community health services ; Occupational health

2. TERMINOLOGIES:
• OCCUPATIONAL HEALTH:
APPLICATION OF PRINCIPLES
OF PREVENTION AND CONTROL OF HEALTH
PROBLEMS IN WORKERS AT VARIOUS LEVELS
TO PROMOTE, PROTECT AND PRESERVE
THEIR HEALTH AND TO REHABILITATE WHEN
REQUIRED.

3. ERGONOMICS
THE TERM IS DERIVED FROM GREEK WORD
“ ERGON” – “WORK” AND
“ NOMOS” – “LAW” .
IT MEANS ADAPTATION OF WORK TO MAN
AND MAN TO WORK FOR IMPROVEMENT OF
HUMAN EFFICIENCY AND WELL BEING.
IEA:
INTERNATIONAL ERGONOMICS
ASSOCIATION.

4. OCCUPATIONAL HEALTH
[THE JOINT COMMITTEE OF WHO & ILO]
The general aims of occupational health should
be the promotion & maintenance of highest
degree of physical, mental & social well being of
workers in all occupations; the prevention
among workers of departures from health
caused by their working conditions; the
protection of workers in their respective
employments from risks resulting from factors
adverse to health; the placing & maintenance of
the workers in an occupational environment
adopted to their physiological & psychological
needs.

5. AIMS
1
• TO INCREASE THE EFFICIENCY
2
• TO INCREASE THE PRODUCTION
3
• TO DECREASE THE ACCIDENTS

6. OBJECTIVES
1. TO PROMOTE YHE HEALTH OF THE WORKERS
2. TO MAINTAIN THE HIGHEST DEGREE OF
PHYSICAL, MENTAL AND SOCIAL WELL BEING
OF THE WORKERS.
3. TO PREVENT THE DISEASE BY ELIMINATION
OF FACTORS WHICH ARE INIMICAL TO THEIR
HEALTH.

7. TRENDS
AND
ISSUES
IN
OCCUPATIONAL HEALTH

8. Jerry Jeyaratnam

9. Two-way relationship between work
and health

10. Global Strategy on Occupational
Health for All (WHO 1995)
1. Occupational Health and National
Development :
Occupational health in the context of
national development as the two are intimately
linked
To encompass the process of improving
the quality of human life, {aspects of economic
development, of improving self-esteem and of
increasing people’s freedom to choose}.

11. 2 .Health and Development :
An intimate relationship between
health, development and the environment
A strong positive relationship
between a nation’s economic status and
health as indicated by life expectancy.

12. 3 .Occupational Health Concerns and
Development:
The health of the workforce is an
essential ingredient for national
development
Adequate recognition of the
potential pitfalls and dangers of development
must be recognized and safeguarded.

13. ISSUES

14. 1. Lack of adequate legal and institutional
structure
2. Lack of proper planning in siting of
industries and residential areas
3. Lack of safety-conscious culture among
workers and management
4. Transfer of hazardous industries
5. High proportion of small-scale industries
6. Lower health status and quality of health
care

15. ERGONOMICS
• TERM COINED IN CONFERENCE AT STOCKHOLM IN 1961
CONDUCTED BY INTERNATIONAL ERGONOMICS
ASSOCIATION.
• SIGNIFICANT CONTRIBUTION IN REDUCING THE INDUSTRIAL
ACCIDENTS & IN OVER ALL HEALTH & EFFICIENCY OF THE
WORKERS.

16. OCCUPATIONAL ENVIRONMENT
• PHYSICAL AGENT:
 Cold
 Humidity
 Heat Radiation
 Air Movement
 Ionizing Radiation
Light
 Noise
Toilet & Hand Washing Facilities.

