Occupational Health Nursing Lecture Notes PDF

**LECTURE NOTES ON OCCUPATIONAL HEALTH NURSING** **NSG 417** **BY** **NR. CATHERINE O. ESEINE** **OCCUPATIONAL HEALTH** **INTRODUCTION** Occupational Health is defined as the branch of health science that deals with the preservation and restoration of the health of the worker in relation to his work and work environment to enhance increased productivity and maximum profit. **History of occupational health** In the ancient days, farmers used ancient tools and machines were scarce. They were self employed and produced what they consumed without mass production. The earliest workers in gold, silver and lead mining industries in ancient Greece and Egypt were not given occupational health service and slaves were the main persons engaged for labour. In the 4^th^ century, Hypocrates recognised the toxicity of lead in mining industry but no attempt was made to protect the workers. In the 9^th^ century, attempt was made to protect the workers in zinc and sulphur mining industries by a Roman scholar, Pliny the Elder. He designed a protective mask for the workers in the industries who were exposed to large amount of industrial dusts and fumes. The Romans showed little interest in occupational medicine. Rather, they were more interested in engineering and military achievements. Occupational Health could be said to have started with the bolder move made in the 17^th^ century in mining industries by an Italian physician, Bernadino Ramazzini in recognition of mining accidents and silicosis. He stressed the importance of industrial hygiene in the prevention of industrial accidents and diseases when he set into motion a drive for recognition of the role of occupations in the dynamics of health and disease. In the 18^th^ century, there was industrial revolution in Europe and America and this was accompanied by new occupational diseases and accidents. The plight of workers was deplorable. Men, women and children were drafted to industries where they were over worked under very cruel and unhealthy conditions. Workers were dehumanized as work was placed above individual health. As a result, workers were dying in hundreds. This led to the development of occupational health service by some physicians such as George Baker, Percival Pott and Charles Turner Thackrah to protect the workers. Occupational Health progressed through the rest of the industrial revolution under the title of industrial medicine, right up to and even after the joint World Health Organization/International Labour Organization Expert Committee on Occupational Health defined it and set its objectives at that committee's first meeting in 1950. In Nigeria, the first occupational health service was introduced in 1789 by the Medical Examining Board of Liverpool with a view of taking care of the health of slave traders carrying slaves from Africa to Britain. Upon the abolition of slave trade, the Royal Niger Company of Britain which was later change to United African Company (UAC) increased its exploitation of trading in Nigeria. The company was empowered to administer the territories by the British Government. During the British colonial rule, Colonel Lugard established health services to take care of the health and welfare of soldiers and other colonial administrators after many of the expatriate soldiers died of malaria. The Public Health Service was created during the Second World War after the medical corps was separated to cater for the military alone. This gave birth to the introduction of some occupational services in some industries in Nigeria which include pre-employment and periodic medical examination and treatment of major injuries and ailments. United Africa Company and John Holt (British companies) were the first to introduce the practices of occupational health in Nigeria. In 1930, Railway, coal mines and some other government establishments provided some forms of occupational health services to their workers. Occupational health service started in full force from the attainment of independence in Nigeria due to mass industrialization. Some legislations that have been enacted include the Workman's Compensations Ordinance of 1941 and the Labour Core Ordinance of 1945. The Labours Ordinances(s) were later replaced by Workman's Compensation Decree in 1987 and Labour Decree of 1974 respectively. The Ministry of Labour was created in 1951 with Mr. P.R.G. Britnell as the Chief Inspector of Factories in Nigeria. In 1955, the Factory Act was enacted and amended in 1958 and was later replaced by the factory Decree of 1987. In 1968, the first Nigerian professor of Occupational Health Dr. G. O. Sofoluwe organised the first international seminar in occupational health for developing countries in Lagos. In 1970, the society of occupational health physicians of Nigeria was created while the division of Occupational and Environmental Health was created in 1976 by the Federal Ministry of Health. **International Occupational Health** ------------------------------------- As industrialization spread from one country to another, so also is the diseases and ailments associated with different