, go
hand-in-hand with technical measures such as enclosure, segregation and local exhaust
ventilation.
The supply of suitable personal protective equipment is a last resort, as this has its own
inherent problems of isolation and discomfort.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.3.2 Explain the effects on the body of the main occupational health hazards
Unit 3:
Physical
Noise, vibration, radiation, heat, etc.
Chemical
Liquids, gases, vapours, dusts, fibres, etc. and the associated hazards.
Biological
Bacteria, virus, fungus, mites, insects, etc.
Psycho-Social
Working hours, relationships, stress, etc.
Ergonomic
Manual handling, workplace layout, etc.
Lifestyle
Smoking, drinking, lack of exercise, dangerous sports, etc.
We shall study many of these occupational health hazards throughout this study unit.
Physical Hazards
Noise
We are surrounded by sound all the time we use it as a means of communication and as a
source of entertainment (music), and we also use it as a source of information about our
environment. Without it, we may become disorientated. However, in certain circumstances, it
can be an intense irritation and a considerable hazard at work. In such circumstances,
unwanted sound is usually referred to as noise. The major problem of noise is hearing
damage, but it can also cause disturbance which can impair efficiency and interfere with
communication which increases the risk of accidents, and stress.
In moderation, noise is harmless, but if it is too loud it can permanently damage hearing. The
danger depends on how loud the noise is and how long people are exposed to it.
The effects may be acute or chronic:
Acute effects are where the peak pressure of the sound wave may be so great that there
is a risk of instantaneous damage to the mechanisms of the ear. This is most likely when
explosive sources are involved such as cartridge-operated tools or guns. The effects of
such trauma to the hearing senses may be permanent or temporary.
Chronic effects are where constant exposure to excessive noise over a period of time
gradually produces damage to the hearing senses. This form of damage may not be
noticed until it has become permanent, although some effects may recede with time.
Generally, such damage to hearing is irreversible. Surgery may reduce the damage in the case
of acute injury to the eardrum, but there is no cure for hearing impairment.
The effects of damage to the hearing mechanisms of the ear may take a number of forms.
Sounds become muffled so that it is hard to tell similar sounding words apart, or to pick
out a voice in a crowd and it is difficult to distinguish speech from background noise. This
effect is known as threshold shift, indicating that the level at which sounds can be
clearly distinguished has reduced. The condition may be permanent or temporary.
Noise induced hearing loss occurs where the ear is unable to respond fully to sound within
the speech range. The person does not necessarily lose the ability to hear sound, but is
unable to distinguish the spoken word clearly even if it is presented with a raised voice.
Tinnitus is a subjective condition where noises in the head or ringing in the ear are the
descriptive symptoms. There are no observable external symptoms. This may be an
acute condition which recedes with time, although the recovery period could be 12 or
more hours where very high exposure levels occur. It may also occur with people who
have a chronic noise-induced hearing impairment, in which case it is usually permanent.
Where conditions in the workplace are such that it is necessary to shout in order to be
understood, or there is a difficulty being understood by someone about two metres away,
there is likely to be a problem.
Vibration
Regular exposure to hand/arm vibration can cause a range of permanent injuries to hands and
arms, collectively known as hand/arm vibration syndrome (HAVS). The injuries can include
damage to the blood circulatory system (e.g. vibration white finger), sensory nerves and
muscles. Pain and stiffness in the hands and joints of the wrists, elbows and shoulders may
also occur.
The injuries can be painful and disabling, e.g. painful finger blanching attacks (triggered by
cold or wet conditions); loss of sense of touch and temperature; numbness and tingling; loss
of grip strength; loss of manual dexterity; and inability to pick up small objects. The condition
can affect work and leisure activities. People may need to avoid further exposure to vibration,
or cold and wet conditions; and have difficulty handling tools and materials and with tasks
requiring fine finger manipulation.
Ionising Radiation
This includes both the streams of particles emitted by the decay of radioactive substances
(alpha- and beta-particles and gamma rays) and X-rays. The energy transmitted is
powerful enough to ionise atoms in living tissue, causing chemical changes at the cellular
level. At high doses, this can result in massive cell destruction, damage to organs and
possibly death. At low doses, it can result in the formation of cancers. If these form in
the reproductive organs, it can cause hereditary effects in descendants.
Non-Ionising Radiation
This form consists of lower energy electromagnetic waves whose energy decreases with
increasing wavelength. There is, then, a spectrum of types of non-ionising radiation
based upon the wavelength of the energy transmitted. This spectrum, together with the
effects on the body, is as follows:
Ultra-violet radiation has low penetrating power and its effects are confined
mainly to the skin and the eyes. Acute effects on the skin are similar to sunburn,
whereas chronic effects include premature aging of the skin and skin cancer, although
this is highly unlikely to be contracted from occupational sources. The most common
effect on the eyes is conjunctivitis, an inflammation of the eye often associated with
welding where it is commonly known as arc eye.
Visible radiation is experienced particularly from high intensity beams such as
lasers, which can cause serious burns to exposed skin tissue and is particularly
dangerous to the eyes.
Infra-red radiation is emitted from any hot material and can cause reddening of
the skin, burns and cataracts in the eyes.
Microwave radiation generates heat by causing the vibration of liquid molecules
within tissues and exposure can, therefore, result in deep-seated burns, particularly
to the eyes.
Radio frequency radiation can cause excessive heating of exposed tissues.
Temperature
The temperature of workrooms should normally be at least 16C although the general
requirement is that it should be comfortable to work in. There will always be situations where,
due to the nature of the work, workers will be exposed to temperatures far above or below
what could be considered comfortable. Examples include:
Extreme heat working with molten metals and in foundries, or hot climates.
Extreme cold working in cold-stores.
Prolonged exposure to excess heat or cold can lead to fatigue, a general slowing of reactions
and a loss of dexterity, affecting both work efficiency and the possibility of making mistakes
which can lead to accidents.
Apart from the risk of burns from contact with hot materials, surfaces and equipment, working
in very hot environments can cause heat exhaustion, dehydration, heat cramps and heat
stroke.
Exposure to extreme cold can lead to a lowering of the bodys deep core temperature, either
locally (e.g. in the fingers or toes) where it may cause frostbite or more generally where it can
cause hypothermia. These conditions are extremely unlikely in an occupational setting, but
lesser effects include shivering, clouded consciousness, pain in the extremities of the body and
reduced grip strength and co-ordination. Contact with very cold materials, surfaces and
equipment can also cause burns.
Chemical Hazards
There are three basic states of matter: solid, liquid and gas, and each of these states can be
in a different form.
Solids
These can be a solid block of, say, wood. If it is put through a sawmill then dust is produced.
Dust is a solid.
Similarly, if asbestos is disturbed or damaged, tiny asbestos fibres are produced.
Liquids
We can all visualise the spray coming out of an aerosol of hair spray. This is just a liquid in a
different form.
Another form of liquid that we should all be familiar with is a mist.
Gases
These are air-like substances that move freely to fill spaces. Vapour given off from liquids
can be put into this category along with gases like hydrogen, carbon dioxide, oxygen,
methane, etc.
Fumes can also fit into this category. A true fume is the gas-suspended particulate given off
by a process, although the word is often used in a wider sense to incorporate exhaust
emissions.
From what we have said above, you can see that substances can be in different states/forms
depending on conditions and how they are being used.
All matter can be in any one of the states depending on circumstances. Temperature and
pressure are two factors that can affect the state of a substance.
Temperature
Take water: at low temperatures it is in a solid state, ice. As the temperature rises it melts
and becomes water, a liquid. If we raise the temperature sufficiently, the water will start to
vaporise and change into steam, a gaseous state.
Pressure
Propane is a good example. At normal atmospheric pressure, propane is a gas. When it is
compressed and stored under high pressure inside a cylinder, it becomes a liquid (LPG
liquefied petroleum gas).
As soon as it is released into the atmosphere, it turns into a gas again.
You should realise that whilst chemicals may not pose a significant hazard in one form or state,
if that form or state is changed due to the operation that is being carried out or the
surrounding conditions, then the risk posed may also change.
The definitions of the categories of danger posed by chemicals within the general toxicology
classification are set out below.
Very toxic
Very toxic substances and preparations are those that in very low quantities cause death
or acute or chronic damage to health when inhaled, swallowed or absorbed via the skin.
Toxic
Toxic substances and preparations are those that in low quantities cause death or acute
or chronic damage to health when inhaled, swallowed or absorbed via the skin.
Harmful
Harmful substances and preparations are any that may cause death or acute or chronic
damage to health when inhaled, swallowed or absorbed through the skin.
Corrosive
Corrosive substances and preparations are those that may on contact destroy living
tissues. The following examples of corrosive substances may be encountered in the
course of industrial processes:
Acids Sulphuric acid; hydrochloric acid; nitric acid; phosphoric acids.
Irritant
These are non-corrosive substances and preparations which through immediate,
prolonged or repeated contact with the skin or mucous membrane may cause
inflammation.
Sensitising
These are substances and preparations that may cause an allergic reaction.
Carcinogenic
Carcinogenic substances and preparations are those which if inhaled or ingested or
absorbed by the skin may induce cancer or increase its incidence.
For the purposes of classification, carcinogens can be divided into three categories, Cat 1
being substances which are known to be carcinogenic to humans, Cat 2 where there is
sufficient evidence to provide a strong presumption of human carcinogenicity, and Cat 3
where there is concern for humans about carcinogenic effects but the available
information is not adequate for making a satisfactory assessment.
Mutagenic
Mutagens are substances and preparations that alter cell development and cause changes
in future generations.
As for carcinogens, there are also three categories of mutagens.
Biological Hazards
When considering biological hazards it is the considerable range of commonly encountered
micro-organisms that first springs to mind.
A micro-organism is a microbiological entity, cellular or non-cellular, capable of replication or
transferring genetic material. There are thousands of species of micro-organisms but only a
few of them are harmful to humans, and of these it is the ones that are capable of causing
occupational ill-health that we are concerned with. The three main categories of micro-
organism that we are concerned with are fungi, bacteria and viruses.
Bacteria
Bacteria are single celled organisms that reproduce by simple cell division. They vary widely in
shape (with the shape being used to classify and name types of bacteria) and include spheres
(cocci), rods (bacilli) and spirals (spirochetes). Some bacilli (such as anthrax) form spores
which enable them to survive adverse conditions such as heat, cold and lack of water.
Viruses
Viruses are included as micro-organisms but are not strictly "alive". They are self-replicating
molecules (genetic material contained in a protein shell) that invade host cells, take control of
the cell material to produce more viruses, and release these viruses to enter other host cells.
Hepatitis and AIDS are two diseases of occupational significance that are caused by viruses
present in human body fluids.
Fungi
The category of microfungi includes moulds and yeasts but excludes larger fungi such as
mushrooms. Some microfungi produce toxins (mycotoxins) that are harmful to humans. Many
fungi reproduce by forming spores that are released, dispersed and find a suitable
environment to grow in. It is the inhalation of organic dust contaminates with fungi spores
(mouldy cellulose-based material such as straw) that cause the biological pneumoconioses
such as farmer's lung.
Although you can draw some comparisons between health effects on the body of biological
agents and of chemical agents, biological agents have the following special properties:
They are living things and can therefore evolve and change rapidly, with new biological
agents appearing regularly.
Their presence is not readily detectable.
Infectious diseases can be transmitted from person to person which poses a community
risk.
Exposure to very low numbers of organisms may be sufficient to cause disease.
Initial low numbers of organisms may multiply rapidly under the right conditions to result
in an infective dose.
Inhalation
Bioaerosols consisting of suspensions of very small particles (bacteria, spores, organic
dusts) generated when materials containing them are disturbed, can be inhaled into the
respiratory tract. The usual defence mechanisms for airborne contaminants which depend
on particle size apply (see later in this study unit) but both materials entrapped by the
cilia, and smaller particles entering the alveoli, may initiate an infection or an allergy.
Ingestion
Biological agents may enter the body through contaminated food and drink, or by hand
contact with contaminated surfaces and then hand-to-mouth transfer. The gastric juices
may be sufficient to destroy some agents but ingestion of contaminated material is a
Skin Contact
Micro-organisms are able to enter the body through cuts, scratches and abrasions. Skin is
rarely completely intact and the minute size of bacteria and viruses allows entry to what
might appear to be an impermeable skin barrier. A further route is that of "injection",
where needle-stick injuries involving contaminated sharp implements such as needles or
glassware and even bites and stings from infected insects or mites, can allow entry of
biological agents through the skin.
Other Routes
Certain circumstances may offer a combination of transmission routes, including direct
contact with an infected person or animal, and contact with infected materials (blood,
body fluids, tissues, organs) where the route of entry may be by any of those discussed
above.
Psycho-Social Hazards
Workplace psycho-social hazards are those non-physical features of the workplace that have
the potential to cause harm to the worker, either physiologically or psychologically. They are
concerned with the design, organisation and management of work. The effects of psycho-
social hazards and health can be considered to be dependent upon the interplay between the
individual and the environment. The way an individual responds or reacts to psycho-social
pressures will depend on their genetics and personal experiences and therefore their ability to
adopt effective coping strategies.
Working Hours
It is still often the culture in many organisations to work long hours, both in the workplace and
by taking work home. This can lead to work-related stress (and the associated symptoms) as
can inflexible working patterns. Shift work and night work can also contribute to stress-related
symptoms, when the individual finds it difficult to adjust to unusual daily/nightly routines.
Relationships
For most workers, there is a significant interaction with other people in the workplace.
Interactions are between colleagues, managers and subordinates and reflect components of
both the formal and the informal organisation of the workplace. Poor relationships are
considered to be those where there is little trust and support.
Issues associated with interpersonal relationships are recognised as a significant source of
occupational stress. This includes conflict between colleagues or with subordinates or
superiors, or a general lack of social support which may be a result of physical, or even social,
isolation. There can also be problems that arise from racial or sexual harassment, or
workplace bullying. Leadership style, abrasive personalities and group pressures can all lead
to conflict and possibly unacceptable behaviour. These issues can all create stress for the
individuals involved and are often difficult to prevent or resolve.
Feelings of isolation and a lack of social support in the work environment have been found to
have a correlation with ill-health effects. Some research has shown that those who report low
social support at work have elevated heart rates and rising systolic blood pressure levels during
the working day. Some research suggests that good working relationships and therefore social
support can be linked to the ability of the individual to control their work environment.
Measures that can be used to try and combat these problems include:
Training in interpersonal skills.
Effective systems to deal with interpersonal conflict, bullying and racial or sexual
harassment including:
Effective grievance procedures.
Proper investigation of complaints.
Stress
In recent years, work-related stress has become recognised as a significant concern.
Work-related stress can be defined as the adverse reaction people have to excessive pressures
or other types of demand placed on them. To be set challenging targets at work can be
motivating, but if demands are placed on workers which they feel they can not cope with, they
will experience stress, which in turn affects morale and performance. Work-related stress is a
complex subject, because it results from the interaction of organisational factors and factors
which are personal to the individual employee.
