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  • Journal of Occupational Safety and HealthDec 2004 Vol. 1 No. 2ContentsErgonomic Study for Optimum Printing Workstation Using Factorial 43 - 49Experiment and Response Surface MethodologyIqbal M., Soewardi H., Hassan A. and Che Haron C.H.Occupational Lead Exposure of Soldering Workers in an Electronic 51 - 57FactoryMimala A., Zailina H. and Shamsul Bahari S.Occupational Heat Exposure of Workers in a Plastic Industry Factory 59 - 66Goh S.B., Zailina H. and Shamsul Bahari S.The Need of Industrial and Organizational Psychologist in Malaysia 67 - 76Shukran Abdul RahmanStress Intervention Study Among Health Nursing Staff In Two Health 77 - 81Districts In Terengganu, MalaysiaAgus Salim MB, Noor Hassim I, Jefferelli SBRoad Safety Audit : An Exploratory Study 83 - 85Veera Pandiyan, V.G.R. Chandran Govindaraju and Nagatheesan V.M.A Report on Needle Stick Injuries for the year 2000 86 - 93Lim Jac FangEmerging Infectious Diseases: Ministry of Health Practice and 95 - 97PlanningFadzilah Hj. Kamaludin
  • Ergonomic Study for Optimum Printing Workstation Using Factorial Experiment and Response Surface Methodology Mohammad Iqbal, Hartomo Soewardi, Azmi Hassan, Che Hassan Che Haron Faculty of Engineering, Universiti Kebangsaan MalaysiaAbstract This paper presents the use of factorial experiments and response surface methodology to determine thebest workstation design configuration of an existing electronic industry. The aim is to find the value of physicaldimensions that gives the best performance for the workstation. Four performance measures are selected; the cycletime, the metabolic energy expenditure, worker’s posture during the task and lifting limitations. The methodologyused in this study consists of two parts. The first part is based on factorial experiments and handles discrete searchover combinations of factor-levels for improving the initial solution. In the second part, the solution that was obtainedearlier is further refined by changing the continuous factors by using response surface methodology. The result of thisoptimization study shows that the optimum value of physical dimensions gives a significant improvement for theperformance measures of the workstation.Impact on Industry: Demonstrate how the ergonomic optimization study could improve the productivity and working practices.Key words: ergonomics, optimization, workstation design, factorial experiment, RSM.Introduction This paper presents a case study of an workstation configurations and four performanceergonomic design of a workstation. The measures are selected for this study. Performanceworkstation considered here is a printing measures that are associated with the workstationworkstation of an existing electronic industry in design problem are usually characterized asMalaysia. Most of the routine tasks of the economical or ergonomic measures. Theelectronic industry studied here are fully measures depend both on the work proceduresautomated. However, some of the workstations and workstation design. This study deals with theare manually operated or semi automated where workstation design only. We assume that thethe workers and the automated machine work structure of the task is already given and the aimtogether simultaneously. The bottleneck for the to provide the most suitable physicalwhole production line is the printing department. environment for doing the job. Accordingly, theThe worker performs the repetitive task of measures that are considered here are those thatworking, while staying at the same positions all are affected by the workstation design rather thanday long. Many workers are complaining of the work orders. Measures such as number ofshoulder aches and lower back aches. This repetitions and exposure time to the risk factorsituation explains the need of redesigning the are disregarded in this study. The performanceworkstation in order to maximize the throughput measures in this study consist of four factors; (i)rate and to create suitable ergonomic working the cycle time (economical measure); (ii) thecondition for the workers. metabolic energy consumption (physiological In order to achieve optimal economic measure); (iii) worker’s posture during the taskand ergonomic results, a comprehensive study of that may indicate risk of injury; and (iv) liftingthe job tasks must be conducted and several limitations (biomechanical).parameters and constraints have to be In this study, we follow theconsidered. There are four parameters of the methodology proposed by Ben-Gal and Bukchin 42
  • (2002). They suggest a systematic design consumption rates multiplied by theheuristic based on Factorial Experiments (FE) workshift time, t s (minute).and Response Surface Methodology (RSM). FEis used to generate candidate configurations of a  m  Eshift = t  ∑ e ×t  Ttask (Kcal) (2)workstation and to build empirical models s  i =1 i i relating design factors to various objective  functions. Based on this model, RSM is utilizedto optimize the design factors with respect to Where, the energy consumption rate pereconomic and ergonomic multi-objective each individual operation ( ei , i = 1, …, m)measures. is generated using the Garg formula (Garg et al., 1978).Methodology • Ptask The methodology used in this study is The worker’s posture during task that mightbased on improving an initial workstation indicate the risk of injury. This measureconfiguration, called the initial solution. The considers the worker’s body position duringinitial solution was obtained from the existing the printing task according to the OWASworkstation. A set of system factors (design guidelines (Karhu et al., 1981; Scott andparameters) has to be defined in order to be Lambe, 1996). The objective is to shortenmodified during the optimization stage. The operations that require inconvenient bodyheuristic of the methodology consists of two positioning. A good solution requires thatparts. The first part is based on factorial during all operations the body positionexperiments and handles discrete search over remains in category one. This category,combinations of factor-levels for improving the called the natural position, insures that noinitial solution. In the second part, the solution damage is caused to the worker. The Ptask isthat was obtained earlier is further refined by the time weighted average of the positionchanging the continuous factors using RSM. categories that are denoted by pi , and i = 1, All of the four performance measuresthat are selected and later integrated using a …, m. Thus,multi-objective function would be described in  m the following section: Ptask =  ∑ p ×t  Ttask    i =1 i i • Ttask (posture category) (3) The printing cycle time (an economical measure) is a measure for the productivity of • Wtask the workstation, and therefore should be The lifting limitations (a biomechanical minimized. The task cycle time consists of measure) are according to the NIOSH m individual operations, where the time to guideline (Waters et al., 1993). This measure perform each operation, denoted by t i , i = takes into account the upper weight limits 1, …, m, is obtained from MTM table. that the worker is allowed to carry in each position during the task time. Wtask is the m time weighted average of the weight limits, Ttask = ∑ t (min/unit) (1) i =1 i denoted for each position by wi , i = 1, …, m, calculated only for those operations that• Eshift involve weights, The metabolic energy consumption in a shift  m   m  is according to Garg guidelines Wtask =  ∑ l ×t × w     ∑ l ×t  (Kg)   (physiological measure). It is measured in  i =1 i i i   i =1 i i  Kcal units and has to be minimized. Eshift is (4) the time weighted average of the energy Where, 43
  • l = { 1 if operation i involves a weight lift i 0 otherwise ~ k ( Wk = W − L ′ w ) (1.2(U w − Lw )) k = 1, ..., K, (5) Where UT (LT ) , U E (LE ) , U P (LP ) and The next stage is to use a multiple UW (LW ) are the upper (lower) limits of theobjective function in order to compare alternativedesign solutions and select the optimal one. In four performance measures respectively andthis study, we follow the multiple–response U T E PW = UT E PW + 0.1(UT E PW − LT E PW ) ′procedure suggested by Myers and Montgomery LT E PW = LT E PW − 0.1(U T E PW − LT E PW ) ′(2002). They constructed a multiple objectivefunction for each alternative, denoted by Dk The desirability function of solution k isand called the desirability function. It reflects the based on geometric mean of its normalizedcombined desirable grade of the kth solution with performance measures, as follows:respect to all performance measures. 1 ∑ rv V r  Assume that the designer has to Dk =  d k ,v ∏ v  k = 1, ..., K, (8)evaluate K different configurations. Accordingly,    v =1 Tk , Ek , Pk and Wk denote respectively the Where d k , v denotes the vth performanceTtask, Eshift, Ptask and Wtask performancemeasure values for solution k = 1, ..., K. Since measure of solution k; and rv is the relativemany multi-objective functions require the importance that is assigned subjectively andperformance measure values to be between zero respectively to each performance measure. Inand one, the following normalization procedure ~ ~will be applied: this study, v = 4, d k ,1 = Tk , d k ,2 = Ek , ~ (Tk = U ′ − T T k )( ( 1.2 U − L T T )) k = 1, ..., K, ~ ~ d k ,3 = Pk and d k ,4 = Wk . Accordingly the ~ (Ek = U ′ − E E k )( ( 1.2 U − L E E )) k = 1, ..., K, desirability function is the following: (6) ~ (Pk = U ′ − P P k )( ( 1.2 U − L P P ))k = 1, ..., K, (a) (b) Fig. 1. The drawing of printing workstation; (a) back view of the worker; (b) right hand view of the worker 44
  • ~ ( ~ ~ ~ 16 D = T 2 × E 2 × P ×W k k k k k ) • Factor C is the vertical attitude in millimeters of the lower edge of the material box k = 1, ..., K, (9) • Factor D is the angle in degrees of the slope of the material box.Where the first two performance measures areconsidered to be twice as important as the last A feasible initial configuration of thetwo. printing workstation is presented in Table 1. The solution is characterized by measures of the fourDescription of the system design factors ( n = 4 ); A, B, C and D respectively. The initial values of the parameters Printing workstation studied here is a (factor level 0) were predicted according to thesemi-automated workstation where worker and position and anthropometrics data of theautomated printing machine work together workers.simultaneously. An aluminum plate (a cashingpart of an electronic equipment) was polishedand printed by the printing machine Result and analysisautomatically. Accordingly, the working table ofthe machine consists of two parts, polishing area The desirability function in equation (9)and printing area. Two workers perform the task is applied to the multiple objectives. Theof this printing operation. The first worker loads desirability values for each configuration arethe aluminum plate (material) to the polish area listed in Table 2. As can be seen from Table2, noof the machine, and then removes it to the dominant solution (solution which is superior toprinting area. After printing operation finished, all other solutions in allthe second worker (stays at the other side of themachine) unloads the material from the machine Table 1. The initial values and the selectedto perform another operation. This study focus ranges of the design factorson the ergonomic improvement related to the Factor level Parameter Deltafirst worker. 0 1 2 A drawing of the workstation is A (mm) 410 380 440 30presented in Fig. 1. The worker takes the B (mm) 1000 970 1030 30material from the material box by his right hand C (mm) 380 350 410 30(Fig. 1.a), delivers it to the polishing area and D (deg) 15 12 18 3then removes it (by using both right and lefthand) to the printing area of the machine. In this performance measures) exists; yet, the initialstage, the machine performs printing operation solution (0000) may be improved. The followingautomatically, and a new cycle begins. analysis includes examination of each Four design factors (parameters) are performance measures separately and evaluationconsidered. All the factors are locations of the multi objective (desirability) functions for(positioning) factors of the workstation. In all measures.particular: The cycle time per task (Ttask) is• Factor A is the horizontal distance in considerably affected by changes in the factors’ millimeters between the edge of the printing values. There is a large difference of about 17.5 machine and the position of the worker % between the best solution (1121 with Ttask =• Factor B is the vertical height in millimeters 3.66 seconds) and the worst solution (2212 with of the working table of the printing machine Ttask = 4.30 seconds). In the mass production environment, such as in this case, this - 45
  • Table 2. Results of the alternative design solutionAlter- Exp. Ttask (sec) Eshift(Kcal) Ptask Wtask (kg) Desir-native (ABCD) Actual Norm. Actual Norm. Actual Norm. Actual Norm. ability 0 0000 3.87 0.62 799.82 0.44 1.67 0.21 3.51 0.40 0.43 1 1111 4.03 0.45 797.82 0.48 1.67 0.21 2.86 0.13 0.33 2 2111 3.78 0.72 799.75 0.44 1.50 0.75 3.63 0.45 0.57 3 2211 4.28 0.20 795.21 0.54 1.55 0.58 3.49 0.61 0.40 4 1211 4.19 0.29 799.60 0.44 1.67 0.21 2.80 0.11 0.27 5 1221 4.01 0.47 798.91 0.46 1.66 0.25 2.72 0.08 0.31 6 2221 4.12 0.36 794.11 0.56 1.54 0.62 3.74 0.39 0.46 7 2121 3.93 0.56 796.54 0.53 1.67 0.21 2.79 0.11 0.36 8 1121 3.66 0.84 796.74 0.51 1.50 0.75 3.61 0.44 0.63 9 1122 3.69 0.81 796.88 0.50 1.47 0.83 3.72 0.49 0.64 10 2122 3.96 0.53 794.91 0.55 1.66 0.25 2.90 0.15 0.38 11 2222 4.14 0.34 795.15 0.54 1.52 0.67 3.58 0.43 0.46 12 1222 4.08 0.40 798.15 0.48 1.66 0.25 2.84 0.13 0.32 13 1212 4.21 0.27 799.42 0.45 1.67 0.21 3.76 0.50 0.34 14 2212 4.30 0.17 795.04 0.54 1.55 0.58 4.68 0.88 0.41 15 2112 4.08 0.40 797.27 0.49 1.68 0.17 2.97 0.18 0.33 16 1112 3.85 0.64 798.62 0.46 1.50 0.75 3.75 0.50 0.57Upper limit 4.39 815.82 1.71 4.77Lower limit 3.59 778.23 1.44 2.73Table 3. Search region and definition parameters for the multiple desirability method Lower Upper Name Goal Lower limit Upper limit Importance weight weightmachine_d (A) 0.8..2.20 0.8 2.2 1 1 -machine_h (B) 0.8..2.20 0.8 2.2 1 1 -matbox_h (C) 0.8..2.20 0.8 2.2 1 1 -matbox_angle (D) 0.8..2.20 0.8 2.2 1 1 -Ttask ≤ 3.59 3.59 4.38 1 1 2Eshift ≤ 778.22 778.22 815.82 1 1 2Ptask ≤ 1.43 1.43 1.71 1 1 1Wtask ≥ 4.77 2.73 4.77 1 1 1improvement is economically significant. At next stage, the desirability function The variation in the energy of each alternative is evaluated. The performanceconsumption during a work shift (Eshift) among measures are first normalized and the desirabilitythe different solutions is relatively small. That’s function is then calculated using the relativewhy this measure is further considered in this importance values given in Equation (9). It isstudy for illustration purposes only, whereas in seen that the best solution is configuration 1122reality it would have been eliminated. with a desirability value of 0.64. The initial Both of the body position category solution is ranked in 7th place with a desirability(Ptask) and the average weight limit (Wtask) are value of 0.43. It means that the configurationsconsiderably affected by configuration changes. ranked from 1st to 6th place are considered betterNote from Table 2 that factor A has a clear affect for any set of relative importance values.on the Ptask and Wtask value. It is seen that the Finally, The RSM is applied to find thebest solutions are obtained when factor A is fixed best solution from configuration 1122. Table 3on its higher level. presents the initial conditions of both the performance measure and the design factors that 46
  • Table 4. Design solution improvement using the RSM Desir- No. machine_d machine_h matbox_h matbox_angle Ttask Eshift Ptask Wtask ability 1 2.20 1.08 2.20 0.80 3.61 796.86 1.44 3.95 0.688 2 2.17 1.04 2.20 0.80 3.60 796.98 1.46 3.92 0.683 3 2.20 1.26 2.20 0.95 3.71 796.11 1.46 3.95 0.663 4 2.20 1.28 2.18 0.81 3.71 796.08 1.46 3.95 0.662 5 2.15 1.18 2.20 0.80 3.67 796.40 1.47 3.90 0.661 6 2.20 1.23 2.20 1.40 3.71 796.26 1.46 3.94 0.660 7 2.20 1.24 2.20 1.88 3.74 796.22 1.46 3.95 0.654 8 2.20 1.29 2.20 1.51 3.75 796.01 1.46 3.95 0.652 9 2.20 1.38 2.20 0.80 3.77 795.63 1.47 3.94 0.652DBS 1 1 2 2 3.69 796.88 1.47 3.72 0.64IS 0 0 0 0 3.87 799.82 1.67 3.51 0.43are used by the optimization procedure. ConclusionExtrapolation presented in Equation (6) was usedhere. That is the four design factors that were In this paper, a case study of anexperimented earlier with level values of one or ergonomic design of a workstation wastwo (in coded terms) are now allowed to vary presented. The aim is to increase the throughputbetween 0.8 to 2.2. The reason for such rate (capacity) of the workstation, as well as toextrapolation is the assumption that one can create a suitable and adjustable ergonomicestimate the response functions over a wider environment, which could accommodate a largesearch region by using the responses obtained in percentage of the workers population. Factoriala smaller experimental region (Myers and Experiment (FE) and Response SurfaceMontgomery, 2002). Methodology (RSM) were used in this study. FE Table 4 presents nine design solutions is used to generate candidate configurations of asorted in a decreasing order by their desirability workstation and to build empirical modelsgrades. Convergence is achieved when the relating design factors to various objectivedistance moved or objective function change is functions. Based on this model, RSM is utilized −6 to optimize the design factors with respect toless than a 10 ratio. For comparison purpose,two solutions from previous steps (as presented economic and ergonomic multi-objectivein Table 2) were added to the table: the initial measures. Compare to the initial solution, thesolution (denoted in the Table by IS), and the final solution of this optimization study gives abest discrete solution (denoted in the Table by better result for the performance measures of theDBS). The best design solution that is obtained workstation.by the response optimization procedure (design Finally, this case of study has demonstrated howNo.1) achieves a desirability grade of 0.688. the ergonomic optimization study will benefit the Compare to the best discrete solution, manufacturing industry. Design modification toapplying the final solution of this optimization the workstation, based on the result of thisstudy gives a significant improvement for the optimization study, would improve theperformance measures of the workstation. productivity and working practices. This mayAlthough the change in the energy consumption also improve the product quality since, if theduring a work shift (Eshift) is relatively small, workers are more comfortable, the product willthere are significant changes in the cycle time per be handled more carefully.task (Ttask) (about 2.2%), the body positioncategory (Ptask) (about 2.1%) and the averageweight limit (Wtask) (about 5.8%) 47
