Penyakit-penyakit Pekerjaan dalam

operasi Kerajaan Tempatan

Hak-Hak Pekerja dan Orang lain.

Occupational Safety and Health

Awareness Course- Minsistry of Housing and Local

Government

Dr. Avinash K. Chand

MBBS, LFOM, DMO, CMIA

Occupational Health Doctor

KESAN KEMALANGAN

KESAN KEMALANGAN

OH : DEFINITION BY WHO/ILO

1. Promotion and maintenance of the highest

degree of physical, mental and social well-

being of workers in all occupations;

2. Prevention of workers of departures from

health caused by their working conditions;

3. Protection of workers in their employment

from risks resulting from factors adverse to

health;

4. Placing and maintenance of the worker in

an occupational environment adapted to

physiological and psychological ability

5. Summary : the adaptation of work to man

and of each man to his job.”

CLASSIFICATION OF OCCUPATIONAL

HAZARDS

Hazards at work may be classified into Acute or Chronic:

Acute

These cause immediate health effects such as by corrosive, irritant, poisonous, inflammable and volatile gases, liquids, and solids.

Chronic

The effect take a long term to manifest (latency period), and may be difficult to identify, e.g. occupational cancers.

TYPES OF OCCUPATIONAL HAZARDS

1. PHYSICAL (including

ERGONOMIC)

2. CHEMICAL

3. BIOLOGICAL

4. PSYCHOSOCIAL

Chemical Dusts, metals, organic solvents, acids,

alkalis, pesticides, etc.

Physical Noise, vibration, ionizing radiation,

heat, cold, lighting, physically

demanding work, e.g. Repetitive

strain injuries, etc.

Biological Viruses, bacteria,

fungi, worms etc.

Psychosocial

Stress – shift work, overworks,

boredom, lack of motivation,

monotony, insufficient

training, Poor organization.

Personal threat – sexual

harassment, abuse,

discrimination.

ROUTES OF ENTRY

• Ingestion Toxic substances may be ingested orally

through contaminated food or drink, during smoking, or through swallowing of contaminated mucus from the respiratory tract. Significant absorption may then occur via the intestinal tract. However, oral toxicity is generally lower than inhalation toxicity for a particular substance because of poorer absorption, dilution from food and drinks and detoxication by the liver.

• Inhalation

This is the most important route of entry for most

substances. The upper respiratory tract

(nose,throat,larynx,trachea and main bronchi)

acts as an important filtration and drainage

system through mucus and cilia to remove

much of the inhaled substances. Particles

smaller than 5 microns are deposited in the

lower respiratory tree (alveoli) but may be

engulfed and cleared by macrophage cells or

absorbed through the alveolar-capillary

membrane.

• Skin absorption

This is an important route for

pesticides,solvents and organic chemicals,

and for microbiological organisms.

Absorption may occur through intact or

especially damaged skin, and is higher at

warm temperatures due to sweating and

vasodilation.

Ionizing and ultraviolet radiation are also

absorbed through the skin.

Skin Structure

Epidermis

Muscle fibers

Subcutaneous

Dermis

METABOLISM

After absorption, the substances are transported in the blood, either in plasma or bound to red blood cells, to other organs or tissues in the body. Some substances are deposited and metabolized in the liver to non toxic compounds which are then excreted through the kidneys.

Others may accumulate in special affinity sites or target organs such as bones(e.g. lead,fluorine,radium), hair(arsenic,cadmium), nerve or fatty tissue (organochlorines).

PHYSICAL HAZARD

Silica (SiO2)

A former tunneling worker

suffered from silicosis

54 y.o. 61 y.o.

Tunneling from18 to 38 years old

Lung changes

Construction materials

including asbestos

Asbestos fibre

A carpenter suffered from

asbestosis

56 y.o. 59 y.o.