trades. Gradually, occupational health was being recognized as a distinct area of medicine deserving special attention in those countries that were the pioneers of industrialization in Europe and America. The oldest international bodies in modern times concerned with global health and safety of people at work are the International Labour Organization (ILO) and the World Health Organization. **International Labour Organization** ------------------------------------- The International Labour Organization (ILO) was founded in 1919 in Geneva, Switzerland under the League of Nations to promote international Labour standard and improvement of working conditions. The ILO programmes, as well as international labour Standards in the form of conventions and recommendations, were approved and adopted by the annual international Labour Conference held in Geneva. The Conference consists of two governments, one employer and one worker representative from each member states. Hence ILO is said to be a tripeptide body made up of representatives from governments, employers and employees. ILO\'s health work included safety and health of all types of worker especially from chemical and other industrial risks, hygiene of seamen, social and medical insurance systems and workmen\'s compensation. In compliance with multi- disciplinary approach, it collaborates with the World Health organization (WHO) in holding a number of Joint Expert Committee meetings in the field of occupational health and safety and publishes inter alia International Medicine guide for ships and ship sanitation. The International Programme for the Improvement of Working Conditions and Environment activities, emphasize that the Improvement of occupational safety and health and working conditions should be considered as a complex problem in which various factors are interrelated, such as protection against risks in the working environment, adaptation of work processes to the physical and mental capabilities of workers, improvement of work schedules and job content. A multidisciplinary approach is stressed. **The World Health Organization** The World Health Organization (WHO) is the specialized agency of the United Nations founded in 1948 with headquarters in Geneva Switzerland. It has the responsibility for global health. Its major role in the field of occupational health started with the report of the First Joint WHO/ILO Committee on occupational Health in 1950 which stated the purpose of occupational health as follows: \"Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention among workers of departures from health caused by their working conditions; the protection of the workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the workers in an occupational environment adapted to his physiological and psychological equipment and to summarize; the adaptation of work to man and each man to his job\". Occupational health, as in other areas of Public Health, lays emphasis on preventive medicine. Occupational health practice is comprehensive. Some of the preventive measures could only be achieved by safe working environment, other conditions that encourage and promote healthful living; and ergonomics in machine design and operations. **OCCUPATIONAL HEALTH NURSING** Occupational health nursing is a specialist branch of public health nursing with its roots in traditional nursing care. An occupational health nurse is a qualified, registered, accountable professional with years of experience of confidentially supporting, treating and helping people in both hospital and community settings. An occupational health Nurse usually has an additional qualification in community/public health nursing. Occupational health nurses (OHNs) aim to combine knowledge of health and business to balance safe and healthful work environments. They provide health education, case management, and safety programs. Registered nurses provide an array of services to business and industry and fill diverse roles in occupational health, including those of clinician, educator, case manager, corporate director, and consultant. They address those factors which are related to the health of the working population and by helping to reduce ill health they can contribute to the increased profitability and performance of organizations and reduce health care costs. **Functions of Occupational Health Nursing** OHN is a multifaceted and multidisciplinary activity concerned with the prevention of ill health in employed populations. This involves a consideration of the two-way relationship between work and health. It is as much related to the effects of the working environment on the health of workers as to the influence of the workers' state of health on their ability to perform the tasks for which they were employed. It focuses on prevention, rather than cure of ill health arising in the workplace. The specific roles of the OHN are listed below: 1). The OHN serves as a link between the management and workers on health matters, advises management about its responsibility as regards health, safety and welfare of workers and explains the relationship between workers state of health and efficiency and productivity. 