Work-related stress has adverse effects on the individual employee and the organisation. For
the employee, the symptoms of stress may be physical or psychological, including headaches,
dizziness, panic attacks, skin rashes, stomach problems, poor concentration, difficulty sleeping
and increased alcohol consumption. If stress is intense or prolonged, it can lead to the onset
of serious physical and mental health conditions, such as high blood pressure, heart disease,
gastrointestinal disturbances, anxiety and depression.
Ergonomics
Manual Handling
People pick up and move objects all the time at work, and any of these actions may present a
hazard. The risk is that the action will cause an injury of some kind to the person undertaking
the operation or, by causing the object to fall or move, there is a risk that someone else may
be injured.
The extent to which there is risk associated with any form of manual handling will be the
subject of a risk assessment. However, that risk does not just arise in relation to the lifting and
movement of heavy loads. These do present a significant risk, but the way in which
apparently light and easy objects are handled can also cause harm.
There are actually four main causes of harm in manual handling operations, as follows:
Failing to use a proper technique for lifting and/or moving the object(s) or load.
Moving loads which are too heavy.
Failing to grip the object(s) or load in a safe manner.
Lifestyle
Individual behaviours and lifestyle choices have real effects on peoples health and their ability
to carry out normal day-to-day activities effectively. Some lifestyle choices will affect the
individuals ability in the workplace.
Smoking
There are clearly sound safety reasons why an employer may want to introduce a smoking
policy in to the workplace, such as the risk of fire or of hazardous substance ingestion.
However, the effects associated with smoking can impact employees health and, therefore,
ability to work, placing a strain on the organisation's productivity.
The serious health effects associated with smoking have been well documented. There are also
many health effects that may have a debilitating effect on the smoker, as well as an increased
risk of mortality. Some of the negative effects associated with smoking include an increased
risk of developing:
Cardiovascular disease.
Respiratory disease, such as emphysema.
Cancers of various organs including the lungs.
Cataracts.
Osteoporosis.
Other effects include elevated carbon monoxide levels (reducing the oxygen-carrying ability of
the blood), poor circulation, delayed wound healing and a reduced immune response.
Research has consistently shown smokers to have more ill-health absences from work, longer
duration absences and to be more likely to retire earlier than non-smokers. Some of the effects
may also impact the individual's fitness for work, such as breathing problems in activities that
require physical exertion or poor circulation where exposure to the cold is part of the activity.
Some research has suggested that smoking is a "susceptibility factor" increasing the risk for
other harmful occupational exposures. Asbestos and smoking appears to be one such an
example.
Drinking
Alcohol abuse, drug abuse and smoking are recognised as being possible indicators that an
individual may be experiencing stress. Alcohol is absorbed into the blood stream and carried to
varying parts of the body including the brain. The blood alcohol concentration will depend
upon a number of factors:
The quantity consumed and the period of time over which it is consumed.
Whether the individual has eaten.
Size and weight of the individual.
Alcohol reduces the ability to co-ordinate and react quickly, and affects thinking, judgment and
moods. Regular long-term drinking can lead to psychological problems including depression.
Drinking alcohol raises the drinkers blood pressure which can increase the risk of coronary
heart disease, and the liver can also be affected with a risk of cirrhosis of the liver.
Alcohol can lead to negative physical and psychological effects as well as increasing work
absence and affecting productivity and safety.
There are a number of reasons why people drink excessively but working conditions, such as
stress, excessive work pressures and unsocial hours may be factors.
Whilst it is difficult to control an individual's lifestyle habits, a programme of health education
and promotion can assist in helping individuals make the right lifestyle choices.
Lack of Exercise
Regular physical activity has been found to have a number of psychological and physiological
benefits, such as:
Feeling more energetic.
Relieving stress.
Reducing feelings of anxiety and depression.
Helping relaxation.
Lowering high blood pressure and preventing the onset of high blood pressure.
Assisting in reducing weight.
Reducing the risk of cardiovascular and respiratory problems.
Increasing overall levels of fitness.
It follows that regular exercise has a positive effect on an individuals health and, therefore,
absenteeism and their ability to carry out work activities.
In addition, research suggests that mental functions such as planning, decision-making and
memory are improved. Exercise also helps to improve balance, co-ordination, mobility and grip
and leg strength. These are all skills and abilities that may be advantageous, if not critical, in
many work activities.
The provision of exercise facilities in the workplace, and education and promotion in relation to
the benefits of exercise, may well represent a cost effective preventative occupational health
strategy of benefit to both the employee and the employer.
Dangerous Sports
Many individuals participate in dangerous sports in their free time and while the employer
cannot control this, it is beneficial to be aware of employee behaviour. Awareness of activities
outside the workplace will assist the employer in identifying possible exacerbation of workplace
injuries or enable them to identify where injuries sustained outside the workplace are likely to
lead to vulnerabilities within the workplace.
The employer can also have an educational role. For example, many employees will go skiing
each year, a number of whom will sustain injuries resulting in lost time from work.
Programmes of education and promotion on the need for fitness and stamina will reduce the
likelihood of such injuries occurring.
An additional area that may be of concern to the employer is that those employees who take
part in dangerous sports may have a perception of risk that leads them to take unacceptable
risks in the workplace. Whilst this will not always be the case, the participation in dangerous
sports may indicate a need for employee behaviour, particularly in the face of danger, to be
considered where safety-critical work activities are concerned.
Finally, in recent years there has been a growth of dangerous sports and activities for
corporate functions and team-building events, which are likely to be considered work activities.
Wherever this is the case employers should risk assess activities, taking into account individual
abilities and skills and the need to ensure that no pressure is brought to bear on individuals
not wishing to take part.
Human Physiology
Respiratory System
The respiratory system is an airway which has two main parts: the air passages (the upper
respiratory tract) and the lungs (see later figure).
Air breathed in through the mouth passes over the larynx (voicebox) and down the trachea
which divides into two bronchi (singular: bronchus).
Each bronchus branches into bronchioles, which are repeatedly branched into terminal
bronchioles, which lead to an infundibulum (literally: a funnel) of alveoli, very much like a
bunch of grapes from which the flesh has been removed.
The alveoli (or air sacs) form the delicate lining of the lungs (one cell thick) across which gas
exchange between the blood and the air takes place.
The entrance to the larynx is protected by a muscular flap, the epiglottis, which closes during
swallowing. Loss of control of the epiglottis allows "aspiration" (going down the wrong way) to
occur. The basic structure of the airway is shown in the following figure.
Air
Gullet
Major bronchioles
Alveoli
Digestive System
The gastrointestinal tract extends through the body from the mouth to the anus. Its function
is the control of ingested foodstuffs, which is dealt with in four main stages:
Ingestion, via mastication and swallowing.
Digestion which involves the treatment of foodstuff for absorption into the body.
Absorption of treated foodstuffs.
Excretion of food residues and desorbed waste products.
The oesophagus is a muscular tube about 25 cm long reaching from the pharynx to the
stomach.
The small intestine is a muscular tube, which extends from the stomach to the large intestine.
The first part of the small intestine is the duodenum.
The large intestine forms the final section of the gastrointestinal tract from the small intestine
to the anus. The large intestine takes no part in digestion or absorption of nutrients. Its main
function is to reabsorb water from the final mixture passed from the small intestine, until the
consistency is satisfactory for normal excretion.
The lining membrane which covers the abdominal and pelvic cavity is a double-skinned
structure called the peritoneum. Peritonitis is an inflammation of this membrane.
The passage of hazardous substances into the digestive system is usually caused by poor
hygiene. The following figure is a labelled schematic plan of the human digestive system.
NASAL CAVITY
TONGUE
MOUTH
PHARYNX
EPIGLOTTIS
TRACHEA OESOPHAGUS
LIVER
STOMACH
PYLORIC SPHINCTER
GALL BLADDER
BILE DUCT
PANCREAS
SMALL INTESTINE:
DUODENUM
ILEUM
LARGE INTESTINE:
LARGE INTESTINE:
COLON
CAECUM COLON
APPENDIX RECTUM
Schematic Outline of
the Digestive System
Circulatory System
The healthy existence of every cell, tissue and organ of the body relies heavily upon a plentiful
supply of oxygen and the removal of waste products. The blood, the circulatory system and
the lymphatic system together provide the main body parts necessary to satisfy these
requirements. Many occupational diseases, ill-health and reduced working efficiency can be
attributed to reduction in the efficiency of the system by hazardous working environments.
The Blood
Blood is a viscous fluid which circulates throughout most of the body structure in a network of
flexible tubes known as blood vessels. There are about six litres of blood in the average adult
body. Blood consists of a clear yellow fluid (plasma) in which are suspended red blood cells for
oxygen transport, white blood cells for combating disease, and platelets which aid clotting.
Blood is made up of approximately two thirds plasma and one third cells. The ratio of the cells
in blood is 500 red cells: 1 white cell: 30 platelets.
Haemoglobin is a complex chemical compound which gives the blood its red colour. The HAEM
provides the 'active' part of the molecule. It is a red pigment, formed by a complex molecule
of iron. The GLOBIN is formed from protein molecules. The two molecular systems are joined
in such a way that they make a composite functional biochemical structure.
Transport of Oxygen
Oxygen molecules (O2) from the air are inhaled into the lungs and pass through the very thin
alveoli epithelium (lining) and capillary blood vessels into the blood.
Nervous System
The nervous system is divided into two main parts: the central and the peripheral. The
central nervous system comprises the brain and the spinal cord. The peripheral part consists
of the motor (controlling movement) and sensory (controlling sensation) nerves. The basic
unit of the nervous system is the neurone. Nerve impulses generated at one end of the
neurone travel along the nerve fibre to release neurotransmitters at the other end.
The central nervous system can be affected by organic solvents or heavy metals to produce
disordered brain function ranging from mild disorder to profound coma.
The peripheral nervous system is affected by neurotoxins, such as organophosphate pesticides,
mercury compounds or lead and its compounds, causing sensory disturbances, motor
dysfunction or both.
Skin
The skin is an organ of the body, in the sense that it performs a function as well as being
connective tissue. The skin forms the outer covering of the body and is continuous with the
membrane lining which covers the cavities within the body structure and which have their
openings at the body's outer surface.
The skin is a distinctly layered structure. The epidermis forms the outermost layer of skin and
is composed of:
The horny zone, which forms the outermost layers of the epidermis.
The germinal (or living) zone, which forms the deeper level in the epidermis and
consists of living cells which can reproduce and move to the horny zone.
The dermis, or the true living skin, forms the inner part of the skin structure and consists of
mainly fibrous and elastic connective tissue. The surface of the dermis (under the germinal
zone of the epidermis) has groups of capillary blood vessels set out at various intervals. The
flow of blood through these areas is important in the control of heat transfer mechanisms.
Many sensory nerve endings are located in the dermis.
The skin is a partially permeable membrane covering the external surface of the body and
provides an excellent protective barrier. However, some substances may pass through the
intact skin and into the underlying subcutaneous tissues, where they are absorbed into the
blood capillary vessels and thence into the circulatory system, e.g. benzene.
Protection of the skin is vital if it is not to be affected by damaging substances.
The Eye
The eyeball (see following figure) is spherical in shape and contains a transparent medium
(vitreous humour) through which light is focused by a lens on to a sensitive layer (the retina).
The front of the eyeball (the cornea) is also transparent.
Light rays entering the eye pass through the cornea and the aqueous humour to be focused by
the lens. The light then continues through the vitreous humour and strikes the retina, where
electrical impulses are generated and transmitted via the optic nerve to the brain.
If the path of the light ray is interrupted by opacity (cataract) of the lens, vision may be
distorted or diminished. Electromagnetic waves in the form of infra-red or laser radiation can
cause damage to the lens or the retina.
The eye is a very sensitive organ that can be irritated or damaged by many common workplace
substances.
The Eyeball
The Ear
This organ can be divided into three main structures: the outer, middle and inner ear (see
figure). Sound waves are collected by the outer ear and pass through the auditory canal to
the ear drum. Changes in sound pressure cause the ear drum to vibrate in proportion to the
sound intensity and frequency. The vibrations are transmitted through the middle ear by three
linked bones and eventually reach the cochlea, a snail-shaped organ in the inner ear.
The cochlea is a spiral tube which contains hairs that vibrate in response to the stimulus
received from the middle ear. Here electrical impulses are produced which travel along the
auditory nerve to the brain, where they are perceived as sound.
Noise-induced hearing loss occurs when the hairs are damaged and no longer respond to
stimuli. The hair cells do not regenerate, so hearing loss is irreversible.
UTRICULUS
PINNA
Key:
1 Auditory canal
2 Auditory nerve
3 Cochlea
4 Ear drum
The Ear
Process of Entry
There are two main ways in which entry may occur:
By absorption across the body's "cover", either the outer skin (epidermis) or the lining
(epithelium) of the inner tract.
By direct entry into the body's structure where the "cover" is broken, i.e. via a break in
the skin (e.g. when the skin is chapped and breaks up on movement, or when a pimple
has been picked).
Entry by this method is sometimes called injection. Be careful not to confuse the term
with medical injection, where the input of the substance is deliberate, with the use of a
hypodermic syringe.
LUNGS EPIDERMIS
Route of entry - Route of entry -
Inhalation Skin Contact
GASTRO-INTESTINAL
TRACT
Route of entry -
Ingestion
passage of some organic liquids; solids and gases do not, in general, pass through the
epidermis.
Routes of Entry
The principal routes of entry into the body are inhalation, skin contact, and ingestion.
Inhalation
The lung is the most vulnerable part of the body, as it can readily absorb gases, soluble dust
and fumes. Nearly every molecule which comes in contact with the lining layer passes through
without much difficulty. You should note that only material in the correct physical state is able
to arrive at the absorbing area. Added to the physical ability of the lining to absorb substances
is the regularity of the breathing cycle. Even small concentrations of a toxic agent in the
atmosphere being inhaled can, after a period, develop a build-up of toxicant in the body. This
is another problem to be considered in connection with chronic toxicity. The lung also provides
the largest area of epithelium for the absorption process to occur.
When you are considering the risk of a material in terms of inhalation, the questions to be
asked are:
Is it a gas?
Is it a liquid that will easily give off vapours?
If it is a solid:
Can respirable dust be generated, or vapours?
If the answers are "yes", then you will be dealing with conditions which provide the greatest
risk of entry of toxicants into the body.
Skin Contact
The skin is the next most vulnerable area, as it can be in contact with toxic substances which
may be solid, liquid or gaseous, and in very high concentrations (i.e. in terms of quantity of
substance to skin area). Fortunately, the epidermis has many layers of protection and does
not allow solid or gaseous substances to be absorbed (in general), so only liquids provide a
hazard. If contact between the epidermis and a toxic substance does occur, a considerable
amount of contaminant can usually be removed before excessive absorption has taken place.
Wearing normal clothing effectively reduces the area available for exposure to a toxic agent.
