Occupational Health & Safety

Dr Ehab Omrani
(M.B.B.Ch) Tripoli University
M.P.H (Occupational Health)
UKM/Malaysia
(D.T.M&H) Tropical Medicine
Mahidol University/Thailand
 Content
 History
 IMP definitions
 Ergonomics
 Occupational environment
 Occupational Hazards
1. Physical
2. Chemical
3. Biological
4. Mechanical
5. Psychosocial
 History
 Bernardino Ramazzini (1633 – 1714) was an Italian
physician.

Father of Occupational
 He is “the

Medicine”
 History
 His book on occupational diseases (Diseases of
Workers) in 1700 outlined the health hazards of:
1. Chemicals
2. Dust
3. Metals
4. Repetitive or violent motions
5. Odd postures, and
6. Other disease-causative agents encountered by
workers in 52 occupations.
 History
In the past occupational health entirely in
relation to factories and mines hence the term
industrial hygiene.

Modern concepts of occupational health know

includes all type of works – industrial,
agricultural, office workers and hospital
workers etc.

Occupational Health
 Occupational Health
ILO / WHO committee held in 1959 gave the following
definition:
Occupational health should aims at promotion and
maintain of the highest degree of physical, mental
and social well being of workers of all occupations

that can be achieved by prevention among

workers from health hazards that caused by their working
conditions.

Occupational Health
Prevention medicine and occupational
health
 Prevention medicine and occupational health have the
same aim , therefore , occupational health is the
application of preventive medicine in all places of
employment.

 Level of prevention:
1. Health promotion and specific protection.
2. Early diagnosis and treatment.
3. Disability limitation and rehabilitation.

Occupational Health
 Important Definitions
 Occupational medicine: occupational medicine attempts to
evaluate the health- related hazards of the workplace, to maintain
health of workers and to return workers who have been injured or
exposed to hazards at work to good health.

 Workers' compensation: it is a system of laws that provide for

income replacement, medical expenses, and rehabilitation services
for people suffering from work related injury or illnesses.

 Occupational diseases: the diseases arising out of or in the course

of employment.

 Work related diseases: aggravation of pre-existing diseases.

 Important Definitions
Occupational trauma: an inevitable sudden onset
event may or may not be followed by injury.
Trauma causes:
1. Human factors: physical.
2. Environmental factors: temperature, humidity , noise and
unsafe machine.
Absenteeism: absence from work due to:
1. Medical causes
2. Non medical causes: social and behavioral such as addiction.
 Put switches, tool, controls and
materials within easy reach of workers
 RISK FACTORS FOR RSI/CTS

• overuse

• poor technique

• poor posture
Carpal Tunnel Syndrome
Due to pressure on the median nerve
 Ergonomics
• Ergonomics is the study of the physical and cognitive
(mental process of understanding) demands of work
to ensure a safe and productive workplace.
• It simply means fitting the job to the
workers
• “The science of studying people at work and then
designing tasks, jobs, information, tools, equipment,
facilities and the working environment so people can
be safe and healthy, effective, productive and
comfortable.” (Ergonomic Design Guidelines, Auburn Engineering, Inc.,
1998).

Occupational Health
 Ergonomics
• The objective of the ergonomics is to achieve the
best mutual adjustment between the man and his
work for the improvement of human efficiency and
well-being

• The idea of ergonomics is to design facilities (e.g.

factories and offices) furniture, equipment,
tools and other job demands to be compatible with
human dimensions, capabilities, and expectations.

Occupational Health
 Engineering anthropometry
• Engineering anthropometry is concerned with
measuring the human body and designing facilities,
equipment, furniture, tools, personal protective
devices etc. to accommodate the dimensions of the
user.

Occupational Health
Well designed computer table
20”
50cm

Occupational Health
 Occupational Environment
• Occupational environment means the sum of external
conditions which is happening at the place of work
and which have an effect on the health of the
workers
• Basically there is three types of interaction in a
working environment
1. Man and physical, chemical and biological agents
2. Man and machine
3. Man and man

Occupational Health
Physical, chemical and biological agents

• Physical agents :– Physical factors that affect health

such as heat, cold, humidity, air movement, light,
noise, vibration and ionized radiation .

• Chemical agents :– Includes all chemicals which are

potentially hazards to the health of the workers.

• Biological agents: – Viral, bacterial, parasitic agents

due to contact with animals, animal products, soil
,water or food.

Occupational Health
 Man and machine
• This interaction is more common in factories
and industries .
• Unguarded, protruding, moving and sharp
parts can be very dangerous to the workers
• Working for long hours in unphysiological
postures is the cause of fatigue, backache,
diseases of joints and muscles

Occupational Health
 Man and man
Many psychosocial factors operate the place of
work.
– Relationship between workers
– Between superior officers
– Factors that affect the psycho-social aspects are
type of work, duration and time of work, salary,
type of leadership
– The domestic environment also may affect the
worker as worries at home will have adverse effect
on the work.

