OCCUPATIONAL

HEALTH
OH Services, Surveillance
& Programming

Llanne J. Concepcion RN
OSH Practitioner : #1033-161205-H-0223
Objectives
By the end of the session, participants will be able to
a. Define occupational health and its role in the
workplace
b. Discuss medical surveillance and biological
monitoring as strategy in the prevention and
maintenance of worker‟s health
c. Identify different strategies in establishing
occupational health program ini construction
industries
Occupational
Health
Defined
Occupational health is the
promotion and
maintenance of the highest
degree of physical, mental
and social well-being of
workers in all occupations
by preventing departures
from health, controlling risks
and the adaptation of work
to people and people to
their jobs. ((ILO/WHO)
Case Study
◦ A case of 20 year old machine
operator whose finger was
accidentally caught by the grinder.

◦ Was referred to nearest medical

facility for immediate treatment
Occupational Health Services
ILO Convention 1985 /OSH Standard Rule 1960

Occupational health services means services entrusted with essentially preventive

functions and responsible for advising the employers, the workers and their representatives
in the establishment/undertaking the following:
a. Requirements for establishing and maintaining a safe and health working environment
which will facilitate optimal physical and mental health in relation to work and
b. Adaptation of work to the capabilities of workers in the light of their state of physical
and mental health
Functions
ILO
◦ Identification and assessment of the
risks from health hazards in the
workplace. Involves surveillance of
the factors in the working
environment and working practices
which may affect worker‟s health.
Requires a systematic approach to
the analysis of occupational
“accidents” and occupational
diseases
◦ Advising on planning and
organization of work and
working practices including the
design of work-places and on
the evaluation, choice and
maintenance of equipment and
on substances used at work
Adaptation of work to the worker
Functions
ILO

◦ Providing advice, ◦ Contributing to occupational

information, training and rehabilitation and maintaining in
education, on occupational employment people of working
health, safety and hygiene age or assisting in the return to
and on ergonomics and employment of those who are
protective equipment unemployed for reasons of ill
◦ Surveillance of workers‟ health or disability
health in relation to work ◦ Organising first aid and
emergency treatment
Rule 1960: Occupational Health Services
• Requirements for medical personnel in hazardous
and highly hazardous workplaces
• Duties of employers, physicians, nurses, first-aiders
• Occupational Health Program:
• Health examinations: Entrance, Periodic.
Special, Transfer and Separation
• Immunization Program
• Health Education and Counseling
• Health records maintenance 8
RA 11058: An Act of Strengthening Compliance with Occupational Safety
and Health Standards and Providing Penalties thereof

DO 198 : Implementing Rules and Regulations RA 11058

◦Occupational Health
Personnel – qualified first
aider, nurse, dentist or
physician engaged by the
employer to provide
occupational health
services in the
establishment
Covered workplaces shall have qualified occupational health
personnel such as certified first-aiders, nurses, dentists, and
physicians duly complemented with the required medical supplies,
equipment and facilities.
The employer shall provide the workers medical services and facilities
and shall not be an excuse from maintaining in the workplace a first aid
treatment room or clinic for workers which shall be as follows:
OH Services / Facilities
• hospital or dental clinic located not more than five (5) kilometers away
from the workplace, accessible in not more than twenty-five (25)
minutes travel time, and the employer has facilities readily available for
transporting workers to the hospital or dental clinic in cases of
emergency.

• For this purpose, the employer shall enter into a written contract with
the hospital for the use of such hospital for the treatment of workers in
cases of emergency.
 DUTIES OF OCCUPATIONAL HEALTH PHYSICIANS
• Organize, administer and maintain OH
program integrating safety program
• Continually monitor health hazards
through periodic inspection
• Prevent disease or injury by establishing
proper medical supervision
• Physical examinations, advice for
placement and health education.
• Medical and surgical care to restore
health and earning capacity of injured
workers.
• Maintain and analyze records of all
medical cases and to prepare and
submit to the employer annual medical
reports as required by this Standards
• Conducts studies on occupational
health within his means and resources.
• Act as adviser to management and
labor on all health matters.
• Report directly to top management in
order to be effective.
DUTIES OF OCCUPATIONAL HEALTH NURSE:
• In the absence of a physician, to organize and
administer a health service program integrating
occupational safety
• Provide nursing care to injured or ill workers;
• Participate in health maintenance examination.
• Participate in the maintenance of OSH by giving
suggestions in the improvement of working
environment.
• Maintain a reporting and record system.
DUTIES OF FIRST-AIDER

