2. What do you mean by eliminate


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The second presentation for the Singapore workshop and AIOH2013

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  • In a review of published evidence for temporal trends that we published in 2007 we identified 38 cases where there was informative data for aerosols. We analyzed the temporal trends on the log-scale assuming an exponential decline in exposure level over time. 58% of these involving aerosols there was a significant reduction in exposure, typically between 5% and 10% per year. Only one dataset (3%) showed a significant increase.
  • 2. What do you mean by eliminate

    1. 1. What do you mean by “eliminate”? John Cherrie INSTITUTE OF OCCUPATIONAL MEDICINE . Edinburgh . UK www.iom-world.org
    2. 2. Summary… • Elimination is a realistic possibility • • • Elimination will be achieved when workplace exposures are projected to cause much less than 1% of all cancers What needs to be done in workplaces to reduce exposure? How effective are the control measures?
    3. 3. For communicable diseases… • • • Control: The reduction of disease incidence. prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts Eradication: Permanent reduction to zero of the worldwide incidence of infection Dowdle WR. (1996)The principles of disease elimination and eradication. Bulletin of the World Health Organization; 76(Suppl 2): 22-25.
    4. 4. Elimination of occupational cancer…. • • • …elimination of the disease as a public health problem (i.e. reduction of cases below what is considered to be a public health risk) What might be suitable target level for occupational cancer? Reduction of incidence of occupational cancers to <<1% of all cancers? Cherrie. We can eliminate occupational cancer from chemicals. Occupational Medicine (2008) vol. 58 (5) pp. 314-315
    5. 5. We know what to do… • • • • • • • • Minimise emission, release and spread of substances Take into account all relevant routes of exposure Control exposure by measures that are proportionate to the health risk Choose the most effective and reliable control options Where needed provide suitable personal protective equipment Review regularly all elements of controls Inform and train all employees Ensure control measures does not increase overall risk http://www.hse.gov.uk/coshh/detail/goodpractice.htm
    6. 6. Range of possible control measures… • • Elimination / substitution Process modification • • • • • • • Change form of materials Reduce temperature Isolation and segregation General ventilation Local ventilation Maintenance, supervision, educati on Personal Protective Equipment
    7. 7. Exposure decreases over time… Aerosols Creely KS et al. (2007) Trends in inhalation exposure--a review of the data in the published scientific literature. Ann OccupHyg.; 51(8): 665-678.
    8. 8. Effectiveness of substitution… • Successes • • • Bladder cancer in the rubber industry andβnaphthylamine Toluene for benzene However, substitutions are complex and may have unexpected consequences • • use of citrus oil rather than trichloroethylene, but… d-limonene when oxidized presents risks as a skin allergen
    9. 9. Exposure Control Efficacy Library • Review of literature on the effectiveness of enclosures, local ventilation and other controls at source • • • • 90 peer-reviewed papers Wide variation in effectiveness The data published since the ECEL report was prepared broadly supports the original analysis Effectiveness in experimental or semiexperimental studies higher than other situations Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library (ECEL). Annals of Occupational Hygiene (2008) vol. 52 (7) pp. 567-575.
    10. 10. ECEL Fransman et al. Development and Evaluation of an Exposure Control Efficacy Library (ECEL). Annals of Occupational Hygiene (2008) vol. 52 (7) pp. 567-575
    11. 11. ECEL Risk Management Measure n LEV in general LEV + enclosure Integrated Mobile General ventilation Estimated efficacy (%) 95% confidence interval 280 82 78 to 84 9 86 69 to 94 133 87 84 to 90 4 61 -28 to 88 42 43 17 to 61
    12. 12. Assigned Protection Factors
    13. 13. Effectiveness of repiratory protection…
    14. 14. Effectiveness of behavioural interventions • Results from a systematic review • • • • 550 potentially relevant articles identified 10 were considered informative Behavioural interventions had a limited positive impact upon exposure Not sufficient to just raise awareness of risks and controls, need to equip workers with skills to act on that knowledge Lunt JA, Sheffield D, Bell N, et al. (2011) Review of preventative behavioural interventions for dermal and respiratory hazards. Occup Med (Lond);61:311–20.
    15. 15. Summary… • • • Focus on a practical definition of elimination is helpful Strategies to control exposure are well understood The effectiveness of the approaches we use is less well defined, but there is sufficient data to know: • • Respirators > Fixed local ventilation > Mobile local ventilation > General ventilation > Behavioural controls There is great variability in effectiveness within a type of control measure