Environmental Health: Nightingale

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Chapter 13

Occupational Health

Learning Objectives

By the end of this chapter the reader will be able to:

• Describe four events in the history of occupational health

• Discuss the significance of the occupational environment for health

• List physical and psychological effects of occupational hazards

• State five categories of health impacts of occupational hazards

• List three methods for the prevention of occupationally related disease

Occupational Medicine

  • Medical specialty focusing on detection and prevention of diseases that arise from the work environment

Occupational Disease

  • Defined as those health outcomes that are “caused or influenced by exposure to general conditions or specific hazards encountered in the work environment.”

Origin of Occupational Health

  • Recognition of occupational risks from mining occurred during Greek and Roman times.

Noteworthy Figures in History

  • Rhazes (ca. 850-923) used occupational classifications in medical case descriptions.
  • Paracelsus (1493-1541) wrote a book on occupational diseases.
  • Bernardino Ramazzini (refer to next slide)

Bernardino Ramazzini
(1633-1714)

  • Considered the “father of occupational medicine”
  • Described the manifestations of occupational diseases
  • His book De Morbis Artificum Diatriba (Diseases of Workers) was published in 1700.
  • Highlighted risks of hazardous chemicals, dusts, medals used in the workplace

Occupational Diseases in
Historical Literature

  • Miners’ asthma
  • Potters’ rot
  • Mad hatter’s disease
  • Phossy jaw
  • Mule spinners’ cancer

Historically Significant Occupational Accidents

  • Triangle Shirtwaist Company fire
  • Gauley Bridge disaster

Triangle Shirtwaist Company Fire

  • Occurred on March 25, 1911, in New York City
  • 146 women died within 15 minutes
  • Doors were locked and fire escapes were nonfunctional.

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Gauley Bridge Disaster

  • Covered a time span that began about 1931
  • Caused exposure of unprotected workers to high levels of silica dust
  • Resulted in about 1,500 cases of silicosis and 1,000 deaths

Nonfatal Occupational Injuries and Illnesses (Private Industry)

  • During 2002, 4.7 newly reported cases
  • Since 2002, the number of cases has continued to decline.
  • During 2008, 3.7 million cases of were reported.
  • Leading causes of injuries were sprains and strains

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The Costs of Occupational Injuries, Illnesses and Fatalities

  • Direct costs of injuries and illnesses during the 2002 were estimated at $45.8 billion.
  • Indirect costs were estimated to be $229 billion.

Leading Causes of
Disabling Conditions

  • Sprains and strains
  • Cuts, lacerations, and punctures
  • Bruises and contusions
  • In 2008, a total of 71.2% of injuries took place in the service-providing sector.

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Agents of Occupational Disease

  • Noise
  • Dusts
  • Toxic heavy metals and their fumes
  • Carbon monoxide
  • Chemicals
  • Ionizing radiation
  • Microbial agents
  • Lifting heavy weights
  • Repetitive motion
  • Workplace accidents
  • Work-related stress

Noise

  • The term ototoxic refers to agents that can produce hearing loss.
  • Ototoxic agents include very loud sounds and several classes of drugs and chemicals used in the work environment.

Toxic Heavy Metals and Their Fumes

  • Toxic heavy metals (arsenic, lead, mercury, cadmium, chromium and nickel) are potential hazards to human health.
  • Processing and milling of heavy metals put workers at risk of breathing fumes and dusts that contain toxic levels of these metals.

Carbon Monoxide (CO)

  • An odorless, hazardous, toxic gas
  • Causes death by depriving the body of oxygen
  • Persons with conditions such as lung disease, heart disease, and anemia are at increased risk of the effects of CO.

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Microbial Agents

  • Are a source of health risks for workers in many occupational categories
  • For example, health care workers, workers exposed to sewage, and agricultural workers may be exposed to bacteria, viruses, and disease-carrying insects.

Work-Related Stress

  • Chronic stress has been implicated in a range of somatic conditions (e.g., coronary heart disease) and mental disorders including depression.
  • Term going postal refers to employees who react to stressful conditions of their environment by committing violent acts.

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Occupationally Associated Diseases and Conditions

  • Allergic and irritant dermatitis
  • Respiratory diseases, e.g., chronic obstructive pulmonary disease and asthma
  • Fertility and pregnancy abnormalities
  • Hearing loss caused by noise
  • Infectious diseases
  • Musculoskeletal disorders
  • Traumatic injuries and fatalities
  • Conditions associated with job stress

Allergic and Irritant Dermatitis

  • The skin is one of the most common sites of contact with chemicals in the workplace.
  • Manufacturing, construction, food production, and activities such as metal plating and engine service put workers at highest risk for skin diseases.

Respiratory Diseases

  • Many of the work-related respiratory diseases are chronic conditions that have long latency periods.
  • Asbestosis, coal workers’ pneumoconiosis, silicosis, byssinosis, mesothelioma, and lung cancer are examples of work-related respiratory diseases.