◦Give immediate temporary

treatment in case of injury or
illness
◦Participate in the maintenance of
OSH programs
◦Maintain medical services and
facilities
 HAZARDS
Anything that has the potential to cause harm, ill health and injury, damage to
property, products or the environment, production losses or increase liabilities
Safety Hazard Health Hazard
Tend to affect individuals by contact with the Affects people by exposure to hazards
hazards

Often an „obvious danger‟ Often „hidden‟ danger

The results of an accident are immediate Ill-Health often builds up slowly

Foreseeable or known „Loss‟ „Loss‟ is often difficult to access

Knowledge since industrial revolution Understanding lags behind, e.g. what triggers an
allergic reaction to some substances

Hardware or safe place solutions are usually Often rely on behavioral safe person or medical
available, expertise
e.g. Guarding, protection of electrical e.g. use of personal protection, safe systems of17work
systems
 Health Hazards
Have potential to adversely affect the health of individuals or groups
and potential to caused occupational diseases which maybe acute,
delayed or chronic and with varying degrees of disability and even
death.
◦ Noise induced hearing loss
◦ Irritant contact dermatitis
◦ Occupational asthma
◦ Upper limb disorders
◦ Back disorders

18
Types of health hazards

CHEMICAL
PHYSICAL

ERGONOMIC
Ergonomic hazards are BIOLOGICAL
the most frequent health
hazard PSYCHOSOCIAL
Mechanism of Toxicity
Factors Influencing Work-Related Diseases
Genetic Physical
factors properties

Lifestyle Magnitude of
exposure
WORK-
Workers’ Workplace
Age RELATED
Susceptibility Factors Duration of
DISEASE exposure

Timing of
Gender
exposure

Medical Multiplicity of
history exposure
 Physical Hazards Adverse Health Effects

Noise
Extreme Temperatures
Noise induced hearing
loss (NIHL) (temporary Heat stroke, Heat
hearing loss, permanent exhaustion, Heat cramps
hearing loss))

Inadequate Vibration
Illumination Hand-arm
Radiation
Visual fatigue, vibration
glare, headache Cataract, radiation burns, cancer, syndrome
congenital birth defects
 Heat Heat generated by physical
SOURCES OF HEAT activity

SUN

Factory roves absorbs heat Heat from machinery

HEAT IS LOSS THROUGH:
 HEAT CRAMPS
Muscle pains or spasms; Depletion
of salt and water

HEAT EXHAUSTION
Develops after several days of
extreme heat exposure
And inadequate replacement of fluids
HEAT STROKE
A medical emergency
Temperature rise to 41.1 C in15
minutes
Recommendations for Working in Hot Conditions
◦ Acclimatization is necessary
◦ Encourage drinking small amount of fluids at
frequent interval
◦ The greater the heat and physical load, the
more frequent the cooling period
◦ The drinks should be available close to the
worker
◦ Proper clothing should be worn
Hypothermia
Our Ears
Hearing Loss
resulting from damage or aging of the central hearing mechanism

Temporary Threshold Shift Permanent Loss

Prolonged exposure to loud sounds,
particularly around 80-90 dB
TEMPORARY increase in the threshold of
audibility for an ear caused by exposure to
high-intensity acoustic stimuli.
recovery in 16-48 hrs.
Caused by physical damage to the ear
mechanism, by disease, by drugs or by
natural aging process
IRREVERSIBLE hearing loss
Declining sensitivity of hearing to high
frequency sound, usually >2000Hz

Certain types of outer or middle ear problem can be corrected at least partially
through surgery.
AUDIOMETRY & AUDIOGRAM

Hearing must be rested for 16-24 hours before testing.