Working as a carpenter from 23 to 56 years old

Lung changes

ERGONOMIC

History of MSD’s (England 19th & 20th Century

BEFORE

AFTER

BEFORE

AFTER

Old New

Mechanical Aids

Victorian WorkCover Authority 39

BIOLOGICAL HAZARD

BIOLOGICAL

HAZARD

eg : HIV/AIDS

VIRUS HIV

WASTING IN

AIDS PATIENT

110101

KARPOSI SARCOMA IN AIDS PATIENT

110101

110101

110101

VIRUS SARS

Typical

Pneumonia Atypical

Pneumonia

Pneumonia

ZOONOTIC DISEASES

Examples :

Nipah virus

Anthrax

Brucellosis

Psittacosis

Leptospirosis

An infection or infectious disease

transmissible under natural conditions

from vertebrate animals to human

NIPAH VIRUS

CHEMICAL HAZARD

n-Hexane polyneuropathy

The 1st patient in the world who was diagnosed to be n-hexane polyneuropathy

19 y.o. Polyethylene lamination (Aug. 1962-Dec. 1962) Sept 1962 : Easy fatigability Oct. 1962 : Body weight loss Nov.1962 : Tingling sensation Dec.1962 : Gait disturbance Jan. 1963 : Grip power 0kg

Organic Solvent

Mass outbreak

of n-hexane

polyneuropathy

among

footwear

manufacturers

disclosed in

1967

Organic Solvent

Stevens-Johnson syndrome due to

trichloroethylene (TCE)

Symptoms and Signs :

Fever & headache

Serious form of Erythema

multiforme

Mucous membrane

involvement :

conjunctivitis, rhinitis,

vesicobullous eruption

Eyes : keratitis, iritis,

uveitis, panopthalmitis

Organic Solvent

Stevens-Johnson syndrome due to

trichloroethylene (TCE)

Organic Solvent

Reproductive disorder and bone marrow damage

due to 2-bromopropane

Organic Solvent

Brain damage of a thinner sniffer

Normal brain (MRI) Brain damage of a thinner sniffer (MRI)

Contents of thinner

Toluene 68%

Ethyl acetate 18%

Methyl isobutyl ketone 9%

Isopropyl alcohol 3%

Butyl acetate 3%

Organic Solvent

ALLERGIC CONTACT DERMATITIS (ACD)

DERMATITIS DUE TO DETERGENT EXPOSURE

PESTICIDES

PREVENTION AND CONTROL

The hierarchy of controls is a list of measures in order of priority or desirability:

Elimination

Substitution

Isolation

Engineering Controls

Work Practices

Personal Protective Equipment

Other preventive measures are:

Environmental monitoring (Industrial Hygiene)

Ventilation Housekeeping Health Education Health Surveillance and Biological

Monitoring

Health Surveillance is the examination of

individual workers on a regular basis for

early diagnosis or identification of changes

or deviations in health status due to

workplace exposure to hazardous

substances.

This may include biological monitoring, which is the measurement of a hazardous substance or its metabolite, or other biological parameters such as enzymes in body tissues, fluids or exhaled air.

BIOLOGICAL EXPOSURE INDICES (BEIs)

These are measurements of the concentration of a chemical determinant in the biological media of those exposed.

Examples - Acetone in urine

- Hippuric acid in urine

- Cholinesterase activity in rbc

- Lead in blood

MEDICAL SURVEILLANCE

MONITORING of a person for the

purpose of identifying CHANGES IN

HEALTH STATUS DUE TO

OCCUPATIONAL EXPOSURE TO CHEMICALS HAZARDOUS TO HEALTH

REPORTING OF OCCUPATIONAL DISEASES

Underreporting :

ICEBERG PHENOMENON

Occupational Lung Disease

Occupational Skin Disease

Occupational Cancers

Zoonoses

NIHL

Neurological Disorders 2o solvents

Poisoning 2o Inorganic and Organic poisons

Ergonomic problems/ Stress

Reported cases

Gross underreporting

NOTIFICATION OF OCCUPATIONAL DISEASES

Legal Requirement

1) Section 32 of Act 139 FMA 1967

(Notification on Industrial Diseases)

~ Duty to report by Medical Practitioner

~ List of notifiable industrial diseases in Third

Schedule

2) Section 32 of Act 514 OSHA 1994

~ Duty to report by employer and Medical

Practitioner

Hak- hak pekerja dan orang lain

Dijelaskan dalam OSHA 1994

OTHER PROVISIONS TO…

73

Ensure the safety, health and welfare of the people at work

Protect others from the safety and health risks arising from the activities of people at work