2). Surveillance of the work environment, factors and work practices that affect workers' health, including sanitary installations, canteens and housing, when such facilities are provided by the employer. 3). Identification and assessment of the health risk in the workplace. 4). Participation in the development of programmes for the improvement of working practices, as well as testing and evaluation of health aspects of new equipment. 5). Advice on planning and organization of work, design of workplaces, choice and maintenance of machinery, equipment and substances used at work. 6). Advice on occupational health, safety and hygiene, and on ergonomics and individual and collective protective equipment. 7). Promoting the adaptation of work to the worker. 8). Collaboration in providing information, training and education in the fields of occupational health, hygiene and ergonomics. 9). Ensures safety devices are provided by the management and judiciously used by the workers. 10). Gives immunization where applicable. 11). Contribution to measures of vocational rehabilitation. 12). Organization of first aid and emergency treatment. 13). Carries out pre-employment and periodic medical examinations. 14). Carries out or assist in carrying out screening exercises such as vision tests, hearing tests, cancer detection tests and chest x-ray to detect lung diseases. 15). She keeps record of all incidence of both occupational and non-occupational diseases and accidents, analyses them and sends to management for action. 16). care for people who become injured or ill at work. 17). provide counselling, give advice and educate employees on health and safety and sickness. 18). develop programs that promote lifestyle changes and individual efforts that lower risk of disease and injury. 19). assist in creating environments that provide a sense of balance among work, family, personal, health and psychosocial concern. 20). teaching and clinical supervision and mentoring. **THE PRINCIPLES AND PRACTICE OF OCCUPATIONAL HEALTH** The promotion and maintenance of the highest degree of workers health is the main objective of occupational health and is of paramount importance to Government and employers of labour. This is because environment at work exposes the worker to hazards of varying nature and proportion. Hostile environment at work will lead to ill-health and consequently bring about absenteeism. The end result of this is low productivity. A worker spends a better part of his day at work more than his home. Since the employer expects better performance from him, the worker has a fundamental right to work in a very conducive atmosphere to maintain a good health while his employer owes him that duty to cater for his health. The employer should ensure the following in order to promote the health of the worker: 1. The worker should undergo pre-employment and periodical medical examination before and after employment. This will ensure early diagnosis and treatment of occupational diseases and accidents. 2. An organized health education service to broaden workers knowledge on hazards associated with their work and the best way to prevent their occurrence. 3. Good location of residential accommodation close to place of work will cater for workers physical and social health. Provision of housing units for workers will help reduce time and energy wasted when waiting for public transport. Alternatively, workers can be commuted to work by factory's vehicles. Loans can also be given to workers to purchase their own vehicles. 4. Hazardous processes at work should either be isolated or abandoned. 5. Regular monitoring of the work environment. 6. Provision of safety devices for workers to promote health and efficiency at work. 7. Health services for early diagnosis and treatment to prevent disability. 8. Rehabilitation of disabled workers. It is inhuman to lay off a worker due to a disability he got during the course of performing his job. The worker can promote his own health at work and home by doing the following: 1. Eating nourishing food regularly (good nutrition). 2. Drinking portable water. 3. Taking adequate exercise, rest and sleep. 4. Living in a well-lighted and ventilated house. 5. Maintaining a high standard of personal and environmental hygiene. 6. Have a harmonious working relationship with colleagues for good social and mental health. 7. Be in a good state of health before picking up the appointment. 