Clean ear properly
No colds or any flu like symptoms
Audiometric test
Prevention of Noise-Induced Hearing Loss
Hearing Conservation Program :

Control Measures
Monitoring
Work Environment Monitoring
Audiometric testing

Education
Hand Arm Vibration Syndrome
A range of reversible and
permanent injuries
◦ Nervous system
◦ blood circulation – blanching
◦ Sensory nerves – numbness, pins
and needles
◦ Muscles
◦ Bones
◦ Joints
Health effects of Whole Body Vibration
◦ Lower – back pain : back,
shoulder or neck disorders,
Exposure to whole body vibration
may cause:
◦ Discomfort
◦ Aggravate pre-existing back
injuries
◦ Motion sickness (low frequency
vibration)
Vibration Control Measures
◦ Technical Control Measures :
automation, remote control and
elimination o reducing vibration from the
design stage or at source, use of
vibration dampers, device for
prevention, suppression, damping and
insulation of harmful vibrations
◦ Organization measures: corrective
maintenance and arrangement of work
◦ Prophylactic and therapeutic measures
◦ Special vibration absorbing handles
fitted to hand tool, springs, suspension,
seats and shock absorbers
Radiation: Non-Ionizing & Ionizing
Radiation Sources Effects
Non-Ionizing
Ultraviolet Sunlight, Arc flash erythema, skin
Welding cancer, sunburn

Infrared Glass Blowing, Cataracts

Furnaces
Ionizing X-rays, Gamma Cancer, congenital
Radiation rays defects, death
HAZARDS AND HEALTH EFFECTS :

CHEMICAL HAZARDS
Chemical Hazards
Adverse Health
Effects

Localized Effect
Systemic Effect
Multisystem Effect

Acute effect
Chronic effect
Toxicology of Organic Solvent
◦ Acute health effects are like in acute
alcoholism
◦ 1st phase : excitation, hyperactive, laughing
and singing
◦ 2nd phase : depression symptoms like
headache, drowsiness, loss of consciousness
◦ I f ill continue e nausea and dizziness occur
◦ Continue exposure - lose of consciousness
followed by comma and might b fatal
◦ Most severe intoxication
 Health Effects of Organic Solvents
◦ Peripheral nervous system
◦ n-hexane, toluene
◦ Liver
◦ Cirrhosis - Toluene, xylene, etc.
◦ Kidney
◦ Toluene, xylene
◦ Lung
◦ Skin
◦ Reproductive
 Lead
◦ Occupational Sources
- Welders
- Radiator repairmen
- Solderers

- Shipyard workers
- Garage workers
- Pipe fitters

◦ Exposure
- inhalation
- ingestion
Health Effects
Prevention
Know the
source of lead
monitoring
Metal fumes : Acute Exposure
◦Metal fume fever :
Influenza-like illness
Chills, muscle aches, nausea, fever
Dry throat, cough, weakness

Rapid recovery without sequelae

Cement

◦ Fine, grayish green powder produced

by heating cement rock or other lime
stone bearing materials

◦ Occupational Sources
- Construction
- Cement Manufacturing

◦ Exposure
◦ Inhalation
◦ Skin absorption
Cement: Health Effects

◦Skin ◦Respiratory Tract

◦Irritation ◦Irritation
◦Small airway
◦Eyes disease
◦Abrasion ◦Pneumoconiosis
◦Irritation
Asbestos
ASBESTOS
Facts
Health
Effects
ASBESTOS EXPOSURE

◦Limit Exposure
◦Avoid handling
◦Worker isolation
◦Wet clean-up methods With Asbestosis :

◦Proper PPE End Smoking

◦Personal hygiene Periodic Vaccination
Oxygen therapy
Silicosis Infectious complications:

Tuberculosis
Respiratory fungal
infections

Prevention :

Dust control
Respiratory protection
Personal hygiene
Medical Monitoring
Health Effects
of Wood Dusts
Irritation of the nose,
throat, and lungs

Sensitization and allergic

reactions in the nose,
throat, and lungs (asthma)
Dust Control
Program
Monitoring
Dust Collectors
Immunization
Lay out
Training an awareness
PPE
 BIOLOGICAL HAZARDS ADVERSE
HEALTH EFFECTS
Viruses
Bacteria Fungal Infections
Flu/Systemic Viral Parasites
Tuberculosis Enzymes
Infection Hookworms
Hepatitis A infections
Tetanus HIV Filiriasis
Other micro
Rabies, Etc. Hepatitis B Pin worm etc.
organism
Covid – 19, etc
infections 56
 Tetanus
A neurological disorder
increased muscle tone
spasms
caused by toxin
produced by Clostridium
tetani bacteria
bacterial spores enters
open wound
.