  • References application. Applied Ergonomics 12 (1), 13- 17.Ben-Gal, I., & Bukchin, J. (2002). The Myers, R. H., & Montgomery, D. C. (2002). ergonomic design of workstation using Response surface methodology. 2nd edition. virtual manufacturing and response surface John Wiley & Sons. New York, NY. methodology. IIE Transaction, 34. Scott, G.B., & Lambe, N.R. (1996). WorkingGarg, A., Chaffin, D.B., & Herrin, G.D. (1978). practices in a perchery system using the Prediction of metabolic rates for manual OWAS. Applied Ergonomics 27 (4), 281- materials handling jobs. American Industrial 284. Hygiene Association Journal, 39 (8), 661- Waters, T. R., Putz-Anderson, V., Garg, A. and 674. Fine, L. J. (1993). Revished NIOSH equationKarhu, O., Karkonen, R., Sorvali, P., & for design and evaluation of manual lifting Vepsalainen, P. (1981). Observing working tasks. Ergonomics, 36(7), 749-776. postures in industry: examples of OWAS 48
  • Occupational Lead Exposure Of Soldering Workers In An Electronic Factory Mimala Arasaratnam, Zailina Hashim, Shamsul Bahari Shamsudin Environmental and Occupational Health Unit, Department of Community Health Faculty Of Medicine And Health Sciences, University Putra MalaysiaAbstract A cross-sectional study was conducted on 83 female electronics factory workers. The respondentscomprised 50 exposed workers who use lead alloy solder and 33 unexposed workers. The objective of this study wasto assess the lead exposure of these workers. Breathing zone were sampled using air sampling pumps. Dust sampleswere collected by wipe method. Venous blood collected and blood pressure were measured. All lead analyses werecarried out with Graphite Furnace Atomic Absorption Spectrophotometer. The mean air lead for exposed workers (570. ± 0.93 µg/m³) was significantly higher than the unexposed workers (0.0067 ± 0.0045µg/m³) (p<0.001). The rightside surface area ( 49.10 ± 34.19 µg/dl) was significantly higher than the left side (8.45 ± 9.04 µg/cm² ) ( p<0.001).The mean blood lead for the exposed workers (5.10 ± 1.42 µg/dl) was not significantly higher than the unexposedworkers ( 5.09 ± 0.88 µg/dl ) . The mean blood pressure was 121 / 72 mmHg and 117 / 72 mmHg for the exposedand unexposed workers respectively. No significant difference between the blood lead concentration (p = 0.786),systolic blood pressure (p = 0.554) and diastolic blood pressure (p = 0.955) between the 2 groups. No significantcorrelation found between blood lead with personal air lead (p = 0.447), left side surface area dust lead (p = 0.937),right side surface area dust lead (p = 0.291), systolic blood pressure (p = 0.201) and diastolic blood pressure (p =0.485). In conclusion, since the biological indicators showed normal values, the electronic circuit board solderingworkers, are not at high risk of exposure to occupational lead.Key words: blood lead, blood pressure, personal air lead concentrations, surface dust lead concentrations, electronic factory worker.Introduction cause tiredness, mood changes, headaches, stomach problems and trouble sleeping. Higher The lead being referred to in this study levels may cause aching, weakness inis in the form of inorganic lead, usually in the concentration or memory problems (Nurunniza,form of metallic lead such as lead oxide or lead 2001; Mazrura, 2000; Kovala et al., 1997;salts. The main routes of exposure to lead in Cooper, 1996).workers are through inhalation into the This study would aim to create arespiratory system. (Proctor et al., 1989). The background data on lead exposure of womenprocess of manufacturing electronic board is workers as well as to create an understanding andquite lengthy. It begins with wafer fabrication, awareness of the dangers of lead and how towafer sawing, die bonding, wire bonding, protect themselves from exposure. Theplating, soldering if necessary, testing and finally objectives of this study are to assess the leadpackaging. Exposure to lead would mainly be exposure of a group of circuit board solderingfrom the soldering process as fumes from the workers and a comparative group in ansoldering material is an alloy containing 40% electronics factory by determining their bloodlead and 60%. The chronic exposure to low pressure, blood lead concentrations, the air leadconcentrations of lead over a long period would and surface dust lead concentrations in the workcause detrimental effects on humans (Nurunniza, areas; to compare the blood lead concentrations,2001; Mazrura, 1996; Megat, 2000; Kovala et al., blood pressure between the 2 groups of workers;1997). to find any correlation between blood lead and Lead exposure increases the risk of high these studied variables in the exposed group.blood pressure (ATSDR, 1989). Massive dosesof lead can cause cardiac abnormalities. Lead cancause serious, permanent kidney and braindamage at high enough levels. Low levels may 49
  • Methodology after work was considered as the lead concentration that the respondents were exposedWorkers demographic background to. This was a cross-sectional study carried Blood Lead and Blood Pressureout at an electronics factory in Petaling Jaya,Selangor. The plant produces various types of The respondent’s venous blood sampleselectronic parts and the employees comprise were collected and preserved (Sinclair andproduction operators who are mostly women. Dohnt, 1984) . The lead analysis carried out withFrom the name list of all the employees, all the the wavelength of 283.3nm according to Hitachi50 lead soldering operators were selected as Method (Hitachi Ltd., 1997) using Hitachi Z-exposed group. Questionnaire interviews were 5000 Series Polarized Zeeman Atomicconducted on the exposed worker to obtain their Absorption Spectrometer. Blood pressurebackground information and from these readings were taken using a digital bloodinformation, the unexposed group were selected pressure monitor (MARS Digital Blood Pressureand matched according to the background of the Monitor) before blood collection.exposed group. From these, 36 non leadsoldering operators were selected purposively as Quality Controlunexposed group and matching was carried outin terms of age, gender, smoking and health Quality control and assurance arestatus. These workers had also given a written procedures that are taken to ensure the quality ofconsent to participate in the study. the data produced in this study. The quality control procedures that were used for this studyAir Lead include pretest of questionnaire, calibration maintenance of all instruments, Standard The workers breathing area was Operating Procedure (SOP) on sampling,sampled for 8 work hours with Escord Elf air- analytical methods and materials.sampling pumps and mixed cellulose ester(MCE) filters with 0.8 µm pore size, 37 mm Ethicsdiameter. The pump was calibrated at a flow rateof 1.7 L/min. A cyclone was attached to the All respondents were briefed about thepump so that only the respirable lead from the study and were asked to participate in the studyincoming air was sampled. The filter papers on a voluntary basis. Consent forms were givenplaced on the cassette holders attached to the to be read and signed. All respondents werecyclone were digested and analyzed to determine given a choice to continue participating in thethe concentration of lead by using Graphite study or to pull out at any time they choose to doFurnace Atomic Absorption (Hitachi Z-5000 so. In following specifications for an ethicalSeries Polarized Zeeman). Method of air lead research, a certified and experienced doctor wassampling was adapted from Method No. 7105 – asked to draw blood from the respondents.Lead by GFAAS (NIOSH, 1994). Finally all the information about the respondents and the company that was involved in thisDust Lead research remains confidential. The study had the approval of the Faculty of Medicine and Health For dust lead sampling, 19 respondents Sciences Ethics Committee.from the 50 exposed group were randomlysampled. Dust lead from the workstation surface Resultswas collected by taking wipe samples. The tissuepaper used as wipes were first weighed. Two sets Background informationof wipe samples which consist of the left andright side surface area were taken before they The respondents who took part in thisstart work and at the end of the shift before they study consisted of mainly Malay and a minorityclean up the table. The samples were collected, Indian ethnic groups. The total number ofweighed and digested according to Method No. respondents was 83, whereby 50 were in the9100: Lead in Surface Wipe Samples (NIOSH, exposed group and the remaining 33 were from1994). The difference between the lead the unexposed group (Table 1). As can be seen inconcentrations in the wipe samples before and Table 1, there are 22 exposed respondents and 33 50
  • unexposed respondents living in the Klang the systolic blood pressure (p= 0.955) and theValley. diastolic blood pressure (p = 0.554 ) between the two groups.Table 1 : Background information of workers Study Groups; Comparisons in Air Lead Variables Frequency (%) The mean personal air lead Exposed Unexposed Total concentration was 0.5723 g/m³ and 0.0067 (n=50) (n=33) (N=83) g/m³ for the exposed and the unexposed group Ethnic groups respectively (Table 3). The distribution of air 45 (90.0) 24 (72.7) 69 (83.1) lead concentration is significantly different from -Malay 4 (8.0) 9 (27.3) 13 (15.7) -Indian 1 (2.0) - 1 (1.2) a normal distribution curve, therefore non -Others parametric statistical test was used to determineResidential areas the difference between the groups. There is a -Klang Valley 22 (44.0) 19 (57.6) 41 (49.4) significant difference in air lead concentration -Non-Klang 58 (56.0) 14 (42.4) 42 (50.6) between the two groups in which the exposed ValleyN = 83 group have higher air lead concentrations than the unexposed group (t = 5.307, p < 0.001).Comparisons of Age and Blood Pressure Table 3 : Lead exposure variables The mean age of the exposed group was Study groups31.08 years and the unexposed group mean ± std.dev. Z prespondents were slightly older with a mean age Variables value valueof 33.78 years. There is no significant difference Exposed Unexposedin age between the exposed and unexposed group (n=50) (n=33)as shown in Table 2. Air lead 0.57 ± 0.0067 ± -5.10 < 0.001** concentrations 0.93 0.0045Table 2 : Biological profile of workers (µg/m3) Study groups Blood lead 5.10 ± 5.09 ± -1.18 0.239Variables mean ± std.dev. t/Z p concentrations 1.41 0.88 value value (µg/dl) Exposed Unexposed (n=50) (n=33) N = 83 Statistic Mann Whitney U test ** Significant at p ≤ 0.01Age 31 ± 6.3 34 ± 6.8 -1.820 0.073(years)∇ Comparison in Dust LeadSystolicblood 121.18 ± 117.58 ± -0.591 0.554pressure 18.59 20.00 The distribution of dust lead(mmHg)≠ concentration was significantly different from a normal distribution curve. Therefore, non parametric statistical test was used. For the leftDiastolicblood 72.16 ± 72.27 ± -0.056 0.955 side surface area, the mean lead concentration ispressure 12.81 11.83 8.45 g/cm² and the right side surface area has a(mmHg)≠ mean of 49.10 g/cm² (Table 4). There is a significant difference in the mean dust leadN = 83∇ statistic test concentration between the left and right side in≠ statistic Mann Whitney U test which the right side surface area has higher dust lead concentration than the left side surface area For the exposed group, the mean (t = -7.231, p < 0.001).systolic blood pressure measurements were121.18 mmHg and for the unexposed group was Comparison of Blood Lead Concentrations117.58 mmHg. The diastolic blood pressure ofthe exposed group had a mean of 72.16 mmHg The distribution of blood leadand for the unexposed group was 72.27 mmHg concentration is also significantly different from(Table 2). There is no significant difference in a normal distribution curve, therefore, non 51
  • parametric test was again used. The mean blood was found between blood lead concentrationslead concentration of the exposed group is 5.10 with air lead concentrations and blood g/dl and for the unexposed group is 5.09 g/dl concentrations for each separate group as well as(Table 3). There is no significant difference in when both groups are combined (Table 5).mean blood lead concentration between the The same test was carried out toexposed and unexposed group. (t = – 0.273, p = evaluate the correlation between blood lead0.786. concentrations and dust lead concentrations for the 19 exposed workers. There is also noTable 4 : Lead dust levels between right and left significant correlation between the two variables hand for the right side surface area as well as for the left side (Table 5). Exposed group mean ± std.dev. Variables Z P value Discussions Right Left value side side From the results it is clear that the (n=19) (n=19) respondents are exposed to very low concentrations of air lead. Through observations,Dust lead 49.10 ± 8.45 ± -3.823 <0.001** the use of central and individual exhaust filterconcentrations 34.19 9.04 systems may have contributed to the low air lead(µg/cm2) concentrations. Each workstation has an exhaustN = 19 suction fan with filter placed directly towardsStatistics Mann Whitney U test where the workers do their soldering work.** Significant at p ≤ 0.01 Therefore, all the fumes from the soldering work will be sucked to the central exhaust fan throughCorrelation between Blood Lead the individual exhaust fan almost immediately.Concentrations with Studied Variables There is very little chance for the fumes to escape unless the workers attempt to solder far The Spearman’s Rho test for correlation away from the suction range of the exhaust.was carried out since most of the data is notnormally distributed. No significant correlationTable 5 : Relationship between blood lead and selected variables Blood lead concentrations (µg/dl) Variables Exposed Unexposed All r P value r P value r P valueAir lead concentration (µg/m3) 0.021 0.887 -0.036 0.844 -0.023 0.840Right hand dust lead level (µg/cm2)# 0.255 0.291 - - - -Left hand dust lead level (µg/cm2) # 0.019 0.937 - - - -Systolic blood pressure (mmHg) -0.078 0.588 -0.146 0.419 -0.142 0.201Diastolic blood pressure (mmHg) -0.025 0.864 -0.085 0.638 -0.078 0.485N = 83# n = 19Statistic Spearman rho test 52
  • Other factors could also be that the this study were higher. This is obvious due to theproduction rates were quite slow at the time of area sampled and the nature of the work that thissampling. Due to the current economic study had focused on. Not only were the workersdownturn, most electronic companies were working with soldering alloy made up of 40%producing at rates far below their normal rates. lead, the area sampled was directly where theAs such, the respondents were working less work was being done and would naturally havebecause there was not much production targeted an extremely high concentrations of lead.and working hours were limited to a maximum The WHO has proposed 40 g/dl asof 6 hours a day. Therefore, the air lead maximal tolerable individual blood leadproduced was probably be lower than it would concentrations for adult male workers and 30have been if production is at maximum capacity. g/dl for women of childbearing age. The The findings of this study were respondents blood lead which did not exceed 10consistent with a study (Sinclair and Dohnt, µg/dl, indicates that lead does not pose any1984) on a group of crafts workers who produce hazard in their workplace and no significantstained glass. Their air sampling indicated air difference found in the mean blood lead betweenlead concentrations ranging between 0.88 to 15 the 2 groups.µg/m³ with a mean of 6.0 µg/m³. This value is Although the soldering workers arehigher than that obtained from this study. The exposed to lead during their work, this exposurePEL for air lead concentration set by the United does not seem to have any effect on their bloodStates Occupational Safety and Health lead concentrations. Therefore, this suggests thatAdministration is 50 µg/m³ whereas Malaysian whatever blood lead concentrations that thestandards set by the Factories and Machinery Act respondents have are not from their workplace(FMA) is 150 µg/m³. All these workers were but from the general environment such asexposed to less than 5 µg/m³ air lead. Therefore, ambient air, food, water, dust from the streets oralthough there was a difference in concentration paints and perhaps emission from nearbyof personal air lead between the exposed and industries. Since the blood concentrations areunexposed groups, their low blood lead very low, no adverse health effects are seen inconcentrations indicates that inhalation was not the respondents.the main route of exposure. One of the reasons why correlation From the statistical results, the lead dust between air lead concentration and blood leadconcentrations for the right side surface area are concentration is often very poor is because evensignificantly higher than the left. This is due to though the respiratory tract is the main route ofthe fact that the workers hold the soldering iron exposure, intake by the oral route such ason their right side surface area of their work area consumption of lead contaminated food andand clean the tip of the iron rod on the right side drinking water may be overwhelming that it willsurface area of the work table. These caused a increase total uptake and therefore, sway a directlot of dust and pebbles of melted solder wire to correlation between air lead and blood leadscatter around the right side of the work table. concentrations (Stellman, 1998). Some other studies have found varying Although there is a significant amountlevels of dust lead depending on the area in of contamination of dust lead at the work station,which they were collected. A study (Kaliamal, this contamination has no effect on blood lead2001) reported dust lead levels in homes to have concentrations. This could mean that althougha mean of 0.07 ng/g/m². Whereas another study the dust lead was present, the workers are(Johnson et al., 2000) among workers working protected from either inhalation or skinon a bridge found that although airborne lead absorption. This could be explained by the factexposure was low, surface contamination was that all the workers use facemasks and glovevery high especially on their clothing 4766 when entering the soldering department. Theyµg/m²) and vehicles (3600 µg/m²). The American must also use finger cots when doing solderingConference of Governmental Industrial work as well as practice good hygiene such asHygienists (ACGIH) has set a Housing and hand washing before and after work.Urban Development (HUD) guideline of 200 Although the mean blood pressure ofµg/ft² for construction work surface lead both systolic and diastolic blood pressure for theconcentration. exposed workers was slightly higher than the When compared to the above studies as unexposed workers, this difference was notwell as to the guideline, the values obtained in significant. The mean blood pressure of the exposed workers was 121.18 / 72.16 mmHg 53