However, the skin of the hands, arms and legs usually has some breaks in its surface and thus
entry into the body "by injection" is always a possibility.
Ingestion
In terms of occupational hazards from toxins, the gastrointestinal tract is the least vulnerable
area of the body. The possibility of solid or liquid toxicants being ingested is very limited.
Even if accidental ingestion does occur, the substance must be soluble in the fluids secreted by
the tract to enable absorption to take place.
Aspiration is a term used to describe another route of entry which concerns the direct entry
of solid or liquid into the lungs. There are two ways by which it can happen. Firstly, when
substances that have been ingested are expelled in vomit and run down into the respiratory
tract. Secondly, when substances are sucked directly into the lungs. A typical situation is
when a liquid is being sucked into a pipette and the tip comes out of the liquid. The suction
back-pressure is released and causes a rush of liquid past the open epiglottis.
Aspiration can have serious consequences. Toxic substances could exhibit an increase in their
relative hazard potential. For example, if a hydrocarbon solvent has been ingested, it is not
likely to be lethal; but if aspiration occurs during vomiting, entry into the respiratory system
could produce a lethal situation.
Another possible route of entry into the body is via the mucous membranes of the eye.
Substances in the form of dust, mist, spray, fume or vapour may dissolve in the moist covering
of the eyelids and undergo absorption into the bloodstream.
Symptoms occur slowly, so they are not recognised until an advanced condition of harm
has developed.
When symptoms are recognised, the harm may be too advanced for full recovery
sometimes no recovery is possible.
Symptoms are often confused with normal ill-health or with getting older.
Symptoms are not always easily identifiable in groups of people with the same exposure,
owing to the effect of differing personal metabolisms.
It is important to note that for both acute and chronic toxicity, time is involved in relation to
their definition, but that the level of toxic action is not defined. Acute toxic action does not
necessarily mean death. Intoxication from drinking alcohol is an acute toxic condition, but only
in rare cases is it the direct cause of death. Cirrhosis of the liver related to intoxication by
alcohol is a chronic toxicity condition from which death can occur.
Some toxic substances, such as cyanide and paraquat, are generally considered to be acute
toxins only.
Note: Students should be aware that for examination purposes, the terms Sources,
Pathways and Receptors have been occasionally used in the place of Sources,
Routes of Entry and Target organs.
Target Organs
The Blood
We now move on to those body systems which are most affected by the absorption of toxic
substances.
Blood is a viscous fluid which circulates throughout most of the body structure. Blood is both a
functional organ and a connective tissue, as it contains specific cells. Blood cells are
suspended in a fluid plasma, which together make up the composite fluid which is called blood.
Being a fluid, blood is able to take the shape of the vessels or organs in which it is contained.
The lack of a specific shape enables blood to enter into any body situation where it is required
to function.
In a healthy adult, the total blood volume is about 8% to 12% of the body weight, with
a volume of between 4 and 8 litres.
The basic composition of the blood is: plasma 55%, blood cells 45%.
The specific gravity of blood is about 1.055, i.e. a little heavier than water.
The blood plasma is slightly alkaline, about pH 7.4, a level which is critically maintained
to ensure maximum operating efficiency.
Blood consists by weight of:
Water 91.0%
Protein 8.0%
Salts 0.9%
The salts are mainly sodium chloride, sodium hydrogen carbonate and salts of calcium, as well
as salts of phosphorus, magnesium and iron. There are traces of organic matter, such as
glucose, amino acids, fats, urea, uric acid and cholesterol. The blood also carries oxygen and
carbon dioxide; internal secretions such as hormones, enzymes and antigens (antibodies); and
blood cells.
Blood cells transported in the blood include:
Erythrocytes (red cells).
Leucocytes (white cells).
Thrombocytes (platelets).
The ratio of the cells in blood is 500 red cells: 1 white cell: 30 platelets.
Erythrocytes
These are biconcave cells (shaped like a doughnut) measuring about 7 m in diameter and
about 2 m thick, and they do not contain a nucleus. They are made in the red bone marrow,
found in the cancellous tissue of long bones, in the bones of the skull, the vertebrae, the ribs
and the sternum.
The erythrocytes contain haemoglobin which provides a chemical system which enables
oxygen to be transported throughout the body. When oxygen obtained from the lungs is
attached to the haemoglobin, it is termed oxyhaemoglobin.
The red cells are the most numerous of the blood cells: 1 mm3 of blood contains about 5
million erythrocytes.
Haemoglobin
You will remember that haemoglobin is a complex chemical compound which gives the
erythrocyte (and the blood) its red colour. The HAEM provides the "active" (or prosthetic)
part of the molecule. It is a red pigment, formed by a complex molecule of iron. The
GLOBIN is formed from protein molecules. The two molecular systems are joined in such
a way that they make a composite functional biochemical structure.
As erythrocytes do not have a nucleus, like other cells do, they are not considered as "living"
systems, i.e. they do not divide and reproduce. Red blood cells have a limited "life" of about
120 days, so the body has to mass-produce them to keep the required operational numbers.
The replacement rate in a healthy body is about 1 million per second. Fortunately, much of
the raw materials are not lost from the body, so, provided the essentials are kept topped up
from the diet, problems do not occur.
Leucocytes
These cells, as the name implies, are white in colour. There are about 8,000 white cells per
mm3 of blood. On average, they are larger than red cells, ranging from 8 m to 20 m in
diameter. The cells contain a nucleus, so they can be considered as "living" cells. There are
two main types of leucocyte which together form the main defensive system in combating
disease and the effects of toxic actions:
Granulocytes
These cells constitute about 75% of the white cells. They are produced in the bone
marrow and the spleen. Their defensive role involves moving in and out of the blood
vessels and wandering freely through the tissues, where they ingest (or "eat") harmful
micro-organisms or debris, by a process called phagocytosis (phago means "to eat").
Granulocytes concentrate at the site of infection or injury to attack foreign matter. They
ingest to an extent that causes them to die and, in doing so, they form "pus" discharge.
The increased microbiological action causes the site to become hot, resulting in
inflammation.
Lymphocytes
Lymphocytes make up about 25% of the leucocytes. They are derived from the lymph
glands, spleen, liver and bone marrow. They are in general not able to ingest foreign
matter like the granulocytes, but they protect the body by forming antibodies.
An antibody is a particular protein molecule produced to neutralise the effect of a foreign
protein molecule or antigen. The production of antibodies in response to an antigen is
called an immune response. As the process takes time to establish, antigens may
overwhelm the body and cause severe illness or death.
Immunisation is the process of giving the body a store of antibodies ready to fight off
infections before they become dominant in the body. An over-response by the body to
antigens is commonly called an allergic, or sensitisation, reaction.
Thrombocytes (Platelets)
Thrombocytes are formed in the bone marrow. Their main function is in the clotting of blood.
They are very small cells about 2 to 3 m in diameter. One mm3 contains about million
cells. The clotting of blood is a complex process depending upon many variable factors. In
essence the reaction involves precipitation of a material called fibrogen from the plasma to
give fibrin, a fibrous material which entangles blood cells to form a clot. Fibrin can become
involved with the structural repair of tissue and form part of the resulting scar. Formation of
scar tissue can be termed fibrosis.
Oxygen Transportation
The oxygen transport process in the blood is associated mainly with haemoglobin in the
erythrocytes. Oxygen molecules (O2) from the air are inhaled into the lungs and diffuse
through the very thin alveoli epithelium and capillary blood vessels into the blood plasma.
They then diffuse across the thin cell membrane of the erythrocyte cells to combine with
haemoglobin and produce oxyhaemoglobin. The reaction with molecular oxygen takes place
with the iron atom in the haem group. The iron atom is in its ferrous or iron (II) state. The
addition of the oxygen molecule does not constitute an oxidation reaction. The oxygen
molecule becomes loosely attached to the iron atom by a special type of bond. The ease
with which the oxygen molecules become attached to the iron atoms in the haem, and the
ease with which they become detached in other tissue, relies upon the "weakness" of this
bond structure.
As each haemoglobin molecule contains four haem groups, the reaction involving the
attachment of oxygen molecules can be represented by a general equation:
Hb + 4O2 = Hb(O2)4
haemoglobin oxyhaemoglobin
The electron arrangement around the iron atom in the haem molecule allows for six covalent
bonds to be formed, but only five are fully used. Four of the bonds are used in the red
pigment, one is used to join the haem to the globin protein structure and the one remaining
position is used to form the special bond to the oxygen atom. The square section with four
nitrogen atoms (one at each corner) is a simplified representation of the haem structure and
the four bonds form the iron atom. The bonds lie in a flat plane at right angles to the globin
and oxygen molecule bonds.
The two important points to note are:
The iron atom in the haem group is in the ferrous iron (II) state.
The bond available for the oxygen molecules is not a normal covalent bond.
Both these factors are important in the mechanism of common occupational intoxications.
Carbon Dioxide
The transport of carbon dioxide in the blood is more complex than oxygen transport. Carbon
dioxide diffuses from tissues into the erythrocyte cells. Only a small percentage actually joins
with the haemoglobin molecules. The remaining carbon dioxide is converted into hydrogen
carbonate ions ( HCO3 ) and transported back to the lungs in this form. In the lung structure,
reoxygenation of the haemoglobin (which has travelled back to the lungs in a special acid
form) takes place and dissociation of the HCO3 occurs. Carbon dioxide is released and after
diffusion in the lungs can be exhaled.
A very small percentage of carbon dioxide (less than 5%) is transported directly by the blood
plasma as HCO3 ions.
The Heart
The heart lies in the thorax, centrally between the lungs and behind the base of the sternum,
but with the apex pointing to the left, i.e. the longitudinal axis of the heart is not vertical. Your
heart is about the size of your own clenched fist and weighs from 240 to 270 grams.
The heart is divided by a septum into right and left sides, which in effect makes it two
"pumps". Each side is divided into an upper and lower chamber: the atrium, which receives
blood, and the ventricle, which distributes blood.
Blood Vessels
In both the systemic and pulmonary circulations of the blood, blood vessels leaving the heart
are called arteries. They branch into named arteries to the organs, e.g. the right and left
pulmonary arteries from the main pulmonary artery. Arteries branch into arterioles; and
arterioles branch into blood capillaries, which supply substances to, and collect other
material from, the cells. Blood from capillaries flows into venules and then into veins.
Venous blood collects in the superior and inferior vena cava and enters the right atrium of the
heart. The blood takes 15 to 26 seconds to travel around the systemic and pulmonary
circulations together.
The Liver
The liver is the largest organ in the body, weighing 1.5 to 1.8 kg (50 to 60 ounces). It is a
solid mass of cells situated immediately beneath the diaphragm, the bulk of it lying in the right
side of the abdominal cavity. The liver plays an essential role in the metabolising of hazardous
substances which have been ingested, inhaled or injected.
The Kidneys
The human body has two kidneys, each lying embedded in fat just below the diaphragm,
behind the abdominal cavity, one on either side of and between the last dorsal and third
lumbar vertebrae.
The kidney on the right side of the body is lower than that on the left, because of the room
taken up by the liver.
The prime function of the kidneys is to help regulate the purity and composition of the blood.
Involved in this process are the following operations:
Excretion of water.
Excretion of salts.
Excretion of nitrogenous breakdown products from protein metabolism.
Excretion of toxic materials or their by-products which have been taken or are absorbed
from a harmful occupational environment.
Assisting in the control of blood pH.
Defence Mechanisms
Inhalation and Respiratory Defences
Respiration not only facilitates the transport of oxygen into and carbon dioxide out of the
lungs, but it also allows the ingress of harmful agents such as chemicals, physically damaging
dusts and fibres, air of excessive temperature or dryness, and biological agents such as
bacteria or viruses. Some of the defence processes are readily identified:
Coughing results in the forceful ejection of inhaled substances.
Goblet cells in the conducting airways secrete mucus which, forming sputum, is
expectorated or swallowed; and the nose itself filters out the largest particles.
Inhalable dust is the total amount inhaled into the respiratory system through the nose.
Respirable dust is the fraction that penetrates through to the gas exchange region of the
lung.
Before we attempt to study the respiratory defence mechanisms in detail, we need to return
for a moment to the respiratory tract (see the figure that follows).
Lung
Diaphragm
Those parts of the respiratory pathway down to and including the terminal bronchioles are the
conducting airways; those beyond constitute the respiratory units, where gas exchange occurs.
Initial filtration of particles larger than 10 m takes place in the hairs in the nasal cavity.
Smaller particles and aerosols between 7 and 10 m are trapped in the mucus secreted by
goblet cells lining the conducting airways and then transported upwards by the ciliary
escalator to the pharynx where they can be either swallowed or expectorated.
Once in the bloodstream, the toxic substance may act upon the blood itself or be carried
around until it affects another organ, such as the liver, kidneys or bladder. Materials swallowed
may be excreted unchanged in the faeces. Others may be acted upon by enzymes, acids, and
other processes in the gut, or be absorbed and pass via the portal vein to the liver. Here they
may be further acted upon and metabolised or conjugated into a variety of soluble by-products
to be excreted in the urine.
Some toxic materials, such as lead, are initially stored in the bones of the skeleton so the toxic
effects can be minimised by slowly allowing it to leach back into the bloodstream.
Substances that pass through the alveolar membrane enter directly into the pulmonary
capillaries or find their way into the tissue spaces of the lungs from which they are drained by
the lymphatic system. Substances reaching the interstitial spaces are sometimes stored
harmlessly prior to draining into the lymphatic system (e.g. tin and iron compounds), or may
result in damage or set up disease processes (e.g. fibrosis or pneumoconiosis). Because the
lymph glands act as filters for substances or micro-predators (such as phagocytes) which are
being carried away by the lymphatic system, they are often involved in lung disease. Many
cancers of the lung, for example, start in the lung's lymph glands.
The following table shows nine examples of input substances, their sites of contact in the
respiratory pathways, together with their principal effects.
Defensive Cells
Defensive cells are very important in protecting the body against harmful inputs of all kinds.
Those associated with work and occupational illnesses make up only a small proportion of such
damaging inputs with which the body has to contend. Two examples will serve to illustrate the
types of defence cell which are important in occupational health and hygiene:
Phagocytes, which play a central role in the prevention of lung diseases.
Blood-borne defensive cells, which give rise to the immune response and the
inflammatory response.
Phagocytosis
Phagocytosis is illustrated in the following figure:
Phagocyte
Cytoplasm
Stage 1: Chemotaxis - proximity of foreign
-Foreign body
body stimulates movement of phagocyte
Cell nucleus towards intruder.
Lysosome
and
Phagocytosis
Harmful particles, micropredators and other foreign bodies engulfed by phagocytes may in this
way be rendered harmless.
Sometimes phagocytes may be killed by toxic action. This results in the formation of pus,
which is then discharged leaving a void subsequently made good by the formation of scar
tissue. In the lungs it causes fibrosis, whereby the tissues lose their elasticity and breathing
becomes progressively laboured.
