Overview of occupational disease dr wayne ramlogan


Published on

Published in: Health & Medicine, Technology
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Overview of occupational disease dr wayne ramlogan

  1. 1. Overview of Occupational diseaseCase StudiesDrWayne RamgoolamHeadOccupational Health UnitSouthWest Regional Health Authority
  2. 2. Worldwide, occupational diseases continue to be the leadingcause of work-related deaths. 2.02 million people die each year from work-related diseases. 321,000 people die each year from occupational accidents. 160 million non-fatal work-related diseases per year. 317 million non –fatal occupational accidents per year.This means that: Every 15 seconds, a worker dies from a work-related accident ordisease. Every 15 seconds, 151 workers have a work-related accident
  3. 3.  Overview of Occupational Disease Definition Historical perspective Classification Management Prevention Case Studies
  4. 4.  Any disease contracted as a result of an exposure to risk factors arising fromwork activity.Protocol of 2002 to the Occupational Safety and Health Convention, 1981 (No.155) Diseases known to arise out of the exposure to substances and dangerousconditions in processes, trades or occupationsILO Employment Injury Benefits Recommendation, 1964 (No. 121), Paragraph6(1) Two main elements are present in the definition of an occupational disease:1. the causal relationship between exposure in a specific working environment orwork activity and a specific disease2. the fact that the disease occurs among a group of exposed persons with afrequency above the average morbidity of the rest of the population.
  6. 6.  Considered to be thefather of occupationaland industrial medicine Diseases ofWorkers(De Morbis ArtificumDiatriba)First edition - 1700Second edition - 1713
  7. 7.  published the first systematic study connecting theenvironmental hazards of specific professions to diseaseExample: lead exposure in potters and painters His book on occupational diseases outlined the healthhazards and other disease-causative agentsencountered by workers in 52 occupations. This was one of the founding and seminal works ofoccupational medicine and played a substantial role inits development. It was he who proposed that physicians should extendthe list of questions that Hippocrates recommendedthey ask their patients by adding, "What is your trade?"
  8. 8.  Chimney Sweepers’Cancer of the scrotum first to associate cancerwith occupationalexposure (1775)
  9. 9.  In what represents one of the earliestepidemiologic studies (or studies of theoccurrence and causes of disease), Pott observedthat chimney sweeps in England had higherrates of scrotal cancer than the rest of thepopulation. In doing their jobs, the chimney sweeps oftenhad to climb into chimneys and sufferedprolonged exposure to soot containingpolycyclic aromatic hydrocarbons
  10. 10.  founder of occupationalmedicine in the U.S. andthe first woman on thefaculty of HarvardMedical School took a leading role in twomajor environmentalcontroversies of the1920s involving leadedgasoline and radium dialpainters (known as the“radium girls”).
  11. 11.  The Radium Girls were female factory workers whocontracted radiation poisoning from painting watch dialswith glow-in-the-dark paint at the United States Radiumfactory in Orange, New Jersey around 1917. The women, who had been told the paint was harmless,ingested deadly amounts of radium by licking theirpaintbrushes to sharpen them; some also painted theirfingernails and teeth with the glowing substance. Five of the women challenged their employer in a casethat established the right of individual workers whocontract occupational diseases to sue their employers The litigation and media sensation surrounding the caseestablished legal precedents and triggered the enactmentof regulations governing labour safety standards
  12. 12. 19th Century Statutory medical service for factory workers▪ Factory Inspectors▪ Medical certification for children▪ Certifying Surgeons▪ Workers with exposure to lead, white phosphorus, explosives, rubber – periodicexams▪ Notification of industrial disease – lead, phosphorus, arsenic, anthrax Common law – employer liable if negligent WC legislation in Europe20th Century WC legislation in North America Development of government agencies and professional associations InternationalCongress on workers’ diseases in Milan - 1906 - ICOH