Establishment of the National Council for OSH

Other related matters

OSHA 1994: CONTENTS

74

The 15 Parts of OSHA 1994:

1. Preliminary

2. Appointment of Officers

3. National Council for OSH

4. General Duties of Employers and Self-Employed Persons

75

5. General Duties of Designers, Manufacturers and Suppliers

6. General Duties of Employees

7. Safety and Health Organisations

OSHA 1994: CONTENTS

OSHA 1994: CONTENTS

76

8. Notification of Accidents, Dangerous Occurrence, Occupational Poisoning and Occupational Diseases and Inquiry

9. Prohibition Against Use of Plant or Substance

10. Industry Codes of Practice

OSHA 1994: CONTENTS

Copyright@NIOSH 2005 77

11. Enforcement and Investigation

12. Liability for Offences

13. Appeals

14. Regulations

15. Miscellaneous

PART I: PRELIMINARY

Copyright@NIOSH 2005 78

Section 1(2)&(3) - SHORT TITLE &

APPLICATION

Persons at work

In all sectors of the economy as in the First Schedule including

public services and authoritative bodies

Exceptions: work on board ships, and the Armed Forces

FIRST SCHEDULE

Subsection 1(2)

Copyright@NIOSH 2005 79

Manufacturing

Mining and quarrying

Construction

Agriculture, forestry and

fisheries

Utilities

Electricity, Gas, Water &

Cleaning services

Transportation, storage and

communications

Commercial – wholesale and

retail

Hotel and restaurant

Financial, insurance, properties

and business services

Public services and authoritative

bodies

PART I: PRELIMINARY

80

Section 2 - PREVAILING LAWS

(1) Additional provisions to any other written law related to

OSH

(2) The OSHA provisions will supersede any conflict or

inconsistencies with previous laws

PART I: PRELIMINARY

81

Section 3 - INTERPRETATION

Industry – public service, or local authorities,

or any activities in the First Schedule

Plant – any machinery, equipment, appliance,

implement or tool, any component thereof and

anything fitted, connect to it

PART I: PRELIMINARY

82

Section 3 - INTERPRETATION

Employer - the immediate employer or the principle

employer or both

Immediate employer – employer that employs the employee

directly, by or through him

Principle employer - the owner of an industry including

manager, the occupier, the legal representative, government,

local authority or statutory body

PART I: PRELIMINARY

83

Section 3 - INTERPRETATION

Worker - a person who is employed for wages under a contract of service

Occupier - a person who has the management or control of the place of work

Place of work- premises where persons work or premises used for the storage of plant or substance

PART I: PRELIMINARY

84

Section 3 - INTERPRETATION Premise – includes any: land, building or part of any building

vehicle, vessel or aircraft

installation whether on land, shores, or floating on any water or

underwater

tent or mobile structure

PART I: PRELIMINARY

85

Section 3(2) - INTERPRETATION

Risk arising - the risk that may come due to

activities of persons at work including:

the work processes

the plant or substances used

the condition of premises used

PART I: PRELIMINARY

86

Section 3(3) - INTERPRETATION

Work – Work as an employee or as a self-employed person

An employee is deemed to be at work throughout the time

when he is at his place of work

A self-employed is at work throughout such time as he devoted to work as a self-employed person

87

Part I: Section 3 Practicable should take into account: the severity of the risk or hazard or risk

the state of knowledge about the hazard or risk and any way of removing or migitate the hazards or risk

the availability and suitability of methods to remove or mitigate the hazard or risk

the cost of removing or mitigating the hazard or risk

PRACTICABLE INTEPRETATION

PART I: PRELIMINARY

88

Section 4 - OBJECTIVES OF THE ACT

To ensure the safety, health and welfare of persons

at work

To protect person at a place of work other than

persons at work

PART I: PRELIMINARY

89

Section 4 - OBJECTIVES OF THE ACT

To promote an occupational environment for persons at work which is adapted to their physiological and psychological needs

To provide the means towards a system of regulations and approved industry codes of practice

PART IV:

GENERAL DUTIES OF EMPLOYERS AND SELF-

EMPLOYED PERSONS

90

Section 18

Responsibility of an occupier of a non-domestic premise is

to ensure the place of work is free from risks to the safety

and health of those other than his workers

Case Discussion…

Kisah Benar