OCCUPATIONA

L HEALTH
ANGEL SARA THANGAMUNI

GR7 3.2
CONTENTS
Introduction

Historical Contributions

Historically Significant Occupational Accidents

Agents of Occupational Disease

Occupationally Associated Diseases and Conditions

Prevention of Occupational Diseases

 INTRODUCTION
Occupational safety and health (OSH) is a multidisciplinary field concerned with the safety, health, and welfare of people at occupation.
Globally, more than 2.78 million people die as a result of workplace-related accidents or diseases, translating to one death every fifteen
seconds. On April 28 The International Labor Organization celebrates "World Day for Safety and Health" to raise awareness of safety in
the workplace.

OCCUPATIONAL DISEASE: Defined as those health outcomes that are “caused or influenced by exposure to general conditions or
specific hazards encountered in the work environment.”

OCCUPATIONAL MEDICINE: Field that specializes in detection and prevention of diseases that arise from the work environment.

The expansion of industrialization in the developing world increases possible hazards to workers who may not have the same level of
safeguards that exist in developed countries.
 HISTORICAL CONTRIBUTIONS

 Bernardino Ramazzini has been called the founder of the field of occupational medicine. He is credited with creating elaborate
descriptions of the manifestations of occupational diseases among many different types of workers.

 Rhazes, a Persian scholar used occupational classifications (eg: goldsmith) in describing medical cases.

 Paracelsus (1493–1541) became one of the founders of the field of toxicology.

 Sir Percival Pott tracked the occurrence of scrotal cancer among chimney sweeps in London during the late 1700s.

 Dr. Alice Hamilton’s description of phossy jaw (phosphorus necrosis of the jaw) was among her contributions to occupational health.
 PHOSSY JAW
Phossy jaw, formally known as phosphorus necrosis of the jaw, was an occupational disease affecting those who worked
with white phosphorus without proper safeguards. It was most commonly seen in workers in the matchstick industry in the
19th and early 20th centuries.

The phosphorus penetrates into a defective tooth and down through the roots to the jawbone, killing the tissue cells which
then become the prey of suppurative germs from the mouth, and abscesses form.

The jaw swells and the pain is intense, for the suppuration is held in by the tight covering of the bone and cannot escape,
except through a surgical operation or through a fistula boring to the surface.

Sometimes the abscess forms in the upper jaw and works up into the orbit, causing the loss of an eye.

Surgery, the only means available to save the life of the patient, led to removal of the jaw bone and further disfigurement.

The scars and contractures left after recovery were terribly disfiguring, and led some women to commit suicide.

During the early 20th century, many countries passed laws that prohibited the use of white phosphorus in matches,
replacing it with red phosphorous.
 HISTORICALLY SIGNIFICANT
OCCUPATIONAL ACCIDENTS

TRIANGLE SHIRTWAIST COMPANY FIRE

 The Triangle Shirtwaist Factory fire in the Greenwich Village neighborhood of Manhattan, New York City, on
March 25, 1911, was the deadliest industrial disaster in the history of the city, and one of the deadliest in
U.S. history.
 The incident took place in a 10-storey building named Asch Building. Doors were locked to prevent the
women from leaving their sewing machines; fire escapes were nonfunctional.
 As a result, when a fire erupted about 4:30 in the afternoon, many of the women (especially on the ninth
floor) perished from the fire when they were unable to escape or were killed when they jumped from
windows or attempted to slide down elevator cables.
 The accident claimed the lives of 146 women within the brief time span of 15 minutes.
 The incident illustrates the deplorable conditions that workers often were forced to endure.
 GAULEY BRIDGE DISASTER
 Aka The Hawks Nest Tunnel disaster, it was a large-scale incident of
occupational silicosis as the result of the construction of the Hawks Nest
Tunnel near Gauley Bridge, West Virginia, as part of a hydroelectric project.

 Facing widespread unemployment during the Great Depression, about three thousand
men came to West Virginia to dig the tunnel. They worked ten- to fifteen-hour shifts, using
drills and dynamite to mine the sandstone, which is composed primarily of cemented silica
sand.