Inflammatory Response
Inflammation is the reaction of tissue to a harmful agent which is insufficient to kill the tissue.
It can follow when a foreign body enters the body by way of inhalation, ingestion, absorption,
pervasion, implantation, surface penetration, trauma, or energy transformation. Although
inflammation is a defensive process of great importance, if called upon to act for too long it
can sometimes result in disease.
Acute Inflammation
Acute inflammation is the immediate defensive reaction of tissue to any injury and is
typified by the following sequence of events:
Initially the capillary vessels in the area of tissue affected briefly constrict.
Then the same blood vessels dilate and the capillary walls become more permeable.
Protein-rich fluid (plasma) exudes from the capillaries into the surrounding tissue,
causing swelling (oedema).
Phagocytes migrate through the capillary walls towards the harmful input, where they
ingest it together with any damaged tissue.
Tissue-dwelling macrophages join with the phagocytes and scavenge the affected
area, which is sometimes additionally bonded by fibrinogen (a protein associated
with blood clotting).
Healing Process
Towards the end of the inflammatory phase, cells called fibroblasts appear and secrete
collagen. This is a fibrous protein which cross-links with polysaccharides (sugars) to
form a meshwork of scar tissue which steadily builds up to repair the affected area. While
this is going on, if the affected area is close to the skin, epidermal cells remove any final
debris in the area and begin to dismantle the scar tissue.
Chronic Inflammation
Sometimes excessive amounts of collagen are formed and in certain chronic inflammatory
responses, macrophages die and other macrophages phagocytose their dead. The
combination of living and dead macrophages forms structures known as giant cells.
Scarring is a repair process by which gaps in tissue are made good. In some types of
chronic inflammation, however, this repair process becomes disordered. The overgrowth
of scar tissue, brought about by over-production of collagen, shrinks and contracts,
tearing and distorting the surrounding tissues. In the lungs, this results in the condition
known as emphysema and some types of pneumoconiosis result in extensive scarring and
fibrosis.
Immune Response
This term describes the mechanisms concerned with defence and preservation of normal body
integrity. In its classical form a wide range of chemicals and micropredators provoke an
immune response which involves the production of antibodies within the space of a few days.
Whenever next the antigen enters the body, it reacts with the residual antibody and the
combination of antigen and antibody can be phagocytosed as detailed above.
In addition to the classical disposal of antigens, two other types of immune response are
recognised:
Surveillance
Sometimes dividing cells give rise to mutant forms and any excess could result in the
growth of abnormal tissue (benign or malignant). Surveillance by immune response
results in these mutants being recognised as alien and destroyed.
Self-Disposal
Redundant blood and tissue cells need to be phagocytosed from the body and the
immune response ensures that redundant cells are recognised as distinct from functioning
cells.
It is important to link the immune response with inflammatory responses, since the two
can be regarded as complementary stages in a continuous process. The immune
response can be regarded as the mechanism concerned with identifying and preparing
any harmful inputs or the resulting damaged tissues for the inflammatory process.
Harmful inputs which can provoke an immune response include:
Micropredators and chemicals.
Energies which cause tissue damage.
Psycho-social climates (to produce, for example, asthma).
Immunity can be natural (by means of the genetic make up of the individual) or acquired
(which in turn may be by artificial means, such as injections, or natural means, through
contracting the disease and building up immunity).
Respiratory Inflammation
The respiratory pathway is vulnerable to attack by many irritants and corrosives or any other
substances which attack the skin. The terminology of the inflammatory processes follows the
pathway of air into the lungs, i.e.:
Rhinitis.
Laryngitis.
Tracheitis.
Bronchitis.
Pneumonia
In extreme cases the effects of inflammation lead to swelling and exudation of fluids resulting
in narrowing or even total blocking of the small conducting airways. Exudation in the alveoli
leads to interference with respiratory gas exchange, even to a fatal degree. Gases of low
solubility will penetrate the respiratory pathway deep into the alveoli. Such gases include
sulphur dioxide, ozone, phosgene and oxides of nitrogen. The inflammation caused results in
fluid accumulating in the respiratory units (oedema). Other irritants include metal fumes
(metal fume fever) and polymer fumes (polymer fume fever).
Irritant Dermatitis
This is caused by corrosive irritants such as acids, alkalis, detergents, oils, metallic
particles, solvents, oxidising and reducing agents and some biological agents (e.g. giant
hogweed). If the irritant is particularly aggressive, it can result in destruction of the skin.
100
PER CENT EFFECT (DEATHS)
LD90
50
LD50
0
LOG DOSE
Dose/Response Curve
The dose-response curve is S-shaped and the mid-point represents the dose which would
cause an effect (in this case death) in 50% of the organisms. It is designated as the LD50.
You should appreciate that LD50 is not an exact value and in recent years there has been much
discussion as to its usefulness and necessity in toxicology. The LD50 values may vary for the
same compound between different groups of the same species of animal.
However, the value is of use in comparing how toxic a substance is in relation to other
substances. The following table gives examples of LD50 values for a variety of chemical
substances.
LD50 Values
Ethanol 10,000
DDT 100
Nicotine 1
Tetrodotoxin 0.1
Dioxin 0.001
Botulinus toxin 0.00001
Once a dose-response relationship has been demonstrated there are a number of parameters
that can be derived from it.
If exposure is oral and lethality is used as the end point, LD50 can be determined as we have
seen previously. LD50 is defined as "a statistically derived expression of a single dose of a
material that can be expected to kill 50% of the animals".
However, the S-shaped dose-response curve can be further analysed mathematically to
determine doses that have a higher or lower probability of fatality. The determination of LD90
from the dose response curve, for example, enables estimation of the dose that will kill the
majority (i.e. 90%) of a sample of animals (see figure above).
Remember that the LD50 classification is only a very rough guide to relative toxicity. It tells
nothing about sublethal toxicity and the data is only strictly valid for the test population, e.g.
rats and the route of exposure, e.g. ingestion. The LD50 tells us nothing about the shape of
the dose-response curve on which it is based. It is possible for two chemicals to have the
same LD50 but one may have a much lower lethal threshold and kill members of the exposed
population at concentrations where the other has no effect.
The use of LD50 testing has declined with the use of fixed dose testing (see later).
Testing for carcinogenic potential is more complex since there is no simple dose-response
relationship. It is not possible to assign a dose below which it can be said that the exposure is
safe. The toxicology of carcinogens is approached in a different way but still involves exposing
laboratory animals (usually rats and mice) to the chemical by oral, inhalation or skin contact
techniques.
There are also short-term predictive tests available which are considered to simulate potential
carcinogenicity in man. They are called short term, in contrast to the usual lifetime studies in
rodents which can take three to four years before a result is available.
Short-term tests include:
Those for mutation (e.g. Ames test).
Tests for DNA damage.
Tests for chromosomal damage.
Tests for cell transformation.
established a study similar to that outlined in the following table can be carried out in order to
classify the substance. Note that the criterion used is 90% survival.
If a large enough sample of animals is used at each dosage level the LD50 value can be
determined from analysis of the data. The initial test dose should be chosen to identify toxicity
without mortality occurring. So if a group of test animals is tested with an oral dose of 500
mg/kg body weight and no signs of toxicity appear, the substance should not be classified in
any of the categories of toxicity.
We can therefore see that a representation of the workplace situation involves individuals of
different age, sex, occupation, race and duration of employment experiencing continually
varying exposures to workplace agents. Within this changing workplace population,
occupational ill-health may occur either during employment, during future employment or after
retirement. From this complicated picture, which is changing with time, the epidemiologist
must try and design studies which will establish a cause and effect relationship between
workplace agents and occupational disease.
If we wish to investigate this process and/or the population there are two basic studies that we
can make.
Cross-Sectional Studies
The cross-sectional study involves a "snapshot in time" of the relevant workforce. A section of
the workforce is examined over a short period of time. The advantage of this type of study is
that it is a quick and cheap opportunity to study the problem in hand, but the disadvantage is
that the population at risk is assessed over a narrow time frame. This means that the
investigators cannot look at exposure and the resulting outcome over a period of time. The
cross-sectional study therefore tends to be:
Outcome-selective: the study examines the prevalence of a particular occupational
condition within the population.
Exposure-selective: the study examines a particular population that has been exposed
to a specified occupational condition.
For this reason cross-sectional studies are also known as prevalence studies.
The design of a cross-sectional study involves the following main stages:
Establishing precise aims.
Defining the study population.
Determining the sample size - important for statistical purposes.
Recruitment of all relevant cases in the sample.
Analysis - prevalence rates in relation to sample groups.
Longitudinal Studies
The longitudinal study involves investigation of the workforce over a significant period of time.
This type of investigation takes longer to carry out and is more expensive, but, because it
takes place over a period of time rather than at a specific point in time, it provides the
opportunity to study exposure and its outcome as a time-related chain of events. Two types of
longitudinal studies are commonly employed:
The case-control method may be used, for example, to investigate the frequency of
asbestos workers who have respiratory problems or lung disease against a control group
drawn from the general population. It is quicker and less expensive than a cohort study
(see below) and is often used as the first step to see if there may be an association
between a suspected cause and a known effect. It is also useful in investigating a disease
of low prevalence. Unfortunately, however, case-controlled studies are generally less
informative than cohort studies and spurious associations are likely to occur.
Death Certificates
These provide a reasonably accurate and quantifiable measure of serious illness.
However, problems occur with:
The accuracy of the cause of death (this relies on the physician's decision as to the
ultimate cause of death).
The occupation of the deceased (this may be the occupation at the time of death
but not necessarily the one that caused the death).
Birth Certificates
These can be used in conjunction with data on congenital malformations and pregnancy
complications to study the effect of parents' occupations on these conditions.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.4.2 Apply the requirements for reporting occupational diseases internally and
externally
Unit 4:
Internal Reporting
At all times the company should be alert to the risks/dangers of employees developing
occupational diseases to which their employees are exposed.
New risk assessments may have to be carried out, if there is a chance that existing
preventive/precautionary measures are deficient; measurements, such as atmospheric or
health monitoring, must be taken and analysed regularly; training in the correct use of
personal protective equipment must be updated.
Accident book entries should be completed when an occupational disease is known to have
caused the injuries. This could be related to a disease like vibration white finger where an
employee has suffered severe pain in their hands and cannot grip the tools he works with.
It is vitally important that companies are aware of the need to carry out strict and regular
monitoring of any employee who works at an activity in which they are vulnerable to
developing an occupational disease. Routine health surveillance must be carried out for those
likely to be exposed to occupational diseases, such as asthma, dermatitis and many others.
Management should analyse, on a regular basis, any relevant information they have available
to them with the objective of identifying any indications of changes that need to be attended
to.
Management should react positively to complaints received by the workforce received either
during consultation or on a piecemeal basis to find suitable cost effective remedies to
occupational health issues.
Management should carefully monitor the ill health of employees who self report their
condition, to see if there are any occupational health issues that need addressing. Sick notes
should also be monitored to identify obvious signs of occupational health issues.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
Unit 5:
Audiometry
This involves the measurement of hearing performance in order to detect actual noise induced
hearing loss. The most commonly used assessment of hearing is the determination of the
threshold of audibility, i.e. the level of sound required to be just audible. This level can vary
for an individual over a range of up to 5 dB from day to day and from determination to
determination, but it provides an additional and useful tool in monitoring the potential ill
effects of exposure to noise. Before carrying out a hearing test, it is important to obtain
information about the persons past medical history, not only concerning the ears but also
other conditions which may have a bearing on possible hearing loss detected by an
audiometric test.
The procedure is repeated several times so that an average threshold can be derived
for the test. Thresholds can vary due to slight changes in the procedures adopted in
setting up the test, e.g. variation of the position of the earphone on the ear.
Following this pre-check, both of the subjects ears are tested through a range of
frequencies (usually 0.5, 1, 2, 3, 4 6 and 8 kHz) and hearing loss recorded for each
frequency, again via a series of sound exposures. From them an average result can be
computed.
When the test is completed, a second threshold check should be carried out to see that no
errors have crept in during the test. Both threshold checks should agree within a
maximum of 10 dB. If they do not, a re-test must be performed.
The accuracy of audiometry can be affected by a number of factors, including:
Equipment limitations - how accurately can either the frequency or the hearing level
be determined?
Learning effect - the first ear tested sometimes appears worse than the second one
since the individual becomes more proficient at detecting the threshold.
Headphone fit - some of the variation in threshold measurement has been attributed to
differences in the location of the headphones, which in turn affect the detection of the
threshold.
Background noise audiometric tests should be carried out in a sound-proof chamber
to eliminate external sounds from influencing the test.
A further complication of audiometric testing is that it is subjective and relies on the co-
operation of the subject. If the subject is unable or unwilling to co-operate with the test then
unrepresentative results will be obtained.
The technique described above enables us to compare the threshold of hearing of the
individual undergoing audiometry with a reference value at a range of octave band frequencies
(125, 250, 500, 1000, 2000, 4000, 8000 Hz). From this data a pictorial representation, an
audiogram, of hearing loss at various frequencies is produced.
Some examples of audiograms reflecting different levels of NIHL are shown below.
THRESHOLD
SHIFT (dB)
-20 NORMAL
HEARING
-10
LEVEL OF
0 SHIFT
10
20
TEMPORARY
THRESHOLD
30 SHIFT
40
50
60
70
80
125 250 500 1000 2000 4000 8000
FREQUENCY (Hz)
The recovery time from a TTS is illustrated in the next figure. Note the recovery is first rapid
and then proceeds at a much reduced rate. The higher the noise exposure, the longer the
recovery time.
TEMPORARY 40
THRESHOLD
SHIFT (dB)
105 Db
30
20
93 Db
10
0
TIME
THRESHOLD
SHIFT (dB)
-20
-10 NORMAL
HEARING
0
LEVEL OF
SHIFT
10
20
30 PERMANENT
THRESHOLD
40 SHIFT
50
60
70
80
125 250 500 1000 2000 4000 8000
FREQUENCY (Hz)
A common use of audiometric testing is at the pre-employment stage. This serves two
purposes: the first is that it enables an initial assessment of hearing ability to be made in order
to establish a base-line, which can be measured by future audiometric tests.
The other purpose is to detect any signs of noise induced hearing loss arising from previous
employment. If this is detected and documented it can serve to safeguard the employer
against any false accusations that hearing loss might have been due to this employment rather
than previous ones.
Spirometry
A spirometer is a device that measures the amount of air that you exhale. The spirometer is
concerned with lung function and involves the employee breathing in fully and sealing their lips
around the mouthpiece of the spirometer. The most common measurements made are:
FEV1 Forced Expiratory Volume in one second. This is the amount of air you can blow
out from your lungs in one second. Normal healthy lungs should be able to blow out most
of the air in that time.
FVC Forced Vital Capacity. This is the total amount of air that can be blown.
FEV1/FVC. This is the proportion of air in your lungs which can be blown out in one
second.