  • whereas the unexposed workers had a mean finally, blood lead at a level of below 10 µg/dl,blood pressure of 117.58 / 72.27 mmHg. This does not cause an increase in blood pressure. Inresult is quite close to the findings in a study of conclusion, the lead soldering workers in thislead battery manufacturing workers (Wu et al., electronic factory are not at high risk of exposure1996) which showed a mean blood pressure of to lead from their workplace.121.7 / 77.9 for the female workers. There is no correlation between bloodlead concentration and blood pressure since the Referencesblood lead was found to be very low. Nodifference in blood pressure was found between Proctor, N.H., Hughes J.P., Fischman M.L.the 2 groups. Hypertension may begin to occur at Chemical Hazards of the Workplace, 2nd ed.,blood lead concentrations of 10 µg/dl and above 1989. Van Nostrand Reinhold, Philadelphia.(Kovala et al., 1997). As such, the results of this Nurunniza Z.A. Comparisons of Blood Leadstudy is consistent with (Kovala et al., 1997) that Concentrations and Neurobehavioralsince the workers’ blood lead concentrations are Scores between Two Groups of Workers inbelow 10 µg/dl, the average blood pressure was Selangor, Malaysia. Final Year Project,normal and not elevated. Occupational lead B.Sc. (Environmental and Occupationalexposure and blood pressure which stated that Health) 2001. Universiti Putra Malaysia.blood lead does not adversely affect blood Mazrura, S. Neurobehavioral Performancepressure unless at very high exposure. A similar Among Worker Exposed To Lead. Master ofstudy (Korrick et al., 1999) also concludes that (Public Health) Thesis,1996. Universitithere was no association between hypertension Kebangsaan Malaysia.and either blood or tibia lead concentrations. Megat, A.M.M. The Association of Blood Lead There are many standards and Concentrations on the Neurobehavioralregulations set by various government and non- among Women Production Workers in angovernmental bodies that are meant to be used as Electronic Factory. Final Year Project,guidelines for both environmental and (B.Sc. Environmental and Occupationaloccupational settings. The Occupational Safety Health) 2000. Universiti Putra Malaysia.and Health Administration (OSHA) of United Kovala T., Matikainen, E., Mannelin, T., Erkkila,States have regulated a Permissible Exposure J., Riihimaki, V., Hanninen, H., Aitio, A.Limit (PEL) for air lead levels at 50 g/m3. It Effects of low level exposure to lead onalso regulates the removal of a worker from neurophysical functions among lead batteryexposure if his/her blood lead level reaches workers. Occup. and Environ. Med.1997.60 g/dl or higher. The American Conference of 54: 487-493.Governmental Industrial Hygienists (ACGIH) ATSDR – American Toxic Substance and Drugrecommends a TWA of 150 g/ m3 for air lead Registry. Lead Toxicity. 1989. USand 30 g/dl for blood lead concentration. The Department of Health and Human Services.Centers for Disease Control (CDC) have Cooper, A.K. Cooper’s Toxic Exposures Deskrecommended that the level of concern for blood Reference. 1996:pp.1286-1296. Croomlead for the general population to be 10 g/dl. Helm Ltd, LondonFrom this study, the blood lead concentrations of NIOSH Lead by GFAAS, (Method No. 7105,these workers conformed to all the regulations Issue 2). NIOSH Manual of Analyticalstated above. Methods, 4th Edition. DHHS NIOSH Publication. 1994.Conclusion www.cdc.gov/niosh/nmam/nmammenu.html NIOSH Lead in Surface Wipe Samples (Method There is a significant difference in air No. 9100, Issue 1). NIOSH Manual oflead concentrations between exposed and Analytical Methods, 4th Edition. DHHSunexposed respondents. Dust lead concentrations NIOSH Publication 1994.on the right side surface area were significantly www.cdc.gov/niosh/nmam/nmammenu.htmlhigher than the left side surface area. However, Sinclair D.F. and Dohnt B.R. Sampling andthere is no significant difference in blood lead analysis techniques used in a blood leadconcentrations and blood pressure between survey of 1241 children in Port Pirie, Southexposed and unexposed respondents. Air as well Australia. Clin. Chem.1984. 10:1616-9.as dust lead concentrations does not directly HITACHI, (1997). Sample Analysis Methods.contribute to blood lead concentrations and GFAA Guide For Polarized Zeeman Atomic 54
  • Absorption Spectrometry (7): pg 48. Japan: bridge:comparisons of trades, work tasks. HITACHI Ltd. Am. Ind. Hygiene Assoc. J. 2000. 61, 815-Pant B.C., Harrison J.R., Long G.W., Gupta S. 819. Exposure to lead in stained glass work. An Stellman, J.M. (Ed). Encyclopedia of environmental evaluation. The Sci. of Tot. Occupational Health and Safety (4th edition). Environ. 1994. 141: 11-15. 1998. International Labour Office, Geneva.Kaliammal M. Relationship between indoor dust Wu, T.N., Shen, C.Y., Ko, K.N., Guu, C.F., Gau, lead level and children’s blood lead H.J., Lai, J.S., Chen, C.J., Chang, P.Y. concentration in Seri Serdang, Selangor. Occupational lead exposure and blood B.Sc. (Environmental and Occupational pressure. Int J. of Epid. 1996. 25: 791-796. Health) 2001. Universiti Putra Malaysia. Korrick S.A., Hunter D.J., Rotnitzky A., Hu H.,Johnson J.C., Reynolds S.J., Fuortes L.J., Clarke Speizer F.E. Lead and hypertension in a W.R. Lead exposure among workers sample of middle aged women. Am. J. of renovating a previously deleaded Pub Health. 1999. 89: 330-335. 55
  • Occupational Heat Stress Of Workers In A Plastic Industry, Selangor Goh See Bena , Zailina Hashimb , Rosnan Hamzahb a Seremban Health Office, Seremban District, Negeri Sembilan b Environmental & Occupational Health Unit, Department of Community Health, Faculty of Medical & Health Sciences, Universiti Putra MalaysiaAbstract A cross sectional study to determine the exposure of heat and its biological effects on the workers in aplastic factory located in the Shah Alam Industrial Estate, Selangor, Malaysia. Forty five respondents from thepolymer section in the factory were selected as the respondents. Variables measured were the environmentaltemperature (WBGTin), air velocity, relative humidity, body temperature, average heart and recovery heart rate.QUESTEMP°34 Area Heat Stress Monitor was used to measure the environmental temperature in °C (WBGTin) andrelative humidity (%). Velocicheck Model TSI 8830 was used to measure the air velocity in meter per second (m/s)while the OMRON Blood Pressure Monitor Model T3, was used to measure average heart rate and recovery heartrate. Body temperature (°C) was measured by the Instant Ear Thermometer-OMRON Gentle Temperature ModelMC509. Interviews using questionnaires were used to determine respondents’ socioeconomic background, previousrisk factors on heat exposure and other information related to heat stress. Results showed that the meanenvironmental temperature for the exposed group was 28.75°C, the mean air velocity was 0.15 m/s and the meanrelative humidity was 58.1%. These production workers were exposed occasionally to heat when loading plasticpowder into the molds as well as demolding the finished plastic products from the molds. The average time ofmonitoring was 2 hours for intermittent exposure and 8 hours duration for overall exposure. Maximum demand forwork load was measured 1 minute after work activities were stopped at the demolding section. There was asignificant difference between body temperature and average heart rate before work, after 2 hours of work and after 8hours of work ( p < 0.001). The mean recovery heart rate after 1 min was 88.0 ± 12.0 beat per min. (bpm), indicatingthat there is no excessive physiological demand. Body temperature (36.8 ± 0.40°C) and average heart rate after 8hours (78 ± 12 bpm) indicated a good body control of heat exposure. Five out of six workplaces monitored hadtemperatures of greater than 28°C (ACGIH TLV). The workers were exposed to moderate heat stress during thestudy period, however, body temperature and average heart rate measurement did not reach unacceptable level ofphysiologic strain.Key words: occupational heat stress, heart rate measurements, blood pressures, plastic industry and physiologic strain.Introduction One of the most overlooked hazards Temperature range from relatively at low 150oCthat encountered in workplaces is heat. Previous to extreme cases of 250oC. Crockford et al.research has found that excessive exposure to (1981) said the hot environment in theseheat at the workplace will develop heat stress industries has a profound effect on workers’(NWOSU, 2000; Cullen and Nadel, 1994). Heat comfort, productivity, safety and health.stress is the aggregate of environmental and This study aims at examining the heatphysical work factors that constitute the total strain and heat stress experienced by workers inheat load imposed on the body (Alpaugh and a plastic industry.Hogan, 1992).The bodily response to total heatstress is called the heat strain (NIOSH, 1986). In Methodologyterms of heat-related illnesses, the mildest formof heat stress are those which cause workers to This is a cross sectional study conductedfeel uncomfortably warm. Further exposure to in a factory at the Shah Alam Industrial Estate,hot workplace may result in heat cramps, heat Selangor. Forty five workers from the polymerexhaustion, heat syncope and heat stroke section were selected as the respondents. This(Kroemer, 1994). In plastic industries, many of study involved six measurements such as the Wetthe processes generate heat to the workplace. Bulb Globe Indoor Temperature (WBGTin), air 56
  • velocity, relative humidity, body temperature, The molding operations are continuousaverage heart rate and recovery heart rate. process which is carried out by two personnel The plastic industry is divided into three with a 12 hours work shift which are made up ofdistinct sectors. The first sector comprises the raw the machine operators and supervisors. Thematerial suppliers, which are used to manufacture highest overall exposure to heat stress waspolymers and molding compounds. The second machine operators. The study population wassector is made up of manufacturers, which made up of all the male production lines workers.convert raw materials into finished products. The Purposive sampling method was carried based onthird sector comprises machinery suppliers, which the inclusion criteria such as: male workers; agesupply equipment to the manufacturers. Many of between 20-55 years; work duration of more thanthe plastics processing machines operate at very 3 months and healthy (non-alcoholic, withouthigh temperature of above 200oC. hypertension and not using drugs). To evaluate the heat stress experienced A workplace with temperature of moreby the workers at the workplace, the than 37oC can influence the body heat exchangeenvironmental parameters at selected work with the environment (Alpaugh and Hogan,locations were measured; metabolic rate for 1992). It was concluded that repeat heat exposuredifferent activities were estimated and mapping for 9-10 consecutive days, can alter bodywere made on the amount of time spent at temperature. Therapeutic drugs interfere withdifferent work locations in the factory (Logan and thermoregulation and affect heat toleranceBernard, 1999). The American Conference of (Deberairdim, 1999). A hypertension patient canGovernmental Industrial Hygienists method for reduce heat transport from the body to skin andestimating metabolic rate was used. The WBGT increases the risk of overheating (Havenith,has proved to be very successful in monitoring 1995).heat stress (ACGIH, 1999). QUESTEMP°34 Area Heat Stress Measurements of body temperature and Monitor was used to measure the WBGTinheart rate were carried out before work, after 2- environmental temperature (°C) and relativehours and after 8-hours of work. Intermittent humidity (%) (Quest Technologies, 1997)exposure should be averaged over 2-hours (US Velocicheck model TSI 8830 measured the airdept. of Labour, 1999). For overall exposure, the velocity (m/s) while the OMRON model T3, waswork period of about 3 to 5-hour could be taken used to measure average heart rate and recoveryas a representative (Logan and Bernard, 1999) but heart rate. Body temperatures (°C) werean 8-hour work period would definitely give a measured by the Instant Ear Thermometer-Omroncomprehensive picture. NIOSH (1986) model MC509. Closed ended self-administeredrecommended the recovery heart rate of 1 minute questionnaires were used to determine(HR@1) as the second criteria of indicator for respondents’ socioeconomic background, theirwork demand and work strain. Heart rate history of risk factor in heat exposure and otherrecovery after 1-minute at the end of removing information related to heat stress. For qualityfinished products from molds was recorded. control, all instruments were calibrated before Four environmental parameters were use.also measured which included the ambienttemperature, radiant temperature, air velocity and Resultsrelative humidity. Environmental parameters wererecorded for 8 hours daily. Background information of respondents The factory was divided into 6workplaces namely Rotational (RS) 160, RS 220, More than half of the respondents wereRock and roll (RR) 1000, RR 2000, metal foreign workers from Bangladesh and Indonesia.fabrication and general site, to facilitate Majority had gone through secondary education.environmental measurement. The four basic steps The age range was between 20 to 50 years oldof molding processes were loading, heating (170 and the majority of the respondents were betweento 370oC), cooling and demolding (10). Time for a 20-30 years old. Sixty percent had a normal BMIwhole cycle takes 60 minutes and average time of 18.5 –24.9. Sixty percent had normal Bodyfor demolding range from 7 to 15 minutes. The Mass Index. All of them had worked for moreheat ejected from machines and molding than 3 months. Majority of them were machineprocesses can contribute to a heat stress that operators (Table 1).requires evaluation (Burges, 1995). The respondents’ health complaints obtained through questionnaire interview are 57
  • tabulated in Table 2. Most frequent health Comparison of body temperature and heartsymptoms experienced were dizziness due to the rate, before and after work.radiant heat produced by the machines. Comparisons of body temperature beforeTable 1 : Background Information of work, after 2 hours and after 8 hours of work are Respondents. as shown in Table 3. The mean body temperature before work was 36.3 ± 0.55oC, after 2 hours of Variables Male Percentage work was 36.7 ± 0.36oC and after 8 hours of work Race was 36.8 ± 0.40oC. Paired t-test gave a significant 14 31.1 difference of mean body temperatures before Malay 2 4.4 Chinese work with after 2 hours work (t = 6.51, p<0.001) 2 4.4 Indian 16 35.7 and before work with after 8 hours of work Bangladesh 11 24.4 (t=5.93, p<0.001) respectively. The means and Indonesia range of the measured body temperatures are Job Classifications shown as box plots in Figure 1. Operator 30 66.7 Comparisons of heart rate before work, Metal Fabricator 5 11.1 after 2 hours, after 8 hour of work and recovery Foreman 5 11.1 heart rate at 1 min after loading plastic powder Quality Controller 2 4.4 and removing finished product from the plastic Supervisor 3 6.7 molds are tabulated in Table 3. The mean heart Age group rate before work was 71 ± 10 bpm, after 2 hours 20 – 30 years 29 64.4 of work was 76 ± 11 bpm and after 8 hours of 31 – 40 years 9 20.0 work was 78 ± 12 bpm. Paired t-test results 41 – 50 years 7 15.6 showed a significant difference before work, after >50 years 0 0 Body Mass Index Table 3 : Comparison of Body Temperature and <18.5 (Underweight) 6 13.4 Heart Rate of Respondents According 18.5 – 24.9 (Normal) 27 60.0 to Work Duration 25 – 29.9 (Overweight) 11 24.4 30 – 34.9 (Obese) 0 0 Main Comparative Variables t p 35 – 39.9 Very obese 1 2.2 Variables >40 Extremely obese 0 0 Education Body temperature °C Primary 2 4.4 Mean ± std. dev. Secondary 38 84.5 Before After 2 hrs work 6.51 <0.001 Tertiary 5 11.1 36.3 ± 0.55 36.7 ± 0.36 Duration of work Before After 8 hrs work 5.93 <0.001 3 – 12 months 10 22.2 36.3 ± 0.55 36.8 ± 0.40 13 – 24 months 9 20.0 After 2 hrs After 8 hrs work 1.68 0.98 > 25 months 26 57.8 36.7 ± 0.36 36.8 ± 0.40 N = 45 Heart rate (bpm) Mean ± std. dev.Table 2: Health Complaints of Respondents Before After 2 hrs work 5.41 <0.001 Health complaints Percentage 71 ± 10 76 ± 11 Before After 8 hrs work 6.38 <0.001 Dizziness 37.8 71 ± 10 78 ± 12 Fatigue 22.2 After 2 hrs After 8 hrs work 2.18 0.034 Nausea 11.1 76 ± 11 78 ± 12 Muscles spasm 11.1 Before At 1 min 5.71 <0.001 Uncoordinated movement 8.9 71 ± 10 88 ± 12 Fainting 2.2 (Recovery Rate) N = 45 58
  • 2 hours work and after 8 hours of work difference with the mean heart rate before work (trespectively (t = 5.41; p<0.001; t = 6.38; = 5.71; p<0.001). The means and range ofp<0.001). The mean recovery heart rate after 8 measured heart rate are showed as box plot inhours of work also showed a significant Figure 2. 3 8 .0 3 7 .5 3 7 .0 3 6 .5 3 6 .0 3 5 .5 44 3 5 .0 N = 45 45 45 T e m p b e fo re w o rk te m p a fte r 2 h r te m p a fte r 8 h r Note : ------- = _____ = Threshold for body temperature Figure 1 : Box plots of respondents’ body temperature ° 110 100 90 80 70 60 50 40 N = 45 45 45 H R b efo re w o rk H R a fte r 2 h r H R a fte r 8 h r Note : ------ = Threshold for heart rate for moderate heat stress (110 bpm) HR : Heart rate (beat per minute) Figure 2 : Box plots of respondents’ heart rate (bpm) 59
  • Assessment of heat stress 26.50 – 30.40 oC. As shown in Table 4, a one way ANOVA test results showed a significant The assessment of heat stress difference in the WBGTin at the 6 studiedis based on the Wet Bulb Globe Temperature workplaces (F=4.090, p=0.004).(WBGT), which is adjusted to work demand Table 5 shows estimated metabolic ratereflected in metabolic rate (NIOSH, 1986). for respondents range from (250 – 300 kcal/hrMeasured Wet Bulb Temperature range from with work/rest regimen of 75% work, 25% rest,(25.5 – 29.3oC); Globe Temperature (28.4 – each hour. Five out six workplaces were above36.1oC); Relative Humidity (44 – 77%) and Air the heat exposure threshold of 28oC (ACGIHVelocity (0.01 – 0.28m/s) at various workplaces TLV). The areas were RS 220, RR 1000, RRin the production lines. One way ANOVA test 2000, Metal Fabrication site and General site.gave a significant value for Natural Wet Bulb However, statistics did not show any significantTemperature and Globe temperature at these correlation between workplaces with bodywork places (F=8,005, p<0.001; F=2.701, temperature or heart rate after 8 hours of workp=0.03). Measurements of Wet Bulb Globe respectively (Table 6).Indoor Temperature (WBGTin) at theseworkplace showed a range of temperature fromTable 4 : The Comparisons In Means For Natural Wet Bulb Temperature, Globe Temperature And Wet Bulb Globe Temperature Indoor Between The 6 Workplaces. *Variable / Areas Range Mean ± std. dev. F pNatural Wet BulbTemperatures (°C) 25.5 – 27.6 27.0 ± 0.52Machine RS 160 25.5 – 26.8 26.2 ± 0.46 8.005 0.001Machine RS 220 27.4 – 29.3 28.0 ± 0.59Machine RR 1000 26.0 – 28.0Machine RR 2000 27.3 ± 0.73 25.9 – 28.7 27.8 ± 0.98Metal Fabrications 26.5 – 28.3General site 27.6 ± 0.57Globe Temperatures (°C) 28.3 – 33.0 31.2 ± 1.40Machine RS 160 29.1 – 33.8 31.4 ± 1.50 2.701 0.03Machine RS 220 31.2 – 33.8 32.6 ± 0.90Machine RR 1000 29.7 – 36.1Machine RR 2000 33.9 ± 2.14 28.4 – 34.5 32.8 ± 2.15Metal Fabrications 28.9 –33.9General site 32.0 ± 1.82WBGTin 26.5 – 28.5 27.7 ± 0.70Machine RS 160 26.8 – 29.0 28.2 ± 0.73 4.090 0.004Machine RS 220Machine RR 1000 28.5 – 30.0 29.2 ± 0.50 27.1 – 30.4 29.3 ± 1.10Machine RR 2000 26.6 – 30.3Metal Fabrications 29.2 ± 1.33 27.2 – 29.9 28.9 ± 0.88General siteNote : N = 8 ( Eight hourly monitoring for each workplace) 60
