occupational environment, hazards and health topic related tro community health nursing

1. Anjana Thomas
GCON Kottayam

2. Occupational environment
• By "occupational environment" is meant the sum of external conditions and
influences which prevail at the place of work and which have a bearing on the
health of the working population. . Basically, there are three types of interaction
in a working environment
(a) Man and physical, chemical and biological agents
(b) Man and machine
(c) Man and man

3. Man and physical, chemical and biological agents
Physical agents
 The physical factors in the working environment which may be adverse to health are
heat, cold, humidity, air movement, heat radiation, light, noise, vibrations and
ionizing radiation.
 The factors act in different ways on the health and efficiency of the workers, singly
or in different combinations.
 The amount of working and breathing space, toilet, washing and bathing facilities are
also important factors in an occupational environment.

4. Man and physical, chemical and biological agents
Chemical agents
 These comprise a large number of chemicals, toxic dusts and gases which
are potential hazards to the health of the workers.
 Some chemical agents cause disabling respiratory illnesses, some cause
injury to skin and some may have a deleterious effect on the blood and other
organs of the body.

5. Man and physical, chemical and biological agents
Biological agents
 The workers may be exposed to viral, rickettsial, bacterial and parasitic
agents which may result from close contact with animals or their products,
contaminated water, soil or food.

6. Man and machine
 An industry or factory implies the use of machines driven by power with emphasis on
mass production.
 The unguarded machines, protruding and moving parts, poor installation of the plant,
lack of safety measures are the causes of accidents which is a major problem in
industries.
 Working for long hours in unphysiological postures is the cause of fatigue, backache,
diseases of joints and muscles and impairment of the worker's health and efficiency.

7. Man and man
 In modern occupational health, the emphasis is upon the people, the conditions in
which they live and work, their hopes and fears and their attitudes towards their
job, their fellow workers and employers
 The occupational environment of the worker cannot be considered apart from his
domestic environment. Both are complementary to each other.
 The worker takes his worries home, and brings to his work disturbances which
arise in his domestic environment.

8. Man and man
 Stress at work may disturb his sleep, just as stress at home may affect his work.
Severe prolonged stress, no matter where it has been aroused, may produce
serious physical or mental symptoms which do not allow man to work efficiently.
 According to ecological approach, occupational health represents a dynamic
equilibrium or adjustment between the industrial worker and his occupational
environment

9. Occupational hazards
An industrial worker may be exposed to five types of hazards, depending upon his
occupation
1. Physical hazards
2. Chemical hazards
3. Biological hazards
4. Mechanical hazards
5. Psychosocial hazards.

11. Heat and cold
• Direct effect of heat: Heat exhaustion, heat strokes, heat cramps
• Indirect effect of heat: Decreases efficiency, increased fatigue
and enhanced accident rates
• Cold: Chilblains, erythrocyanosis, immersion foot, frost bite

12. Light
• Poor illumination: Eyestrain, head ache, eye pain, lachrymation,
congestion around cornea, eye fatigue, miners nystagmus.
• Excessive brightness: Discomfort annoyance, visual fatigue,
blurring of vision

13. Noise
• Auditory defect – Temporary/ permenant hearing loss
• Non auditory effect- Nervousness, fatigue, interference with
communication

14. Vibration
• After long time of exposure, the fine blood vessels of the fingers
may become increasingly sensitive to spasm – white fingers

15. Radiation
• UV radiation: Intense conjunctivitis and keratitis (welders flash )
• Ionizing radiation: Genetic changes, malformations, cancer,
leukemia, depilation, ulceration, sterility and in extreme cases
death

16. BIOLOGICAL HAZARDS

17. BIOLOGICAL HAZARDS
• Workers may be exposed to infective and parasitic agents at the place
of work. The occupational diseases in this category are brucellosis,
leptospirosis, anthrax, hydatidosis, psittacosis, tetanus, encephalitis,
fungal infections, schistosomiasis and a host of others. Persons
working among animal products (e.g., hair, wool, hides) and
agricultural workers are specially exposed to biological hazards

18. MECHANICAL HAZARDS
• The mechanical hazards in industry centre round machinery,
protruding and moving parts and the like. About 10 per cent of
accidents in industry are said to be due to mechanical causes.