A graphic representation in the form of a spirogram is usually included in the results.
Spirometry readings will vary according to age, size and sex, medical conditions, previous
employment experience (e.g. inhalation of dust) etc., and charts are available with normal lung
function readings against which a comparison can be made.
Where an individual has narrowed (obstructive) airways, e.g. due to asthma, or chronic
obstructive pulmonary disease, the FEV1 will be low but the FVC will be relatively normal, i.e.
the amount of air that can be blown out quickly is reduced. Conditions such as fibrosis or
pneumoconiosis that affect the lung tissue itself or affect the capacity of the lungs create a
restrictive pattern and will reduce the FVC, but the FEV1 will remain normal. It follows that
where both a restrictive and obstructive pattern exist, both the FEV1 and FVC will be reduced.
Spirometry is an effort-dependent test that requires careful instruction and the co-operation of
the test subject. Therefore, like audiometry, if the subject is unable or unwilling to co-operate
with the test then unrepresentative results will be obtained. Also, like audiometry, lung
function tests may be carried out at the pre-employment stage and can also be used as a
benchmark for future comparison.
Dermatological Testing
Regular dermatological testing by means of skin checks and patch testing can identify adverse
skin reactions to sensitising agents.
Chest Radiography
The principal use for chest radiography is for screening people in dusty occupations where
there is a risk of pneumoconiosis. Although mass radiography has been used to advantage in
identifying tuberculosis in the population at large, pneumoconioses require X-ray films of
greater definition to establish accurate classification of the stages of the disease. It also has
uses in investigating symptoms which become apparent in the upper respiratory system.
However, the use of X-ray techniques for screening for lung cancer (either occupational or non-
occupational) is more doubtful.
Biological Monitoring
Biological monitoring involves the measurement and assessment of workplace agents in
tissues, secretions, excretions or expired air to evaluate exposure and health risk compared to
an appropriate standard.
Biological tests are used for the early detection of occupational disease and its precursors and
include periodic examinations of blood or urine samples to detect excessive absorption of
potentially toxic substances; analysis of gases and vapours in exhaled breath; chest X-rays;
liver function; renal function and nerve condition.
Biological monitoring takes into account routes of absorption, effects of workload, and
exposure outside the workplace. The following are the most commonly used techniques.
Liver Function
The liver is another organ which plays a central role in metabolic processes and is
susceptible to the effect of absorbed toxic substances, especially if they are fat soluble.
Damage can be to the liver cells themselves or to the transport mechanisms to and from
the liver. There is a considerable list of occupational hepatotoxins (toxins which can
damage the liver), including organic compounds (alcohol included), antimony, arsenic and
yellow phosphorus; and infective agents such as serum hepatitis.
Screening techniques for occupational liver disease also fall into two groups: those
related to the measurement of exposure to and absorption of hepatotoxins; and those
which monitor general liver function. Tests involve monitoring levels of specific
metabolites such as bilirubin and gamma-glutamyl transferase to assess liver function.
Nervous System
Toxic damage to the nervous system may affect the peripheral nervous system (motor
and sensory function) or central nervous system (brain function and impairment of
consciousness). There is a range of neurotoxins which produces peripheral neuropathy
(arsenic, lead and mercury) or behavioural changes (carbon disulphide, methylene
chloride, toluene); thus there is a need for medical and environmental control of persons
working with known neurotoxins, including regular biological monitoring. Tests include
visual testing, nerve transmission tests (electomyography, neuromuscular transmissions)
and assessment of intelligence, personal and psychological tendencies.
The advantages of biological monitoring include the following:
It can help to demonstrate whether personal protective equipment (e.g. gloves, masks)
and engineering controls (e.g. extraction systems) are effective in controlling exposure.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.6.3 Describe and explain the physical and psychological effects of occupational stress
Unit 7:
Emotional (Feelings)
The emotional effects that stress can cause include:
Irritability.
Anxiety.
Irrational fear.
Feelings of hopelessness.
Aggressiveness.
Resentment.
Depression.
Cognitive (Thinking)
The cognitive effects (in the mind) that stress can cause include:
Inability to concentrate.
Inability to make decisions.
Low esteem.
No self-confidence.
Memory lapse.
Misperception.
Loss of perspective.
Behavioural (Actions)
The behavioural effects that stress can cause include:
Increased alcohol consumption.
Increased smoking.
Difficulty sleeping.
Poor concentration.
Inability to cope with everyday tasks and situations.
These symptoms may be short term in response to an isolated finite period of excess pressure,
or long term if the pressure is unabated.
Physiological
The physical effects of stress in the workplace can involve a range of symptoms which include:
Raised heart rate.
Increased sweating.
Headaches.
Dizziness.
Blurred vision.
Aching neck and shoulders.
Skin rashes.
Lowered resistance to infection.
These symptoms are usually short-lived, depending on the nature of the stressful condition.
However, prolonged exposure to stress can lead to more serious ill-health conditions.
Stress is also associated with a number of serious ill-health conditions that may result from
prolonged chronic exposure. Examples of these are:
High blood pressure.
Heart disease.
Anxiety and depression.
Ulcers.
Thyroid disorders.
We can see, therefore, that chronic stress may lead to a range of ill-health conditions and
diseases, and must therefore be treated seriously as a workplace agent capable of causing
occupational ill-health.
Control
Stress used to be regarded as something which primarily affected senior managers in highly
responsible positions, but research has shown that lack of control over work is a more
significant cause, and this is more likely to be found in jobs lower down the organisation.
Senior managers often have considerable discretion in deciding which tasks they will undertake
and when, whereas subordinates are likely to be subject to greater control and to work to
more rigid timescales. Lack of control is particularly acute in jobs where the pace of work is
set externally to the employee, e.g. by a production line or the demands of customers.
Demands
Demands on the individual employee are often regarded as the main cause of work-related
stress. Stress can arise either if a worker is allocated too much work to do with insufficient
resources (e.g. where it is not possible to complete a task within the time available) or if the
work is too difficult and the worker has not received appropriate training or the task is beyond
their capability.
Employers must also introduce special safeguards for young people an employer must not
employ a young person for work that is beyond their psychological capacity, such as dealing
with people who are aggressive or abusive.
The physical and psychosocial environment in which work is carried out can also be a source of
stress. Aspects of the physical environment which affect workers include temperature, noise,
vibration, light, ventilation and workstation design. A significant factor in the psycho-social
environment is the risk of violence, e.g. for workers who have to deal face-to-face with angry
members of the public.
Work underload, when an employee does not have enough to do, or feels insufficiently
challenged by their work, can also result in stress.
An employee must receive sufficient training to be able to undertake the main functions of
their job. If an employee is not given basic induction training when they start a new job or
additional training when changes are made, such as the introduction of new working methods
or a new piece of equipment, they will struggle to carry out their duties effectively, inducing
feelings of worry and anxiety.
Support
An employee receives support formally from management and informally from colleagues and
others with whom they interact at work. If the employee feels unsupported because, for
example, they feel that the problems they face are not appreciated by management or there is
a lack of social support from colleagues they are more likely to experience work-related
stress.
Relationships
There is a wide variety of different people with whom we interact at work, including managers,
colleagues, subordinates, customers, suppliers and members of the public. Often such
relationships can be an important source of support, but they can also cause stress, e.g. if
there is interpersonal conflict. Harassment and bullying are particularly important causes of
stress and if they are not tackled can lead to stress-related illness.
Harassment and bullying is defined as offensive behaviour involving an abuse of power by one
person over another. This may arise as a result of prejudice based on factors such as gender,
ethnic origin, religion or disability, or from other sources of power, such as a person's
hierarchical position in the organisation, age, length of experience, educational background,
social class, etc. Harassment and bullying can take place at all levels in the organisation and
may be perpetrated by a manager towards a subordinate, between colleagues or by a
subordinate towards their manager. Obvious examples of harassment and bullying include
racist abuse, requests for sexual favours, spying and pestering, but it can also take more
subtle forms, such as persistent belittling in front of others, excessive supervision, withholding
information or social isolation.
Role
If a worker's role in the organisation is unclear, because they are unsure of the scope,
responsibilities and requirements of the job, or they are subject to conflicting demands, this is
a significant source of stress.
Change
Organisations are constantly having to adapt to changing external and internal conditions, such
as new technology, political regulation and competition. Their response may include
restructuring, downsizing and new ways of working. Such changes can have a beneficial
impact for individual employees by making their work more interesting and enabling greater
job satisfaction, but change can also cause worry, anxiety and feelings of insecurity,
particularly if there is a threat of job losses.
Work Performance
The detrimental effect of stress on work performance may manifest itself as:
Reduction in output or productivity.
Increase in wastage and errors.
Deterioration in planning and control of work.
Poor decision-making.
Relationships
Deteriorating relationships at work can result in:
Tension and conflict between colleagues.
Poor relationships with clients.
Increased incidence of industrial relations or disciplinary problems.
Sickness Absence
The range of ill-health conditions attributable to stress is likely to cause an increase in
general sickness absence but the main increase is usually that of frequent short periods of
absence.
Control
Control relates to the influence that the individual has on the way he/she does their work.
Employees should be able to have a say about the way they do their job.
Employees should be encouraged to have more say in how their work is carried out, e.g. in
planning their work, making decisions about how it is completed and how problems will be
tackled. Staff should be encouraged to use their initiative and to take an interest in developing
new skills that will enable them to face new challenges in the workplace. Consultation with
staff over work patterns will help to make the individual feel that they have control and
influence over their work situation.
Demands
In this area, which concerns issues such as workload, work patterns and the working
environment, employees should be able to cope with the demands of their job.
The employer should ensure that demands on staff are not excessive in relation to the agreed
hours of work, and should be prepared to re-prioritise tasks or re-negotiate deadlines to
ensure that no employee is put under undue pressure. Staff with the appropriate skills for the
job should be employed. Risk assessments should be undertaken to control physical and
psychosocial hazards.
Support
Support in the workplace relates to the help that employees receive in terms of
encouragement and resources from colleagues at every level of the organisation. Employees
should receive adequate information and support from their colleagues and superiors.
Feedback to employees is an important way of improving performance and maintaining
motivation. All feedback should be positive, with the aim of bringing about improvement, even
if it is challenging. Feedback should focus on behaviour, not on personality. Managers should
ensure that feedback is given for tasks which have been performed well, not only when there
are problems.
Employees should also be made aware of the support that is available to them within the
organisation, whether from line managers, particular colleagues, the Human Resources
Department or any other source, and how to access it if necessary.
Relationships
Tension, conflict and unacceptable behaviour in the workplace all lead to a stressful work
environment. Employees must not be subjected to unacceptable behaviour, such as bullying.
In order to achieve this, clear standards of conduct should be communicated to employees,
with managers leading by example. The organisation should have policies in place to tackle
misconduct and harassment and bullying. It is important that employees are encouraged to
report behaviour that is unacceptable in the workplace without feeling intimidated.
Role
It is important that an individual understands clearly their role within the organisation. Role
conflict can contribute significantly to occupational stress. Employees should understand their
role and responsibilities.
An employees role in the organisation should be defined by means of an up-to-date job
description and clear work objectives and reporting responsibilities. If employees are uncertain
about their job or the nature of the task to be undertaken, they should be encouraged to ask
at an early stage.
Change
The management of change has become increasingly important as organisations develop and
restructure to cope with internal and external pressures. Change can be stressful for anyone
at any time, but particularly so in the workplace when an individuals employment may be
threatened. The organisation should involve staff frequently when change is being
implemented.
If change has to take place, employees should be consulted about what the organisation wants
to achieve and given the opportunity to comment, ask questions and get involved. Any
possible impact on jobs should be explained, training should be available if required, and staff
should be made aware of the timescale involved. Employees should be supported before,
during and after the change.
Culture
An organisation has a positive culture when there is open communication and trust between
employer and employees. Workers should be encouraged to raise any problems, knowing that
they will be recognised and dealt with promptly. There should be recognition of the
importance of striking the right work-life balance. Work-related stress should be treated
seriously, with the employer responding positively to any concerns.
Training
Employees need to be competent and feel comfortable about doing their jobs. Induction
training should be provided to new employees and the training needs of all workers be
regularly assessed to ensure that they are equipped to deal with new challenges. There is a
range of ways in which training can be provided, both on and off the job.
Work Performance
Has the output or productivity improved?
Is there a decrease in wastage and errors?
Is there an improvement in the planning and control of work?
Is there better decision-making?
Relationships
Has tension and conflict between colleagues eased?
Are there better relationships with clients?
Are there fewer industrial relations or disciplinary problems?
Sickness Absence
Has general sickness absence been reduced, particularly short periods of sick leave?
Rehabilitation
Even after implementing such measures, there may be some sources of stress which are
unavoidable and efforts should therefore be directed towards helping the individual employee
to cope, by means of appropriate supervision, workplace counselling and stress management
training. In some case, particularly if there has been significant absence from work, a gradual
reintroduction to the work place with shorter hours and additional general training may be
beneficial to the individual and the organisation.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
Unit 8:
Definitions
Bullying
The purpose of bullying is to hide inadequacy. The focus of such bullying is often
competence-based, often believed to be due to the lack of competence of the individual being
bullied. In reality, the target of bullying is often competent and popular, and the bully is
aggressively projecting their own social, interpersonal and professional inadequacies. Such
inadequacy might be to avoid facing up to their problems or accepting responsibility for their
behaviour, or to distract and divert attention away from their own incompetence. Bullies are
typically aggressive, cowardly, impulsive and dominating. Bullying is often psychological but
rarely physical, except where males are involved. The bully may be a compulsive liar, with a
deceptive nature - in such cases their word, even under oath, is questionable.
Such bullies tend to remain in their positions within a company if it is a badly managed or
insecure workplace. There are various types of bullying, e.g. pressure (shouted or sworn);
corporate (snooping or spying on employees); institutional (entrenched in the culture of the
organisation); cyber bullying (by misuse of the e-mail system), etc.
A common definition of bullying may be "offensive, intimidating, malicious or insulting
behaviour, an abuse or misuse of power through means intended to undermine, humiliate,
denigrate or injure the recipient."
Bullying can take many forms, e.g. verbal abuse, violent gestures, physical violence, allocation
of blame and 'picking on' workers unfairly, public humiliation of workers, or a more 'subtle' war
of words to undermine the worker's confidence.
It is regular intimidation that undermines the confidence and capability of the individual.
Extreme cases of bullying are easily spotted but more subtle incidents may be hard to identify
as specific behaviour.
While bullying is the common feature of all harassment, discrimination, abuse, conflict and
violence, bullying varies from harassment in many ways.
Harassment
Harassment is unwanted, unwelcome, unacceptable or intimidating conduct affecting the
dignity of men and women in the workplace. It may be related to age, sex, race, disability,
religion, nationality or any personal characteristic of the individual, and may be persistent or an
isolated incident. Such actions or comments are seen as demeaning and unacceptable.