  • for accumulated effects on heat stress. (Nag et Table 5 : Heat Stress At Various Workplaces al., 1999). with Moderate Work Task The box plots represented the body temperature data collected during the study Workplaces Measured Work period (Kinnear and Gray. 1999). The highest WBGTi regime value of body temperature measured was 37.3°C Machine RS 160 27.7 and 37.4°C after 2 hours and after 8 hours of Machine RS 220 28.2* work respectively. There was a significant 75% work, difference for body temperature measured at Machine RR 1000 29.2* 25% rest, Machine RR 2000 29.3* different work durations. However, body each hour Metal fabrication 29.2* temperature of below 38.0°C as a threshold General sites 28.9* value is considered a safe exposure for the respondents (ACGIH, 1999). *Measured WBGTi is above the recommended Logan et al., (1999) found in his study ACGIH TLV of 28.0. on 31 aluminum smelters who were exposed to heat, that 95% of the subjects had oralTable 6 : Correlation between WBGTin with body temperature below 38.0°C. Azwan and Rampal temperature and heart rate of (2001) also recorded 96.2% out of 164 respondents. respondents selected for a heat stress study at Main Co-related two major steel plants was 37.5°C (below the Variable Variables r p body temperature threshold for a safe exposure). Heart rate is a measurement of both WBGTin Body temperature 0.143 0.348 work demands and heat stress. Heart rate is a (after 8 hrs work) valuable guide in accessing hazards to health workers exposed to heat stress (Mirnard, 1973) . Heart rate 0.150 0.325 There was a significantly difference for (after 8 hrs work) body heart rate at different intervals of work durations. The highest value of average heart Discussions rate measured was 100 bpm and 103 bpm for work after 2 hours and work after 8 hours. Zenz This study involved only male et al., (1994) that daily average heart rate should respondents. Exposure to excessive heat is be less than 110 bpm for moderate work-load, associated with nephrolithiasis (Borghi, 1993) could probably result in a significant rise on testicular cancer (Zhang, 1995) and poor semen body heart rate. Recovery heart rate (HR@1) was quality (Bonde, 1992). A high incidence of uric based on the heart rate at 1 minute after work acid stones was present in the workers who were stop. As interpreted, if was greater than 120 exposed to heat stress (Borghi, 1993). Majority bpm, then work task and heat stress is of the respondents were foreign workers. All the considered high (NIOSH, 1986). respondents were in the age group of 20 to 50 Measurements of Natural Wet Bulb years. The overall height of the study Temperatures (NWBT) showed a range of 25.5 to respondents range from 156 – 179 cm, whereas 29.3oC, the Globe Temperature (GT) had a range weight of the respondents range from 43.8 – of 28.3 to 36.1oC and the Wet Bulb Globe 121.1 kg. Sixty percent of them had a normal Temperature indoor ( WBGTin) was in the range Body Mass Index (BMI). Age and BMI are of 26.5 to 30.4oC. There was a significant confounders and can influence heat stress. The difference for NWBT, GT and WBGTin in the 6 length of employment in the factory range from workplaces. However, there was no significant 3 months to 15 years. correlation between WBGTin with body Beside rectal temperature as a measure temperature or heart rate after 8 hours of work of body temperature, ear canal temperature can was found. These could be due to several factors. also be used. It was carried out by inserting a The short periods of time required for loading sensor in the ear canal (NIOSH, 1986). At highly plastic powder and removing product from the heated workplace, body temperature would start mould under the intense heat may not affect the to rise depending on the environmental heat. For workers as much as that would be predicted from this reason, body temperature is good indicator the WBGTin values (Havenith et al., 1997). The factory is semi-auto with most of the manual task handled by hoists and forklifts. These had greatly 61
  • reduced the manual lifting activities and Referencestherefore, reduce the heat load on the workers(Helander, 1991). Majority of the workers in the NWOSU (2000). Heat Related Injuries. Healthpolymer section had worked for more than 3 and safety department. NWOSU homepage.months and thus had acclimatized themselves http://nwosu.edu/well with the environment (Shido et al., 1999). Cullen, MR. and Nadel, E. (1994). ThermalWhen exposure to heat takes place over an stressors in Cullen, M. R. Textbook Ofextended period in workplace, a process of Clinical Occupational Environmentalphysiological adaptation called acclimatization Medicine. USA:W.B. Saunders Publisher.occurs. It is manifested as a reduction in the heart pp. 658-666rate and internal body temperature at the expense Alpaugh, EL. and Hogan, TJ. (1992).of increased sweating. Worker acclimatizes to a Temperature extremes in Barbara. A. P. (Ed)specific dry or humid atmosphere and to a Fundamentals of Industrial Hygiene 3rdspecific workload. Any increase in this load or in edition pp. 265-280. USA: National Safetythe thermal burden may result in health damage Council.(Havenith, 1995). NIOSH- National Institute for Occupational Sixty percent of workers had normal Safety and Health. (1986). Criteria For ABMI of 18.5-24.9, giving a better heat tolerance Recommended Standard Occupational(Donohue and Bates, 2000) and all of the foreign Exposure To Hot Environments. Departmentworkers come from tropical countries with hot of Health and Human Services, Washington.climate. Majority of the workers were also young pp.1-107.and about 64% are between the age group of 20- Kroemer. KHE., Kroemer, HB. and Kromer-30 years old. Havenith et al., (1997) showed in Ekbert, KE. (1994). Ergonomics-How Tohis study on factory workers that older workers Design For Ease And Efficiency. Prenticehave less efficient sweat glands. The respondents Hall Publisher. pp. 244-263.are also considered healthy because they have Crockford, GW. (1981) The thermal environmentfew health complaints. It was also observed that in Schilling, RSF., Occupational Healththe workers have short hourly break in between Practice 2nd Edition. London: Butterworthsthe work tasks whereby they were able to drink Publisher. pp. 453-490.water. This also reduced their body dehydration Logan, WP. and Bernard, ET. (1999). Heat stresswhen their bodily fluid are balance and thus cause and strain in an aluminum smelter. Am Ind.less heat stress. Hyg Assoc. J. 60:659-665. ACGIH - American Conference of GovernmentalConclusion Industrial Hygienists. (1999). 1992-1993 Threshold Limit Values for Chemical In summary the findings of this study Substances and Physical Agents andsuggest that workers in this plastic industry were Biological Exposure Indices. Cincinnati:exposed to moderate heat stress during the study ACGIH pp.89-96.period. Even though the measured WBGTi at OSHA (1999). Heat Stress. Technical Manualvarious workplaces were slightly above the Section III. Chapter 4. US Dept. of Labour.recommended ACGIH threshold level, the body Kearns, MP. and Corrigan, N. (1999). Opentemperature and average heart rate measured did flame heating methods for the rotationalnot reach unacceptable level of physiologic moulding of plastics. Rotation Nov : 34-38strain. Furthermore, no significant correlation Burges, WA. (1995) Recognition Of Healthwas found between the WBGTi with the body Hazards In Industry. A Review Of Materialstemperature as well as the heart beat. However, And Processes, 2nd edition. Canada: Johnpreventive measures to excessive heat exposures Wiley & Sons. Inc.which can cause physiological strain and Deberairdim, LJ. (1999). Handbook ofeventually lead to poor health outcome of the Occupational Safety And Health. 2nd Edition.workers must be addressed by the management USA: John Willey and Sons Publisher.in order to sustain productive and healthy Havenith, G. (1995) Individual Heat Stressworkers. Response. Physiological Research Center, University Park, PA, USA. pp. 67-77. Quest Technologies. (1997). Questemp34° Thermal Environment Monitor, Operator’s 62
  • Manual. Wisconsin, USA: Quest Havenith, G. Coenen, J., Kistemaker, L. and Technologies. Kenney WL., (1997) The Relevance OfBorghi, L. (1993). Hot occupation and Individual Characteristics For Human Heat nephrolothiasis. J. Urol. 150(6):1757-1760. Stress Response Is Dependent On WorkZhang, ZF. (1995) Occupational exposure to Intensity and Climate Type. Physiological extreme temperature and risk of testicular Research Center, University Park, cancer. Arch. Env. Health. 50(1):13-17. Pennsylvania, USA.Bonde, JP. (1992). Semen quality in welders Helander, M. (1991) A Guide To The Ergonomics exposed to radiant heat. Brit. J. Ind. Med. Of Manufacturing. USA: Taylor & Francis 49:5-10. Publisher.Nag, A. Kothari, D. and Desai, H. (1999). Shido, O. Sugimoto, N. Tanabe, M. and Exposure limits of women in hot Sakurada, S. (1999). Core temperature and environment. Ind J. Med. Res. 138:110. sweating onset in humans acclimated to heatKinnear, PR. and Gray, CD. (1999) SPSS For given at a fixed daily time. J. Appl. Physiol. Windows Made Simple 3rd Edition. UK: 276 (4):1095-1101. Psychology Press Ltd. Donoghue. AM. and Bates GP. (2000). The riskAzwan A. and KG Rampal. (2001). Heat stress of heat exhaustion at a deep underground among workers in two steel plants in metalliferous mine in relation to body-mass Peninsular Malaysia. Paper presented at the index and predicted VO2max. Occup Med. 2nd National Public Health Medicine 50 (4): 259-263. Conference at the Summit Hotel, Subang Jaya. 17 -19th April 2001. AcknowledgementMirnard D. (1973). Industrial Environment-Its Evaluation and Control. Physiology of Heat Acknowledgement to the Management of the Stress. (NIOSH) Department of Health and Plastic Industry and the workers who Human Services, Washington . volunteered in the study. Research funded by theZenz. C., Dickerson, OB. and Horvath, E. (1994). faculty of Medicine and Health Sciences, Occupational Medicine 3rd Edition. Ohio, Universiti Putra Malaysia. USA: Mosby Publications, pp. 305-331. 63
  • The Need of Industrial and Organizational Psychologist in Malaysia Shukran Abdul Rahman Department of Psychology, International Islamic University Malaysia.Abstract Psychology has been well-accepted for application in virtually all aspects of human activities, includingmaking a living. Thus, the objective of this paper is to introduce the application of psychology at workplaces.Specifically this paper addresses the importance of the profession of Industrial and Organizational Psychologist in theincreasingly advanced and industrious society of Malaysia. It highlights the areas that the professional cares for, aswell as its roles and positions in the view of the nation’s needs. Besides that, this paper also stresses the essentialissues that Industrial and Organizational Psychologist practicing in Malaysia should consider. In short, this paperadvocates the need of having professionals to look into the well-being of individuals contributing towards makingMalaysia a developed nation.The Need of Industrial and Organizational words, Industrial and Organizational PsychologyPsychologist in Malaysia discusses and explains how the knowledge on human behaviours and mental processes are Psychology is a field of study that applied to work settings. Practitioner in this areafocuses on human behaviour and mental is known as Industrial and Organizationalprocesses. In Psychology, many researches have Psychologist whose roles are important inbeen conducted to look at human behaviours and today’s dynamic work organizationstheir mental processes at various settings and characterized by never-ending changes andconditions. In its field, principles and concepts of diversified human resources. Besides that, otherpsychology have been established to understand job titles such as Occupational Psychologist,and explain the behaviors of human being as they Work Psychologist, Career Psychologists, Careerdo in various social settings. In fact, Psychology Professional or Personnel Professional, are alsois applicable to all aspects of human activities, used interchangeably. The important dimensionsincluding in work settings. An applied field of in the field can be categorized into six generalPsychology which concentrates on the fields, such as those which have been outlined bybehaviours and mental processes of human being Munchinsky (2000), which areat work is Industrial and OrganizationalPsychology. (1) Selection and placement: Industrial and Greenberg and Baron (2000) refer Organizational Psychologists designIndustrial and organizational psychology as a recruitment and selection methods. Theyfield that seeks knowledge of behaviour in also manage selection processes; and theorganizational settings by systematically placement of workforce in organization.studying individuals, group, and organizational Their role is important in helpingprocesses. In a specific conception, Brehm and organization to look for employees whoKassin (1996) defined Industrial and have person-job fit or person-organizationOrganizational Psychology as the study of fit. Their expertise in developing andhuman behaviour within business and other administering psychological tests, helporganizational settings. The primary objective of identify individuals’ different needs, values,Industrial and Organizational Psychology is to interests, and aptitude helps organization tomaintain the well being of both organization and have employees who suit job demands, andits members, particularly when its major focus is also assist employees to achieve jobon individuals, groups and organization. In other satisfaction. Above and beyond that, 64
  • Industrial and organizational psychologists degree of job commitment andmay also come to the picture of one’s career satisfaction, or need for transfer. Moreeven at the outset of his or her career path. importantly, Industrial andThey offer advice on career decision-making Organizational Psychologist must also(help individuals to select job) as well as prepare and present the performancecareer development. This is known as career appraisal feedback to individualplanning, which happens at individual appraisee, or to prepare mechanism toprocess (Isaacson & Brown, 2000). handle the feedback exercise.(2) Training and development: Training can (4) Organization development: Industrial be referred to as the planned effort to and Organizational Psychologist helps help employees’ learning, retention, and organization in becoming a top-notch transfer of job-related activities (Riggio, organization by changing staff 2000). Industrial and organizational members’ attitude, or behaviors through psychologists help organization in various organizational development or managing training-related matters organizational behavior modification, (conducting training needs analysis, which ultimately promote efficiency designing training programs, and among staff members and productivity implementing them). With the advanced of the organization. Armstrong (1984) technology and complex lifestyles, refers organizational development as the workplace also requires employees to effort to plan and implement equip themselves with knowledge and programmes designed to enhance the to cope with the sophisticated demands effectiveness of an organization, so that at work. However, the tasks to equip it can function and respond to change. them do not lie on their parts per se, but Thus, Industrial and organizational are also borne by the employers. psychologists are instrumental in Industrial and organizational enhancing organization productivity and psychologists help train employees to harmonizing staff work-related have higher levels of cognitive ability, attitudes. By being involved in increase psychomotor skills, perceptual management decision, they offer ideas speed, and emotional intelligence that pertain to employees’ needs and through in house programs or attending expectations for consideration by the training organized by other training management before the implementation provider. of any work procedures or administrative systems in an(3) Performance appraisal: In employing organization take place. Besides that, organizations, performance appraisal they also help identify worker serves as a systematic description of motivation; measure job satisfaction, individual or group’s strengths and study consumer needs, and their weaknesses (Cascio, 1998). The satisfactions to products. These are evaluation of employees is important to important because organization will be know whether they are performing moving forward or develop further by competently. Performance appraisal the support of the motivated workers, requires comprehensive evaluation of and the satisfied employees and employees’ work behaviours (input), customers. performance or outcome (output) and attitudes. Appraising these aspects are (5) Quality of Work Life (QWL): Riggio important for management to decide, (2000) refers Quality of Work Life as not only employees’ remuneration or the evaluative state of all aspects of promotion, but also their training needs, work, which is determined by the suitability with the job placement, compensation and benefits, opportunity 65