 The workers were not given any masks or breathing equipment to use while mining. They
were denied breaks and even forced to work at gunpoint. As a result of the exposure to
silica dust, many workers developed silicosis.

 Estimates indicated that as many as 1,500 workers contracted silicosis and 1,000 died
from this cause.
 AGENTS OF OCCUPATIONAL
DISEASE
NOISE
◦ Noise is any unwanted sound which can be made of pure tones, narrow band of frequencies and
sound impulses.
◦ The term ototoxic refers to agents that can produce hearing loss. (very loud noises, drugs &
chemicals in working environment).
◦ Noise-induced hearing loss is cumulative.
◦ Sharp reduction in hearing acuity can be commonly seen among Construction Workers,
Manufacturing units and Transport.

DUST
◦ Exposure is linked to Lung diseases.
◦ Coal worker’s pneumoconiosis = Coal dust
◦ Brown Lung Disease = Cotton & textile dust
◦ Other pulmonary diseases linked to dust exposure include asthma, emphysema, lung cancer, COPD
etc
TOXIC HEAVY METALS & THEIR FUMES
◦ The toxic heavy metals (arsenic, lead, mercury,
cadmium, chromium, and nickel) are potential hazards
to human health.
◦ These metals come in contact with humans when they
are inhaled as particles or fumes in work settings such
as mining.
◦ Lead: plumbers, radiator repair workers, painters,
ceramic workers, metal workers and individuals who
work in firing ranges.
◦ Arsenic: Coal-fired powerplant workers, Glass
manufacturing units, farmers exposed to farming
chemicals.
CARBON MONOXIDE
◦ Odourless and one of the hazardous toxic gases
found in work environment.
◦ Causes death as it combines readily with Hb,
depriving human body of O2.
◦ Workers who have preexisting diseases that affect
the circulation and oxygen-carrying capacity of the
blood are at increased risk of the effects of CO
poisoning.
◦ Cigarette smoking COHb levels.
◦ Firefighters, Construction workers, Welders,
Smelters are at high risk of exposure.
◦ Adequate ventilation should be ensured in high risk
work spaces.
 IONISING RADIATIONS
◦ They are commonly seen in healthcare facilities, such
as nursing homes, specialized clinics, dentistry suites,
and hospitals.
◦ Other occupational settings that hosts such exposure
CHEMICALS include nuclear generating plants, and plants for the
◦ Chemical exposures have been associated with production of nuclear weapons.
dermatoses, liver disease, and many other conditions. ◦ Sources: Radionuclides & X-ray
◦ Industrial chemicals: colorants, dyes, disinfectants, machines (healthcare)
pharmaceuticals, preservatives, and solvents. ◦ Can cause Skin burns, Acute radiation
◦ Chemicals involved in manufacture of plastics and syndrome, cancer and CVDs
paints: epoxy resins, acrylates, and formaldehyde. (Cardiovascular Diseases)
◦ Each of these chemicals pose varying health hazards
to exposed individuals depending on the degree of
exposure.
MICROBIAL AGENTS WORK-RELATED STRESS
◦ Source of health risks for workers exposed to sewage, agriculture ◦ Chronic stress = Coronary Heart Disease, Depression
workers, hospital employees. ◦ The term going postal refers to employees of the post
◦ Nurses & practitioners = communicable diseases
office and other companies who react to stressful
◦ Agents of concern & associated disease are listed below: conditions of their environment, particularly the work
 Bloodborne pathogens environment, by committing violent acts.
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Human immunodeficiency virus (HIV)
 Bacteria
• Tuberculosis
• Anthrax
 Viruses
• Influenza
• Other communicable respiratory diseases
 OCCUPATIONALLY ASSOCIATED
DISEASES & CONDITIONS
I. ALLERGIC & IRRITANT DERMATITIS
• Also know as Contact Dermatitis.
• It is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it.
• The rash usually develops within minutes to hours of exposure and can last 2-4 weeks.
• Signs and symptoms of contact dermatitis include:
o A red rash
o Itching, which may be severe
o Dry, cracked, scaly skin
o Bumps and blisters, sometimes with oozing and crusting
o Swelling, burning or tenderness
• Workers at highest risk of occupational skin diseases are employed in
manufacturing, construction, food production, and activities such as metal
plating and engine service.
OCCUPATIONALLY ASSOCIATED
RESPIRATORY DISEASES
II. CHRONIC OBSTRUCTIVE PULMONARY DISEASE & ASTHMA:
• It is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
• Includes chronic and unspecified bronchitis, emphysema, asthma, and other chronic lower respiratory
diseases.
• 3rd leading cause of mortality in US.
• Occupational exposure can exacerbate pre-existing asthma.
• COPD is related to workplace exposure to dusts.
• Signs and symptoms of COPD may include:
o Shortness of breath, especially during physical activities
o Wheezing
o Chest tightness
o A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or
greenish
o Frequent respiratory infections
o Lack of energy
o Unintended weight loss (in later stages)
o Swelling in ankles, feet or legs
III. PNEUMOCONIOSIS IV. ASBESTOSIS
• Aka Occupational Lung Disease. • Pulmonary fibrosis associated with exposure to asbestos.
• Chronic
• Pneumoconiosis can be defined as the accumulation of dust in the
lungs and the tissue reaction to it. • Declines in pulmonary functions and increased risk of lung cancer.