Prevention
Active immunization
with tetanus toxoid
Careful wound
management
Housekeeping
PPE
Personal Hygiene
 Tuberculosis
Chronic bacterial infection
Caused by Mycobacterium
tuberculosis (tubercle bacilli)
Damages the lungs and
other body parts
Fatal if not treated properly
Prevention
Monitoring
Adherence to 6 month treatment regimen (DOTS)
Personal Hygiene
 HIV/AIDS
Acquired Immunodeficiency Syndrome (AIDS)

REMEMBER!
 Abstinence
 Be Faithful
 Correct and consistent
condom use
 Do not use Drugs

 Education
 COVID - 19
• SARS-CoV-2 is a new virus.
• First cases identified with pneumonia in Wuhan, China, December 2019.

• It spreads the same way as colds and flu –

through droplets which are created when
we talk, cough and sneeze.
• People can get infected when these
droplets enter the nose, eyes or mouth.
• Touching contaminated objects puts the
droplets onto hands. Touching face, the
droplets can enter via nose / eyes /
mouth.

60
Symptoms Headache
Fever Shortness of
breath

Cough Sudden loss of Diarrhoea

smell and taste
Fatigue

Muscle
Sore throat aches

Symptoms start about one day after There is no specific treatment.

exposure, but can be as long as 14
days; mild to severe symptoms might
be present
Some might be asymptomatic
Mild symptoms can be treated with medicine to
lower the fever, or relieve pain.
If symptoms are more severe, treatment in
hospital is required.

61
 Prevention
◦ Good personal hygiene : hand washing; use of(70% alcohol-
based hand sanitizer
◦ Physical distancing : 1-2 meter away from others
◦ Cough, sneeze etiquette
◦ Wearing of Mask at all times or other PPE in high risk areas
◦ Clean and disinfect frequently touch areas every 2 hrs.
◦ Seek medical attention once with symptoms: use medical
assessment questioner

62
HAZARDS AND HEALTH EFFECTS :
ERGONOMIC HAZARDS
Ergonomics
The study of work and the relationship of work to the physical and
cognitive capabilities of the person
the task
(job content
& context)

the the
Fitting the job (tools, tasks and organization tool
environment) to the
employee, instead of forcing
the worker to fit the job
the the
environment workstation
 ERGONOMICS RISK FACTOR
Force Identify and remove
ERGONOMIC RISK
Repetition ergonomic risk
FACTORS
Posture
Musculo factors

Over time response to risk factors leads to Skeletal Preventing risk factors
Poor Work Practices Disease
INDIVIDUAL RISK Poor Health Profile Identify and remove
FACTORS No Recognition of individual risk factors
early warning signs
Ergonomics in Construction
Common Conditions
Ergonomics
◦ Musculoskeletal Disorders
◦ Neck-shoulder pain
◦ Low back pain

Carpal tunnel
syndrome
 PSYCHOLOGICAL HAZARDS
Troubles an individual very much to an extent that his
general well-being is affected
Psychological Hazards
◦ Work-related stress : excessive working time,
overwork, burnout
◦ Bullying – emotional, verbal
◦ Sexual harassment
◦ Violence at work
◦ Body odour
◦ Health effects
◦ Occupational stress, Anxiety, depression
◦ Cardiovascular Disorders, GI Disorder
◦ Drug Abuse, Smoking
 Identification

Control
Evaluation
Solving
Effectiveness Occupational
Health Hazards
OH and its effects
Hazard
Implement
Prioritization
Control

Select
Control
Health Risk Control program consists all necessary steps
to protect workers
◦ Exposure to substance or system
◦ Training and procedures to monitor worker exposure
◦ Monitoring of the health hazards