  • to participate in management decision, work. Coovert (1995) said that works promotion in career path, job nowadays have become increasingly specifications, job security, mobile and electronic. Today, a job has organizational culture and employee become more complex or multifaceted, relation. They are also responsible to to the extent that a driver must not only ensure conducive human relation or know how to drive but also to camaraderie among employees happen, communicate with customers at the and more importantly help ensure the delivery point, and then advise purchase success of leadership in the organization order to the headquarters using high- by promoting positive organizational tech machines. To illustrate further, at citizenship behavior (OCB) (Baron and construction sites, or factory shop Byrne, 2000). At work, Industrial and floors, employees are exposed to unsafe organizational psychologists help conditions and having a high tendency monitor employees safety, health and to be involved in unsafe behaviors when welfare which may be affected by work handling hazardous materials or or employee behaviours. They organize machines. Thus, Industrial and stress management programmes, organizational psychology is needed in provide Employee Assistance the design of tools, building, Programmes (EAP), help employees equipments, and machines so that they taking precautionary measures to give input on human factor in order to manage stress, audit hazardous work make them user-friendly. In other behaviors and unsafe working words, Industrial and Organizational conditions in order to avoid, or reduce Psychologist has indispensable role to accidents in the workplace. These play in promoting harmonious efforts to maintain QWL also cover interaction between individuals and beyond one’s working hours in the technology. They also help organization sense that Industrial and Organizational to build and create conducive work psychology also help promote the well environment which will facilitate the being of employees when they are at attainment of job satisfaction, home. Industrial and Organizational commitment and healthy work Psychology can help develop high activities. Besides that, they also Tension Discharge Rate (TDR) among promote safe human-machine employees so that they are interaction. Thus, Industrial and psychologically sound before going organizational Psychology is sine qua back to be with family members. In non in facilitating and maintaining other words, despite ensuring quality occupational safety, and health among work, Industrial and Organizational employees by having great concerns to Psychologist also work to ensure their interaction with machinery objects employees’ quality off-the-job that they handle at work. activities. In short, Industrial and Organizational psychologist help The need of Industrial and Organizational employees to achieve well-being both at Psychology in Malaysia work and home. Historically, Industrial and(6) Ergonomic – Literally means work law, Organizational Psychology starts as a specialty ergonomic is defined by Goetsch (1999) area in 1946 as industrial psychology when the as ‘the science of conforming the Division of Industrial Psychology of the workplace and all its elements to the American Psychological Association was worker’ (p145). At a workplace, established (Munchinsky, 2000). Industrial and employees deal with equipments to Organizational Psychology was not so labelled expedite their work or to accomplish before that, especially in the early years (1900- 66
  • 1916), although there were scholars who focused that changes in human work-related activities areon psychology applied to work. A Psychologist also of never-ending phenomena. Right from thenamed W.L. Bryan published a paper about industrialization era to the informationtelegraphers work activities in 1897, which was communication technology era, there have beenpresented to the American Psychological many demands on efficient management ofAssociation in 1903. Another important figure is behaviours and cognitive processes of employeesWalter Dill Scott who applied psychology to at work so as to meet the challenges imposed byadvertising, personnel selection and management the world of work. Following this line ofissues (Schultz and Schultz, 2002). The development the application of Psychology atdevelopment of Industrial and Organizational workplaces, or the need for Industrial andPsychology became more rapid in the World Organizational Psychologist in MalaysianWar 1, and kept on becoming more important in workforce is definitely vital. The expertise ofthe World War 2 when the Unites States Army Industrial and Organizational Psychologists’ isinvolved psychologists in screening and vital in helping the management to tackle variousclassifying millions of recruits for military human behaviours and their cognitive patterns soservices. The Hawthorne studies, Scientific as to correspond to the manpower needs at aManagement approach, Human Relation particular time or in a particular organization.approach, or Classical Organizational theory are The role of a personnel discharging theimportant milestones in the development of duties of Industrial and OrganizationalIndustrial and Organizational Psychology field. Psychology is definitely very crucial in anyIn 1965 the American Psychologist described organization as it involves matters pertaining tothree core domains of Work and Organizational the management of human resources, theirPsychologists which are personnel psychology, welfare, safety and health. However, thehuman factor psychology, and industrial social profession as Industrial and Organizationalpsychology (later known as Organizational Psychologist has yet to become an important jobPsychology). The industrial clinical psychology in many countries, or perhaps not even listed as aand marketing psychology were later become the post in an organization. In Malaysia, the field ofnew domains in the guideline for the training of Industrial and Organizational Psychology isWork and Organizational Psychologists (Wolff, rather new though it has been long offered in a1998). Guion (1965) included engineering few educational institutions in the nation. In thispsychology, military psychology, consumer regard, the inclusion of professionals that handlepsychology, personnel psychology and industrial such an important matter in the Malaysianand organizational psychology in the profession. Standard Classification of Occupation (1998)Other new domains mentioned in Wolff (1998) indicates that Malaysia does need Industrial andare ergonomics, work and health, stress Organizational Psychologists in her rapidlymanagement, traffic psychology, managerial growing workforces.psychology, career guidance, and automation. In Malaysia, the role of Industrial and In Malaysia, during the early 1980’s, Organizational Psychologist is very crucial in thethe role played by Psychology was relatively sense that they can help Malaysia achieve theminor. In 1983, Ward reported that they were aim to become a developed country in its ownonly 23 Psychologists who were imported to fill Malaysian model. MASCO has classified thethe needs of Malaysia’s growing technological, occupational personnel as Main Group 2, giveneducational advances, and industrial the title of professional. The title given to thosedevelopment. For most of the history of involved in managing occupation-related mattersPsychology in Malaysia, focus has been so far is the Personnel and Career Professional (groupconfined to areas such as education and 243). The book outlines the functions of thecounselling making psychology as a profession professional whose specifications befit those ofwhich is still in its infatuation stage. The the areas covered in Industrial andinexhaustible changes in human life, Organizational Psychology. The functions, whichcharacterized by political, economic, correspond to the six dimensions, are outlined ingeographical and social variables give the notion the following table. 67
  • imperative in Malaysia, as the professionals haveThe need for Industrial and Organizational been equipped to be culturally sensitive, orPsychologists in Malaysian Industrial Sectors. having the ability to be alert to the needs and behaviours of locals; and culturally fluent who, Work in a particular culture must be or the ability to understand people from differentviewed according to the culture’s own value. In culture, and to work in diverse internationalthis relation, Psychologists practicing in environment (Dubrin, 2001)industrial sectors in a particular country must On the one hand, it is no doubt thattake local values into account in their human some human resource managements used in theresource exercises. In the case of Malaysia, it has West are exceptional, but on the other hand, itsbeen clearly advocated and agreed that the implementation in this nation may not be ascountry would achieve the status of developed superb as they are in their original culture. Tocountry in its own shape. Hence, it is of give reason, the way a foreign human resourceimportant concerns that due considerations be technique functions, and is accepted are differentgiven when thinking of, and recommending from the way it works and accepted here for theinterventions for workforce in Malaysia. The different characteristics the managers andprofessionals in charge of workforce must value employees in both societies have. Malaysians arehuman factors in work activities by not relatively higher in both power distance andneglecting the cultural dimension of Malaysians collectivistic dimensions, as opposed to those ofbefore introducing and implementing any the people in the Western countries.culturally bound system in Malaysian Nevertheless, since the human resourceworkplaces. This is in line with Wolff (1998) techniques practiced in those countries carrywho states that psychologists should be aware of remarkable strengths, therefore, Industrial andcultural and social economic background that can Organizational Psychologists may bring themdiffer from one country to another. The here to benefit the locals, prior to which theyfundamental cultural dimensions in all societies, must have them cross-validated so that they aresuch as have been stated by Hofstede (1984), valid and reliable to be used in this country. As awhich include power distance, result, Malaysian workforce will become ascollectivism/individualism, uncertainty competitive and efficient as the employees in theavoidance, and masculinity/femininity can help West, in addition to the desired local workthem to design intelligible and comprehensible values. In short, if a good personnel orhuman resource systems. As for the Malaysian administrative practice which originated fromcontext, there are two distinct dimensions which other culture were to be implemented inindicate significant attributes of the Malaysian Malaysia, the management must take intoworkforce, power distance and collectivism account the nature of the culture of employees in(Hoftede, 1991). Among the desired values the organizations in a related note, in the globallyamong Malaysians are a sense of cooperation, increasing society; workplaces encountermutual understanding, and respect for each other. diversity of workforces and customers orBesides that, another unique attribute of business partners. In Malaysia there are a greatMalaysians include the values of budi and number of foreign owned companies whichbahasa to mean courtesy, and respect, lending provide job opportunities to a huge number ofassistance, support, or compassion to others Malaysians. If these companies import and(Hamid, 1988). To illustrate, Abdullah, (1996) exercise human resource management productsdescribes Malays as polite, non-assertive, and from their own cultures without having themnon-aggressive when forwarding their demands. cross-validated, then the employees mayThey will not be too direct in expressing their experience cultural shock in their own countries.opinion to their superiors for involving in such a This may lead to the feeling of discomfort, or thesituation may increase the likelihood of having change of some desired values mainlyinterpersonal conflict between both parties. For characterised by high collectivistic dimension,this reason, the institution of the post ofIndustrial and Organizational psychologists is 68
  • Table 1: Dimensions in the field of Industrial and Organizational Psychology that befit MASCO’sspecification. Dimension in Industrial and MASCO’s descriptions of personnel in charge of employees or Organizational Psychology human resources1 Selection and placement Analysing accomplished jobs in organization, conducting interviews with employee, supervisors and management, and writing job specification of posts (Job analysis) Giving advice, and discharging the recruitment and selection of personnel; placement of employees.2 Training and Development: Conducting training-needs analysis; identifying employees who require training or retraining; identifying area that need training; and training new employees; facilitating transfer of training; Giving advice on career advancement, career decision-making, opportunity to upgrade knowledge, or advanced training.3 Performance appraisal Designing and conducting performance appraisal, managing promotion, and compensation; maintaining personnel records and human resources database4 Organization development Determining training needs in organization; giving advice, and implementing tasks on work-related aspects, which include job analysis, personnel administration, research and human resource planning; training or career information and vocational counseling.5 Quality of Worklife Assessing and giving advice to individuals on career opportunity and career decision making including career related personal problems of students, their study problems as well as special needs Publishing employee handbook on work procedure, policies (e.g safety, quality, environment policies). employee-employer relation6 Ergonomic Group number 315 (Unit 3152) in Masco states a profession featured to care for occupational Safety, Health, and Quality. It covers machines, building, object handing, and work processes meet the specified standards.which may be phased out by individualistic and Organizational Psychologist is, hence,dimension among employees. Thus, it is assumed imperative to inculcate cultural sensitivity amongthat the presence of foreign administrative expatriates who are managing local workforces.personnel in Malaysian workforce may create a In this case, Abdullah (1996) further said that “asnumber of implications particularly if they were we respond to the demands of global workplace,to adopt the human resources techniques some of the new work-related values such aspracticed in their parent organizations. Expatriate competitiveness, assertiveness and challengingbringing their native management style adapt to existing ways of getting things done may belocal needs and culture before using them in initially discomforting for most of us, especiallylocal organizations. The expertise of Industrial the Malays, as we have not internalized them at 69
  • an early age.” (p.17). It is expected that the seeking activities. Adultery, drug-consumption,presence of Industrial and Organizational alcohol-abuse, partying, abandonment of babies,Psychologist in such organizations help the and other immoral activities have been reportedexpatriate to understand, learn, and practice the to be rampant among young workforce stayingculture of the locals, thus promoting respects apart from their family members. On this note,among multicultural employees, which in turn Industrial and Organizational Psychologist mustwould enhance the job satisfaction of employees be there in workplaces to help guide, educate,and their productivity. The end result would be and help the workers to adapt themselves at workthe high productivity of the organization. as well as after their working hours. AlthoughIndustrial and organizational psychologist is also not really specified in the Industrial andinstrumental in making the country having a Organizational Psychologist’s role, in the interestcompetitive workforce, but in an environment of of individuals’ well-being, it would be ennoblingindustrial harmony and social justice so that any to see this professional to also oversee theintervention taken would serve their purposes, i.e welfare of the employees even after theirbringing benefit to both local employees and the working period. Preservation of unique localorganization. Undoubtedly, people in different culture and controlling the emergence ofcultures would have differences in thinking, undesirable culture are deemed important so as tofeeling, acting and the likes (Hofstede, 1991). In avoid any negative impact the foreign valuesthis relation, being multicultural, multiethnic, have on local community, thus upholding theand multi-religious in nature, Malaysian harmonious nature of the Malaysian workplace.Industrial and Organizational Psychologist The author is also of the opinion thatshould help realize the importance of Industrial and Organizational Psychologist ismulticultural integration as it links very strongly definitely needed in Malaysia to contend with thewith organizational harmony and, subsequently safety and health of employees at work. In thisenhance workers’ commitment, satisfaction and light, the post of Industrial and Organizationalmotivation. Recategorization of employees from Psychologist is very important in that it coulddifferent ethnic origin is essential in the effort to look after employees’ safety and health-relatedmake them able to work together for the affairs. An important safety issue at work can bebetterment of the organization. This would result related to sexual and racial harassment atin a multicultural organization, in which all workplaces. Industrial and Organizationalworkers will feel free to be themselves (Fine et Psychologist can create affirmative actions toal., 1995). maintain a workplace free of sexual as well as As far as employee personal racial harassment and intimidation. Besides that,developments are concerned, it is highly unsafe behaviors of employees can also beexpected that Industrial and Organizational professionally managed by this professional forPsychologist would be instrumental in guiding its occurrence may create hazards to thethe former to have healthy lifestyles and socially employees themselves and in turn implicated theacceptable norms. In the expanding industrial organization such as when accident takes place.sectors, there are bound to be difficulties in The consumption of drug at work, for instance,managing the social conducts of industrial creates harm to the employees in workplaces andemployees particularly when the majority of the consequently affects the productivity of theworkforces are youths who join job-markets after organization. Hence, the tasks to maintain safetycompleting their secondary education, or even at workplace, and keep out criminals andlower secondary education. As youngsters, they unhealthy individuals would require Industrialare vulnerable to a new culture especially the and Organizational Psychologists to come upnegative ones, featured by hedonistic attitude, with interventions in managing problems at thewhich is against the local norms. Their off-the workplace or among workers.job activities are very much shaped by the new Industrial and Organizationalenvironments, at work or residential. Left Psychologists may also offer career counseling inunguided, these employees experience cultural business setting. Osipow (1982) said that theirshock and ended up indulging in illegal pleasure- roles include counseling both the employer and 70