• Causes fibrosis of lungs & lung nodules. • Asbestos-associated mesothelioma is a rare form of cancer that invades the
chest lining.
• Substances that can cause pneumoconiosis: • In 1973, the EPA banned the spraying of materials that contained asbestos
◦ Asbestos (asbestosis & mesothelioma) on buildings.
◦ Cotton dust (byssinosis) • In 1989, the agency issued a regulation that would prohibit most other uses
◦ Silica – containing dusts (silicosis) of asbestos.
◦ Coal dust (black lung disease, coal worker’s • Symptoms:
o Shortness of breath
pneumoconiosis)
o A persistent, dry cough
• Symptoms may include:
o Loss of appetite with weight loss
o Cough
o Fingertips and toes that appear wider and rounder than normal
o Lots of phlegm
(clubbing)
o Shortness of breath o Chest tightness or pain
 V. SILICOSIS
• Inhalation of silica particles.
• Three types:
o ACUTE

o ACCELERATED

o CHRONIC

• Early Symptoms include:

IV.BLACK LUNG DISEASE o A nagging cough
• Aka Coal worker’s Pneumoconiosis. o Phlegm
• Occurs when Coal dust is inhaled. o Trouble breathing
Most common among coal mine
workers. • Late Symptoms include:
• Causes scarring of the lungs upon chronic exposure leading ◦ Fatigue
to lung losing its elasticity, increases difficulty of respiration. ◦ Weight loss
• Enactment of the Federal Coal Mine and Safety Act of 1969 ◦ Chest pain
in US-- average dust levels declined sharply in coal mines. ◦ Fever that comes on suddenly
• Initial symptoms include: ◦ Shortness of breath
◦ Cough ◦ Swollen legs
◦ Shortness of breath ◦ Blue lips
◦ Chest tightness
◦ Black sputum
 FERTILITY & PREGNANCY
ABNORMALITIES
• Includes dysfunctions that affect foetuses and infants.
• Birth defects
• Prematurity
• Low birth weight
• Spontaneous Abortions
• Developmental Disabilities
• Workplace hazards that are linked to fertility & pregnancy
abnormalities:
• Chemicals used in workplace settings – 4000+ chemicals
= adverse reproductive effects
• Exposure to anti-cancer drugs.
• Lead, solvents, ionizing radiations
 HEARING LOSS CAUSED BY NOISE
 Noise is a pervasive environmental problem. Even when noise levels are not sufficient to damage hearing,
they may interfere with everyday life and impact the quality of our lives adversely.
The threshold of hearing is 0 dB/HL (decibel prehearing levels).
Sounds at 85 dB/SPL (Decibel per Sound Pressure Level) = slight hearing loss.
Brief exposure to sounds at 100 dB/SPL = severe, permanent hearing loss.
Work-related noise is associated with hearing impairment. Data from the 2011–2012 National Health and
Examination Survey indicated that about 33% of individuals exposed to noise at work had auditory
impairment in comparison with 20% of those not exposed.
 Although one of the primary direct consequences of excessive noise is hearing loss, other health
consequences may include cardiovascular effects (eg: exacerbation of high blood pressure), increases in
stress levels, sleep deprivation and reduction in cognitive functioning.
 Some experts believe that prolonged exposure to noise may result in psychological reactions that have
adverse consequences for people’s immune system status and physical well-being.
 NOISE IN WORKPLACE
CONSTRUCTION INDUSTRY