19. MECHANICAL HAZARDS

20. PSYCHOSOCIAL HAZARDS

21. PSYCHOSOCIAL HAZARDS
• The psychosocial hazards arise from the workers failure to adapt to an alien
psychosocial environment. Frustration, lack of job satisfaction, insecurity, poor
human relationships, emotional tension are some of the psychosocial factors
which may undermine both physical and mental health of the workers. The
capacity to adapt to different working environments is influenced by many
factors such as education, cultural background, family life, social habits, and
what the worker expects from employment.

22. Health effect of psycho social hazards
Psychological and behavior
changes
• Hostility
• Anxiety
• Depression
• Alcoholism
• Drug abuse
Psychosomatic ill health
• Fatigue
• Headache
• Pain in the shoulders, neck and
back

23. CHEMICAL HAZARDS
• Local action
• Inhalation
• Dusts
• Gases
• Metals and their compounds
• Ingestion

24. OCCUPATIONAL DISEASES
I. Diseases due to physical agents
 Heat: Heat hyperpyrexia, heat exhaustion,
 Cold: heat syncope, heat cramps, burns and local effects such as prickly heat. Trench foot, frost bite,
chilblains
 Light: Occupational cataract, miner's nystagmus: Caisson disease, air embolism, blast
 Pressure (explosion)
 Noise: Occupational deafness
 Radiation: Cancer, leukaemia, aplastic anaemia, pancytopenia
 Mechanical: Injuries, accidents factors
 Electricity: Burns.

26. 3) Metals and their compounds:
• Toxic hazards from lead, mercury, cadmium, manganese, beryllium,
arsenic, chromium etc.
4) Chemicals: Acids, alkalies, pesticides
5) Solvents: Carbon bisulphide, benzene, trichloroethylene, chloroform, etc.

27. O/D cont…
III) Diseases due to biological agents:
Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis,
psittacosis, tetanus, encephalitis, fungal infections, etc.
IV) Occupational cancers:
Cancer of skin, lungs, bladder.
V) Occupational dermatosis:
Dermatitis, eczema.
VI) Diseases of psychological origin:
Industrial neurosis, hypertension, peptic ulcer, etc.

28. PNEUMOCONIOSIS
• Dust within the size range of 0.5 to 3 micron, is a health hazard
producing, after a variable period of exposure, a lung disease
known as pneumoconiosis, which may gradually cripple a man
by reducing his working capacity due to lung fibrosis and other
complications.

29. Silicosis
• Among the occupational diseases, silicosis is the major cause of permanent
disability and mortality. It is caused by inhalation of dust containing free silica or
silicon dioxide (Si02). The incidence of silicosis depends upon the chemical
composition of the dust, size of the particles, duration of exposure and individual
susceptibility. The higher the concentration of free silica in the dust, the greater the
hazard.

30. Silicosis
• Clinical manifestations: Some of the early manifestations are irritant cough,
dyspnoea· on exertion and pain in the chest. With more advanced disease,
impairment of total lung capacity (TLC) is commonly present.
• Diagnostic measures: An X-ray of the chest shows "snow-storm" appearance in
the lung fields.
• Management: There is no effective treatment for silicosis.

31. Anthracosis
• Previously it was thought that pulmonary "anthracosis" was inert. Studies indicate
that there are two general phases in coal miner’s pneumoconiosis - (1) the first
phase is labelled simple pneumoconiosis which is associated with little
ventilatory impairment. This phase may require about 12 years of work exposure
for its development (2) the second phase is characterised by progressive massive
fibrosis (PMF); this causes severe respiratory disability and frequently results in
premature death.

32. Byssinosis
• Byssinosis is due to inhalation of cotton fibre dust over long periods of time. The
symptoms are chronic cough and progressive dyspnoea, ending in chronic
bronchitis and emphysema. India has a large textile industry employing nearly 35
per cent of the factory workers. Incidence of byssinosis is reported to be 7 to 8 per
cent in three independent surveys carried out in Mumbai, Ahmedabad and Delhi.