Chronic Obstructive Pulmonary Disease (COPD) and Asthma

  • About 30% of cases of COPD and asthma can be linked to occupational exposures.
  • COPD is related to workplace exposure to dusts.
  • Asthma has become the most frequently diagnosed occupational respiratory disease in the U.S.

Fertility and Pregnancy Abnormalities

  • Examples are birth defects, prematurity, low birth weight, spontaneous abortions, and developmental disabilities.
  • A total of 4 million chemicals in use commercially have not been tested for their reproductive effects.
  • Most of the 1,000 chemicals used in the work environment that have been demonstrated to cause adverse reproductive effects among animals have not been tested with humans.

Hearing Loss Caused by Noise

  • The second most-commonly self-reported occupational injury or illness
  • As many as 10 million workers in U.S. suffer from noise-induced hearing loss.
  • Prolonged exposure to noise may result in psychological reactions that adversely impact the immune system and physical well-being.

Nature of Sound and Hearing

  • Sound is produced by oscillating waves of various frequencies.
  • The term Hertz (Hz) denotes the number of cycles per second associated with the oscillation of a given sound wave.

Sound Pressure Level (SPL)
and Decibels (dBs)

  • The sound pressure level (SPL) is a measure of the intensity of sound.
  • The SPL is reported on a logarithmic scale that uses decibels (dBs).
  • An increase of 10dB represents a 10-fold increase in sound intensity.
  • dBs are advantageous for characterizing the large variability in the range of sounds that the human ear can perceive.

Two Employment Categories Affected Greatly by Noise

  • Construction industry—bulldozers, heavy trucks, and loading machines
  • Healthcare industry—high-speed bone-cutting drills and suctioning devices

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Permissible Noise Levels
in the Workplace

  • The NIOSH recommended exposure limit (REL) for noise exposure in the workplace during an 8-hour shift is 85 dBA.
  • dBA refers to A-weighting, meaning that exposure is an 8-hour time-weighted average.

Infectious Diseases (Examples of Workers at Risk)

  • Healthcare workers
  • Public utility workers
  • Agricultural workers
  • Social service workers and corrections personnel
  • Clinical laboratory specialists
  • Mortuary workers
  • Adult film industry workers

Musculoskeletal Disorder (MSD)

  • Refers to “an injury or disorder of the muscles, nerves, tendons, joints, cartilage, or spinal disks.”

Common MSD in the Workplace*

  • Sprains, strains, tears
  • Soreness, pain, hurt, except the back
  • Back pain, hurt back
  • Hernia
  • Carpal tunnel syndrome
  • Tendonitis
  • Musculoskeletal system and connective tissue diseases and disorders, except tendonitis

*Refer to Figure 13-17 in the text.

Traumatic Injuries and Fatalities

  • In 2007, approximately 15 workers died every day in the United States from traumatic injuries.
  • The BLS reported a total of 5,214 fatal occupational injuries in 2008.

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Industries with the Largest Numbers of Deaths

  • Construction
  • Transportation and warehousing
  • Agriculture, forestry, fishing, and hunting

Job Stress

  • The term job stress is “defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker.”

Conditions Associated with Job Stress

  • Anxiety, stress, and neurotic disorders
  • “Going postal”
  • Critical incident stress

Note: Of six job categories, the classification of technical, sales, and administrative support had the highest percentage of cases of anxiety, stress, and neurotic disorders in 2001.

Preventing Occupational Disease

  • Primary Prevention
  • Engineering controls
  • Quieter machinery, improved building ventilation
  • Modification of work practices
  • Safety education and training programs
  • Administrative controls
  • Organization of work shifts and rotation of employees

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Personal Protective Equipment (PPE)

  • Apparatuses “designed to protect employees from serious workplace injuries or illnesses resulting from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards.”

Primary Prevention Versus Use of PPE

  • The three methods of primary prevention are preferred over other methods for protecting workers such as the use of PPE.

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Examples of PPE

  • Devices to protect against airborne hazards
  • Respirators
  • Devices to protect hearing
  • Ear muffs and ear plugs
  • Protective eyewear
  • Goggles, face shields, safety glasses, and full-face respirators

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Public Health Surveillance

  • Surveillance systems include the collection of information about occupational injuries and illnesses and maintenance of databases on exposures to occupational hazards.

U.S. Agencies That Conduct Surveillance

  • National Institute for Occupational Safety and Health (NIOSH)
  • National Center for Health Statistics (NCHS)
  • Bureau of Labor Statistics (BLS)
  • Occupational Safety and Health Administration (OSHA)
  • Mine Safety and Health Administration (MSHA)

Surveillance Programs Operated by NIOSH

  • National Surveillance System of Pneumoconiosis Mortality (NSSPM)
  • National Traumatic Occupational Fatalities (NTOF) Surveillance System
  • State-based Sentinel Event Notification System for Occupational Risks (SENSOR)

Exposure Limits

  • Guidelines and regulations for limitation of workplace exposures to hazardous agents
  • The threshold limit value (TLV) “Refers to airborne concentrations of substances and represents conditions under which it is believed that nearly all workers may be unaffected.”