17. • BIOLOGICAL AGENTS:
 VIRUS
 RICKETTSIA
 BACTERIA
 PARASITES
• CHEMICAL AGENTS:
 TOXIC GASES
 VAPOURS
 FUMES
• MECHANICAL AGENTS:
 UNPROTECTED MACHINES
 LACK OF SAFETY MEASURES

18. • PSYCHO-SOCIAL AGENTS:
Relationship Among Workers
And Authority
Job Insecurity
Conditions Of Employment
Working For Long Hours In Same Postures

19. OCCUPATIONAL ENVIRONMENT
MAN AND
MACHINES
1) MECHANICAL
AGENTS
MAN AND MAN
1)PSYCHOSOCIAL
AGENTS
MAN AND AGENTS
1)PHSICAL
2) CHEMICAL
3) BIOLOGICAL

21. 1 ) PHYSICAL HAZARDS:
I. Heat & cold
II. Light
III. Noise
IV. Vibration
V. Ultra violet radiation
VI. Ionizing radiation

22. • CHEMICAL HAZARDS :
– Local Action
–Inhalation
• Dust
• Gases
• Metals And Their Components
–Ingestion
• BILOGICAL HAZARDS :
–Infective & Parasitic Agents
• MECHANICAL HAZARDS :
–Machinery Works

23. • PSYCHOSOCIAL HAZARDS:
– PSYCHOLOGICAL & BEHAVIORAL
CHANGES:
• ( HOSTILITY, AGGRESSIVENESS, ANXIETY, DEPRESSION,
ALCOHOLISM, DRUG ABUSE)
– PSYCHOSOMATIC ILLHEALTH:
• (FATIQUE, HEAD ACHE, PAIN IN SHOULDERS, PEPTIC
ULCERS,HT)

24. OCCUPATIONAL
DISEASES
PHYSICAL
AGENTS
CHEMICAL
AGENTS
BIOLOGICAL
AGENTS
OCCUPATIONAL
CANCERS
OCCUPATIONAL
DERMATOSIS
PSYCHOLOGICAL
ORIGIN

25. I ) DISEASES DUE TO PHYSICAL AGENTS:
1. HEAT
1. HEAT HYPER PYREXIA
2. HEAT EXHAUSTION
3. HEAT SYNCOPE
4. HEAT CRAMPS
5. BURNS
2. COLD
1. TRENCH FOOT
2. FROST BITE
3. LIGHT
1. CATARACT
2. MINER’S NYSTAGMUS
4. PRESSURE
1. CAISSON DISEASE
2. AIR EMBOLISM
3. BLAST
5.NOISE
OCCUPATIONAL DEAFNESS
6.RADIATION
CANCER
LEUKEMIA
APLASTIC ANEMIA
PANCYTOPENIA
7.MECHANICAL FACTORS
INJURIES AND ACCIDENTS
8.ELECTRICITY
BURNS

26. DISEASES DUE TO CHEMICAL
AGENTS
(I )GASES:
– CO2,CO, HCN, CS2, NH3, N2, H2S, HCL, SO2 – GAS
POISONING
(II)DUSTS:
– 1)INORGONIC DUSTS:
• COAL DUST- ANTHROCOSIS
• SILICA – SILICOSIS
• ASBESTOS – ASBESTOSIS, CANCER LUNG
• IRON - SIDEROSIS

27. – 2) ORGONIC ( VEGETABLE) DUSTS:
• CANE FIBRE – BAGASSOSIS
• COTTON DUST – BYSSINOSIS
• TOBACCO – TOBACOSSIS
• HAY – FARMER’S LUNG
(III) METALS AND THEIR COMPONENTS:
• Metals like lead, mercury, cadmium, manganese,
arsenic, chromium.
(IV) CHEMICALS:
Acids, Alkalies, Pesticides
(V) SOLVENTS:
carbon bisulphide, benzene,
trichloroethylene, chloroform

28. III. DISEASES DUE TO BIOLOGICAL
AGENTS
Brucellosis
Leptospirosis
Anthrax
Actinomycosis
Hydatidosis
Psittacosis
Tetanus
Encephalitis
Fungal Infectiions

29. (IV) OCCUPATIONAL CANCERS:
Skin, Lungs,Bladder
(V) OCCUPATIONAL DERMATOSIS:
Dermatitis, Eczema
(VI) DISEASES OF THE PSYCHOLOGICAL ORIGIN:
Industrial neurosis, Hypertension,
Peptic ulcer.