Typical examples might be:
Any physical contact which is unwanted, e.g. sexual advances.
Coercion, isolation or 'freezing-out'.
The display of offensive material, e.g., 'pin-ups'.
Offensive or racist jokes.
Unwelcome remarks about a person's dress, appearance, race or marital status.
Shouting at staff.
Personal insults, verbal abuse, etc.
Persistent criticism.
Setting impossible deadlines.
High Absenteeism
Bullying or harassment at the workplace may result in increased levels of employee
absenteeism. Trends can be identified by looking at absence records, especially for shift
workers who have been regular attendees but suddenly start showing high levels of
absenteeism, possibly due to a change of shift supervisor or shift personnel.
Great care is required in dealing with such situations as it can lead to the resignation of the
person involved.
Poor Morale
For the employer the result of bullying and harassment is not just poor morale amongst the
workforce, but it can also lead to high staff turnover, reduced productivity, lower efficiency and
a divided workforce with an apparent lack of commitment.
Staff Surveys
Staff surveys regarding the subjects of bullying and harassment may be a useful tool against
their occurrence in the workplace. The surveys could be informal or formal - whatever their
format valuable information may be obtained. Typical information that might be asked relates
to its seriousness, main sources, the form it takes, frequency, time taken off, causes,
availability of counselling, etc. Any such surveys should be anonymous and confidential. This
should be made clear to all staff who take part in the survey. It is also important that
management is seen to support the survey, emphasising their opposition to bullying and
harassment in the workplace.
Communication/Consultation
A significant problem with regard to bullying and harassment is that those who are subjected
to it feel particularly vulnerable and are often reluctant to complain. It is therefore important
that all staff are encouraged to use whatever communication channels are available within the
organisation in order to highlight any problems that exist. Management therefore has a
responsibility to attempt to establish appropriate methods of communication to deal with such
problems.
Signs on notice boards, confidential counselling, advice and support services, continuous
expression by whatever communication method is available of what the organisation considers
to be unacceptable behaviour, and readily accessible information on how to make complaints
are all important. Widespread availability of the company policy on bullying and harassment is
also essential. Consultation by management with employee representatives offers an
opportunity for any concerns to be expressed on both sides.
Team briefs, one-to-one discussions (not just when appraisal is due), newsletters, etc. are all
forms of communication that can be used to spread knowledge and information about
concerns relating to unsuitable behaviour in the workplace, which will hopefully encourage
victims to come forward with any complaints.
It is usually best to attempt to deal with complaints internally on an informal basis. In this
manner the problem can be dealt with both speedily and effectively. This can minimise a
potentially embarrassing situation and prevent a breach of confidentiality.
However, if an informal approach is ineffective, and it is a serious case, e.g. assault, or if the
individual prefers, formal action may be required. Such formal action must take place within
the company's normal disciplinary procedures/guidelines. Such policies should give the
complainant the right to register their complaint with someone outside their direct
management line since the complaint may be against their line manager.
Development of Policy
A formal policy relating to bullying and harassment is sometimes useful but often firms tend to
include the topic within other personnel policies; staff should be involved in the development
of such policies. A useful starting point may be a simple checklist which might include:
A statement of commitment from senior management.
An acknowledgment that bullying and harassment are problems for the organisation.
A clear statement that bullying and harassment will not be tolerated.
Examples of unacceptable behaviour.
A statement that bullying and harassment may be treated as disciplinary offences.
The steps the organisation takes to prevent bullying and harassment.
Responsibilities of supervisors and managers.
A statement regarding confidentiality for any complainant.
Reference to grievance procedures (formal and informal), including timescales for action.
Details of investigation procedures, including timescales for action.
Reference to disciplinary procedures, including timescales for action, counselling and
support availability.
Training for managers.
Protection from victimisation.
How the policy is to be implemented, reviewed and monitored.
The company must initially make it clear that bullying and harassment are unacceptable and
will not be tolerated and provide definitions of bullying and harassment at work and
notification that they are disciplinary offences.
The policy should apply to all staff on and off company premises, and include personnel
working away from their base as well as contractors and visitors.
As such, the policy should contain clear responsibilities for employers, management and
employees under any applicable health and safety at work legislation.
The company should avoid an authoritarian and confrontational style of management and
nurture one of consultation.
The policy should have and maintain a confidential, clear and fair grievance and disciplinary
procedure which allows the company to deal quickly and effectively with complaints of bullying
and harassment.
Standards of behaviour at work should be made clear to all staff by means of an organisational
statement. This may be supplemented by guidance booklets, a staff handbook, and awareness
training sessions or seminars.
Complaints of bullying and/or harassment, or information from staff relating to such
complaints, must be dealt with fairly and with appropriate confidentiality and sensitivity.
The role of safety representatives in such proceedings should be made clear. They have a dual
role, i.e. educating the workforce about inappropriate behaviour as well as receiving
complaints from employees.
A specific policy relating to bullying and harassment has a number of advantages, e.g. it helps
good relationships in the workplace, promotes equality of opportunity and social justice, avoids
stress and hostility and promotes formal procedures for creating a safer, healthier and happier
workplace.
An effective policy is one that is legal (where applicable), agreed, and produced as a result of
proper consultation and negotiation between unions and employers. The policy should be
widely known and put into practice. There should also be a procedure to review and monitor
the policy, including any complaints made.
Other measures it may include are opportunities for the appropriate training of all employees
and managers in the conduct of hearings, as well as providing trained counsellors. The policy
should be included in recruitment or induction packs. Such a policy should include details of
an independent person who may provide help and support for those being bullied or harassed.
A bullying and harassment policy should include the following specific areas:
Scope
The policy should give guidance on all aspects of bullying including definitions, company
commitment, individual responsibilities, appropriate complaints and disciplinary procedures and
penalties/action that might be taken. The policy should cover all staff including managers,
contractors, visitors and members of the public, as well as information on where to get
assistance, counselling, etc.
Rationale
The underlying principle or reasons for such a policy must be clearly laid out, e.g. bullying/
harassment is unacceptable in the workplace. Employers have a responsibility towards their
employees in this respect. Bullying and harassment as such can have a detrimental effect not
only on the individuals concerned, but also on their families and the organisation itself.
Management Responsibilities
The ultimate responsibility for such a policy procedure rests with the managing director, board
of directors or the management board, as appropriate. Similarly in smaller organisations it
may be the senior partner who is responsible. Good practice involves appointing such a
person to be responsible, accountable and with appropriate authority for such a policy. In such
a case they might need to ensure that the policy and procedures are fully developed,
implemented and appropriately carried out in all areas of the organisation, e.g. reporting
complaints, disciplinary procedures, counselling, etc. Where appropriate the responsible
person might need to appoint a competent person to deal with such measures. Other
management responsibilities include ensuring that the policy achieves all its objectives, and
any monitoring, review and reporting to senior management as required.
Disciplinary Procedures
Initially the complaint must be investigated promptly and objectively, and the complaint taken
seriously. The investigation must be seen to be objective and independent. Decisions can
then be made as to what action needs to be taken, e.g. initially counsel bullies to enable them
to change their offensive behaviour. This might rectify matters informally in a way that
provides a confidential and informal approach. In this way the complaint may be resolved
without further action taking place. However, if bullying continues then an investigation must
be carried out, and if necessary, disciplinary action taken at the appropriate level of the
organisations disciplinary procedure. The procedure followed must be fair to both the
complainant and the person accused.
Briefly, a disciplinary procedure should:
Provide for matters to be dealt with quickly.
Ensure that individuals are made fully aware of what their disciplinary offence is.
State the type of disciplinary action and who can take it.
Provide for a full investigation which gives individuals an opportunity to state their case.
Allow individuals to be accompanied by an employee representative or a colleague.
Not permit dismissal for a first offence (except for gross misconduct).
Ensure an explanation is given for any disciplinary action taken.
Specify an appeals procedure.
In cases which appear to involve serious misconduct, and there is reason to separate the
parties, a short period of suspension of the alleged bully/harasser may need to be considered
while the case is being investigated. This should be with pay unless the contract of
employment provides for suspension without pay in such circumstances. A suspension without
pay, or any long suspension with pay, should be exceptional as such action in itself may
amount to a disciplinary penalty. Do not transfer the person making the complaint unless they
ask for such a move.
Written warnings, suspension or transfers are examples of disciplinary penalties that might be
imposed. Care must be exercised when a possible suspension or transfer is considered (unless
contracted to) as this could breach the employees contract, e.g. transfer to a different
location, which means additional expense or a less responsible job.
Where gross misconduct is involved dismissal without notice may be appropriate, but must
follow a laid down procedure.
It is important that the disciplinary system is always strictly adhered to and that the procedure
is followed correctly and fairly. Because of its very nature a disciplinary procedure is often
seen to be part of the management system. It is also often the case that managers are the
cause of bullying and harassment in the workplace because of their status and power. The
disciplinary procedure must therefore be seen to be working fairly and must give both the
complainant and the accused every opportunity to put forward their cases.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.8.2 Determine, implement, evaluate and maintain measures for controlling risks
associated with shift working
Unit 9:
When shift workers adjust their sleep/wake cycle, circadian rhythms do not adjust quickly
enough, with each rhythm adjusting at a different rate. Some take a week or more to adjust
completely, by which time shift workers are often changing to another shift pattern. How
quickly the circadian rhythms adjust depends on individual factors such as age, gender,
physical health and chronotype (the scientific name for the individual circadian rhythm
pattern). Some people are more prone to morningness (larks) and others to eveningness
(owls). Others fall in to neither category.
Digestive Problems
A number of studies have shown a greater prevalence of gastrointestinal disorders, such as
appetite disturbances, bowel irregularity, peptic ulcers and colitis in shift workers. As gastric
function is affected by the internal body clock, perhaps such findings are not surprising.
However, shift workers usually also have disrupted mealtimes, with food being eaten hurriedly
and in less than comfortable surroundings. It is also often the case that good catering facilities
are not available during the night shift, possibly resulting in a poorer diet.
Gastrointestinal disorders appear to be the most reported health effect of shift work, both
anecdotally and scientifically.
Cardiovascular Disease
The 2003 ILO study we considered earlier indicates an association between cardiovascular
disease and shift work although this could be confounded by the fact that shift workers may be
of a lower socio-economic status than day workers. Behavioural factors, such as the frequent
consumption of high fat/carbohydrate meals, smoking, alcohol intake and the irregular timing
of meals may all be contributory factors. Heart disease is also often associated with factors
such as anxiety, stress and sleep disorders, conditions that tend to be linked to shift work.
Respiratory Problems
Lung function may well decline at night, especially for those with a chronic respiratory
condition. Asthma attacks and allergic reactions may become worse at night.
Reproductive Problems
Recent research is beginning to show links between women working shifts, particularly rotating
shifts, and a number of reproduction issues including:
Quality of Life
Shift work not only causes desynchronisation with the internal biological clocks but also with
social life. The constraint that shift work imposes on one individual also tends to impact the
social and family life surrounding them. Free time with families, particularly children, can be
limited and shift workers may alter their sleep patterns to fit in with family life, leading to
further sleep deprivation.
The shift worker is often prevented from entering in to the formalised frameworks of their
social environment and may have less of a role in decision-making in the household, possibly
introducing the feeling of isolation. Time spent with partners tends to be limited and the
quality of any time spent together can be questionable. Shift workers often find it difficult to
fulfil parenting and social responsibilities, e.g. a parent working a late shift may find it difficult
to attend a school open evening.
The resultant psychological tensions can further exacerbate any physical or mental conditions
experienced by the shift worker. The extent of the impact on the quality of life tends to be
determined by age, number and age of children and to some extent the personality of the
individual.
Neurotic (anxiety, restless, moody)/ stable (calm, reliable) personality: those with
neurotic tendencies tend to be less able to cope with shift work.
Morningness or eveningness: those people exhibiting morningness tend to have
problems adapting to shift work and have an inability to cope with night work.
Age: while older individuals are more experienced, better at coping and have fewer
domestic pressures, they tend to become more shift work intolerant beyond the age of
40. This may be a reflection of the tendency of the individual to become more of a lark
as he/she gets older. There is a school of thought that over 40 years of age, night shift
should be on a voluntary basis only.
Existing medical conditions: some conditions, such as an existing gastrointestinal or
cardiovascular problem, may result in the individual being more vulnerable to the risks
associated with shift work.
One of the most important factors in relation to the organisation of the work to be
considered is the shift pattern. Any assessment would need to consider:
The possibility of increased risk of accidents and injuries caused by sleep deficit and
fatigue. Consideration will need to be given to:
The type of shift pattern and the frequency of rotation.
Any increased risk of physical effects caused by the disruption of the internal body
clock and disturbed eating patterns.
Any increased risk of psychological problems resulting from the biological disruptions
and the pressures and conflict created with social and family life.
In addition, consideration should be given to:
Whether any other occupational hazards, the risk from which is increased while working
shift work, exist.
That adequate workplace facilities are available.
Workplace conditions, such as heating, lighting and ventilation, which should be at an
optimal level to maintain alertness.
The regularity of health assessments.
Unlike normal hazards it is not possible to refer to existing agreed standards. The health
effects of shift work are complex and, as outlined above, some evaluation of the individual is
therefore required. A Standard Shift Work Index (SSI) has been developed (Barton et al,
1995), which is a tool which utilises self-report questionnaires aimed at determining the
physical and psychological risks to the health of shift workers. The SSI relates to
characterising the work context, effects on health and well-being and individual differences,
which may modify those effects. There are other questionnaires available, all of which are
useful tools to assist in the risk assessment process.
For example, education on the practical means of achieving effective sleep may be beneficial,
as people's circadian rhythms are to some extent reset by external factors such as sunlight;
thus avoiding bright light as far as possible following the night shift is advisable. Simple
measures such as the importance of sleep routines, signage on front doors at home to prevent
daytime callers, turning the telephone on to the answerphone/turning the mobile phone off,
and avoidance of caffeine prior to sleep will all assist in achieving effective sleep.
Healthy eating rules are the same as for day workers, but shift workers tend to eat at irregular
times. Alcohol and caffeine can have a disruptive effect on sleep at the end of a shift. As the
circadian rhythm for gastrointestinal function is at a minimum during the night certain foods
will cause problems if eaten during the night, and there are often less nutritious foods available
to the night worker.
The benefits of regular exercise are well known but shift workers often find it more difficult to
establish a regular exercise regime due to their shift pattern. Generally exercise just prior to
the shift is likely to be more beneficial than exercise prior to sleep, which is likely to increase
alertness.
Health Assessments
Health assessments should be carried out before workers begin shift work and at regular times
after starting employment. Identification of individual characteristics which are associated with
poor tolerance with shift work, particularly night work, can assist partly in the selection of
suitable employees and also with the coping strategies applicable to the individual. The
frequency of regular assessments is likely to be determined by the risks associated with the
particular shift pattern and the characteristics, including age and fitness, of the individual.