8. Be intelligent, responsible, careful and vigilant as these contribute to safety at work. 9. Should obey all the rules and regulations at his work place. **INDUSTRIALIZATION AND URBANIZATION** Industrialization usually involves progressive transformation of an economic system from rudimentary productive methods to more complex manufacturing processes. It is a systematic change that aims to reshape the productive forces of a given country. In developing countries including Nigeria, people were living in the vicious cycle of poverty and diseases such as malnutrition, warm infestation, bacteria and parasitic infections along with problems of migration from rural to urban areas, indiscriminate employment of vulnerable groups and hazards associated with rapid introduction of new processes and products. Industrialization emerged in the 18^th^ century through what was known then as the Industrial Revolution, a movement that started in Great Britain and had a global impact later. This process of transformation consisted in the application of recently developed technologies to manufacturing processes. This translated into higher levels of automation, productivity and quality that helped the economic system transition from being fundamentally agricultural to having new industries like steel, textile, transportation, housing or chemicals. Many individuals were implementing new techniques to manufacture new products that flooded the market quickly. Urbanization typically begins when a factory or multiple factories are established within a region, which creates a high demand for factory labour. Other businesses such as building [manufacturers](https://www.investopedia.com/terms/m/manufacturing.asp), retailers, and service providers then follow the factories to meet the product demands of the workers. This creates even more jobs and demands for housing, thus establishing an urban area. The increasing use of chemicals in industries and agricultural production created new hazards for the workers. The resultant ugly health problems and their consequences became more and more obvious. Yet, Occupational Health hazards rarely received priority attention from policy makers. What made the matter worse was that many employers ignored the problem or even denied the existence of health problems to workers. This was because labour was plentiful, people seeking for job were numerous. A disabled worker could easily be replaced, wages were very low. This seemed to encourage industrial owners and managers to neglect safety. Accidents were believed to be inevitable and so were regarded as an \"act of God\". The outcome of these was enactment of industrial legislation such as Factory Acts and Workmen\'s Compensation Acts for the survival of workers, prevention and control of industrial health hazards, accidents and other illnesses. Problems associated with Industrialization and Urbanization With the attainment of political independence, massive development took place. Peasant farming with the use of simple tools meant to provide moderate portions to feed the family was replaced with mass production with use of complicated machines to farm for the nation. All types of industries sprang up and the communities became urbanized leading to high demand for education and health. This led to more exposure to occupational diseases and accidents. In addition, other diseases like malaria, malnutrition, infections and parasitic infestations further make the worker prone to occupational diseases and accidents. Effects of Urbanization and Industrialization on the worker Though urbanization has merits and demerits, for the purpose of this course, we will concentrate on the demerits. 1. Malnutrition and undernutrition: The worker who hitherto was growing his crops to feed his family in the village is no longer able to do so as he may not have land for farming in the city. His salary may be too meagre and the nature of his job may make it impossible for him to cook his meals especially if he is living alone. 2. Overcrowding: Due to meagre salary, the worker may not be able to rent a comfortable accommodation. It is worse if he has a large family. 3. Loneliness: The worker who may have been separated from his family and friends is suddenly lonely and this can affect him. He can end up with broken home, alcoholism, falling into wrong hands and friends that will lead him to criminal tendencies and importation of diseases like sexually transmitted diseases. Effects of Urbanization and Industrialization on Community health 1. Environmental sanitation problems in the area of refuse disposal and air pollution. 2. Nutritional problems 3. Social problems like prostitution, crimes, family separation, divorce, children delinquency. 4. Infections like communicable diseases and STIs 5. Mental health problems which may be due to unemployment, stress, loneliness. **WORK ENVIRONMENT** The work environment is plagued with numerous occupational hazards and every job done by any individual has its risks. Workers can be exposed to dust, chemicals, heat, cold, fumes, noise, organisms, frustration, dilapidated building etc. The work environment can be classified into physical, biological, chemical and social environment. 