33. Bagassosis
• Bagassosis is the name given to an occupational disease of the lung caused by
inhalation of bagasse or sugarcane dust. . The symptoms consist of breathlessness,
cough, haemoptysis and slight fever. Initially there is acute diffuse bronchiolitis.
There is impairment of pulmonary function. If treated early, there is resolution of
the acute inflammatory condition of the lung. If left untreated, there is diffuse
fibrosis, emphysema and bronchiectasis.

34. Preventive measures
(1) dust control:
(2) personal protection:
(3) medical control:
(4) bagasse control:

35. Asbestosis
• Asbestos is of two types - serpentine or chrysolite variety and the amphibole type.
Asbestos enters the body by inhalation, and fine dust may be deposited in the
alveoli. The fibres are insoluble. The dust deposited in the lungs causes pulmonary
fibrosis leading to respiratory insufficiency and death; carcinoma of the bronchus;
mesothelioma of the pleura or peritoneum; and cancer of the gastro-intestinal
tract.The risk of bronchial cancer is reported to be high if occupational exposure to
asbestos is combined with cigarette smoking.

36. Asbestosis
• Clinically the disease is characterized by dyspnoea which is frequently out of
proportion to the clinical signs in the lungs. In advanced cases, there may be
dubbing of fingers, cardiac distress and cyanosis. The sputum shows "asbestos
bodies" which are asbestos fibres coated with fibrin. An X-ray of the chest shows a
ground-glass appearance in the lower twothirds of the lung fields.

37. Asbestosis
• The preventive measures consist of: (1) use of safer types of asbestos (chrysolite
and amosite); (2) substitution of other insulants: glass fibre, mineral wool, calcium
silicate, plastic foams, etc.; (3) rigorous dust control; (4) periodic examination of
workers; biological monitoring (clinical, X-ray, lung function), and (5) continuing
research.

38. Farmer's lung
• Farmer's lung is due to the inhalation of mouldy hay or grain dust.
Micropolyspora faeni is the main cause of farmer's lung. The acute
illness is characterized by general and respiratory symptoms and
physical signs. Repeated attacks cause pulmonary fibrosis and
inevitable pulmonary damage and corpulmonale.

39. LEAD POISONING
• Lead poisoning may occur in three ways:
• (1) INHALATION: Most cases of industrial lead poisoning is due to inhalation of
fumes and dust of lead or its compounds.
• (2) INGESTION: Poisoning by ingestion is of less common occurrence. Small
quantities of lead trapped in the upper respiratory tract may be ingested. Lead may
also be ingested in food or drink through contaminated hands.
• (3) SKIN: Absorption through skin occurs

41. LEAD POISONING
• CLINICAL PICTURE: The clinical picture of lead poisoning or plumbism is
different in the inorganic and organic lead exposures. The toxic effects of
inorganic lead exposure are abdominal colic, obstinate constipation, loss of
appetite, blue-line on the gums, stippling of red cells, anaemia, wrist drop and foot
drop. The toxic effects of organic lead compounds are mostly on the central
nervous system insomnia, headache, mental confusion, delirium, etc.

42. LEAD POISONING
• DIAGNOSIS: Diagnosis of lead poisoning is based on:
• History: a history of lead exposure
• Clinical features: such as loss of appetite, intestinal colic, persistent
headache, weakness, abdominal cramps and constipation, joint and muscular
pains, blue line on gums, anaemia, etc.
• Laboratory tests: Body stores is about 150-400mg, blood level- 25 μg/100ml.
An increase of 70 μg is associated with clinical symptom

43. LEAD POISONING
• PREVENTIVE MEASURES
(1) Substitution: That is, where possible lead compounds should be substituted by
less toxic materials.
(2) Isolation: All processes which give rise to harmful concentration of lead dust or
fumes should be enclosed and segregated.
(3) Local exhaust ventilation: There should be adequate local exhaust ventilation
system to remove fumes and dust promptly

44. LEAD POISONING
(4) Personal protection: Workers should be protected by approved respirators.
(5) Good house-keeping: Good house-keeping is essential where lead dust is
present. Floors, benches, machines should be kept clean by wet sweeping.
(6) Working atmosphere: Lead concentration in the working atmosphere should be
kept below 2.0 mg per 10 cu. metres of air, which is usually the permissible limit or
threshold value.