Evaluation of lifestyle behaviours, such as the use of alcohol, tobacco, caffeine and sleeping
pills may be appropriate. Other measures of blood pressure, cholesterol levels and weight and
body fat assessment may be appropriate. Reference to a worker's previous health
records/medical history may also be useful.
Where a health assessment identifies certain medical conditions, it would be advisable for the
employer to move an individual to a day shift where possible. Such medical conditions may
include:
Diabetes, particularly where treatment with insulin or a strict timetable is required.
Some heart and circulatory problems.
Stomach or intestinal problems.
Medical conditions affecting sleep.
Some chronic chest disorders.
The UKs Health and Safety Executive has developed useful guidance regarding the
management of shift work. HSG256 can be downloaded from www.hse.gov.uk and is useful
background reading.
C O N T E N T S
BACKGROUND ..................................................................................................................................................... 3
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.9.1 Describe the main hazards to new and expectant mothers and explain how they
may cause harm
2.A.9.2 Advise employers on their responsibilities in relation to new and expectant mothers
Unit 10:
Background
A new or expectant mother is considered to be an employee who is pregnant, who has given
birth within the last six months or who is breast-feeding.
There are many women who work while they are pregnant and who return to work while they
are breast-feeding. In many work situations there are risks to both the mother and unborn
child, which may affect their health and safety. In this respect the working conditions of a
woman while she is pregnant or breast-feeding need to be considered closely. Employers have
a responsibility to protect new and expectant mothers at work, and in many countries
legislation governing new and expectant mothers will in place to ensure that risks are properly
managed. Due to signs of pregnancy not being immediately apparent in all cases, notification
to employers (at the earliest possible time) that a worker may be pregnant or breast-feeding is
important to enable any adjustments to be made to safeguard the mother and the child and
protect them from harm.
Physical Agents
Certain physical agents may cause problems during pregnancy.
Vibration
Regular exposure to shocks, low frequency vibration, e.g. driving or riding in off-road vehicles,
or excessive movement may increase the risk of a miscarriage or low birth weight for the baby.
These sorts of problems can occur when travelling inside or outside of work.
Noise
Excessively noisy workplaces and prolonged exposure to loud noise may lead to increased
blood pressure and tiredness. In this respect there are no particular problems for women who
have recently given birth or who are breast-feeding.
Radiation
Significant exposure to certain ionising and non-ionising radiation is known to be harmful to
the unborn child. Work procedures and codes of practice should be adopted to keep exposure
as low as reasonably practicable. Pregnant women should have any such possible exposure
reviewed and control measures should be adopted according to the risk assessment. Anyone
at risk to such radiation should be moved to another part of the work system for the duration
of the pregnancy and consequent period of breast-feeding.
Radioactive material can be ingested or inhaled by the mother and then transferred to the
unborn child, or may irradiate the unborn child through the wall of the womb. Similarly,
radioactive material may pass into the milk of a breast-feeding mother and hence to the child.
Radioactive contamination of the skin may also present a direct radiation hazard to the
suckling infant.
Pregnant or breast-feeding mothers are at no greater risk than other workers to optical
radiation. Exposure to electric and magnetic fields (e.g. radio-frequency radiation) is not
known to cause harm to the unborn child or the mother. However, extreme over-exposure to
radio-frequency radiation could cause harm by increasing body temperature.
Temperature
Working in high or low temperatures can also give rise to certain problems and care must be
taken that the woman wears appropriate clothing and that suitable rest facilities and
refreshments are provided. Pregnant women feel the heat easily and possible fainting or
dehydration may occur due to heat stress. Such effects may also impair someone who is
breast-feeding and has recently given birth.
Biological Agents
Exposure to infectious diseases can infect the unborn child if the mother is infected during
pregnancy, e.g. hepatitis B, HIV/AIDS, herpes, TB, syphilis, chickenpox, typhoid, rubella -
(German measles), toxoplasmosis transmitted from undercooked meat, contaminated soil or
Chlamydia (from sheep). Clearly, due to the type of work certain occupations are at more risk
than others, e.g. laboratory workers, people looking after animals, etc.
Chemical Agents
Problems in pregnancy, etc. may be caused by chemical handling or through skin absorption,
etc. (handling drugs or specific chemicals such as pesticides, herbicides, insecticides and
fungicides, lead and lead derivatives, mercury and mercury derivatives, etc.) including chemical
agents that have specific risk phrases assigned to them that indicate a risk to the mother or
the child.
Typical chemicals that present a risk include:
Substances labelled R40, R45, R46, R61, R63 and R64.
Carbon monoxide (see below).
Lead and lead derivatives (see below).
Mercury and mercury derivatives (see below).
Chemical agents of known and dangerous percutaneous absorption.
Lead
Exposure to lead and lead derivatives by pregnant women has been associated with abortions,
miscarriages, stillbirths and infertility. There are strong indications that exposure to lead,
either before or after birth via the mother or during early childhood, can impair the
development of the childs nervous system.
Lead can be transferred from blood to breast milk and hence to the child.
Mercury
Mercury metal has long been known to have effects on individuals and to target certain
systems within the human body, e.g. the nervous system. Exposure to organic mercury can
cause problems for unborn children, e.g. affecting an unborn baby's growth and nervous
system, as well as having effects on the expectant mother. Inorganic mercury compounds, on
the other hand, do not seem to have such effects.
Static Postures
Standing or sitting for long periods of time, e.g. at production lines and during DSE work may
lead to certain problems e.g. varicose veins, blood may pool in the legs, stress, postural
problems, etc. To avoid such problems a risk assessment should be undertaken.
Stress
Unusually stressful work, e.g. too much work, too little time to complete work, sustained high
levels of work, and autocratic management styles, may cause work-related stress and
subsequent ill-health, e.g. raised blood pressure, increased heart rate, headaches, dizziness,
various aches and pains, poor concentration, etc. Such stress, in addition to that caused by
being pregnant, e.g. financial consequences, may result in further anxiety and the situation
becoming untenable. Hormonal, physiological and psychological changes occur, and
sometimes change rapidly during and after pregnancy, possibly affecting a woman's
susceptibility to stress, or leading to anxiety or depression in certain individuals.
The situation needs to be carefully monitored and reviewed as the pregnancy develops. It
may be that stress can be reduced by removing the person from their usual work, by adapting
the job itself to the individual's needs, or by providing counselling. Stress has been linked to
an increased incidence of miscarriage and also with impaired ability to breast feed.
Miscellaneous Conditions
Other work conditions that can cause problems include:
Lone working may be a problem for pregnant women as they are more likely to need
urgent medical attention.
Passive smoking, as well as smoking by pregnant women, has been shown to have effects
on the individual, e.g. possibility of lung cancer for the woman and low birth weight for
the unborn child.
Work at heights is hazardous for pregnant women, e.g. on ladders or platforms, due to
their increased size. Increased size may also affect a pregnant woman's agility, co-
ordination and reach/balance.
Problems due to increasing size may cause any personal protective equipment not to fit
properly, or may make work in confined spaces impossible.
A pregnant woman may be considered more vulnerable to violence at work if she is in a
job where she has contact with clients/customers/patients that may have aggressive
tendencies.
Stressful travelling conditions may cause difficulties for pregnant women, especially in the
latter stages of pregnancy.
Morning sickness may be a problem arising from early shift work or associated with
nauseating smells.
New and expectant mothers who work in compressed air are at risk of developing
decompression illness (DCI), i.e. the bends. Potentially the unborn child could be
seriously harmed by such an illness. Pregnant women normally are advised not to dive at
all during pregnancy due to the possible effects we have noted above.
also important to discuss the new or expectant mothers working conditions with her. This is to
help identify any risks which may cause health problems for her or her child.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
Unit 11:
Types of Disability
A disabled person is generally considered to be a person who has a physical impairment,
e.g. including sensory such as those affecting sight or hearing, or psychological
impairment, e.g. including learning disabilities or clinically well recognised mental illness, i.e.
one classified in the International Classification of Diseases and which has a substantial and
long-term adverse effect. In this respect there is more than a minor or trivial limitation on the
persons ability to carry out normal day-to-day activities. This may include their mobility,
manual dexterity or physical co-ordination; speech, hearing or eyesight, and perception of risk
or danger. It applies where the disability has lasted 12 months or is expected to last 12
months or more or for the rest of the persons life, e.g. impaired vision.
Excluded from this definition of disability are addicts, e.g. alcohol, nicotine, etc., those with
personality disorders, arsonists or persons with a tendency to steal or carry out physical or
sexual abuse of other persons, etc., those with seasonal hay fever and similar conditions, or
individuals with severe disfigurement, such as tattoos, piercings, etc. However, the definitions
of disability will of course vary from country to country.
Psychological Impairment
This would cover mental or psychological impairment, including learning disabilities or clinically
well recognised mental illness, such as one classified in the International Classification of
Diseases which has a substantial and long-term adverse effect. Here there would be more
than minor or trivial limitation on the individual's ability to carry out normal day-to-day
activities. Factors that might influence the person's response to the work itself and the
workplace conditions include the design of the job itself, its organisation and management
allied with the social environment at work, e.g. the response of individuals, management, etc.
to disabled workers. In particular repetitive, monotonous tasks or work that is not particularly
demanding may affect the individual involved. Similarly work that is isolated from the
mainstream with the consequent lack of involvement and communication might well cause
problems leading to stress, etc. at work for the disabled person.
Physical Impairment
Clearly certain jobs are outside the physical capabilities of people with particular disabilities,
including wheelchair users, where their manual dexterity and physical coordination might
cause problems. Sensory disabilities affecting sight or hearing would make certain types of
work a problem for the individual's own particular safety, e.g. in emergency situations where
emergency lighting only is activated or obstructions are in place, or details are relayed via
tannoy systems. Appropriate design of tasks and workstations and the use of ergonomic tools
and equipment can help disabled workers. In manual handling situations limiting the size,
weight or number of loads, or providing manual handling aids, would help disabled persons.
Employers Responsibilities
Employers must not unfairly discriminate against any person due to a disability. Measures must
be taken to make any reasonable adjustments as necessary to services and premises to allow
access to all persons who need to use them.
Reasonable Adjustments
If an employer fails to make a "reasonable adjustment" to the working arrangements or
physical features of premises which place a disabled person at a substantial disadvantage
compared to a non-disabled person, and cannot be justified, it may be regarded as
discrimination.
The requirement to make reasonable adjustments is in three main areas:
Changing practices, policies and procedures, i.e. what the employer does (practice);
what the employer intends to do (policy); and the employer's plans to go about it
(procedure).
Providing auxiliary aids and services, e.g. provision of information on audio tape and
or a sign language interpreter. There are many examples of auxiliary aids or services for
those who have hearing disabilities or visual impairments, but consideration should also
be given to how communication barriers can be overcome for people with other
disabilities, e.g. a customer with a learning disability may be able to access a service by
the provision of documents in large, clear print and plain language or by the use of colour
coding and illustrations. Deafblind people (individuals who have a severe combined sight
and hearing impairment) may require other assistance, e.g. information leaflets produced
in braille or Moon, good lighting and acoustics, induction loop systems, etc.
Overcoming a physical feature by removing the feature or altering or avoiding it, or
providing services by alternative methods.
When an employer becomes aware of an employee's disability, certain adjustments that could
be considered reasonable are:
Adjustments to premises or workstations.
Allocating some of the disabled person's duties to another person.
Transferring the employee to another post.
Altering working hours.
Assigning the employee to a different place of work.
Allowing time off for rehabilitation, assessment or treatment.
Giving, or arranging for the employee to receive, training.
Providing training for other employees.
Acquiring or modifying equipment.
Modifying instructions or reference manuals.
Modifying procedures for testing or assessment.
Providing a reader or interpreter.
Providing supervision.
Any reasonable adjustment will take regard of certain criteria with regard to the adjustment,
such as:
Its effectiveness.
Its practicability.
Its financial and other costs.
The extent of any disruption caused.
The extent of the employer's financial or other resources.
The availability of financial or any other assistance.
It is good practice for the employer to discuss the adjustments with the disabled person, as
the individual is often the best person to identify what is needed.
In emergency situations a disabled person's safety may be aided by certain adjustments such
as:
Fire alarms fitted with flashing lights or the provision of a vibrating pager to alert a
hearing impaired employee.
Assigning work colleagues to alert and assist in an emergency.
Making sure that employees with learning difficulties fully understand safety procedures
and fire regulations.
Ensuring first-aiders are fully conversant with the first aid implications of, for example,
diabetes and epilepsy; and ensuring that a thorough lifting and handling assessment has
been carried out and that the appropriate equipment is purchased.
Reasonable steps should be taken to provide an alternative method for making services
available to disabled people, where a physical feature makes it impossible or unreasonably
difficult for them to use these services.
Extra Lighting
Good lighting is essential for everyone for visibility and safety and more especially for disabled
persons. All types of lighting must be carefully designed and located to avoid creating hazards
or obstacles to people moving through any buildings or facilities. All lighting, including natural
light, should be controllable/adjustable where possible to suit the needs of the individual.
Good light levels are particularly important in potentially hazardous areas, e.g. stair wells or
changes in level along a route, such as changes in height of a ramp. Lights should be
positioned where they do not cause glare, reflection, confusing shadows or pools of light and
dark and misleading visual effects. Passive infrared sensors can be used to detect dim light
and activate booster lighting. Keeping windows, blinds and lamps clean maximises the amount
of light available. Uplighters placed above a standing person's eye level can deliver a
comfortable, glare-free illumination.
Care should be taken with fluorescent lights as they create a magnetic field which causes a
hum in hearing aids, as can the main power supply cables into a building. The lighting design
should control the location, quantity and quality of both natural and artificial light and any
changes in lighting levels must be gradual throughout the workplace and relatively even, giving
good differentiation of surfaces and levels without glare. Staircases must be well illuminated
a good rule of thumb is 100 lux at tread level.
Indirect rather than direct lighting is the most comfortable form of lighting. Particular care
must be taken with the design of lighting in areas with shiny surfaces, while glazing at the end
of corridors should be avoided; side lighting is preferable.
Width of Aisles
Clearly the width of aisles for access/egress is important especially for wheelchair users and
particularly in the event of an emergency. Building and fire, planning regulations should
dictate such widths.
Staff Training
Disability training should be part of any training policy and plan and is an important factor in
providing "reasonable adjustments". Employees should be aware of the requirements of
disabled customers and potential customers and colleagues and how to respond to requests
for reasonable adjustments. They should know how to provide an auxiliary service and how to
use any auxiliary aids which the service provider offers. Employees can also be encouraged to
acquire additional skills in serving disabled people, e.g. communicating with hearing impaired
people and those with speech impairments by taking disability etiquette into account. Training
can be delivered by disabled people; which gives a valuable insight into how disabled people
experience certain problems.
There are many misconceptions and wrong assumptions, e.g. visual impairment is frequently
equated with blindness and little attention is paid to colour or tone contrast to help orientation
at work. There are also misconceptions about the high cost of providing good communications
for people who are hard of hearing. Well-trained staff will be more resourceful in developing
access solutions and in tailoring services to meet the needs of specific individuals or groups of
disabled people.