1). Physical Environment: The components include; Building Industrial waste (refuse and litters) Arrangement for ventilation such as windows and doors Noise generated by machines Temperature -- heat and cold Lighting condition Air 2). Biological Environment: This includes; Plants Micro organisms like bacteria, fungi and viruses Large animals like snakes, dogs, cats, donkeys, and other wild and dangerous animals like tiger, lion etc 3). Chemical Environment: This includes chemical agents like dust, fumes, gas, liquid, and vapour resulting from painting, panel beating, welding, mining etc 4). Social Environment: This has to do with relationship between the worker and colleagues as well as between the worker and the management. It also includes social welfare services provided for the workers such as recreational facilities, subsidized food, housing schemes and transportation facilities. **Relationship Between Work and Health** ---------------------------------------- The knowledge and understanding of the relationships and interactions between work and health is important in the practice of occupational health and safety. Both work and health positively and negatively affect each other. Work is supposed to be a means of economic survival and source of satisfaction and happiness where properly planned and executed. It also provides for social status and companionship as well as shared responsibility. But on the negative aspect, it can result to stress, dissatisfaction and threat to employee\'s health and well-being and their attendant morbidity and death. It means that work has effect on health and vice versa. The working environment and the working conditions can positively or negatively affect the employees\' health protection and health maintenance. Also, the workers' health can affect his or her performance and productivity depending on environmental dispositions and the nature of occupational organization and policies. Poor health reduces productivity and worker\'s efficiency. Effects of Work on Health ------------------------- There are many benefits that can be obtained as follows: 1. Work serves to relieve boredom. 2. It provides avenue for creativity. 3. It serves as means of personal/economic gain and means of livelihood. 4. It contributes to life satisfaction and happiness. 5. It serves as source of challenge for human growth and development. 6. It creates opportunity for socialization and companionship. 7. Good health increases capacity to work. 8. It promotes productivity and increases worker\'s performance. 9. It encourages emotional and psychological satisfaction. 10. It reduces stress and promotes intra and interpersonal relationship in the work setting. 11. It increases alertness to danger. Negative Effects of Work on Health ---------------------------------- The negative effects of work on health form the basis for Occupational Health both in developed and developing countries. The nature, situation and conditions of work determine the type and nature of occupational hazards (diseases and accidents) prevalent in a particular occupation/industry. Even the work processes, products and bye products can constitute a health hazard to the workers, their immediate families and their neighborhoods. The hazards can affect many organs of the body causing some pathological changes that can threaten the health and well-being of workers. The threat can result in physical, mental, social and behavioral changes and even death if prompt treatment is not instituted. This is why it is very necessary for occupational health practitioners to have thorough knowledge of the hazards associated with each occupation for quality care provision and accuracy in diagnosis. The workers should also be well educated on the hazards in their particular occupation. This will enable them take precautionary measures and then comply with the occupational safety measures provided for them. The specific effects of poor health include the following: 1. Poor health erodes the company growth and productivity. 2. It leads to poor disposition of workers and their capacity to function effectively at work. 3. It leads to poor performance of the employees 4. It reduces productivity due to absenteeism from illness. 5. It contributes to risks for the workers and to other members of entire family. 6. It causes company to pay compensation to the injured worker. 7. It brings about stresses and low moral to both work and the employer. **Benefits of Occupational Health Promotion in the work environment.** ---------------------------------------------------------------------- Generally, the introduction of Occupational health in industries and other occupations can benefit everybody especially the management, the employers and the employees. The workplace is an ideal setting for promoting the health and well-being of the employees and the employers. A large number of the population spends greater part of their time and energy at work environment each day making the work place the second home for the worker. Also, Occupational Health is meant not only for the worker but is extended to the family members and the entire community directly or indirectly. When the employees are healthy physically, emotionally and psychologically the atmosphere within the occupational setting becomes encouraging, relaxed and inviting. The productivity increases, the company stands better chance of growth. Through Occupational Health, conditions that cause illness and accidents are far more reduced if not prevented. The benefits of Occupational Health at work settings are listed below; 1. Improvement of worker\'s health behaviour due to relaxed atmosphere in the work setting. 2. Improved worker\'s health. 