Controlling of
Choosing a control method may involve:
Health Risks at
• Evaluating and selecting temporary and permanent controls.
Work
• Implementing temporary measures until permanent
(engineering) controls can be put in place.
• Implementing permanent controls when reasonably
practicable.
Strategizing Control Setting

Developmental Approach Regulatory requirements

Information Relevant laws, standards,

Education issuances and guidelines
Training
Campaigns Enforcement
Good practices Implementation
Successful cases Inspection
Competitions Evaluation
Demonstrations
Interventions
 Developing
Occupational Health Program
◦ Occupational health program is designed to prevent
occupational diseases or wok-related condition
◦ Medical checks to ensure that employees remain in good heath
and not being harmed by their work
◦ Medical Screening and medical surveillance
◦ Compliance with occupational health and safety legislations
◦ Program shall be develop to deal with specific needs

73
 Health Monitoring
Medical Screening Medical Surveillance
Purpose Early diagnosis and Detect and eliminate the underlying cause
treatment

Strategies Physical Examination Ambient Monitoring

Diagnostic tests Biological Monitoring
Health Surveillance
Health Monitoring
Medical screening Medical Surveillance

1. Clinical in focus 1. Preventive in focus

2. One source of medical data 2. Monitor results of screening
3. Detection and treatment of actual 3. Systematic continuous, repetitive health-
disease related activities that should lead to
4. No analysis of data because deals corrective action
with individual 4. Group experience – analysis of pattern of
illness in a target population
 Medical Surveillance
• systematic assessment of
employees exposed or
potentially exposed to
occupational hazards. This
assessment monitors
individuals for adverse health
effects and determines the
effectiveness of exposure
prevention strategies.
Why do we conduct Medical
Surveillance

Individual Changing Changing

susceptibility physical hazard level
ability
77
 What are the factors that affect
worker‟s health?
Hazards exposure in
the workplace
Personal-Social Factors
• Gender, age, race, residence
tc.
• Medical history
• Family history
• Occupational status
• Employment conditions
• income
Workers health practices
• Risk taking behavior
• Physical fitness
• Nutrition
• Habits, vices (smoking,
substance abuse
Access to health services
• Occupational health
services
• Hospitals and
rehabilitations centers
• Health and accident
insurance
78
Steps in Surveillance of Occupational
Diseases

1.Identification of
1.Hazard and 1.Selection of 1.Interpretation of
target organ
exposure medical screening data and
toxicities for each
assessment tests Recommendation
hazard

1.Communication 1.Evaluation of
1.Recordkeeping
of results control measures
Surveillance of Occupational Diseases
1. Hazard and exposure assessment

Estimate intensity,
frequency and
1.Types of Exposure Exposed
Process Involved duration of
substances pathways population
exposure to
toxic agent
Surveillance of Occupational Diseases
2. Identification of Adverse health outcomes for
each hazards
Industry/Process Hazard Target Organ System
Machine Operator Noise Ears
Painting Toluene Nervous system (dizziness, headache,
euphoria)
Skin (dermatitis)
Kidney, liver

3. Selection of Medical Screening Test/s

Hazard Health Risk Test
Noise Noise-induced hearing loss Audiometry
Toluene Nervous system Neuro examination
Liver Liver profile
Biological monitoring
(urinary toluene)
Surveillance of Occupational Diseases
4. Interpretation of Data and Recommendation

Individual action
What to do if tests are
abnormal?
• Removal from exposure
• Referral for further tests
• Treatment
Group patterns
What to do if a group of workers show
poorer lab results than the others?
• Determine relation between
exposure and test results
• Was there overexposure?
• Ineffective control measures?
Surveillance of Occupational Diseases
5. Communication of results
Feedback of individual results
• Prompt and informative
feedback
• Implications of tests
• Confidentiality
Feedback of group results
• Collective findings
• Overall findings and trends
(normal or abnormal)
Recommendations for prevention
• Ensure confidentiality (use job
codes, job titles or other exposure
surrogates instead of the names
of individual employees)
 Surveillance of Occupational Diseases
6. Recordkeeping