45. LEAD POISONING
(7) Periodic examination of workers: All workers must be given periodical medical
examination. Laboratory determination of urinary lead, blood lead, red cell count,
haemoglobin estimation and coproporphyrin test of urine should be done periodically
(8) Personal hygiene: Handwashing before eating is an important measure of personal
hygiene. There should be adequate washing facilities in industry. Prohibition on taking
food in work places is essential.
(9) Health education: Workers should be educated on the risks involved and personal
protection measures.

46. LEAD POISONING
(10) Treatment:
• Saline purge – will remove unabsorbed lead from gut
• Use of d-pencillamine
• Ca – EDTA(chelating agent) promote lead excretion in urine

47. OCCUPATIONAL CANCER
• Skin cancer – hazard of gas workers, coke oven workers, tar distilleries, oil
refineries , road makers
• Lung cancer – gas, asbestos industry, nickel and chromium work, arsenic
plants
• Cancer bladder – aniline, rubber, dying industry, electric cable industry
• Leukaemia – exposure to benzol, roentgen rays, radioactive substance

51. Control of industrial cancer
(1) elimination or control of industrial carcinogens. Technical measures like exclusion of the carcinogen from the
industry, well-designed building or machinery, closed system of production, etc.,
(2) medical examinations
(3) inspection of factories
(4) notification
(5) licensing of establishments
(6) personal hygiene measures
(7) education of workers and management
(8) research.

52. OCCUPATIONAL DERMATITIS
• Occupational dermatitis is a big health problem in many industries.
• The causes may be;
• Physical - heat, cold, moisture, friction, pressure, X-rays and other rays
• Chemical - acids, alkalies, dyes, solvents, grease, tar, pitch, chlorinated phenols etc.
• Biological - living agents such as viruses, bacteria, fungi and other parasites; Plant products
leaves, vegetables, fruits, flowers, vegetable dust, etc.

54. Occupational dermatitis
• The dermatitis-producing agents are further classified into:
(1) primary irritants
(2) sensitizing substances.
Primary irritants (e.g. acids, alkalies, dyes, solvents, etc.) cause dermatitis in workers exposed
in sufficient concentration and for a long enough period of time. On the other hand, allergic
dermatitis occurs only in small percentage of cases, due to sensitization of the skin.

55. Occupational dermatitis- prevention
(1) Pre-selection:
(2) Protection
(3) Personal hygiene
(4) Periodic inspection

56. OCCUPATIONAL DISEASES - RADIATION HAZARDS
• .Exposure to radium also occurs in mining of radio-active ores, monozite sand
workers and handling of their products.
• Exposure to ultraviolet rays occurs in arc and other electric welding processes.
• Infrared rays are produced in welding, glass blowing, foundry work and other
processes where metal and glass are heated to the molten state, and in heating and
drying of painted and lacquered objects.

57. OCCUPATIONAL DISEASES RADIATION
HAZARDS
• Preventive measures
(1) Inhalation, swallowing or direct contact with the skin should be avoided.
(2) In case of X-rays, shielding should be used of such thickness and of such material as
to reduce the exposure below allowable exposures.
(3) The employees should be monitored at intervals not exceeding 6 months by use of the
film badge or pocket electrometer devices.
(4) Suitable protective clothing to prevent contact with harmful material should be used.

58. OCCUPATIONAL DISEASES RADIATION
HAZARDS
(5) Adequate ventilation of work-place is necessary to prevent inhalation of harmful
gases and dusts.
(6) Replacement and periodic examination of workers should be done every 2
months. If harmful effects are found, the employees should be transferred to work
not involving exposure to radiation,
(7) Pregnant women should not be allowed to work in places where there is
continuous exposure.