3. Improved workers moral and job-satisfaction. 4. Improved workers efficiency and productivity. 5. Lower sickness rates, lower accidents and injury rates. 6. Reduced absenteeism, reduced labour turnover. 7. Reduced health cost to the employee, the management and the employers. 8. Improved corporate image and industrial relations. 9. Lower compensation for occupational illnesses and injuries. 10. Improved intra-personal and inter-personal relationship within the companies, the family and in the community. **OCCUPATIONAL HEALTH PROBLEMS** The occupation or the nature of work performed by a person exposes him or her to health hazards associated with that occupation. Diverse occupations exist. They include traditional manufacturing industries (automobile. automotive and appliances); service industries (banking, health care, and restaurant); education, agriculture, construction, mining, and newly high technology firms like computer chips manufacturing companies and many others. Each of these occupations has peculiar health hazards associated with it. These health hazards interact with numerous nutritional, hygienic, microbial and social factors in the worker\'s environment to aggravate their effects on health. There is also interaction between work hazards and chronic diseases such as malaria, diabetes, hypertension and cancer. Types of health problems include accident, occupational diseases, chemical hazards and many others. These hazards seriously affect the health of the employees and invariably their productivity. Definition of Occupational Health Problems ------------------------------------------ Occupational health problems can be regarded as diseases, accidents and other hazards arising from the work environment or situations that arise in the attempt to perform tasks in any occupation. It is a compensable disease that arises out of and in the course of employment. This definition hinges on the condition that entitles the worker to compensation from the employer. Types of Occupational Health Problems ------------------------------------- Common Health problems include: 1. Occupational lung diseases (including lung cancer, pneumonoconioses, and occupational asthma) 2. Musculoskeletal injuries such as back injuries, neck injuries, arthritis, vibration problems and white finger diseases. 3. Occupational cancers (other than lung cancers). 4. Traumatic deaths, amputations, fracture and eye loses. 5. Cardiovascular diseases (including myocardial infarction, stroke and hypertension) 6. Reproductive health problems such as prematurity, abortion. 7. Neurotoxic illnesses. 8. Noise induced hearing loss. 9. Dermatologic problems (including dermatoses, burns, and lacerations). 10. Psychological problems. **Occupational Health Problems in Industry** -------------------------------------------- Workers in industries do face numerous occupational health problems. Such problems seriously affect their productivity and life span. The main problems include: Problem of social and environmental pollution, air pollution, noise pollution, ergonomic and chemical pollution. 1. Social and environmental health problems include increases in migration of both skilled and unskilled workers from rural to urban centers causing overcrowding and environmental pollution. The migration results in unemployment, poverty, lower standard of living delinquent behaviour such as abuse of drugs and alcohol, prostitution, robbery, and psychological problems among others. These outcomes bring about stress, anxiety and their implications. Apart from environmental pollution, there is problem of poor housing, overcrowding, poor working conditions and malnutrition. 2. Traumatic injuries are common especially where protective measures are not taken seriously. Most known injuries include musculo-skeletal injuries, traumatic amputations, bruises, lacerations. 3. Air pollution is a serious health problem of industrialization. Apart from contamination of air and the entire environment through automobile and industrial fumes, it introduces harmful pollutants from the exhaust of internal combustion and diesel engines. The pollutants affect the entire body organs and cells causing such risk conditions as cancer, degenerative and chronic diseases including irritation of respiratory system and cardiac problems, loss of visibility leading to accidents. Air pollution also affects the plant growth negatively resulting in poor food production and nutritional problems such as malnutrition and anaemia. The end result being increased morbidity and mortality. 4. Excessive temperature and humidity in industries have their own problems. This occurs in industries where the industrial processes make atmospheric control difficult. Examples of such industries are textile mills, laundries, breweries. The resultant problems include eye inflammations, respiratory and gastro-intestinal problems and even exhaustion resulting from atmospheric extremes. 