Occupational Health
 Man and man
Psychosocial factors: these are the human relationships
amongst workers themselves in one hand , and those in
authority over them on the other.
For example: work stability , job satisfaction , leader ship
style , degree of responsibility.

Occupational environment of the worker can not considered

as a part from his domestic environment , BUT both are
complementary to each other.

Occupational Health
 Prevention of Occupational Disease
Medical Measures:
1. Pre-employment exam
2. Periodic Medical Exam
3. Health Education
4. Biological Monitors
5. Registration
Engineering Measures:
Personal Protective Equipment (PPE): Safety
(goggles, gloves, shoes), ear protection ,
Apron, Lung protection ( N95% Mask
Face)….etc
 Occupational hazards
• Physical
• Chemical
• Biological
• Mechanical
• Psychosocial

Occupational Health
 Physical hazards
1. Heat
2. Cold
3. Light
4. Noise
5. Vibration
6. Ultraviolet radiation
7. Ionizing radiation

Occupational Health
1. HEAT
 Heat is a common physical hazard in many industries
 It is a main problem in foundry, glass & steel industries, cotton
textile industry, mines, and in all other industries with ovens
and furnaces.

 The direct effects of heat exposure are burns, heat stroke,

heat exhaustion, heat cramps and heat syncope.

 Indirect effect such as decrease efficiency , increase fatigue

and enhance accident rates.

Occupational Health
 Heat stroke
 This is attributed to failure of the heat regulating (thermo-
regulation)mechanism.
 Characterized by:
1) Very high body temperature which may rise to 43.3o c
2) Profound disturbance including delirium, convulsion,
partial or complete loss of consciousness
3) Hot & dry skin with diminished or no sweating.
4) Outcome is often fatal even if the patient brought quickly
to medical attention the death rate up to 40%
5) This condition treated by rapid cooling of the body in ice
water bath till the rectal temperature falls below 38.9oc.
 Heat exhaustion
 It is a milder illness than heat stroke caused primarily by
inadequate replacement of water and salts lost in perspiration.
 Characterized by:
1) Heat exhaustion typically occurs after several days exposure
to high temperature.
2) The worker usually presented with normal temperature or
moderately elevated.
3) Clinically the patient complain of dizziness, weakness and
fatigue but may be sever enough to require hospitalization
especially in elderly patients.
4) Treatment is directed towards normalizing fluid and
electrolyte balance.
 Heat cramps
• Heat cramps occur in persons who are doing heavy
muscular work in high temperature and humidity.
• The cause of heat cramps is loss of sodium and
chloride in the blood.
• There are painful and spasmodic contractions of the
skeletal muscles.
 Heat syncope
This is a common mild ill-effect of heat, in its milder
form
The person standing in the sun becomes pale, ↓ Bp
with sudden collapse and no ↑temperature.
This condition results from pooling of blood in
lower limbs due to dilatation of blood vessels
the amount of blood return to the heart reduced
lack of blood supply to brain.
The treatment by lie the patient in the shade with the
head slightly down.
 Cold
Injuries due to cold may be general or local:
1. General cold injury as a result of hypothermia
characterized by numbness, loss of sensation, muscular
weakness, desire for sleep , coma and even death.
2. Local cold injury may occurs at :
• Temp above freezing (wet cold conditions) as in
immersion or trench foot .
• Temp below freezing (dry cold conditions) as in frostbite
treatment by warmed the affected part by using water at
44deg for at least 20 m at the same time intake of hot
fluids will promotes general rewarming.
Trench Foot
Frostbite
 Light
 The workers may exposed to poor illumination or
bright light both can be harmful .
 In poor illumination:
1. The acute effects include :headache, eye pain, lacrimation and
eye fatigue.
2. The chronic effect include miners nystagmus.
 Excessive brightness or glare is associated with
discomfort, visual fatigue and blurring of vision.
 Both conditions can lead to accidents

Occupational Health
 Noise
Physics of Sound
o Noise
 unwanted sound
o Sound
 The physical phenomenon that stimulates our
sense of hearing.
 An acoustic wave that results when a
vibrating source, such as machinery.
 Noise
• Noise is a health hazard in many industries and are of two
types
– Auditory
– Non-auditory
• Auditory hazard includes temporary or permanent hearing
loss
• Non-auditory effects include nervousness, fatigue and
annoyance
• The degree of injury depends on the intensity, duration of
noise