30. PNEUMOCONIOSIS
( DUST DISEASE – SIZE OF 0.5 TO 3 MICRON )
• Silicosis
• Anthracosis
• Byssinosis
• Bagassosis
• Asbestosis
• Farmer’s Lung

31. SILICOSIS
 Inhalation Of Silica Or silicon dioxide.
1947 – 1st reported from kolar gold mine.
 Incubation period – few months to 6 years
“Nodular fibrosis” (3- 4 mm in dia)
Irritant cough,dyspnoea, pain in chest are
the symptoms
 “ Snow-storm” appearance in X – ray
 Silico - TB

32. ANTHRACOSIS
(COAL MINERS PNEUMOCONIOSIS)
• Previously Called As Pulmonary
Anthracosis.
• Two Phases In This:
– Simple Pneumoconiosis (12 Yrs Of Work
Exposure)
– Progressive Massive Fibrosis (Pmf)

33. BYSSINOSIS
• Inhalation Of Cotton Fibre Over
A Period
• Chronic Cough, Progressive
Dyspnoea, Chronic Bronchitis,
Emphysema Are The Symptoms.
• Incidence Rate Is 7 – 8 %

34. BAGASSOSIS
• Inhalation Of Bagasse Or Sugar Cane Dust
• 1st Reported By Ganguli & Pal (1955) In Kolkata.
• Known As Thermoactinomyces Sacchari.
• Breathlessness, Cough, Hemoptysis, Slight Fever,
Bronchitis, Diffuse Fibrosis, Emphysema,
Bronchiectasis
• Preventive Measures: Dust Control, Personal
Protection, Medical Control, Bagasse Control(
Spraying With 2% Proprionic Acid)

35. ASBESTOSIS
• Commercial Name; Are Silicates Combined With
Megnesium, Iron, Calcium, Sodium &
Aluminium.
• 2 Types: (1) Serpentine Or Chrysolite Variety (
Hydrated Megnesium Silicate)
(2) The Amphibole Type ( Crocidolite –
Blue, Amosite – Brown, Anthrophyllite – White)
• Enter Through Inhalation – Pulmonary Fibrosis.
• Preventive Measures: Use Safer Type, Use Glass
Fibre, Dust Control.

36. FARMER’S LUNG
• Due to inhalation of hay or grain dust
• 30% of moisture content favoring the growth
of micropolyspora faeni.
• General respiratory & physical symptoms.
• Repeated attack causes pulmonary fibrosis &
corpulmonale.

37. LEAD POISONING
• Properties Of Lead: Low Boiling Point, Mixes
With Other Metals Easily, Easily Oxidized,
Anticorrosive.
• Components Are: Arsenate, Oxide, Carbonate,
Sulphide.
• Industrial Use: storage Batteries, Glass
Manufacture, Ship Building, Printing
Properties, Rubber Industry.
• Non Occupational Sources: Gasoline,
Automobiles (1000 Tones), Lead Pipes For
Drinking Water, Lead Paint On Windows &
Toys.

38. • Mode of entry: inhalation, ingestion, skin
• Body stores: average adult population 150-400
mg, blood vessels-0.2 – 0.3 mg /day
• Distribution in the body:95% in erythrocytes,
transported to liver,kidneys,bones, 90%
excreted(feces)
• Clinical picture: organic compounds:
abdominal colic, obstinate constipation, loss of
appetite, blue line on gums, stripping of red
cells, anemia, wrist drop & foot drop.
• Inorganic compounds: (CNS) insomnia,
headache, mental confusion, delirium.