Specific training such as deaf awareness may be required. If awareness training is
impairment-specific and emphasises medical conditions, it may inadvertently reinforce the
medical model of disability. Training is sometimes provided by a non-disabled person, and in
awareness training, simulation may be used. This involves participants using a wheelchair or
blindfolds, distorting glasses or ear defenders.
A comprehensive disability training programme may cover many topics, such as the context of
disability today, including history, politics, society, health, education, media, family, and
cultures; and the legal requirements, such as all barriers: sensory, physical, intellectual,
institutional, attitudinal, customer care, etc.
Training at all stages should be considered, including induction, on the job, and retraining.
Training may need to involve the disabled person's lack of experience in a certain task/job or
lack of awareness of potential risks/hazards involved. Such training may also need to consider
their possible lack of maturity.
C O N T E N T S
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.11.1 Outline the particular vulnerabilities of children and young persons in the
workplace
Unit 12:
machine/the operation of certain equipment, etc. can also cause problems and mistakes may
be easily made.
Furthermore the influence of peer group pressure could lead to children and young persons
being influenced in their attitude/approach to their work. Individuals are employed by
organisations, but in the work situation individuals invariably work together in groups. Even if
the work does not require people to work together in this way, individuals establish informal
social relationships with the other people they come into contact with in the work situation
(their peers). The influence of groups on the behaviour of individuals, and how they relate to
the organisation as a whole, has been the subject of a great deal of research and writing by
management experts over many years.
All groups, whether they are formal work groups within the organisation or informal groups
(e.g. a group of friends who go out for a drink every week after work), establish a pattern of
attitudes, behaviours, values and beliefs, etc. known as group norms to which members
are expected to conform. The pressure to conform can be very strong and comes from the
need for approval and acceptance (and the converse needs to avoid disapproval and rejection).
Thus, these norms are immensely powerful influences on behaviour.
Group norms develop through the informal processes of social interaction to support the
shared goals of the members of the group. Even within formal work groups, these goals may
not necessarily coincide with the organisations goals for the group they are likely to include
the organisations formal goals, but may well extend beyond those into meeting other needs.
For example, a particular group within an office may be quite happy to meet whatever
production targets are given them, but always organise their work to enable them to finish
early on a Friday so they can go for a drink together. In order for the organisation's own
values and expected behaviours to be adopted by the group, they must be accepted as
appropriate to the needs of the group.
This has considerable implications for health and safety in that it would appear that, in order
for individuals to conform to the organisations policy and practices, these policies and
practices have to be accepted as part of the norms of the groups to which they belong. If
these norms are oriented in favour of encouraging good health and safety practices in the
workplace, an individual within that group will normally react or respond by accepting those
same values. However, if the group norms dictate that, for example, wearing protective
clothing or following safety codes is silly, individuals will be reluctant to conform to the
organisations policy, or if they do, may seek to find ways around it. Young persons are
particularly vulnerable to such peer group influences since they are likely to be impressionable
and to lack the maturity and confidence to stand up to peer group pressure.
It is therefore vital that employers particularly assess the risks to young and inexperienced
workers.
With increasing experience we would expect an employee to become more competent at their
job and to have developed an ability to cope with issues such as health and safety. However,
there is also the risk of complacency and a tendency to cut corners may become apparent.
Age and experience are correlated with differences in accident susceptibility as the graph
below indicates. Though its exact shape will vary with circumstances, the curve will remain
roughly the same, with the greatest susceptibility to accidents occurring with lack of
experience and in the younger age groups.
Experience
Age/frequency curve
Frequency
of
Accidents
Experience/frequency curve
Age
there is a negative view of health and safety measures, the opportunities for distortion are
high. Knowledge, experience and a sense of vigilance are often, of course, attributes that
young persons in the workplace lack.
If there are problems with a person's basic perception of a situation, then there are obviously
going to be errors in his/her perception of risk. In many situations when assessing a risk there
is safety in numbers. Faulty perception of a risk could be corrected by another persons clearer
perception of an issue. Perception also depends upon knowledge and experience. A group will
usually have more to contribute than an individual, and an older person more than a younger
one.
Physical stress, resulting in injury or general fatigue principally through poor posture
and excessive demands on manual dexterity, but also in respect of exposure to excessive
noise and vibration.
Visual problems principally through excessive brightness or prolonged concentrated
work on small objects, either on the display screen itself or in respect of components used
in a work process, such as in the manufacture of electronic equipment.
Mental stress principally through excessive demands of task performance and lack of
control over working processes, but it may also be brought about by adverse
organisational and physical environmental conditions.
These effects are generally all chronic effects, brought about by prolonged exposure to the
activity or conditions.
A machine, workstation or piece of equipment must be designed for a person. No two people
are alike in terms of shape, size and range of joint movements and as such machines are
required to suit or be able to be adapted for a wide range of individuals. Poorly designed
workstations, i.e. normally designed for the average person, need to be adjustable. Typically
an unsuitable workbench height may cause young people to adopt unnatural positions leading
to discomfort and possible neck, shoulder and back problems. Similarly repetitive movements
using force or awkward movements may cause the individual to have problems with their
joints, e.g. tenosynovitis inflammation of the sheath surrounding the tendon causing pain,
tenderness and swelling over the tendon.
The characteristics of the equipment used in the performance of work activities can themselves
increase the risk of harm by putting extra strain on the body, particularly a body that is still
developing, in two main ways.
The physical characteristics of the equipment itself, e.g.:
By being difficult to manipulate, such as handles being too small or too large to grip
easily, or drawers being too tight to move easily.
By encouraging poor posture, such as non-adjustable seats or connecting cables
being too short and restricting the position in which, say, an iron can be used.
The position of the equipment in relation to the worker in the position he/she normally
occupies, e.g.:
Requiring the worker to work bent over in order to handle items on a conveyor belt.
Continually having to reach down to pick up items from a low position, particularly
when sitting.
Continually having to get up from a sitting position to reach equipment.
Generic Assessments
Providing a current risk assessment takes account of the characteristics of young persons and
of the specific factors outlined above, there is no need to carry out a new risk assessment
each time a young person is employed, i.e. an employer can use and develop generic risk
assessments. Such assessments can be modified to deal with particular work situations, i.e.
temporary or transient work. Irrespective of this, the risk assessment needs to be reviewed if
the work changes or if there is reason to believe that it is no longer valid, etc.
Restricting Work
The extent of the risks identified in the risk assessment will determine restrictions on the work
of the young persons employed. It is important that young persons are not employed in the
following activities where significant risks to their health and safety cannot be avoided:
Work beyond their physical or psychological capacity.
Work in which there is a risk to their health from extreme cold or heat, or from noise or
vibration.
Work involving their harmful exposure to radiation.
Work involving their exposure to agents which are toxic, carcinogenic, cause heritable
genetic damage, or harm to the unborn child or which in any other way chronically affect
human health.
Work involving the risk of accidents which it may be assumed cannot be avoided by young
persons owing to their insufficient attention to safety or lack of experience or training.
and control measures put in place to protect their health and safety. This training should include a
basic introduction to health and safety, eg first aid, fire and evacuation procedures etc.
As well as training, you will need to bear in mind that young people are also very likely to need
more supervision than adults. Effective supervision will also help to monitor the effectiveness of the
training young people have received, and there will be clear benefits in assessing whether a young
person has the necessary capacity and competence to do the job.
C O N T E N T S
OVERVIEW .......................................................................................................................................................... 3
Learning Outcomes
When you have worked through this Study Unit, you will be able to:
2.A.12.1 Explain how the misuse of alcohol and drugs may affect an individual
2.A.12.2 Explain how the misuse of alcohol and drugs may affect an organisation
2.A.12.3 Advise the employer of their responsibilities in relation to alcohol and drugs
Unit 13:
Overview
"Abuse" has been defined as "persistent or sporadic excessiveuse inconsistent with or
unrelated to acceptable medical practice".
Drug misuse refers to the use of controlled (illegal) drugs as well as the misuse, whether
deliberate or unintentional, of medically prescribed drugs and substances such as solvents.
Remember that alcohol is just another drug.
Alcohol or drug abuse in the workplace can cause significant problems both socially and in
regard to health. An intoxicated worker or one who is under the influence of drugs can be a
danger both to himself and to others, e.g. a drunk-driver may endanger the lives of all his
passengers as well as his own. Alcohol is, in reality, just another type of drug. However,
historically, the society in many countries has often viewed alcohol differently.
alcohol up to ten hours after, amphetamines one to two days after, cannabis up to five weeks
after, etc. Guidance on sensible drinking gives specific situations of when not to drink at all,
e.g. before or during driving; using machinery, electrical equipment or ladders; when working
or in the workplace.
The health and safety of drinkers and drug-takers themselves and others could be
compromised by all these possible effects, e.g. increased risk of accidents when working with
machinery, hand tools or driving.
It is imperative that during their time at work there is a clear distinction between individuals'
possible addiction, dependence, intoxication, tolerance, overdosing and recreational use of
both alcohol and drugs. Importantly problems at work may not only be introduced by the use
of alcohol and drugs, but the effects of withdrawal can also have similar damaging effects.
Many people take a number of such drugs and the consequences of a synergistic effect arising
need to be taken into account.
Reduced Concentration
Alcohol or drugs tend to reduce an individual's concentration span. Safety-critical jobs, e.g.
control room operators, train operatives, pilots, crane operators, bus drivers, etc. may
therefore compromise not only their own safety but also that of other individuals, groups of
workers and organisations that they work for.
Reduced Inhibitions
Another possible side effect of alcohol or drug abuse is that inhibitions are reduced with an
associated lessening of people's attitude to safety, especially in positions which require a high
level of alertness in relation to the job taking place. Such problems can affect the mood and
expectations of individuals and others at work.
The implications to safety of a train driver operating a main line train at speeds of up to 120
m.p.h. with a reduced level of alertness to hazards and dangers would be horrific.
High Absenteeism
The majority of people who have a drinking problem are in work and some hold down
responsible positions. People with drink problems can and do reduce their intake, but
proactive behaviour, i.e. before problems occur, can be productive. This approach is often
more effective than dealing with a problem that has become too serious to ignore.
Irrespective of size, businesses can take practical steps to minimise the risks associated with
inappropriate drinking/drug use.
Monitoring absences and sickness rates is one way of gathering information about potential
problems in this area. The information required is likely to be collected by the organisation for
its human resource management function. It is not easy to interpret absence records in order
to identify alcohol and drug-related problems. One indication may be a high incidence of
absences on Mondays. Certain individuals view the weekend as a time to relax from the
pressures of the working week by perhaps drinking to excess, or using recreational drugs.
Feeling unable to cope with the workplace on a Monday morning may manifest itself by a
significant number of absences at the beginning of the week.
However, it is also possible that arriving home in the evening after a pressurised day leads to
one drink to relax, followed by more, with the after-effects being felt the following morning
and the associated ill-health effects.
Short-term absences (one or two days, particularly at the beginning of the week) rather than
longer-term absences are more likely to reflect an alcohol or drink problem in the individual.
However, always remember that this is not an easy area in which to make clear judgments.
Ill-health as a result of alcohol or drug misuse may take some time to become evident and it is
not always obvious that it is caused by activities at the workplace, but could be due to
problems outside work itself, e.g. family problems/personal relationships leading to increased
alcohol consumption.
Poor Morale
A high staff turnover is a general indicator of problems in the workplace. One such problem
may manifest itself due to the use/misuse of alcohol and/or drugs. There may be many
reasons for this pay, poor morale, lack of training, lack of opportunities, work conditions
problems at home, etc. Some of these may have implications for, or be a reflection of, the
health and safety culture and, again, it is important that management is clear about the
underlying causes and what they may imply for health and safety.
Exit interviews are increasingly used by many organisations to identify why employees want to
leave or are asked to leave and the results from these may provide indicators of the state of
health and safety in the organisation. Thus, for example, reasons such as excessive workloads
or lack of training may indicate conditions which give rise to high levels of stress or a lack of
appreciation and skills in respect of safety procedures. Alcohol and drug use may be seen as a
way out of such problems. Low morale may also be of concern since this is often associated
with an apathetic attitude towards safety.
that the health and safety culture is also poor. Similarly, the absence of accidents is not, on its
own, a clear indicator of a positive culture.
Accidents do happen. What is important is why they happen. Thus, accident reports need to
be clear about the causes of accidents, not simply their outcomes in terms of injuries caused.
In this case, then, near misses are just as important. If they show a regular pattern of similar
causes, then that may indicate a cultural problem in that the causes are not being addressed.
Accidents and their causes represent a learning opportunity for the organisation to prevent it
happening again. If that challenge is not being picked up, it may be because health and safety
is not a sufficient priority.
Other ways of analysing accident data may also indicate problems. It may be that a certain
level of accidents is normal in an organisation or a particular type of work not necessarily a
high level, but an average of one or two incidents a month on, say, a large construction site.
If this level is exceeded, then there may clearly be problem. However, a lower level may also
indicate a problem in that accidents may not be being reported.
If there is a very low incidence of accidents in the workplace, it is important to know why.
Many organisations have very low levels of risk (compare office work with, say, mining), and
slack attitudes to safety may not necessarily result in accidents, or even near misses.
It is not always possible to know to what extent a condition is due to activities within or
outside the workplace. Employers cannot be held responsible for ill-health arising from the
personal life styles of their employees (such as smoking, diet, alcohol and other drug abuse,
lack of exercise or dangerous sports). An ill-health condition caused by an activity other than
work can, though, be made worse by an industrial situation, although compensation is only
paid for work-related conditions.
Control Strategies
Certain control strategies could help employees and also the business:
Identification of the scope of the problem within the organisation.
Identification of the problem from the effects on the individual noted earlier or through
identification by another employee or self-admission.
Treatment and rehabilitation of those affected, taking care with regard to confidentiality.
Counselling procedures, e.g. through various agencies such as Alcoholics Anonymous, the
Samaritans, etc.
Consultation with the employees concerned.
Training of supervisors and managers in identifying and addressing drug or alcohol misuse
problems.
Where more extensive testing is required (i.e. for drug abuse), further consent may be
required. Medical confidentiality should be paramount at all times.
Testing is a complicated procedure and must be carried out under strict conditions to ensure
correct samples are taken and no tampering takes place.
Testing for alcohol and drugs must be included in the company's health and safety policy and
must be applicable to all employees, including management. Agreement in this area is
important, as it can include pre-, periodic, random or rehabilitation testing. The employees
should be aware of the need for compliance and enforcement and the consequences of any
non-compliance. The policy might include selection of staff, inclusion in contracts, medical
surveillance, alcohol/drug testing, forbidding drinking at work, inclusion in accident
investigation procedures, disciplinary procedure, etc. The policy must be known to all
employees, contractors, subcontractors and temporary staff.