 Sources of Noise: Bulldozer, heavy trucks,
loading machines, jackhammers, nail guns and
drillers.
 As a consequence of exposure to high noise
levels, many older carpenters have diminished
hearing acuity.
Also by age 25, carpenters typically have the
hearing acuity of persons who are 50 years old
with no noise exposure.
HEALTHCARE
 Sources of Noise: high-speed bone-cutting
drills and suctioning devices.
Sound levels in OT are believed to reach
118dB.
 In dental offices, dentists and hygienists are
exposed to excessive noise from air
compressors, ultrasonic instrument cleaners,
high-speed dental drills, and scalers.
PERMISSIBLE NOISE LEVELS IN
WORKPLACE
The NIOSH (National Institute of Occupational
Safety and Health) Recommended Exposure
Limit(REL) for noise exposure in the workplace
during an 8-hour shift is 85dB.
 Employers are required to post warning signs
in work areas where noise levels exceed 85dB.
 For higher noise levels, exposure times must
be limited.
 INFECTIOUS DISEASES
1. Healthcare workers:
◦ Increased risk of exposure to HEP B & C viruses, HIV Virus.
◦ Sources of exposure include:
◦ Accidental needle sticks
◦ Biohazards from Direct patient contact
◦ Contact with blood & blood products

2. Public Utility Workers: exposed to hazards of disease carried by raw

sewage.

3. Agricultural Workers:
◦ Zoonotic Diseases through contact with animals
◦ Through disease agents contained in soil.

4. Social Service Workers & Correction Personnels: Increased risk of TB

5. Clinical Lab Specialists:
◦ Contact with specimens including blood-borne pathogens, viruses & bacterial agents
◦ Yersinia pestis, Salmonella Typhi

6. Mortuary Workers:
o Exposed to a range of microbial agents as human bodies are embalmed or exhumed from burial sites.

7. Adult Film Industry Workers:

◦ Risk of Blood-borne diseases and STDs.
 MUSCULOSKELETAL DISEASES
The term musculoskeletal disorder (MSD) refers to “an injury or disorder of the muscles, nerves, tendons, joints, cartilage, or spinal
discs.” MSDs accounts for 31% of all nonfatal occupational injury and illness cases requiring days away from work.

A. CARPEL TUNNEL SYNDROME B. BACK INJURIES

◦ A condition associated with ◦ Back injuries were accounted for about 17% of all the
compression of the median nerve, occupational injuries and illnesses that required time
which runs from the forearm to the away from work in 2015.
palm of the hand through the carpal ◦ Risk factors:
tunnel of the wrist. ◦ Performing repetitive movements that affect the
◦ Causes numbness or pain in the back
◦ Remaining sedentary for long periods
wrist.
◦ Putting too much strain on the back (heavy
◦ May require prolonged period of
lifting).
absence from work.
◦ Occupation with high risk of back injuries include:
◦ Common occurrence: ◦ Nursing practitioners (38%)
◦ Meat packing industry ◦ Labourers
◦ Extensive use of computer ◦ Carpenters
keyboard. ◦ Drivers
 JOB STRESS & ASSOCIATED
CONDITIONS

JOB STRESS:
 Defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the
capabilities, resources, or needs of the worker.
 Job stress is associated with adverse physical health effects (eg: experiencing physical symptoms) and adverse mental health
consequences (eg: depression).