5. Poisonous - harmful substances other than gases and fumes can be present in industries to cause problems. Chemicals used in industrial plant operations can act as poisons to cause harm to the skin. Chemical chronic poisoning can occur in workers improperly handling materials in routine operations without protective measures. **Occupational health problems in Health Institutions** ------------------------------------------------------- Health workers in health institutions (hospitals, clinics, health centres etc) are faced with numerous health problems which impact seriously on their status. The hospital environment by its nature is full of hazardous problems. The problems could be classified into endogenous and exogenous. a. Exogenous problems are such that were brought into the hospital environment by the health worker suffering from such a condition such as tuberculosis, Human Immunodeficiency Virus (HIV), chicken pox and other conditions that have long incubation period and cannot be diagnosed early for preventive measures to take place. b. Endogenous problems are those acquired within the hospital from patients, patients\' relations or even from workers. Example of such problem include hepatitis B, HIV, other blood sera (that is hazards due to exposure to infected blood and other body fluids), other problems include protozoa infections such as malaria parasites. The hazard could occur through needle stick injuries, lacerations from razor or Lancet or scalpel blades that were infected and other sharp instruments. Occupational hazards in the health industry are: 1. Hazards resulting from radiation such as x-rays used for radiotherapy. This can result in radiation injuries like cancer. This is seen mostly in workers in x-ray departments where radio-active substances are used for therapeutic purposes. 2. Problems due to exposure to communicable diseases such as tetanus, chickenpox, and other blood borne pathogens. This is a major concern when caring for infected patients. The presence of resistant organisms causes extra concern and makes treatment difficult. Workers who have frequent contact with blood and blood products and those engaged in intravenous therapy have a special risk for exposure to hepatitis B. 3. Problems due to exposure to food and water borne diseases include diarrhea, gastroenteritis, caused by schistosomiasis, salmonella's organisms. These problems occur due to contamination of food and water within the environment of the health institution. 4. Problems resulting from hazardous chemical agents do occur. Anaesthetic gasses can increase the risk of spontaneous abortion in pregnancy; maternal illness and death in severe cases and the risk of fetal malformation or death in severe cases. Chemotherapeutic agents used in the treatment of cancer are extremely toxic. Contact with many drugs, especially antibiotics during preparation and administration may cause the health worker to develop sensitivity. This can cause transitory problems such as hand and skin rashes and other undesirable effects. Cleaning agents and disinfectants used in hospitals can cause some hazards if not properly used. 5. Back and joint injuries are common occupational problems among hospital workers. These problems interfere with the working life of people. They occur due to improper body alignment before and after lifting patients and equipment. 6. Other problems include occupational stress which may be due to pressure of work, shortage of personnel, interpersonal relationship with other staff or with supervisor or with patients or patients\' relations or even with self. There could be physical attack from violent and emotionally unstable patients; burn outs due to pressure of work or other various psychosocial stresses at work. Health workers mostly at risk of health problems include doctors, nurses, laboratory staff, radiographers, mortuary attendants, cleaners, physiotherapists and many others. The major sources of the health problem could be hospital wards, hospital clinics, theatres, laboratory, mortuary and other areas where patients are being treated and blood and other body fluids and specimens are taken for investigation. **Occupational Health Problems in Agricultural Settings** In developed and developing countries including Nigeria, agricultural work is the main occupation for majority of the people. The type of agricultural work varies and ranges from mechanized to non-mechanized farming. The activities involved include: clearing the ground, planting, weeding, harvesting, and processing, among others. Then for animal husbandry it involves breeding, raising and caring for animals. Biological hazards include zoonosis or diseases transmitted by animals during caring and handling of animal products and wastes. Examples of such health problems include: anthrax, brucellosis, bovine tuberculosis, Lassa fever, rabies, bird flew and many others. These problems arise during planting, harvesting and primary processing of all types of crops as well as problems arising from breeding, raising and caring for animals, tendering market gardens and nurseries. Parasitic diseases transmitted due to contact with polluted water in farm lands and poor sanitary conditions of agricultural environment include: hookworm disease (ankylostomiasis), schistosomiasis especially in irritant and riverine farm