Occupational Health
 Effects of noise exposure
 Auditory effects:
1. Auditory fatigue usually appears at 90 dB intensity and
4000 Hz frequency.
2. Sensory hearing loss is the most serious pathological
effect:
 Repeated or continuous exposure to noise around 100
decibel may result in a permanent hearing loss
 Effects of noise exposure

 Non auditory effects:

1. Interference with speech communication.
2. Annoyance(psychological response) : workers
exposed to high intensity of noise were often irritated,
short tempered and impatient.
3. Physiological changes: rise in blood pressure
,increase in heart rate, rise in intracranial pressure,
increase in breathing rat and in sweating. Also it
causes sleep problem, nausea and fatigue.
CONCEPT OF NOISE RISK

NOISE EXPOSURE
+
INTENSITY DURATION

HEARING LOSS
 Simple Method for Assessing Noise Exposure

Stand at arm’s length from co-worker. If you cannot speak in normal tone and have
to SHOUT to communicate, then the level is too high and should be reduced

Source: ILO Noise at Work

The noise has two important properties: loudness or
intensity which measured in decibels dB and
50
frequency which measured by hertz Hz .
 PERMISSIBLE EXPOSURE LIMIT
(PEL)

• 85-90 dB over 8 hours work day is the level of

noise allowed in most standards .
Hearing conservation program(H.C.P)

1- Noise monitoring.
2- Engineering control.
3- Administrative control.
4- Education.
5- Audiometry.
6- Use of hearing protective devices.
Dosimeter

SOUND LEVEL METER

 Noise Control

Options:
Control at the source
Control at the noise path
Protect the receiver
 NOISE CONTROL
Engineering Admin PPE

Source Modify process or • substitute/eliminate

equipment • maintenance

Path • Absorbers • Isolate noise:

• Enclosures - by time
• Isolates - by location

Receiver • Restrict exposure • Plugs or

• Training & education Muffs
 Ear protection

Foam Earplugs Premolded Reusable Earplugs Earmuffs

Source: NIOSH, Education & Information
Division
Source: NIOSH, Education & Information Division.
 Vibration
• Using pneumatic tools such as drills and hammers
will expose the worker to frequency range from 10-
500Hz.
• Vibration usually affects hands and arms.
• Joints of hands, elbows and shoulders may also be
affected by long exposure to vibration.
• Vibration can be controlled by engineering
modification of the machine.

Occupational Health
What is Hand - Arm Vibration (HAV)?
 HAV occurs when the hands and arms are exposed to
vibration.

 vibration especially in the frequency range 10 to 500

Hz, may be encountered in work with
1. Pneumatic tools (hand-held power tools) such as
drills and hummers.
2. Guiding materials by hand into a machine for
processing. That result in disturbance of hand
function.
After months or years of exposure the fine
blood vessels undergo vasospastic changes
(white fingers, raynaud`s phenomenon) with
the clinical syndrome of HAVS.
Disturbance in hand function caused by Hand
Transmitted Vibration :
1. Vascular damage
2. Neurological
3. Musculo-skeletal
Each component could occur independently
 Impairment due to HAVS

• White finger, numbness, tingling

• Pain
• Loss of tactile sensation in hands(clumsy)
• Reduced manual dexterity
• Reduced grip strength/cramps
• HAVS is preventable but once damage is done
it is permanent
 Radiation
Workers may expose to radiation in their work
places.
Types of Radiation:
1. Ultraviolet radiation
2. Ionizing radiation as X- ray and radio active
isotopes.
 Ultraviolet radiation
• Workers involved in arc welding of metals are
exposed to UV radiation
• It can lead to conjunctivitis and keratitis
(welders flash).
• Symptoms are redness of eyes and pain
• Normally the patient will recover in a few days
without any permanent effect on eyes

Occupational Health
Ionizing Radiation Penetrating Power

www.bcm.edu/bodycomplab/Images/pntrtn.gif
 Dose Response Tissue

Examples of tissue Sensitivity

Very High White blood cells (bone marrow)
Intestinal epithelium
Reproductive cells
High Optic lens epithelium
Esophageal epithelium
Mucous membranes
Medium Brain – Glial cells
Lung, kidney, liver, thyroid,
pancreatic epithelium
Low Mature red blood cells
Muscle cells
Mature bone and cartilage
 Sources of ionizing radiation
People may be exposed to ionizing radiation from 3 main sources:

1. Natural background radiation

• Comes from cosmic rays from our solar system and radioactive
elements normally present in the soil. This is the major
contributor to worldwide radiation exposure.
2. Medical radiation
• Ionizing radiation is used in the diagnosis and treatment of some
medical conditions. This can be in the form of radiation that
penetrates from outside the body, or radioactive particles that are
swallowed or inserted into the body.
• Imaging tests: Certain types of imaging tests, such as x-rays, CT
scans, and nuclear medicine tests (While, MRI and ultrasound
exams do not use ionizing radiation)
3. Non-medical, man-made radiation:such as above ground
nuclear weapons testing that took place before 1962.
 Hazards & control of radiation
The radiation hazards include: radiation sickness,
leukemia, cancer, sterility , genetic mutation , congenital
malformation and in severe cases death.