  • employee on issue pertaining to (1) assessing regarded as the overall goals of an organization.employee work styles, and suggest way to This social accountability approach believes thatchange ineffective work styles; (2) helping profit is nothing if employees are not valued ormanagers identify the undesirable consequences treated in the way they deserve. In this case,of work activities, such as repetitive work, forced Malaysia is in a definite need of Industrial andrelocation, and job loss; (3) helping employees Organizational Psychologist whose concern andidentify strains caused by work-related problems focus include the situational variables associatedand suggest way to manage them; (4) helping with adaptation in the business and industrialidentify organization identify hazards associated settings (Isaacson & Brown, 2000).with stress and work; (6)preparing people for The professionals also help the secondretirement or retrenchment; (7) helping part of career development of an individual,management improve the process of performance known as career management, which is theappraisal; (7) helping management to identify the institutional process. The first part is thespecial concerns of professionals such as individual process of career planning, managedsurgeons; (8) building effective team work; (9) before the individual join the organization, asdesigning and implementing substance and what has been discussed earlier. At the end of thealcohol abuse programs, and treatment programs day, the beneficiaries of the career managementfor abusers; and (10) designing and are not only the workers but the organization asimplementing programs to improve employees’ well.health. Another major justification for hiring Training of Industrial and OrganizationalIndustrial and Organizational Psychologist is to Psychologist in Malaysia.help industrial sectors in increasing their profit.For this reason, Industrial and Organizational As a discipline, psychology wasPsychologists working in corporate context must regarded as a new field in Malaysia. Psychologyhave certain desirable mindsets which encompass was first offered to students in University ofidentity, profit motive, emphasis on Malaya in the early 60’s in Education andorganizational development, and levels of Sociology programs (Wan Rafaie & Abdulevidence acceptable to decision making Halim, 1974 cited in Ward, 1983) and later in(Isaacson & Brown, 2000). It is important, Medicine (Tan & Wagner, 1971 cited in Wardtherefore, for Industrial and Organizational 1983). Obviously, the role played by PsychologyPsychologist to take on the identity of business was relatively minor before the 1980’s, aspeople first and psychologist second because reflected by the inadequate standards of publicthey are now not only concern with the psychological services and facilities (Ward,employees satisfaction but also operational 1983). The first institution to offer psychologyquality, and efficiency, customer satisfaction, program in a distinct department is themarket penetration, resource allocation, and Department of Psychology in Nationaldemonstration of impact (Wilbur & Vermilyea, University of Malaysia (or Universiti1982). This will, to some extent, put Industrial Kebangsaan Malaysia) in 1970, followed byand Organizational Psychologists in a dilemma. International Islamic University Malaysia inIn fact, in order to achieve the aim for profit, 1990. At the present time both universities andIndustrial and Organizational Psychologist must other new universities are offering Master’s andnot only pander to the organization’s interest in Doctoral degrees including the specialization inprofit but also to tackle the well being of those Industrial and Organizational Psychology. Theworking for the organization, by providing department of Psychology in UKM has beenconducive workplaces, which in turn help largely concentrating on applied psychology withworkers to enjoy working, and ultimately emphasis on industrial behaviors, apart fromincrease productivity. This argument is supported counselling and psychometric. In Internationalby Drafke & Kossen (2002) who are of the Islamic University Malaysia, students may opt toopinion that social goals should not be concentrate on courses related to Industrial andconsidered as competition for profit but also Organizational Psychology during undergraduate 71
  • level. At postgraduate levels the Department market. Being professionals who master theoffers a specialization in Industrial and knowledge of human behavior and cognitiveOrganizational Psychology. The Faculty of processes, Industrial and OrganizationalCognitive Science and Human Development in Psychologists can provide great assistance inUniversity of Malaysia in Sarawak offer providing relevant human resources that suit theindustrial and organizational psychology needs of a particular workplace or organization.programs at undergraduate level. The programs In Malaysia, the role of Industrial andoffer a choice of specializations which are Organizational Psychologist is very crucial in thecognitive science (which includes human sense that they can help Malaysia achieve themachine interface), human resource aim to become a developed country in its owndevelopment, and organizational counselling. Malaysian model.Besides that, the university also conducts Now, with the more rapid growth ofprograms at postgraduate levels. The School of industrialization, and higher rate of employmentPsychology and Social Work in University of as well as employable citizens, Industrial andMalaysia in Sabah offers a specialization in Organizational Psychology must become aIndustrial and Organizational Psychology. critical profession to Malaysia, the same way weUniversity of Northern Malaysia offers industrial regard health care professionals as criticaland organizational psychology related courses in personnel. On the premise of enhancingits School of Management, and School of Social individual well-being, one must not only concernDevelopment. The School of Management offers the physical or biological well-beings but also onan undergraduate program in Human Resource that of the mind. Mental well-being is somewhatManagements so does the School of Social very crucial in the features of modern developedDevelopment. Malaysians for only with this quality Malaysians Though carrying different can move forward to be important players in bothnomenclatures, the institutions are actually local and international job markets. Thus, thepreparing their students with psychology-related need of Industrial and Organizationalcourses which fit the scenario of globally rapid Psychologist as a profession is deemed necessarypost industrial information era. Indeed the and practical. The training of Industrial andpresence of professional personnel to manage Organizational Psychologist would ultimatelyworkers and workplaces in today’s world of yield professionals who are equipped with thework is imperative in the sense that they would ability to promote well being among Malaysians,help serve for the betterment of workforces in in line with the effort of the country to developMalaysia. Malaysian who are, not only materially fit, but psychologically well-judged. Indeed the healthyConclusion lifestyle among Malaysians would be adequately well taken care of if the nations are supported by Lowernberg & Conrad (1998) stated established health services such as the servicesthat Industrial and Organizational Psychologist by health care provider, and also psychology caremust be prepared to deal with almost all provider which include the service of counsellor,problems involving people in organization. The social worker, and industrial and organizationaldynamic nature of the world of work requires psychologist.Psychologist to play more of the roles to predictwhat would happen in a rather unstable trend of Referenceemployment. In this case, Rafaie (2001) statedthat the changes of industrial era to quaternary Abdullah, A. (1996) Going Local: Culturalera featured by globalization, diversified Dimensions in Malaysian Management,workforces, work teams, emerging employment Kuala Lumpur: Malaysian Institute ofrelationship, and information technology, have Management.put high demands on psychologists to help Armstrong, M. (1984) A Handbook of PersonnelMalaysians adjust so that there are fit into the Management Practice, London: Koganchanges that are continuously taking place in job Page. 72
  • Aziz, N.L, Ann, T.B., Nor,G.M., Sin, H.W., Lowernberg, G. & Conrad, K.A. (1998) Current Kheng, K.S., & Peng, T.N. (1980) Culture Perspectives in Industrial/ Organizational and Fertility: The case of Malaysia. Psychology. Boston; Allyn and Bacon. Singapore: Institute of South East Asian Munchinsky, P.M. (2000) Psychology Applied to Studies. Work. Belmont: WadsworthBrehm, S.S. & Kassin, S.M., (1996) Social Osipow, S.H. (1982) Counselling Psychology: Psychology, Boston: Houghton Mifflin Applications in the world of work. TheBaron, R.A., & Byrne, D. (2000). Social Counselling Psychologist, 10, 19-25 psychology: Understanding human Riggio, R.E. (2000) Introduction to Industrial interaction. Boston, MA: Allyn & Bacon and Organizational Psychology. NewCascio, W.F. (1998) Applied Psychology in Jersey: Prentice Hall. Human Resource Management, New Jersey: Schultz D. and Schultz, S. E (2002) Psychology Prentice Hall and Work Today, New Jersey: Prentice HallCoovert, M.D. (1995) Technological Changes in Tan, E.S. & Wagner, N (1971) Psychiatry in Office Bobs. In Howard, A (Ed) The Malaysia. In N. Wagner & E.S. Tan (eds.), Changing Nature of Work. San Francisco: Psychological Problems and Treatment in Jossey-Bass Malaysia. Kuala Lumpur: Universiti MalayaDepartment of Manpower, (1998) Malaysian Press Standard Classification of Occupation, Wan Rafaei Abdul Rahman & Abdul Halim Kuala Lumpur: Percetakan Nasional Othman (1974) Peranan dan OrientasiDrafke, M.W. & Kossen, S. (2002). The Human Psikologi dan Ahli-ahli Psikologi di Side of Organization, New Jersey: Prentice Malaysia. Paper presented at Conference on Hall. Peranan dan Orientasi Sains Sosial dan Ahli-Dubrin, A.J. (2001). Human Relations: ahli Sains Sosial di Malaysia, Universiti Interpersonal, Job-Oriented Skills. New Kebangsaan Malaysia. Jersey: Prentice Hall. Wan Rafaei Abdul Rahman (2001) Meeting theFine, G.A, Cook, K., & House, J. S. (1995). Challenges of the New Millennium: The Sociological perspectives on social Cross Cultural Approach, In Noraini, M.N., psychology., Boston: Allyn and Bacon Zafar, A.A., & Ashiq, A. S. (Eds.)Goetsch, D.L. (1999) Occupational Safety and Psychology for Well-Being and Self Health for Technologists, Engineers, and Actualization. Kuala Lumpur: IIUM Managers, New Jersey: Prentice Hall. Ward, C (1983) The role and status ofGreenberg, J., & Baron, R.A. (2000). Behavior in psychology in developing nations: A organizations. Boston, MA: Allyn & Bacon. Malaysian case study. Bulletin of TheGuion, R.M. (1965) Industrial psychology as an British Psychological Society, 36, 73-76 academic discipline. American Psychologist, Wilbur, C.S., & Vermilyea, C.J. (1982). Some 20, 815-821. business advice for counsellingHamid, I. (1988) Masyarakat dan Budaya psychologist. The Counselling Psychologist, Melayu. Kuala Lumpur: DBP 10, 29-30.Hofstede, G. (1991) Cultures and Organizations: Wolff, C.J (1998) The Role of the Work and Software of the mind, London: McGraw- Organizational Psychologist. In Drenth, Hill. P.J.D., Thierry, H., & Wolff, C.J. (Eds.)Hofstede, G. (1984) Culture’s Consequences: Handbook of Work and Organizational International Differences in Work-Related Psychology: Introduction to Work and Values. Beverly Hills, CA: Sage Organizational Psychology. East Sussex:Isaacson, L.E. & Brown, D. (2000) Career Psychology Press. Information, Career Counselling, and Career Development. Boston: Allyn and Bacon. 73
  • Stress Intervention Study Among Health Nursing Staff In Two Health Districts In Terengganu, Malaysia a Agus Salim MB, bNoor Hassim I, cJefferelli SB a Occupational Health Division, National Institute of Occupational Safety and Health b Department of Community Health, Medical Faculty, Universiti Kebangsaan Malaysia c Occupational Health Department, BASF Petronas Chemicals Sdn. BhdAbstract Stress is on one of the important hazards faced by nursing staff. Although various intervention methods toreduce stress have been developed, its effectiveness among Malaysian nurses has yet to be established. This studyinvolved 185 health nursing staff working at health districts Kemaman and Dungun in Terengganu. Health nursingstaff from Kemaman (n=94) was selected as intervention group whereas those from Dungun (n=91) were chosen ascontrols. Members of the intervention group were given stress awareness education. They were taught how to reducestress by relaxation methods. Teaching was conducted through lectures, practical training and providing a stressguidebook. A stress reliever card and letter reminding respondents to practice stress reduction methods were sentevery two weeks. The total intervention period was 6 weeks. The control did not receive any education on stressreduction or encouragement to practice any stress reduction techniques throughout this period. The effectiveness ofthe intervention programme was measured by comparing changes in stress symptoms scores. Stress symptoms weremeasured using a modified Personal Stress Inventory questionnaire. The study found significant reduction of stresssymptoms (42.66 ± 20.36 to 35.51 ± 22.60) in the intervention group after intervention compared to beforeintervention. However there was no significant difference in change of mean score of stress symptoms between bothgroups. Further studies need to be conducted to establish an intervention programme, which is suitable and effectivein reducing stress among health nursing staff.Key words: nurses, stress, intervention programme, education, relaxation techniquesIntroduction leave service at a relatively young age of 45 (Griffiths 1998). Work is often a significant stressor to an There are two main approaches to stressindividual. In United Kingdom, stress is the intervention programmes at work. The firstsecond to work-related musculoskeletal disorders approach focused on the modification of stressor;as an occupational health problem (Griffith whereas the second approach is to enhance the1998) and the nursing profession has been rated individual stress coping mechanism (Bellarosa &as one of the most stressful job (OPRA 2000). In Chen 1997). The modification of stressorMalaysia, a study among the Kuala Lumpur approach is easily monitored and measured.Hospital nursing staff discovered the prevalence Among all the established individual stressof stress was 49.5% (Rokiah, 1994). The management methods, the relaxation techniqueprevalence of stress among community nurses in has often shown to be most effective (Lusk 1997,Kelantan on the other hand was lower at 38.5% Tsai et al. 1993).(Majdah, 1999). Stress among nursing staff is a In spite of indications of the highconcern because it is associated with medical prevalence of stress among nurses, there have notnegligence and negative behaviour, which leads been any published studies on the effectivenessto poor quality of health services (Jones et al. of stress management programmes among1998). It is also a concern because many nursing nursing staff in Malaysia. We decided tostaff perceive that early retirement as the best undertake this study using relaxation techniquesolution to overcome stress at work and plan to as the intervention tool. 74
  • Methodology breathing exercise and progressive muscular relaxation technique (Ministry of HealthThis community intervention stress study was Malaysia 2000; Nicole 1999). A stress relieverconducted in Terengganu, Malaysia. The study card was sent out to participants in week 1, 3,was designed as in table 1. and 5 to motivate respondents to apply stress A sample size of 96 subjects per group relief techniques they were exposed to.was suggested based on sample size calculation The effectiveness of the interventionusing method proposed by Lwanga and programme was determined by comparingLameshow (1991). The sample population was changes in stress symptoms score among thenursing staff at Maternal Child Health Clinic in intervention group before and after interventionTrengganu. The exclusion criteria were those on and control group before and after intervention.study leave and maternity leave. Nursing staff in Stress symptoms were measured using aKemaman district was selected to be in the modified Personal Stress Inventory (PSI)intervention group whereas those from Dungun (Micheal, et al. 1984). The inventory consists ofwere selected as controls. Consent to participate 52 stress symptoms, which can be categorizedin study was taken from all the respondents. further into 6 physiological subscales and 5Data was collected during both the pre psychological subscales. The PSI was used byintervention period as well as the post both Rokiah (1994) and Majdah (1999) in theirintervention period, which were 6 weeks apart stress study. Data were analysed using a Stastical(table 1). Package for Social Science (SPSS). Upon completing the first phase of datacollection, the intervention group was taught Resultshow to reduce stress which included stresseducation, practicals and motivation (Table 2). There were about 229 nurses employedThe researcher carried out stress education in both health districts. Of this, 196 were eligiblethrough lectures based on a stress guidebook. for the study of which 97 were from theThe content of the lecture included definition of intervention group and 99 in control group. Thestress, stressors at work, impact of stress, and response rate after six week was 96.9% in theprinciples of stress management. Practical intervention group and 91.9% in the controltraining on relaxation techniques followed this. groups (Table 3).Two relaxation methods were used namelyTable 1 : Summary of study designGroup Sampling method First phase Intervention programme Second phase (6 weeks)Intervention Universal U1 P1 U2Control Universal U1 P0 U2Table 2: Stages of stress intervention programmeStages Activity Methods Duration Number of Frequency (minutes) participants per session 1 Stress education Lecture 90 10-15 1 2 Stress practical Practical 30-60 10-15 1 training 3 Stress motivation Letter - - 3 times (every 2 weeks) 75
