Health Fitness Regulations for Public Employment PDF

Health Fitness Regulations for Public Employment Dr. Badr Ghwoidi Occupational Medicine Specialist, Taif Health Cluster MBBS, MSc, Fellowship in Occupational Medicine  Objectives and Notes This lecture will cover Ministry of Civil...

Health Fitness Regulations for Public Employment Dr. Badr Ghwoidi Occupational Medicine Specialist, Taif Health Cluster MBBS, MSc, Fellowship in Occupational Medicine  Objectives and Notes This lecture will cover Ministry of Civil service Policy and procedure regarding public employment. A refreshed policy may be needed soon for future pre-employment assessment of other sectors. The policy will cover the following: Conditions that disqualify individuals from meeting health fitness standards. Health Fitness Regulations for Public Employment, with Visual Acuity Levels Required at Recruitment for Positions that Demand Specific Visual Requirements. List of Jobs Requiring Color Vision Proficiency. Reinstatement in service, extension of service duration. Pre-employment examination form. Examples of Important tests. The following conditions disqualify individuals from meeting health fitness standards:  1- Surgical Conditions: Large hernias unless fully healed Large hydroceles or hematoceles unless fully healed Elephantiasis if the size of the affected part hinders functionality Malignant tumors in general Amputation of a limb in roles requiring the use of the amputated limb Evident, incurable splenomegaly Incurable ascites Severe liver cirrhosis Bone and joint tuberculosis unless fully healed.  2- Respiratory Conditions: 3- Cardiovascular Conditions: Active pulmonary tuberculosis Heart failure until cardiac function until it has been dormant for at is stabilized. least one year pleural effusion until it is fully absorbed acute and subacute pneumonia and pulmonary abscesses until they are healed.  4- Urinary System: Presence of albumin in the urine does not disqualify an individual from health fitness. Large amounts of albumin in the urine when all casts, except for hyaline casts, or more than five red or white blood cells are found in a high-power microscopic field, along with elevated blood pressure, and a blood urea level above 75 mg%. Persistent blood sugar levels exceeding 120 mg% when fasting, or exceeding 180 mg% at peak, accompanied by ketones, unless treated, with the condition stabilized and ketones cleared.  5- Mental, Neurological, and Epileptic Disorders, and Psychological Conditions: All uncurable mental, neurological, and epileptic disorders. Curable cases are postponed until it is confirmed that the condition has been stable and symptom-free for at least one continuous year). Note: Psychological conditions are generally divided into two types: A. Mild conditions, known as neurosis, include hysteria, anxiety, and reactive depression (depression neurotic or reactive). These do not prevent functional employment. B. Severe psychological conditions, or psychosis, traditionally referred to as mental disorders, such as: 1. Schizophrenia. 2. Manic-depressive psychosis. 3. Paranoia. These cases must be referred to a specialist for examination and a report on their suitability for service. 6- Dermatological and Venereal 7- Communicable Diseases: 8- Severe Visual Impairment: Diseases: Less than 6/60 vision in (Chronic and incurable contagious All infectious diseases until they Both eyes, even with corrective skin and venereal disease are fully cured and no longer lenses, regardless of type. (STDs/STIs) affecting multiple contagious. parts of the body and However, individuals with lower incompatible with work duties). visual acuity or blindness may be - Active (positive) leprosy until the considered for positions that do case is no longer infectious. not require vision. Health Fitness Regulations for Public Employment, with Visual Acuity Levels Required at Recruitment for Positions that Demand Specific Visual Requirements:  A- Technical Positions in General: 1. Specialist doctor, general practitioner (resident). 2. Pharmacist, pharmacy assistant, nursing supervisor, nurse, midwife. 3. Science specialists (Chemistry, Physics, Geology, and similar fields). 4. Teacher, "Physical Education Teacher or Trainer." 5. Agricultural engineer or equivalent. 6. Technician positions, whether holding a high or intermediate qualification, in various specialties. 7. Technical worker, physical therapist, laboratory assistant. 8. Notaries, members of judicial councils, legal and Sharia investigators. Required Level: 6/36 vision in both eyes with glasses. Color perception: (according to job nature).  B- Engineers and Equivalent Positions: 1. Engineer, draftsman, photographer (except those in surveying). 2. Archaeological restorer. Required Level: 6/18 – 6/18 or 6/12 – 6/24 or 6/9 – 0 (Has vision in only one eye) with glasses. Color perception: (according to job nature).  C- Technical Positions in Certain Departments: 1. Meteorology (‫)اﻟﻌﻣل ﻓﻲ ﻣﺟﺎل ﻣراﻗﺑﺔ اﻟطﻘس‬: weather observer and assistant – meteorology controller – aerial photographer and assistant. 2. Civil Aviation: air traffic controller and assistant – wireless technician (operations) – wireless technician (maintenance). 3. Ports: port controller – port officer. 4. Surveying: engineer – computer operator – typist – photographer – specialized surveyor – surveying controller. 