JOB STRAIN: arises from employment that combines low control over the decision- making process with high psychological demands.

CRITICAL INCIDENT STRESS refers to intense reactions that arise from witnessing violent behavior or from dealing with traumatic
incidents such as those experienced by paramedics or personnel who are first responders to disasters.
Sources of job stress include:
1. Work overload
2. Job dissatisfaction
3. Job insecurity
4. Workers’ lack of control over their environment and conditions of employment.
5. Assembly line work that involves repetitive tasks
6. Dealing with members of the public who may be abusive
7. Inadequate compensation and lack of benefits.
 PREVENTION OF OCCUPATIONAL
DISEASE
Primary prevention is the best control method of occupational mishaps. This includes:
A. Engineering Controls
This includes physical modification of work environment to avoid disasters.

B. Modification of Work Practices

Providing safety education and training programs that helps change work procedures, building a safer
work-place scenario..

C. Administrative Control
Organization and management of work shifts for employees, thereby minimizing hazard exposure.
 OTHER PROTECTIVE MEASURES
A. USE OF PERSONAL PROTECTIVE EQUIPMENTS:
 Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration (OSHA) as
apparatuses “designed to protect employees from serious workplace injuries or illnesses resulting from contact with
chemical, radiological, physical, electrical, mechanical, or other workplace hazards.
 PPE includes a variety of devices and garments such as face shields, safety glasses, hard hats, safety shoes, goggles,
coveralls, gloves, vests, earplugs, and respirators.

PROTECTION AGAINST AIRBORNE HEARING PROTECTION PROTECTIVE EYEWARE

HAZARDS
Includes the use of Plugs and Ear muffs - Includes goggles, face shields,
Two basic PPE types: safety glasses, and respirators that
• Contaminants remover cover the full face.
• Clean air supplier - It offers
• Protection against solid objects.
• Barrier against fluids & gases.
 PUBLIC HEALTH SURVEILLENCE
 Public health surveillance is defined as “the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation,
and evaluation of public health practices, closely integrated with the timely dissemination of these data to those who need to know.”

 Includes:
 The collection of information about occupational injuries & illnesses.
 Maintenance of databases on exposures (exposure databases) to occupational hazards.

 Multiple US federal agencies collaborate in surveillance programs. This includes NIOSH, the National Center for Health Statistics (NCHS), OSHA, and the Mine
Safety and Health Administration (MSHA).

 Examples of surveillance programs operated by NIOSH are:

 National Surveillance System of Pneumoconiosis Mortality (NSSPM)
 National Traumatic Occupational Fatalities (NTOF) Surveillance System
 State-based Sentinel Event Notification System for Occupational Risks (SENSOR)

 A state-level surveillance of occupational diseases and injuries is the Occupational Health Surveillance and Evaluation Program (OHSEP) operated by the
State of California’s Department of Health Services.
 EXPOSURE LIMITS

In order to protect workers from these higher exposure levels to hazardous agents, organizations and government agencies have
established guidelines and regulations for limitation of exposures. These standards make use of the following terms:

Threshold Limit Values (TLVs) “Refers to airborne concentrations of substances that represents conditions under which it is believed
that nearly all workers may be unaffected. Guidelines are provided by American Conference of Governmental Industrial Hygienists
(ACGIH).

Biological Exposure Indices (BEIs) “A measure of the amount of chemical absorbed into the body.”

Permissible Exposure Limits (PELs) “An allowable exposure level in the workplace air that is averaged over an eight-hour shift.” This
type of average is called a timeweighted average (TWA).

Maximum Allowable Concentrations (MACs) “defines permissible levels of exposure to chemicals.”