1. Medical recordkeeping – test

results, interpretation, records of
notifications
2. Exposure evaluations
3. Resulting environmental
modifications
4. Requirements, procedures, and
interpretation of findings for
health surveillance as specified
by national legislation
Rule 1050- Records of Accidents
and /or Illnesses
◦accidents/illnesses must be reported to the DOLE
Regional Office every month
◦Annual Work Accident/Illness Exposure Data
Report
◦Basis of accident trends: Surveillance
Summary of Reporting Requirements

1. Employer‟s Work Accident/Illness Report-IP-6

2. Annual Work Accident/Illness Exposure Data
Report-IP-6B
3. OSH Committee Report
4. Annual Medical Report Form- 47-A
DO 198
Promotion of the following health domains
DOLE
Department Order 53-03
Pursuant to RA 9165 or
Comprehensive Drugs Act of 2002

Guidelines for the Implementation of a Drug-Free Workplace

Policies and Programs for the Private Sector

Policy and Guidelines

Random Drug testing
Monitoring and Referral
DO 198
Promotion of the following health domains
DOLE
Department Order 208-2020
Pursuant to RA 11036 or Mental Health Act od 2018

Guidelines for the Implementation Mental health policies and

programs in Private Sectors

Policy and Guidelines

Awareness and Education
Promotion of healthy lifestyle and work – life – balance
Treatment and Referral
DO 198
Prevention and Control of the following health domains

DOLE
Department Order 73-05
• Pursuant to Executive Order No. 187
“Instituting a Comprehensive and Unified Policy for the TB
Control in the Philippines”

Guidelines for the Implementation of Policy and Program on

TB Prevention and Control in the Workplace

Policies and guidelines

Prevention Programs
Treatment and Referral
Monitoring
DO 198
Prevention and Control of the following health domains
DOLE
Department Order 102-10
Pursuant to RA 8504 or Philippine AIDS
Prevention and Control Act of 1998
Guidelines for the Implementation of HIV and
AIDS Prevention and Control in the Workplace
Program
Policies and guidelines, Prevention Programs, Treatment and Referral,
Monitoring
DO 198
Prevention and Control of the following health domains

DOLE
Department Advisory 05-10

Guidelines for the Implementation of a

Workplace Policy and Program on Hepatitis B
Policies and guidelines, Prevention Programs, Treatment and Referral,
Monitoring
DO 198 Occupational Safety and Health Programs
OTHERS

REPUBLIC ACT 9211

Tobacco Regulation Act of 2003
Section 6. Designated Smoking And Non-Smoking Areas

• All designated smoking areas shall have at least one (1)

legible and visible sign posted, namely "SMOKING AREA"
for the information and guidance of all concerned. In
addition, the sign or note posted shall include a warning
about the health effects of direct or secondhand
exposure to tobacco smoke. Non-smoking areas shall
likewise have at least one (1) legible and visible sign,
namely: "NO SMOKING AREA" or "NO SMOKING".
DO 198 Occupational Safety and Health Programs
OTHERS
Safety and health promotion, training and education, to include the following
 Orientation of all workers on OSH
 Conduct of risk assessment, evaluation and control
 Continuous training on OSH of OSH personnel
 Work permitting system

Provision of workers’ welfare facilities

Emergency and disaster preparedness and response plan to include the organization and creation of
disaster control groups, business continuity plan, and updating the hazard, risk and vulnerability
assessment, as required
Solid waste management system
Control and management of hazards
Prohibited acts and penalties for violations
Cost of implementing company OSH program
 P.D. 626 Employees Compensation
and State Insurance Fund
◦ Prescribed Minimum Standards for Periodic Medical Examinations Designed
for the Early Detection of Occupational Diseases:

◦ Exposure to occupational hazards enumerated in the “list of Occupational

Diseases” is a requirement to undergo:

◦ Periodic medical examinations :

◦ < than 3 mos. - exposure to: Benzene or its homologues, Ionizing Radiation
and Organophosphates
◦ > than 3 months: Lead, Mercury, Manganese, Chromium and Carbon
disulfide
 SUMMARY
The ultimate goal of occupational safety and
health services is prevention of adverse effects
from workplace exposure

• Tools and capacities for primary prevention of

occupational hazards
• Basic requirements for workplace health
protection
• Regulations and standards and their
enforcement
• Workplace health promotion