  • Table 3: Subject response - pre and post interventionGroup No of nursing staff First Phase (n) Second phase (n)Intervention 111 97 94Control 118 99 91Table 4: Socio-demographic and occupational status of intervention and control groups Socio-demographic and occupational Intervention group Control group X2 P value factors (n=94) (n=91)Age < 30 42 35 2.42 0.299 30-40 24 19 > 40 28 37Marital status Married 75 68 0.68 0.411 Single / widower 19 23Number of children Nil 28 29 0.64 0.726 1-3 42 36 ≥4 23 41Family income (RM) < 1000 19 14 0.85 0.653 1001-2000 33 36 > 2000 42 41Work category Staff nurse 37 35 0.55 0.907 Community nurse 33 29 Assistant nurse 14 17 Mid-wife 10 10Duration of services in Ministry ofHealth (year) <1 15 16 4.09 0.252 1-5 25 19 6-10 14 7 > 10 38 47Duration of services on the presentunit (year) <1 34 26 11.77 0.008* 1-5 37 27 6-10 18 13 > 10 7 24History of work promotion Yes 15 16 0.09 0.769 No 79 75 There was no significant difference of At he beginning of the study, there wassocio-demographic and occupational factors no significant difference in stress symptombetween the intervention and control group scores between the intervention and controlexcept that those in the control group had been in groups (p > 0.05). After 6 weeks, there was aservice longer than those in the intervention significant reduction in stress symptoms scoregroup (table 4). from 42.65 ± 20.36 to 35.51 ± 22.60 (p < 0.05) in 76
  • the intervention group. No significant difference was conducted over a relatively short period.in stress symptoms was seen in control group. Analysis showed similar socio-demographic andThe effectiveness of the programme was then occupational characteristics between theascertained by comparing the magnitude of stress intervention and control groups. A comparison ofsymptom score changes. There was a higher stress levels between both groups prior toscore reduction in intervention group as intervention was not statistically significantly.compared to the control group. However these The effectiveness of stress interventionchanges were not statistically significant (p > programme is measured by comparing the0.05) (table 5). magnitude of stress score changes. In this study Further analysis using the General although the degree of reduction in stressLinear Model (GLM) was done to determine symptoms score was higher in the interventionpredictors of changes. The mean difference from group compared to control group but the changeall respondents was – 5.24 ± 18.07. Older age, was not statistically significant. Tsai andbeing a staff nurse and community nurse, and Swanson-Crockett (1999) however were able tohistory of work promotion were the predictors of show reduction in stress among nursing staff atscore changes (p < 0.05). Participation at the Hospital in Taiwan after 5-week participation instress intervention programme was not a an intervention programme. Muir (1997) founddeterminant factor (Table 6). The equation significant reduction in depression level amongresulted from the GLM analysis was: his study respondent who practiced the relaxation technique for one-year. Mean difference of stress symptom scores = A heterogonous population and 24.61 – 0.58 (age) – 11.20 (staff nurse) – 13.58 sampling methodology may explain why our (community nurse) – 8.15 (history of work study did not show any significant stress promotion) reduction. The target population consisted of different work categories such as staff nurses, A process evaluation of a stress community nurses, assistant nurses and mid-intervention programme was also conducted. The wives. These individuals are likely to differ inmajority of respondents perceived that stress educational background, attitude andeducation, guidebook and practical sessions were motivational level. Furthermore the respondent’sgood and effective (> 80% respondents). category was based on the type of district not theMotivation to practice the relaxation technique stress level. Although the stress levels for bothwas also high after receiving the stress reliever groups were not statistically different at thecard (table 6) phase 1 of the study but it might impact on the overall results. Process evaluation of theDiscussion intervention programme indicated it was well designed and executed. In intervention studies, the response rate We believe the findings that theand percentage of respondents retained association between stress scores with age,throughout the study is important. We managed employment as either a staff nurse or communityto achieve this because the nursing staffs in this nurse and history of work promotion are relatedstudy were confined to their clinics and the studyTable 5: Mean difference of stress score symptoms between pre and post intervention Mean difference pos – pre (sd) p value Variable Intervention group Control group (n=94) (n=91)Stress symptoms score - 7.14 (18.78) - 3.27 (17.20) 0.15Statistical analysis: paired t-test (p > 0.05) 77
  • Table 6: Motivation to practice relaxation technique after receiving the stress reliever card (n=94) Motivation to practice Yes (%) No (%) Stress reliever card 1 87 (92.6%) 7 (7.4%) 2 81 (86.2%) 13 (13.8%) 3 83 (88.3%) 11 (11.7%)to the good coping mechanism, educational di Negeri Kelantan. Tesis Sarjana. Universitistatus, working experience and work motivation Kebangsaan Malaysia.which are known) factors influencing stress McLeroy. K.R., Green.L.W., Mullen. K.D. &(Callan, 1993) Foshee.V (1984). Assessing the effects of For future studies of stress intervention health promotion in worksites: a review ofprogrammes, we suggest conducting intervention the stress programme evaluation. Healthsessions for smaller groups per session, utilizing Education Quaterly. 11(4):379-401.multi-intervention techniques (McLeroy et al., Micheal. P.O., Dennis. T.J. & Patricia. Z.W.1984) and having a longer intervention and (1984). Stress assessment. In. Micheal.P.Ofollow up study period. & Thomas.H.A (editor). Health promotion in the workplace, page 185-220. New York:References John Willey & Sons. Ministry of Health Malaysia. 2000. TrainingBellarosa C., & Chen P.Y. (1997). The package promotion of mental health, healthy effectiveness and practicality of lifestyle campaign 2000 – mental health life occupational stress management skills working adults. intervention: a survey of subject matter Muir. J. (1997). Stress in the community : expert opinion. Journal of Occupational teaching relaxation. Nursing standard. Health Psychology. 5(1):156-163 11(51):36-38.Callan V.J. (1993). Individual and organizational Nicole. C.K.J. (1999). Guidelines on relaxation strategies for coping with organizational techniques. Psychiatric departments, change. Work and Stress. 7(1):63-75 Hospital Universiti Kebangsaan Malaysia.Griffith. A. (1998). Work-related illness in Great Occupational Physician Reporting Activity Britain. Work and Stress. 12(1):1-5 (OPRA). ( 2000). Quarterly report. AJones. J.W., Barge. B.N., Steffy. B.D., Fay. constituent scheme of the Occupational L.M., Kunz.L.K. & Wueber. I.J. (1988). Disease Intelligence Network (ODIN). Stress and medical malpractices: Manchester, England. organizational risk assessment and Rokiah. M. (1994). Prevalens tekanan dan intervention. Journal of Applied Psychology. penyebab tekanan kerja di kalangan 73(4): 727-733 jururawat terlatih Hospital Kuala Lumpur.Lwanga. S.K & Lemeshow. S (1991). Sample Tesis Sarjana. Universiti Kebangsaan size determination in health studies. Geneva: Malaysia. World Health Organization. Tsai. S. & Swanson-Crockett. M. (1993).Lusk. S.L. (1997). Health effects of stress Effects o relaxation training, combining management in the worksite. AAOHN imagery, and meditation on the stress level Journal. 45(3): 149-152. of Chinese nurses working in modernMajdah. M. (1999). Prevalens stres dan factor hospitals in Taiwan. Issues in Mental Health pekerjaan di kalangan jururawat masyarakat Nursing. 14:51-66. 78
  • Road Safety Audit: An Exploratory Study a Veera Pandiyan Kaliani Sundram, bV.G.R. Chandran Govindaraju, c Nagatheesan V. Marimuthu a Department of Marketing, Faculty of Business and Management, University Technology of MARA b Department of Economics, Faculty of Business and Management, University Technology of MARA c Occupational Safety and Health Executive in Shell Refining Company (F.O.M) BerhadAbstract A road safety audit is a formal examination of an existing or future road or traffic project, or any projectthat interacts with road users, in which independent, qualified examiners look at the projects crash potential andsafety performance. The objectives of road safety audit are to identify potential safety risks for road users and toensure that measures to eliminate or reduce the risks are fully considered. Road safety audit works in two ways toensure that safety is improved, namely by removing preventable crash producing elements at the design stage and bymitigating the effects of any remaining risks by the inclusion of suitable crash-reducing elements. The present paperfocuses on providing a preliminary or basic understanding of the Road safety Audit. Later the discussion is precededfurther to the important elements and the various stages in the Road Safety Audit. Finally, the conclusion focusesbriefly on the implementation of the Road Safety Audit, which can only be successful if the members of the AuditTeam possess sufficient specialized professional knowledge and other virtues.Key words: road safety audit, road accident, road safetyIntroduction There are several crucial measurements taken by our government through Road Branch According to the World Health of the Public Works Department (PWD),Organization (WHO) reported road accidents Highway Planning Unit (HPU), and Roadhave been projected to be the third highest global Engineering Association of Malaysia (REAM) tokiller by 2020, after heart disease and depression, increase the road safety, hence reduce accidentand road accidents were a major public health and its fatality rate. Among the recommendationproblem in Asia and the Pacific with some 10 given by our Economic Planning Unit to enhancemillion people severely injured or killed annually safety measurement was Road Safety Audit.in Asia. WHO also estimates that if current Road Safety Audit is needed to ensure potentialtrends continue, the problem (road accidents) hazards, which are preventable, are not present inwill be the third highest global cause of disease a completed road scheme (HPU, 1998).or injury by 2020. Last year, there were 6,282 fatalities Road Safety Auditdue to road accidents in Malaysia with thehighest percentage of deaths involving Road safety issues are rather a complexmotorcyclists (50.4 per cent), Although last engineering and behavioral problem. Theyears death rate had declined from 8.2 per respective problems are affected by numerous10,000 registered vehicles in 1996 to 4.9 per variables such as human factor, vehicle10,000, the figure was still high if seen from a performance, road condition and environment.comparative index of one to two fatalities per Many countries always pay great attentions to10,000 registered vehicles achieved by road safety issues. Research works are beendeveloped countries like the United States, carried out assiduously by countries of all levelUnited Kingdom, Japan and Australia. of development status to address and apprehend(BERNAMA, 2004) the road safety problems. They pay greater attention to the both technical measures and road 79
  • safety policies. For improving road safety in the principles to the design of a new or a modifiedlate 80s, UK developed a systematic road safety road section to prevent future accidents occurringaudit procedure. Road safety audit was also or to reduce their severity. The procedure isapplied in Australia, New Zealand, Sweden and usually carried out at some or all of five stages inMalaysia etc. (Guo et al., 2003). carrying out a scheme: feasibility study, draft The procedure of road safety audit design, detailed design, pre-opening and a few(RSA), which originated in Great Britain and is months after opening. An essential element ofnow being spread in several countries around the the process is that it is carried out independentlyworld, can be incorporated in the framework of of the design team. It should be undertaken by adesigning, constructing, and operating road team of people who have experience and up-to-infrastructure as a means for preventing date expertise in road safety engineering andaccidents. RSA, which can be applied to both accident investigation.new and existing road facilities, is typicallycarried out by an independent team consisting of The Purpose Of Road Safety Audithighway engineers and/ or traffic safety experts. The paramount aim or objectives ofWhat Is Road Safety Audit? RSA is to ensure the existing and new roads and traffic schemes are safe to operate at any time. A Road Safety Audit is a series of As mentioned earlier in this paper, the safetyformal checks of road and traffic works, both concern is fostered throughout the life cycle ofexisting and future, in relation to their accident the respective road projects. This means thatpotential and safety performance. Recall the safety should be considered throughout theAustralian handbook’s definition of the Road whole preparation and construction of anysafety Audit: “ a formal examination of an project" (IHT, 1996). More specific aims are:existing or future road or traffic project, or any • To minimize the number and severity ofproject which interacts with road users, in which accidents that will occur on the existingan independent, qualified examiner reports on the and new road;project’s accident potential and safety • To avoid the possibility of the schemeperformance (Austroads, 1994). giving rise to accidents elsewhere in the Road safety audits are concerned with road network; andthe safety of all road users -motorists, • To enable all kinds of users of the newpedestrians, and bicyclists -- and are sometimes or modified road to perceive clearlyperformed during all stages of a project, how to use it safely.regardless of size or type. The Road Safety Audit Whatever the reason for the scheme, a safetyProgram (RSAP) is a useful device for audit always begins with a road design. An auditidentification of potential safety improvement in is intended to identify potential road safetystreet, roads and vehicular thoroughfares. problems by looking at the scheme as if throughHowever, other road safety exist which appear to the eyes of the potential users of all kinds, and toaccomplish this sane goal of improving road make suggestions for solving these problems bysafety applying the principles of road safety engineering (AUSTROADS, 1994; Danish RoadElements In Road Safety Audit Directorate, 1993; IHT, 1996). This means that an audit goes much farther than just assessing According to this concept, all safety whether or not the relevant design standards areissues should be examined during the life cycle properly applied.of the road, which includes the planning, design, By minimizing at the design stage theconstruction, maintenance and operation stages. risk of accidents during the lifetime of a roadThe scope of safety audit is usually confined to scheme, there is less likelihood of having to takean individual road scheme, which may be a new accident remedial measures later, and the whole-road or modification to an existing road. The life cost of the scheme can be reduced.basis for safety audit is the application of safety 80
  • Stages Of Road Safety Audit attention should help everyone involved in making decisions regarding changes to road The process of safety audit as applied to an infrastructure to assess the safety implications ofindividual road scheme can be seen as taking the many choices that arise during the designplace at up to five stages (Wrisberg and Nilsson, process, and thus increase the road safety1996), some of which can be combined for awareness of infrastructure planners, designerssmaller schemes: and authorities.• Planning. During this stage, the nature and The essence of road safety audit is that extent of the scheme are assessed, and the it is carried out by auditors who are independent starting points for the actual design are of the design team, have expertise in both determined, such as route options, the highway design and road safety, and are properly relevant design standards, the relationship of trained and experienced in carrying out audits. the scheme to the existing road network, the This means that not only must they possess number and type of intersections, and sufficient specialized professional knowledge whether or not any new road is to be open to and have the required experience, but they must all kinds of traffic. also possess the communication skills necessary• Preliminary design. Horizontal and vertical to present audit results constructively and alignments and junction layout are broadly encourage a positive response to them from the determined. At the completion of this stage, design team. the design should be well enough established The cost of implementing the accepted so that, if necessary, decisions can be made suggestions from RSA (including re-design) may about land acquisition. be relatively low and manageable, inline with the• Detailed design. Layout, signing, marking, definition of RSA, which suggestions need to be lighting, other roadside equipment and compatible and cost-effective relative to the landscaping are determined. phase of the projects.• Pre-opening stage. Immediately before the opening, a new or modified road should be References driven, cycled and walked. It is advisable to do this under different conditions such as AUSTROADS, (1994) Road Safety Audit, darkness and bad weather. Sydney, AUSTROADS National Office.• Monitoring of the road in use. When a new Danish Road Directorate (1993) Safety Audit or improved road has been in operation for a Handbook, Copenhagen: Danish Road few months, it is possible to assess whether Directorate. it is being used as intended and whether any Guo, Z., Gao, J. and Kong, L. (2003) ‘The road adjustments to the design are required in the safety situation investigation and light of the actual behavior of the users. characteristics analysis of black spot ofChecklists have been designed for use during arterials highways’, International Journal ofeach stage of auditing. (AUSTROADS, 1994; Advances in Transportation Studies, Sec A:IHT, 1996). In practice, these checklists have 1,9-20.proved very useful as reminders for the auditors, Fai Azz J.K., (2004) BERNAMA, dated 27 Julbut there is also a risk that they are used too 2004blindly as recipes without sufficient Highway Planning Unit, (1998) Quality of Roadsconsideration for individual situations. What is in Malaysia, Road Safety Report, Economicrequired is a combination of judgment, skill and Planning Unit, Prime Minister’s Department,systematic working. Kuala Lumpur. IHT, (1996) Guidelines for Road Safety Audit,Conclusion London, England. Wrisberg, J., Nilsson, P.K. (1996) Safety Audit in Road safety audit is an important means Denmark - a cost-effective activity.for paying explicit attention to road safety during Copenhagen: Danish Road Directorate.the design of road schemes. This explicit 81