5. Workers involved in microscopic examinations and similar devices: laboratory doctors – laboratory technicians – biology teachers, and those in similar specialties. Required Level: 6/12 – 6/12 or 6/9 – 6/18 with glasses not exceeding 6 diopters. Color perception: (according to job nature). For wireless technicians (operations) and surveying specialists, color perception is not required.  D- Ophthalmologists: Required Level: 6/9 – 6/9 or 6/6 in both eyes, or 6/6 – 6/12, without any obvious real strabismus. E- Certain Maritime Positions: 1. Captains, navigators, tugboat captains, chief seafarers, and lookouts. Required Level: 6/9 – 6/9 or 6/6 – 6/12 without glasses. Color perception: via Ishihara test Visual field is normal No visible real strabismus ٍRetina is normal. Navigators are permitted to use glasses if they are 40 years or older, provided the correction does not exceed 2 diopters. 2. Chief seafarers in small vessel guidance – seafarers. Required Level: 6/12 – 6/12 or 6/9 – 6/18 without glasses. Color perception: via Ishihara test. Visual field is normal No visible real strabismus Retina is normal. F- Positions That Do Not Require Visual Acuity: Muezzin – Quran teacher – Imam and preacher –Teachers of religious and Arabic sciences in schools or religious institutes – Marriage contract officiants.  List of Jobs Requiring Color Vision Proficiency Jobs that require color vision proficiency due to the nature of their work: A. General Technical Jobs: 1. Meteorology: Meteorologist and assistant – Assistant Meteorological Technician – Meteorological Observer. 2. Civil Aviation: Air Traffic Controller and assistant. 3. Ports: Port Controller. 4. Those working in microscopic examination and similar machines – Laboratory Doctors – Laboratory Technicians – Biology Teachers.  Jobs that require color vision proficiency due to the nature of their work: B. Physicians: Ophthalmologist – Forensic Doctor. C. Some Maritime Jobs: 1. Captains – Pilots – Chief Mariners – Lookouts. 2. Chief Mariners for guiding small vessels. D. Specialized or General Technical Jobs: 1. Pharmacist – Assistant Pharmacist. 2. Science Specialists (Chemistry, Physics, Geology). 3. Teachers of the following subjects: (Chemistry, Practical Arts Drawing, Embroidery Arts – and other artistic works such as Textile, Engraving, Decoration). 4. Electrician – Wiring Works – Decor Specialist or Engraving and Decoration Specialist.  Jobs that require color vision proficiency due to the nature of their work: E. Engineers: 1. Engineer or Decor, Engraving, or Decoration Designer – Chemical Engineer – Electrical or Wiring Engineer. 2. Restoration Engineer. F. Civil Aviation: Wiring Technician – Maintenance. Those working in air traffic monitoring. G. Surveying: Engineer – Designer – Computer Operator – Map Printer – Photographer – Surveyor – Surveying Supervisor.  Jobs that require color vision proficiency due to the nature of their work: H. Teachers of the Following Institutes and Colleges: 1. Industrial Institutes. 2. Intermediate Colleges, Science and Mathematics Centers – Education Colleges – Girls’ Colleges, Educational Departments (Chemistry Division). 3. Art Education Institutes – Drawing and Practical Arts Division. 4. Sewing and Home Economics Institutes. I. Health Technicians: Radiology Technician – Health Inspector – Medical Registration and Statistics Technician – Nursing Technicians (Male and Female).  Reinstatement in service, extension of service duration Medical examinations for reinstatement in service, extension of service duration, and termination of service fall under the jurisdiction of the General and Local Medical Committees. Exemption from the health fitness requirement for appointment to service is within the authority of the General Medical Committees. Occupational Medical committees consist of the following members: ⁻ Occupational Medicine. ⁻ Medicine. ⁻ Surgery. ⁻ Psychiatry. ⁻ Any subspecialty needed can be called upon. Guidelines: A) It is essential to complete all fields of the form according to the position for which the candidate is applying. B) It is recommended that the person filling out this form be familiar with the Health Fitness Regulations beforehand. C) If the candidate's medical condition is treatable within a period not exceeding sixty days, as determined by the medical authority, they will be deemed fit for the position, provided they undergo a medical examination after recovering from the noted condition. D) "Other illnesses" mentioned in this form refer to the following: 1. Dermatological and sexually transmitted diseases. 2. Any other illnesses not included in the form but for which the position requires the applicant to undergo a medical examination. E) If the concerned authority conducts additional tests, the results will be delivered to the candidate personally. F) A positive result in any of these tests does not necessarily disqualify the candidate from certain positions that do not require the respective examination.  