39. • Diagnosis: lab test-(coproporphyrin in urine (<
150 µg/lt), amino levulinic acid in urine (<5 mg/lt)
• Preventive measures:
– Substitution
– Isolation
– Local exhaust ventilation
– Personal protection
– Good house keeping
– Working atmosphere
– Periodic examination of the workers
– Health education
• management: saline purge, d- penicillamine is
effective.

40. OCCUPATIONAL CANCER
• skin cancer: (75%) caused by coal, tar, x- rays,
oils & gases.
• Lung cancer: nicket, chromate, asbestos, coal,
tar, 7 cigarette smoking.
• Cancer bladder: 1st –man in aniline industry
(1895). Caused by- aromatic amines ( dying
industry, rubber, gas, electric cable industry)
• Leukemia: exposure to benzol, roentgen rays,
radio active substanses.

41. • PREVENTIVE MEASURES:
– Medical examination
– Inspection of factories
– Notification
– Licensing of establishments
– Personal hygiene measures
– Education of workers and management
– Research.

42. OCCUPATIONAL DERMATITIS
• Causes:
– Physical – Heat , Cold, Moisture, Friction,
Pressure, X- Rays.
– Chemical – Acids, Alkalis, Dyes, Solvents,
Grease, Tar, Pitch.
– Biological – Viruses, Bacteria, Fungi, Other
Parasites
– Plant Products – Leaves, Vegetables, Fruits,
Flowers, Flower Dusts.
• Dermatitis Agents: 1) Primary Irritants.
2)sensitizing
Substances.

43. PREVENTION
Pre-
selection
Protection
Personal
hygiene
Periodic
inspection

44. Occupational hazards of agricultural
workers ( big industry)
• Zoonotic diseases: brucellosis, anthrax,
leptospirosis, tetanus, TB(bovine), Q-
fever.
• Accidents: insects, snake bite
• Toxic hazards: fertilizers, insecticides or
pesticides.
• Physical hazard: extreme temperature,
humidity, solar radiation.
• Respiratory diseases: grains, rice husks,
coconut fibers, tea, tobacco, cotton,
hay,wood.

45. Occupational accidents
• Causes:
– Human factors:
• Physical – hearing los, visual loss
• Psychological- carelessness,
inattentiveness, overconfidence,
ignorance, inexperience, emotional stress,
accident proneness.
• physiological – sex, age, time, experience,
working hours.
– environmental factors:
• Temperature, poor illumination, humidity,
noise, unsafe machines.

46. PREVENTION
• Placement Examination
• Adequate Job Training
• Continuing Education
• Ensuring Safe Working
Environment
• Establishing Safety Department
• Periodic Surveys For Finding Out
Hazards
• Careful Reporting

47. Measures for health promotion of
workers
(ILO/ WHO- 1953)
• Nutrition
• Communicable Disease Control
• Environmental Sanitation
• Mental Health
• Measures For Women & Children
• Health Education
• Family Planning

48. PREVENTION AND CONTROL OF
OCCUPATIONAL DISEASES

49. DISABILITY LIMITATION & REHABILITATION
• Early Diagnosis & Prompt Treatment,
Rectification Of The Condition.
• Alternative Job For Injured Or
Disabled.

50. WOMEN AND OCCUPATIONAL
HEALTH
• MENSTRUATION & DYSMENORRHEA
• PREGNANCY
• MENOPAUSE
• ABILITY OF WOMEN TO WORK

51. Workplace violence
• Workplace violence refers to violence that
originates from employees or employers and
threatens employers and/or other employees.
• Definition
– “Incidents where people are abused, threatened
or assaulted in circumstances relating to their
work, involving an explicit or implicit challenge to
their safety, well-being or health”.

52. FORMS
• Non-physical Violence (Intimidation,
Abuse, Threats Etc.)
• Physical Violence (Punching,
Kicking, Pushing Etc.)
• Aggravated Physical Violence (Use
Of Weapons, E.G. Guns, Knives,
Syringes, Pieces Of Furniture, Bottles,
Glasses, Etc.)