Control:
1. Monitoring of the amount of radiation received by
(Dosimeter), the maximum permissible level of
occupational exposure of radiation is 5 rem per
year (International Commission of Radiological Protection)
2. Use of effective protective measures as lead shields
 Chernobyl Disaster
The Chernobyl disaster is widely considered to
have been the worst nuclear power plant
accident in history.
The battle to contain the contamination and
avert a greater catastrophe ultimately involved
over 500,000 workers
The long-term effects such as cancers and
deformities are still being accounted.
 Chemical hazards

Almost all industries use chemicals and

as science advances more complex
chemicals are being made.

Occupational Health
 Chemical hazards
Chemicals can act in 3 ways:
1. Local action
2. Inhalation and
3. Ingestion
The ill effects produced depend on the
duration and intensity of exposure and also
individual susceptibility

Occupational Health
 Local action of chemicals
• Dermatitis, eczema, ulcers and even cancer
• Occupational dermatitis is a major health problem
in many industries
• Some chemicals may be absorbed through the skin
and cause systemic effects
 Inhalation of chemicals
• It may occur as
– Dust
– Gases
– Metals and their compounds

Occupational Health
 Inhalation of Dusts
 Dusts are finally divided solid particles with size ranging from(0.1
microns to 150 microns) are produced in many industries (e.g. mines,
textile , pottery, wood or stone working industries).

 Dusts are classified into:

1. Soluble dusts such as cotton and jute, which dissolve slowly and
eventually eliminated by body metabolism

2. Insoluble dust such as silica , coal and asbestos , remain permanently

in the lung leading to pneumoconiosis

• Dust < 5 microns directly inhaled into the lung

and retained their causing pneumoconiosis,
this fraction of dust called respirable dust
Occupational Health
DEPOSITION IN RESPIRATORY SYSTEM
• NASOPHARYNGEAL DEPOSITION (upper
respiratory tract)
– 7 µm to 20 µm A.E.D.
• TRACHEOBRONCHIAL (conducting airways)
– 5 µm to 7 µm A.E.D.
• ALVEOLAR REGION (gas exchange area)
– 0.5 µm to 5 µm A.E.D.
 Ingestion of chemicals
Occupational diseases also result from
ingestion of chemicals like Lead, Mercury,
arsenic , phosphorus …etc
Usually the ingestion through contaminated
hands, food and cigarettes.
Most of the ingested material excreted through
feces and only a small amount reached the
general circulation.

Occupational Health
A surgical mask is
NOT respiratory
protection
 Biological hazards
Workers may be exposed to infective agents at
the place of work leading to many diseases.
Examples are brucellosis, leptospirosis,
tetanus, encephalitis, anthrax hydatidosis,
tetanus, fungal infections….etc.
Health care workers(HCW), persons working
among animal products (hair, wool, hide) and
agricultural workers are especially exposed to
biological hazards.

Occupational Health
There are three primary routes of entry:
1- Air born disease
2- Food born disease
3 blood borne diseases that pose the
greatest risk to HCW

There are about 2.5% cases of HIV, 40% of HBV and

HCV among HCW worldwide in a year 2000 that
results from these occupational exposures
• A study in Brazil teaching hospital, found that46%
of the nursing students and 83.3% of the medical
students did not wash their hands before or after
caring for their patients (2010)
• A study in Pakistan found that 37% of the MO in
the first level care facilities never used gloves for
procedures while more than 50% of other
healthcare workers never used gloves during
performing procedures. ( 2007)
 Mechanical hazards
Mechanical hazards in industry centers
including machines that are moving (cutting,
drilling etc.), protruding (projecting) and
compressing.

About 10% of injuries in factories are due to

mechanical causes

Occupational Health
 Psychosocial hazards
Psychosocial hazards arises from the workers
failure to adapt to different working
environment, this may be influenced by:
1. Education
2. Cultural background and
3. Social habits.
The hazards may be divided into:
1. Psychological and behavioral changes
2. Psychosomatic disorders
Occupational Health
 Psychosocial hazards
Psychological and behavioral changes:
– Hostility, aggressiveness, anxiety, depression, alcoholism,
drug abuse

Psychosomatic disorders:
– Fatigue, headache, body pains, peptic ulcer, hypertension,
heart disease

Occupational Health
Occupational Health
Occupational Health
Thank you