59. OCCUPATIONAL HAZARDS- AGRICULTURAL
WORKERS
1. Zoonotic diseases: Brucellosis, anthrax,leptospirosis
2. Accidents: insect bite, snake bite
3. Toxic hazards: Toxic hazards from fertilizers, insecticides or
pesticides
4. Physical hazards: due to temperature, humidity, solar radiation
5. Respiratory diseases

60. ACCIDENTS IN INDUSTRY
• HUMAN FACTORS:
• Physical – physical capacities
• Physiological – sex, age, time, experience, working hours
• Psychological – carelessness, ignorance
• ENVIRONMENTAL FACTORS
• Temperature, ventilation, noise

62. Accident prevention
(1) Adequate preplacement examination.
(2) Adequate job training.
(3) Continuing education.
(4) Ensuring safe working environment.
(5) Establishing a safety department in the organization under a competent safety engineer.
(6) Periodic surveys for finding out hazards.
(7) Careful reporting, maintenance of records and publicity

63. Conclusion
• Injuries and diseases in the workplace are unfortunately very
common. Whether they are a laceration on the arm from a lathe,
inhalation of asbestos over a period of years or a stumble down
the stairs while visiting the vending machine, they can run the
gamut and all deserve to be validated.

64. SICKNESS/ ABSENTECISM
• CAUSES
1. Economic causes
2. Social
3. Medical
4. Non occupational causes

65. SICKNESS/ ABSENTECISM
• PREVENTION
• Good factory, management and practices
• Adequate preplacement examination
• Good human relations application of ergonomics

66. HEALTH PROBLEMS DUE TO INDUSTRALISATION
1. Environmental sanitation problem
1. Housing
2. Water pollution
3. Air pollution
4. Sewage disposal
2. Communicable disease
3. Food sanitation
4. Mental health
5. Accidents
6. Social problems
7. Mortality & morbidity

67. MEASURES FOR HEALTH PROTECTION
1. Nutrition
2. Communicable d/s control
3. Environmental sanitation
1. Water supply
2. Food
3. Toilet
4. General plant cleanliness
5. Sufficient space
6. Ventilation and temperature
7. Protection against hazards
8. Housing
4. Mental health
5. Measures for women and children
6. Health education
7. Family planning

68. PREVENTION OF OCCUPAATIONAL DISEASES
1. MEDICAL
2. ENGINEERING
3. STATUTORY / LEGISLATIVE

69. 1. Medical measures
• Preplacement examination
• periodical examination
• Medical and health care services
• Notification
• Supervision of working environment
• Maintenance and analysis of record
• Health education and counselling

70. 2. Engineering measures
• Design of building
• Good housekeeping
• General ventilation
• Mechanization
• Substitution
• Dust
• Enclosure
• Isolation
• Local exhaust ventation
• Protective devices
• Environmental monitoring
• Statistical monitoring
• Research

71. 3. Legislation
• The factories act – 1948
• The employees state insurance act
• The plantation act
• The minimum wages act
• The maternity benefit act

72. The factories act - 1948
• Scope
• Health, safety and welfare
• Employment of young persons
• Hours of work
• Leave with wages
• Occupational diseases
• Employment in hazardous processes

73. The employees sate insurance act
• Small factories employees 10 or more personal
• Shops
• Hotels and restaurants
• Cinemas and theatres
• Road motor transport establishments
• News paper establishment private medical and educational
institution employing 20 or more

74. Benefits to employees
• Medical benefit
• Sickness benefir
• Maternity benefit
• Disablement benefit
• Dependants benefit
• Funeral expenses
• Rehabilitation allowances

75. Benefit to employer
• Exemption from the applicability of workmen’s compensation act
1923
• Exemption from maternity benefit act 1961
• exemption from payment of medical allowance to employees and
their dependents or arrangeing for their medical care
• Rebate under the income tax act on contribution deposited in the
ESI account
• Healthy workforce

76. RAJIV GANDHI SHRAMIK KALYAN YOJNA
• Under the Scheme, an Insured Person/Insured Woman going out of
employment after being insured three or more years due to closure of the
Factory/Establishment as defined under the Industrial Disputes Act,
involuntary retrenchment or permanent invalidity, are entitled to :
• Unemployment Allowance equal to 50% of the wage for a maximum period
of two years and 25% of the average salary from the 13th to 24th months,
subject to fulfilment of eligibility conditions.
• Medical care for self and family from ESI Hospitals/ Dispensaries during the
period IP receives unemployment allowances.
• Vocational training provided for upgrading skills- Expenditure on fee/
travelling allowance borne by ESIC

77. Thank you ……