53. Types of workplace violence
Criminal violence
Service user violence
Worker–on-worker
violence
Domestic violence

54. Workplace violence and aggression
Buss (1961)identified eight types of
aggression:
• Verbal-passive-indirect (failure to deny false
rumors about target, failure to provide
information needed by target)
• Verbal-passive-direct ("silent treatment",
failure to return communication, i.e. phone
calls, e-mails)
• Verbal-active-indirect (spreading false
rumors)
• Verbal-active-direct (insulting, acting
condescendingly, yelling)
• Physical-passive-indirect (causing others to
create a delay for the target)

55. • Physical-passive-direct (reducing
target's ability to contribute, i.e.
scheduling them to present at the end
of the day where fewer people will be
attending)
• Physical-active-indirect (theft,
destruction of property, unnecessary
consumption of resources needed by
the target)
• Physical-active-direct (physical
attack, nonverbal, vulgar gestures
directed at the target)

56. Risk Assessments
• Management of Health and Safety at Work
Regulations 1999 states that, “every employer
shall make a suitable and sufficient assessment
of:
– The risks to the health and safety of his
(or her) employees to which they are
exposed whilst they are at work; and
– The risks to the health and safety of
persons not in his employment arising
out of or in connection with the conduct
of him or his undertaking”.

57. • Any risk assessment must identify:
– The nature of the hazard and potential
for harm
– The factors that increase the
likelihood of staff exposure to the
hazard
– The measures necessary to eliminate,
reduce or manage the risk of exposure
to the named hazard

58. High-risk workplaces
Elements Are Commonly Found In Workplaces
• Sexual harassment
• Verbal abuse
• Minimum-wage payrolls
• Discrimination
• Workplace bullying
• Poor or dangerous working conditions
• Lack of job security.
• Physical attacks (i.e. hitting, shoving)
• Threatening behaviour (shaking fists, destroying
property or throwing things)

59. Occupational Groups At Higher Risk
From Workplace Violence
The Canadian Centre for Occupational Health and Safety lists
• Health Care Employees
• Correctional Officers
• Social Services Employees
• Teachers
• Municipal Housing Inspectors
• Public Works Employees
• Retail Employees

60. Dealing With Disgruntled Employees
• Maintain eye contact
• Give the employee full attention.
• Speak and move calmly and slowly.
• Encourage the employee to tell you why they are upset.
• Acknowledge the employee's feelings.
• If their complaint is valid, accept responsibility and
criticism.
• Try to define the true problem.
• Ask open-ended questions.
• Be open and honest.
• Encourage the employee that you will investigate the
problem and search for a solution.

61. Preventative maintenance
The Employee Assistance Program
(EAP)
Diagnosis.
Treatment. Screening.
Prevention.

62. CHILD LABOUR
• Child labour refers to the
employment of children
in any work that deprives
children of their
childhood, interferes
with their ability to
attend regular school,
and that is mentally,
physically, socially or
morally dangerous and
harmful.

63. • The incidence of child
labour in the world
decreased from 25% to
10% between 1960 and
2003

65. THE CHILD LABOUR( PROHIBITION &
REGULATION ) ACT, 1986
• PASSENGER,GOODS MAIL TRANSPORT BY RAILWAYS
• CARPET WEAVING
• CINDER PICKING, CLEANING OF ASH – PITS
• CEMENT MANUFACTURING
• BUILDING CONSTRUCTION OPERATIONS
• CLOTH PRINTING, DYEING, WEAVING
• MANUFACTURING OF MATCHES, EXPLOSIVE, FIRE WORKS.
• BEEDI MAKING
• MICA CUTTING, SPLITTING
• WOOL CLEANING
• PRINTING

66. Disaster Management At the Workplace
• Hazards at work include
any ‘danger’ or ‘unsafe
workplace conditions or
practices (dangers) that
could cause injuries or
illness (harm) to
employees.’