  • A Report On Needle Stick Injuries For The Year 2000 Lim Jac Fang Occupational and Environmental Health Unit, Department of Health, SabahIntroduction Important elements of an overall prevention Workers in the health care industry and strategy include the following:related occupations are at risk of occupationalexposure to blood borne pathogens, including • Engineering controls (an example is thehuman immunodeficiency virus (HIV), hepatitis use of safer needle-bearing products).B virus (HBV), hepatitis C virus (HCV), and • Organizational controls (examples areother potentially infectious agents. the elimination of unnecessary sharps The primary route of occupational and training in the use of sharpsexposure to blood borne pathogens is accidental disposal containers).percutaneous (through the skin) injury. Health • Surveillance of NSIs to assess theircare workers handle sharp devices and frequency and circumstances.equipment such as hypodermic and sutureneedles, intravenous blood collection devices, Methodologyphlebotomy devices, and scalpels. Health careworkers with the most involvement in direct A total of forty seven cases of NSIspatient care e.g., nursing staff, sustain the highest were reported to the occupational health unit andproportion of reported NSIs (needle stick the majority was from the hospitals. Problemsinjuries). encountered during the analysis were mainly of Many of these injuries occur after the inadequate data entry.device is used and during disposal activities. As Analysis was made with reference to themany as one-third of all sharps injuries have number of time the HCW was injured,been reported to be related to the disposal mechanism of injury, knowledge on universalprocess. The factors most often related to sharps precautions, categories of staff involved, theirinjuries include the following: years in service, parts of body injured, • Inadequate design or inappropriate percentage compliant to UICP (universal placement of the sharps disposal infection control precautions), and finally if they container. had attended any program on NSI/UICP. • Overfilling of sharps disposal containers. Category of staff • Inappropriate sharps disposal practices by the user during patient care. Nursing staff (74.47%) which includes The use of safer needle-bearing students, dental assistant etc., form the majorityproducts, worker education and training, other of those injured. Medical officers (12.77%) weremeasures for preventing sharp injuries, and the next group followed by attendants (6.38%),compliance with standard precautions for medical lab technologists (4.26%), and medicalpreventing exposure to blood borne pathogens assistants (2.13%). Attendants were injured as ashould be part of an overall strategy for result of indiscriminate disposal although they dopreventing NSIs. not by the nature of their job handle needles and sharps. 82
  • CATEGORIES OF STAFF 40 35 35 30 25 no. of cases 20 15 10 6 5 2 3 1 0 MLT MO NURSES ATTD MA categories of staff CATEGORIES OF STAFF INJURED 25 20 20 15 10 7 6 5 5 2 3 2 1 1 0 MLT MO STU. N SN ATTD DSA JM MA TANYears in service experience rather than strict adherence to standard guidelines. However, being senior does Junior staff (68.09%) was noted to be not confer protection from NSI. Standardmore prone to NSI than senior staff (31.91%). operating procedures, therefore must be followedThis is most probably due to their lack of at all times for the different work processes. 83
  • YEARS IN SERVICE 35 32 30 25 20 cases 15 15 10 5 0 < 5yrs > 5yrs ServiceKnowledge on UICP Frequency of injury A majority of the health staff (46.81%) The number of staff injured for the firstwas found to have a poor working knowledge on time (87.2%) was considerably higher than thoseUICP, 31.91% had an average score, while only who were injured more than once (12.8%). There21.28% had a good working knowledge on is an urgent need to reduce the frequency ofUICP. Twice yearly training/refresher programs injury in this category as every time they get anon NSI/UICP are recommended for all health NSI, the likelihood of being infected with thefacilities besides induction training for the various blood- borne infection increases.various categories of staff. KNOWLEDGE ON UICP 25 22 20 15 15 cases 10 10 5 0 Poor average Good Knowledge 84
  • FREQUENCY OF INJURIES 45 41 40 35 30 cases 25 20 15 10 6 5 0 >1 1st time Times Injured NUMBER OF STAFF ATTENDED COURSE 35 31 30 25 no. of cases 20 16 15 10 5 0 Attended Not Attended staff attended courseCourse attended on NSI/UICP Training and education remains one of the effective ways by which the staff can gain new Most of the affected staff (65.96%) had knowledge, update old ones and refresh forgottennot attended any training on universal ones. It is one of the pillars in occupationalprecautions and/or needle stick injuries whereas health and safety and must remain and on-going34.04% said they had attended some training. program in all facilities. 85
  • Mechanism of injury clean trays were some of the causes of injury to unsuspecting staff. 23.4% of the cases occurred Recapping contributed to the highest while carrying out the various procedures. Strictnumber of those injured in 1999. For the year adherence to standard operating procedures will2000, indiscriminate disposal (44.78%) was the help to reduce such injuries. Recappingmain mechanism by which the staff was injured. contributed 17.02% of cases while 6.38% wasNeedles were left/lost in the linen and not due to separating needles and 8.51% due to beingreported to the supervisor, used needles left in jolted/accidental while working. MECHANISM OF INJURIES 25 21 20 15 cases 11 10 8 8 5 3 0 indiscriminate procedures seperating needle recap accident/jolted disposal Mechanism of InjuryParts of body injured Compliance to UICP Working with sharps naturally exposes All of the facilities where the injury hasthe fingers and hands to injury. 80.85% of the occurred were audited for their compliance tostaff was injured on the fingers, 12.77% on the UICP. 46.81% of the place of work of the injuredhand, 4.26% and 2.13% on the foot and forearms were found to be non-compliant while 53.19%respectively. Many of the respondents stated that were satisfactory. Much more is needed to beone of the ways to reduce sharps injury was by done to reduce the incidence of NSI andusing gloves which unfortunately confers no subsequently the risk of infections to the variousprotection at all. It is a false sense of security blood-borne diseases.depending on gloves. 86
  • PART OF BODY INJURED 40 38 35 30 25 cases 20 15 10 6 5 2 1 0 0 Fingers Foot Hand Fore arm others part of body COMPLIANCE TO UICP 25 facility 22 > 85% < 85% complianceConclusion the health facilities and the awareness of the need to report all cases of injury. A total of 47 cases of NSI was reported Indiscriminate disposal of sharps by theto the occupational health unit compared to 38 staff is due to various factors chief among themcases last year. Although this increase is not is the placement and availability of sharpssignificant, it does signify that more of the staff disposal bins. It is interesting to note that whileare being made aware of the hazards posed by recapping was the main problem in 1999, it isNSI through the various activities undertaken by third on the list by mechanism of injury this year. This must surely be due to the effort by the in- charge of the various facilities in training and 87
  • educating their staff. One way to overcome the are not only placed in a corner, but also have toproblem of indiscriminate disposal is to provide dispose sharps into a somewhat narrow opening.adequate number, size for the job at hand, and They have to bend every time they want toease of disposal of sharps into the bin. dispose of sharps and this can lead to ergonomic Overfilling frequently occurs because problems when they have to repeatedly do it inthe staff cannot visualize the level in the bin and an eight hour working day. In addition, injuriesthis level is denoted by a line outside the bins. can occur in an overflowing bin when the hand isProbably a transparent area at the critical point brought to the opening of the bin. Many staff arecan be marked on to the bin, if a wholly also not aware of the method of disposal of thetransparent bin cannot be provided. Most of the bins or how they should be collected forstaff do not know what is written on the bin nor disposal.understand the symbols. This can lead to misuse One effective method for properand abuse of the bins that has been provided to placement of sharps disposal bin is to place themprotect them. Training and education again must at a height so that the contents and hence thebe emphasized as one of the effective ways to level is visible to the staff. This also reduces thedeliver safety messages. need to bend down thus reducing ergonomic Placement of the bins is of utmost problems and a healthier and safer workingimportance because frequently bins are placed environment. A suggested working model iswhere they are not accessible easily to the staff. given below and can be modified to suit theMost of the time bins are placed in a corner of different working environment. Feedback on thisthe room presumably because it is ‘dirty’ or is most welcome.contaminated. Staff have a problem when bins Eye level = 55-57cm 15 degrees An ideal standing installation height 50-55cm for sharps bin 118-120cm Line of sight 88
  • Emerging Infectious Diseases: Ministry of Health Practice & Planning Fadzilah Hj. Kamaludin Infectious Disease Surveillance Section, Ministry of Health Malaysia There are disturbing trends of emerging have existed but are rapidly increasing inand re-emerging infectious diseases, globally and incidence or geographical range 2,3.locally thus giving it a real cause of concern. In the last few years, Malaysia hadThese include diseases by agents hitherto witnessed the occurrence of several emergingunknown in human such as Severe Acute infectious diseases such as Enterovirus or HandRespiratory Syndrome (SARS) and Ebola; those Foot and Mouth Disease (HFMD), Nipahthat were purely zoonoses but had now affected encephalitis and SARS. The Anthrax scare andman such as bovine spongioform encephalitis Avian Influenza situation in neighbouring(BSE) in United Kingdom and avian influenza in countries have also alerted the Ministry of HealthVietnam and Thailand; those that were thought (MOH) and other relevant agencies to monitorto be eliminated but reappeared such as plague in these diseases at local level.India and those that begun to show reverse trends The Ministry of Health Infectioussuch as tuberculosis (TB) and malaria. Malaysia Disease Preparedness and Response Planis no exception. Viral fever EV71, addresses these threats by developing aChinkugunya, Conjunctivitis C24 variant or comprehensive strategy which include publicNipah encephalitis were local examples of health and medical responses, laboratory supportunknown or exotic infectious diseases occurring and capacity building.in recent years. Several existing surveillance systems In this age of globalization with functioning in Malaysia were reviewed,expanding air travel and industrial trade, improved and strengthened. Collaborative effortsMalaysia is vulnerable to a wide array of new from private sectors, universities and otherand resurgent infectious diseases. Apart from the relevant agencies were established anddirect health consequences on morbidity, strengthened at national, state and district levels.mortality and its staggering cost, these infections The zoonotic disease surveillance is aalso have far reaching implications upon collaborative effort with the Veterinarysustainable development, psychosocial, Department Services (VDS) and the foreigneconomic, political and global security. workers infectious disease surveillance with World Health Organisation (WHO) has FOMEMA Sdn. Bhd.defined the emerging infectious diseases as Taking advantage of the new‘those due to newly identified and previously technologies in information management,unknown infections which cause public health exchange and dissemination such as geographicalproblem either locally or internationally’. information systems (GIS), the public healthWhereas for the reemerging infectious diseases, laboratory information system (PHLIS) and thethe WHO has defined as ‘those due to the Internet, strengthening and linking withreappearance and increase of infections which established laboratories and surveillancewere known, but had formerly fallen to levels so facilities were coordinated and enhanced.low that were no longer considered as a public Regional coordination were being developedhealth problem’.1 The Institute of Medicine of the within ASEAN +3 countries; for exampleNational Academy of Sciences, U.S.A., has epidemiological surveillance is coordinated bydefined as ‘those diseases whose incidence in Thailand and strengthening laboratory capacity ishumans has increased within the past two coordinated by Malaysia. The purpose is todecades or threatens to increase in the near detect, promptly investigate and monitorfuture’. We can define ‘emerging’ as infections emerging pathogens, the disease they cause andthat have newly appeared in the population, or the factors influencing their emergence. These 89
  • findings are then shared between participating available. The designated hospitals (currently allcountries. state hospitals) will have isolation wards or Sometimes it is not possible to identify rooms and manned by general physicians andearly any specific outbreaks of emerging and re- cases referred to regional hospitals whenemerging disease until it has reached major necessary.proportions. Although the statutory notifiable The Sungai Buloh Hospital, which isdisease surveillance system is well in place, there currently under construction, will be equippedis none for the newly emerging infectious with a level 4 containment facilities. Onediseases. A newly formed syndromic approach dedicated wing of the hospital is for thesurveillance system was introduced to overcome management of infectious diseases. It isthe delay in identifying unknown etiological proposed that all states would have a mobileagents in outbreaks which may provide an Decontainment unit for outbreak management atavenue for early identification of emerging field site.disease. The syndromic approach is based on the The hospital laboratory serves as a keyrevised International Health Regulations (IHR) for surveillance of infectious pathogens. Aproduced by WHO. laboratory-based surveillance involving all state For better management of infectious hospital microbiologists reporting identifieddisease outbreaks at district, state and national infectious pathogen to MOH started in 2002.levels, MOH had developed a Preparedness This surveillance mechanism aims to provide anResponse Plan. This plan would enable the early warning system to emerging infectiousMinistry to tackle any health crisis including bio diseases from the laboratory.terrorism attacks. The plan envisages the setting Some of the agents involved in anup of Rapid Response Teams (RRT) at district, outbreak are highly pathogenic and wouldstate and national level. Standard operating require special high containment facilities forprocedure (SOP) and checklist for outbreak their processing. The infectious Diseasepreparedness were also formalized. The RRT is a Research Center (IDRC) has been set up at thepredetermined team based on expertise and Institute of Medical Research (IMR). This servesassembled by matching expertise with incident as a primary center for promoting and conductingneed. This plan would need competent field quality research and act as a training center on allepidemiologist. aspect of infectious diseases in Malaysia. The Competent public health officials with Bio safety level 3 (BSL3) facility at IMR and infield experience and trained in applied future at the National Public Health Laboratoryepidemiology, remains the most vital framework (NPHL) will enable diagnostic and researchfor successfully identifying emerging infectious work on hazardous pathogens to be conducted indiseases. MOH had recently embarked on a a manner that will protect the safety of thetraining program namely the Epidemic laboratory workers as well as the environment.Intelligence Program (EIP) to train and To establish the appropriatestrengthen the capacity and capability in infrastructure to response to a new disease threat,detection and response to outbreaks for public human resources, facilities for laboratoryhealth doctors. This program is adapted from the capacities and clinical training, communications,highly successful training program at CDC logistic support and organizational structure mustAtlanta, USA for epidemiologist. be developed. Other factors such as risk To provide maximum utilization of communication, networking and organizationalresources, hospitals and laboratories were management are also important key elements inidentified as regional and designated hospitals. combating infectious diseases.The regional hospitals were manned by In view of the recent SARS outbreak,Infectious Disease Physicians and equipped with health care workers (HCWs) were constantlyisolation wards or rooms. Medical services that is being exposed to infectious disease threats eitherutmost important in infectious disease directly or indirectly. The Occupational Healthmanagement such as respiratory, Unit under the Disease Control Division isgasteroenterology and neurology will be made constantly reviewing and improving its strategies 90
  • and activities to safe guard workers as a whole. response to emerging infectious diseases threats.Notification of occupational disease has been However political leadership at the highest levelimplemented but still much underreported. is also needed in order to mobilize the Needle stick injury among HCWs is communities to ensure speedy action andused as a quality assurance indicator for practice coordination at district, state and national level.of universal precaution and also as a proxy for Networking and collaboration with relatedHIV and Hepatitis B. TB is also an important re- agencies is also crucial for its success.emerging infectious disease among HCWs and isa caused for concern. ReferenceConclusion World Health Organisation. Emerging Infectious Diseases. World Health Organisation, 1997. Emerging infectious diseases are (http://www.who.int/archives/whday/en/docimportant and a complex health problem. It has uments1997/whd01.pdf)been shown that weak surveillance system, Morse SS, Schluederberg A. Emerging viruses:insufficient laboratory support, lack of response the evolution of viruses and viral diseases. Jand epidemiological expertise and insufficient Infect Dis 1990;162:1-7.funds usually hamper effective response against Morse SS. Examining the origins of emergingemerging infectious diseases. It is hoped that viruses. In: Morse SS, ed. Emerging viruses.with the preparedness plan, the Ministry of New York: Oxford University Press,Health Malaysia, will be constantly vigilant to 1993:10-28. 91