  13. 13.  Skin cancer – sunlight, tar, oils, soot, arsenic Silicosis – quarries, mines, stone cutting Coal workers’ pneumoconiosis Lead poisoning Mercury poisoning Bladder cancer – organic dyes Lung cancer –chrome, nickel, radon, asbestos
  14. 14.  Occupational diseases caused by exposure to agentsarising from work activities (Hazards) Diseases caused by chemical agentsDiseases caused by physical agentsDiseases caused by biological agents Occupational diseases by target organ systems Occupational respiratory diseasesOccupational skin diseasesOccupational musculo-skeletal disordersMental and behavioural disorders Occupational cancer Cancer caused by the following agents Other diseases
  15. 15.  Physical Chemical Biological Mechanical &Ergonomic Psychosocial
  16. 16. HAZARD EXAMPLESPhysical Noise,Vibration, Radiation, HeatChemical Dusts, Metals, Solvents, GasesBiological Human tissue & bodily fluids (blood)Microbial pathogensAnimal and animal productsErgonomic/Mechanical Lifting & handlingPoor postureRepetitionPoor equipment & workplace designPsychosocial Organizational Psychosocial FactorsHigh demandLow controlViolence and aggressionLone workingShift workNight workLong working hours
  17. 17. Target organ systems Occupational infections Respiratory & Cardiovascular disorders Skin disorders Musculoskeletal disorders GI & UrinaryTract disorders Eye disorders Neurological disorders Psychiatric disorders Reproductive disorders Haematological disorders Medically unexplained occupational disorders
  18. 18. Occupational Infections Respiratory & CardiovascularBlood borne virusesHep B,CHIVMeningococcalTuberculosisLegionnairesTetanusInfluenzaZoonosesAnthrax (cows,sheep)Glanders (horses, cats, dogs)Brucellosis (cows, sheep, goats, pigs)Lyme disease (deer)Q fever (sheep, cows goats)Orf (sheef)Occupational AsthmaCOPDHypersensitivity pneumonitisFarmer’s lung (mouldy hay, grain, straw)Bird fanciers lung (bird excreta)Mushroom workers lung (mushroom compost)Bagassosis (bagasse from sugar caneMalt workers lung (mouldy barley)Ventilation pneumonitis (water in AC systems)Metal fume feverPneumoconiosesCoal workersAsbestosisSilicosisLung cancerPleural disorders (mesothelioma)Coronary heart disease
  19. 19. Skin Musculoskeletal GI & Urinary Eye NeurologicalDermatitisContact urticariaSkin cancerPigmentationdisordersPhotodermatitissclerodermaLower back painWRULD’SCarpal tunnelTenosynovitiscapsulitisHepaticAngiosarcomaCirrhosisHepatotoxicityGI cancersRenal failureBladder cancerConjunctivitisCataractRetinal burnsBrain cancerParkinsonismOrganophosphateHAVSNIHLPsychiatric Reproductive Haematological UnexplainedPsychosesStressPTSDImpaired fertilityAdverse pregnancyBone Marrow aplasiaMethaemoglobinaemiaHaemolysisHaematological malignanciesSick buildingsyndrome
  20. 20.  Diagnosis Clinical investigation▪ Occupational history (plus routine history)▪ Identify occupational risk factors for disease / patterns of exposure▪ Understand job demands▪ Physical examination▪ Investigations (functional test of target organ)▪ Audiometry, spirometry, blood & radiological investigations Workplace investigation▪ Review job description▪ Review job task analysis▪ Visit workplace understand processes▪ Review hygiene data where available (may require furtherworkplace monitoring)
  21. 21.  Epidemiological investigationSir Bradford Hill established the following nine criteria for causation (doesfactor A cause disorder B).▪ Strength of the association. How large is the effect?▪ The consistency of the association. Has the same association beenobserved by others, in different populations, using a different method?▪ Specificity. Does altering only the cause alter the effect?▪ Temporal relationship. Does the cause precede the effect?▪ Biological gradient. Is there a dose response?▪ Biological plausibility. Does it make sense?▪ Coherence. Does the evidence fit with what is known regarding the naturalhistory and biology of the outcome?▪ Experimental evidence. Are there any clinical studies supporting theassociation?▪ Reasoning by analogy. Is the observed association supported by similarassociations?