67. • Workplace emergencies are unforeseen situations that
threaten to disrupt or shut down your operations, and
cause physical or environmental damage.
• Emergencies may include:
• Floods
• Hurricanes
• Fire
• Toxic gas
• Chemical spills
• Radiation
• Explosions
• Civil disturbances
• Violence resulting in bodily harm and trauma

68. • Analyze Impact
– analyze the hazard to determine its nature,
cause and impact.
• Develop Fail Safes
– An emergency action plan describes the actions
employers and employees must take to ensure
safety from fire and other emergencies.

69. • Method for reporting fires and other
emergencies.
• Evacuation policy and procedure
• Emergency escape procedures and assignments;
names, titles, departments and telephone
numbers of individuals within and outside your
company to contact for additional information
under the emergency plan.
• Procedures for employees who perform critical
operations and rescue and medical duties for any
workers designated to perform them.

70. • Emergency Evacuation
– Employees designated to assist in emergency
evacuation procedures should be trained in the
complete workplace layout and various alternative
escape routes.
– Ensure that evacuation routes and emergency
exits are clearly marked and well lit, as well as
wide enough to accommodate the number of
people who will be using the exits
– train your employees in first-aid procedures,
including protection against blood borne
pathogens; respiratory protection, including use of
an escape-only respirator

71. • Evaluate, Update & Monitor
– Develop the plan, review it with your employees
to make sure everyone knows what to do before,
during and after an emergency.
– Keep a copy of your emergency action plan
– hold practice drills regularly to keep employees
prepared.

72. WORKPLACE DISASTER
PREPAREDNESS TRAINING
• The Red Cross Workplace Disaster
Preparedness Program is a FREE 60 to 90
minute training, with a focus on potential
Northwest area natural and man-made
disasters. It is brought directly to your
workplace complete with disaster products
and materials.

73. • The hands-on training will help prepare your
associates for inevitable emergencies and
unthinkable events.
• The program covers family preparedness for
employees, workplace emergency preparedness
and business continuity planning.
• Each participant receives an information packet.
• Class participants earn special savings at our
online store

74. LEGAL ISSUES IN OCCUPATIONAL
HEALTH (LEGISLATION)
• THE FACTORIES ACT, 1948
• THE EMPLOYEE’S STATE INSURANCE ACT
• THE MINES ACT
• THE PLANTATION ACT
• THE MINIMUM WAGES ACT
• THE MATERNITY BENEFIT ACT

75. OCCUPATIONAL TEAM

76. • Occupational Health Practitioner
• Occupational health Physician
• Occupational Health Clinical Specialist
• Occupational Health Advisor
• Occupational Psychologist
• Counsellor
• Specialist Occupational Health Physiotherapist
• Specialist Occupational Health Physiotherapist
• Occupational Health Secretaries

77. ROLE OF COMMUNITY HEALTH NURSE
• DEFINITION:
Community health nursing is the
application of nursing & public health
philosophy & skills to the relationship of
people to their occupations for the
purpose of prevention of disease & injury
& the promotion of optimal health,
productivity & social adjustment.

78. Roles & responsibilities
WHO technical report series -24
• Carrying out the therapeutic programme
designed by the physician.
• Maintenance of the physical & psychological
environment
• Carrying out measures for the prevention of
diseases
• Co-ordinating nursing efforts with other
members of community groups

79. As by ILO/WHO committee (1952)
• Assistance in general administration,
maintenance & arrangement of health
facilities
• Emergency & primary treatment of accidents
• Assistance with pre-placement & other
medical examinations
• Arranging for follow up treatment.
• Assistance in general preventive health
measures

80. • Health education & counseling
• Assistance in supervision of factory hygiene &
accident prevention
• Advice on specific health question to
management & workers
• Maintenance of records & statistics
• Co-operation with & referral of workers to
general community agencies for help as &
when necessary.

81. THANK YOU