TB Screening ALL new HCW need to be screened for latent tuberculosis infection (LTBI) either by: Interferon Gamma Release Assay (IGRA) “preferred if available” or Two-Step Tuberculosis Skin Testing (TST) or (2 Step PPD) If the TST or (PPD) documentation is Positive: You will need to do an Interferon Gamma Release Assay (IGRA) If Results are negative nothing further is needed. o If results are positive, a chest x-ray is required. If results of chest x-ray are negative, nothing further is required. If results of the chest x-ray are positive follow up with further testing is required. (Applicant cannot begin employment until documentation of follow up is provided)  Exclude persons who have had the following from testing: a. Live vaccine administered within the past 3 weeks or on the same day as the TST because live-virus vaccines may cause a false negative reaction. b. Current febrile illness. c. Documented positive PPD. The Tuberculin Skin Test (TST) detects individuals infected with Mycobacterium tuberculosis. The skin test is administered intradermal using the Mantoux technique by injecting 1.0 ml containing 5 TU of purified protein derivative (PPD) solution. If a person is infected, a delayed-type hypersensitivity reaction is detectable 2 to 8 weeks after infection. The reading and interpretation of TST reactions should be conducted within 48 to 72 hours of administration by trained healthcare professionals. Give a written appointment card for TST reading. Inform the patient of the importance of returning for a reading of the TST within 48 to 72 hours (2 to 3 days). m. Provide written information about the TST (a pamphlet or brochure). *(for more information check Occupational Health Clinics Program 2019 – Final Manual)  Measurement 1. Measure the induration (hard bump) rather than the erythema. 2. Palpate the area with the fingertips, measuring the diameter of induration perpendicular to the long axis of the arm. 3. Use a ballpoint pen to mark the edges of the induration. 4. Use a tuberculin skin test ruler or a ruler with millimeter marks to measure the distance between the two points. Recording and documentation: a) Record the date that the TST was administered. b) Record the brand name of the PPD solution, lot number, manufacturer, and expiration date in the patient’s records. c) Record results in millimeters of induration (0 mm if there is no induration) rather than as positive or negative. d) Record the date and time of reading and the name of the person reading the TST. e) Provide the patient and ordering physician with written documentation.  Chest Radiograph: Chest radiographs help differentiate between LTBI and pulmonary TB disease in individuals with positive TST results. For TST-positive individuals: 1. Clinical evaluation to exclude active tuberculosis: a. Order chest radiography as part of a medical evaluation for a person who has a positive TST. b. Determine baseline CBC and liver function test (LFT). 2. Refer to Infectious disease consultant for evaluation and possible prophylaxis. After baseline testing, routine periodic retesting is recommended for persons who had abnormal initial results and other persons at risk for hepatic disease. *(for more information check Occupational Health Clinics Program 2019 – Final Manual)  Healthcare workers: Healthcare candidates should undergo the following serologic tests: Viral hepatitis (B) "HBs Ag”. Viral hepatitis (C) "HCV Ab”. HIV Test. The Ishihara Color Blindness Test  What is Ishihara Color Blindness Test? * Color Vision Deficiency * Pseudoisochromatic Plates The Ishihara test identifies red- These plates contain colored green color blindness. It's a dots forming numbers or quick and effective screening patterns. People with color tool. blindness see different patterns. * Common Screening Tool Used worldwide, this test helps diagnose inherited color vision deficiencies. It's not for acquired deficiencies. How the Ishihara Test Works: Plate Examples Hidden Number Different Number Winding Path Some plates have numbers only visible with Those with color blindness might see a Some plates use winding paths instead of normal vision. different number. numbers. Normal Color Vision vs. Color Deficiency Normal Color Vision Color Deficiency Individuals perceive the full spectrum of colors. They can distinguish Difficulty differentiating between specific colors, usually red and between shades and hues effectively. green or blue and yellow. Can be Congenital or Acquired: Congenital Acquired Present from birth, usually genetic. Develops later, due to disease or injury. Types of Color Vision Deficiencies Protanopia Deuteranopia Reduced sensitivity to red light. Reduced sensitivity to green light. Reds appear darker, almost Impacts red-green distinction. brownish. Tritanopia Rare; reduced sensitivity to blue light. Confuses blue with green. Conducting the Ishihara Test: Step-by-Step Controlled Lighting Ensure proper lighting, preferably natural daylight. Standard Distance Hold plates at a standard distance, typically 75cm. Time Limit Give a time limit, usually 3 seconds per plate.  Test Administration: Present the plates one by one, asking the patient to identify the number or pattern they see on each plate. The patient should not wear any color-enhancing glasses during the test. Record the responses carefully after each plate. Considerations: The test should be conducted on each eye separately if there’s a need to check for unilateral color vision deficiencies. Avoid prompting or giving clues during the test. Interpreting the Ishihara Test Results Correct Responses Normal Color Vision Errors on Specific Plates Indicates Type of Deficiency Multiple Errors More Severe Deficiency Case Studies: Ishihara Test Interpretation 1 Case 1 2 Case 2 Patient sees '2' instead of '74'. Patient sees no number. Indicates red-green deficiency. Suggests more severe color blindness. Thank you Any Questions?