  22. 22.  Treatment Treat emergent medical issues Decide on return to work strategies▪ Fit to work▪ Job modification (workplace, procedures)▪ Modified working hours▪ Modified duties (fit to work with restrictions)▪ Redeployment▪ Ill health retirement
  23. 23.  Five (5) steps1. Hazard Identification2. Risk assessment3. Control measures(Hierarchy of control)4. Monitoring5. Audit
  24. 24.  HazardPotential adverse effect of an agent orcircumstanceE.g. Mesothelioma is a hazard of asbestos RiskProbability that a hazard will be realized, giventhe nature and extent of a person’s exposure toan agent or circumstanceE.g. Risk of mesothelioma from asbestosdepends on the type of fibre and the amountthat is inhaled
  25. 25. How do the Occupational Physicians identifyhazards? Clinical Assessment Toxicological Assessment Epidemiological Assessment
  26. 26.  Exposure Assessment Determine what are the nature and extent of theexposures that will occur if a course of action isfollowed. Estimation of risk Determine what is the likely probability of eachhazard if the course of action is followed
  27. 27. • ELIMINATION• SUBSTITUTION• Procedure, agent• ENGINEERING CONTROLS• Ventilation, enclosures• ADMINISTRATIVE CONTROLS• Information, instruction, training; task rotation ; health surveillance• PPE• Hard hat, ear plugs, glasses, gloves, coveralls, boots
  28. 28.  Monitoring compliance with controls Company enforcement Regulatory bodies (OSH Agency) Audit controls Set standard Measure performance Review Implement change Repeat cycle
  29. 29. CASE 1Lead Poisoning In A ConstructionWorker
  30. 30. Clinical Investigation History Medical25 year old male4 week history – lethargy, abd pain, headaches, NauseaRecent onset – weakness and tingling sensation - HandsSmoker OccupationalGeneral labourer with contracting firm for 2 yearsRepair and refurbish old buildingUse of sander to remove paint from walls
  31. 31.  Physical Examination Generalized abdominal tenderness Other wise unremarkable Investigations BloodElevated blood lead levelsBlood film – basophilic stippling of erythrocytesConsistent with lead poisoning
  32. 32. Workplace Investigation Several employees performing similar duties Not provided with adequate or sufficient PPE Coveralls, boots, dust masks No provision for respirators Share safety glasses No dedicated site for breaks Took breaks and ate meals in the building theywere repairing
  33. 33. Diagnosis &Treatment Acute lead poisoning Suspended from work based on recordedblood lead level (Used exposure limits set byControl of Lead atWork Regulations UK) Referred to Internal Medicine for Chelationtherapy.
  34. 34. Occupational HealthCase Management Employee Surveillance▪ Biological monitoring (blood lead levels) monthly untilacceptable level▪ Condition significantly improved one month laterhowever still unfit to work▪ Job modification not an option▪ Redeployment not an option▪ Ill health retirement not considered (temporary issue)(No attempts by employer to improve work practices)
  35. 35.  Employer Duty to assess the risks to his workers asstipulated in the Occupational Safety and HealthAct ofTrinidad &Tobago Complete the required risk assessment Institute measures considered to be reasonablypracticable to prevent or control exposureswithout resorting to the use of PPE as the initialcontrol
  36. 36.  Employer Elimination and substitution not viable options Engineering controls▪ Introduction of local exhaust ventilation (vacuum sys)▪ Dust suppression techniques (use of water) Administrative controls▪ Provision of clean eating and rest facilities as well as suitable washing facilities▪ Enforcement of separate clean and dirty zones, banning smoking, drinking andeating in the latter▪ Information, instruction and training with respect to lead▪ Implementation of pre employment screening as well as a health surveillanceprogram for all at risk employees inclusive of biological monitoring▪ Respiratory fit testing for employees using Respiratory PPE PPE▪ Provision of adequate and sufficient PPE
  37. 37. Summary Employee no longer works for the general contractingfirm having opted instead to seek employmentelsewhere Issues Employer did not consider all elements of the hierarchy ofcontrol Jumped straight to PPE and even that may have beeninappropriate (Respiratory PPE) No national policy or guideline addressing lead exposureat work as well as exposure limits to be enforced Which international best practice regarding exposures andlimits should we follow (UKVS USA)
  38. 38. CASE 2Organophosphate Poisoning In A PesticideSprayer
  39. 39. Dr.Wayne RamgoolamMB.BS, MSc Occupational Medicine (UK), MFOMOccupational Medicine SpecialistPhone: (868)-385-6000Email: wayner@occumedltd.comwww.occumedltd.com