lands, tetanus, sleeping sickness, malaria, skin rashes and many others. Allergic diseases do occur due to inhalation of vegetable pollen dusts, animal dusts, organic chemicals and reaction to certain food substances. Such diseases include asthma, byssinosis from cotton dust, bagassosis from sugar cane bagasse, allergic conjunctivitis from rubber, dermatitis from wood dust, and allergic skin reaction to certain grasses and chemicals. Physical problems do occur as a result of exposure to prolonged heat and sunlight, noise from farm machinery, dust and fumes, puncture wounds from sharp instruments and woods, cuts, bruises and lacerations. These can cause severe preventable diseases like tetanus, bacterial infections and gangrene of the wound. Other problems include backache resulting from prolonged bending, heavy load and wrong posture. Accidents and other injuries do occur and they can result from liquid or gas splashing, electrocution due to electrical faults, falling from height such as palm trees, mango trees, tractor accidents, and so on. There are also records of stings and bites such as human bite, snake bite, dog bite, scorpion bite and many others. When the stings and bites occur, the treatment is always an emergency in order to save life and protect the individual. Human bites do occur over ownership of farm, and it is the most dangerous if treatment is not taken at once. Social problems include: low income, poverty, lack of healthcare and health facilities, water borne diseases like diarrhoea, cholera, schistosomiasis, dysentery, parasitic problems like hook worm, tape worm, and other water borne diseases got from polluted stagnant dirty waters in the farm land as well as sanitary conditions. Food poisons also do occur either as a result of contamination at the harvesting, preparation, serving or even eating with soiled hand or contaminated plates and cutleries. Work place violence is a serious cause of health problems. It may occur over ownership of farm land or economic trees. This can cause interpersonal or even communal violence, body injuries and death in severe cases. **Occupational Health Problems of Education Institutions** ---------------------------------------------------------- Educational institution (primary, secondary and tertiary) is purely a learning institution where teachers and students interact. The proprietor of the school is the employer while teachers and students are regarded as employees. Both teachers and students are exposed to various occupational problems. Teachers face such problems as: - Accidents - might occur resulting in injuries like falls, chalk board dropping from the wall or knocking the feet against had objects. - Infections can occur. It could be transmission from infected student or from the school environment through the use of infected animals for practical demonstration or contaminated environment e.g. chickenpox, measles. - Needles prick injuries occurring during practical demonstrations on how to inject animals or vaccination and immunization of animals. - Varicose veins in severe cases resulting from long standing and pressure. - Respiratory problems due to inhalation of chalk particles and particles from dust within the school environment. - Dehydration due to talking, heat on radiation, convention and conduction of heat. - Electrocution due to faulty electrical appliances in the school premises and in the offices. It can occur during laboratory demonstrations or even during teaching process. - Loss of voice due to strains on the vocal cord during long period of talking in large classes. The teacher has to try to increase the volume of the voice while teaching to carry the class along. - Anxiety and its implications like hypertension, other cardiac anomalies resulting from strains and stresses in school. The stress can be caused by the pressure of work; from students especially with stubborn students; from, employers, from self-due to inner tensions from inability to fulfill one\'s desires, stresses from work overload; generated by caring for students and their personal problems; poor remuneration and irregular payment of salary. Other causes of anxiety and stresses include organizational structure of the school, job insecurity facing teachers; students parent intrusions, relationship with school workers and co- teachers as well as relationship with supervisor. Most importantly poor knowledge and skills to teach. - Other causes of emotional dissatisfaction include back pain, frequent headache, pains and disabilities, and other illnesses. The health problems of the teacher can cause absenteeism and decreased productivity, poor learning and poor students\' performance. Indirectly this could cause poor growth of the school. **Factors that Contribute to Health Problems of Workers** --------------------------------------------------------- The following factors contribute to worker\'s problems in occupational setting: Biophysical: ------------ Human biological factors are those related to maturation and aging, genetic inheritance, and physiological functions. The age compositions of workers in occupational settings do affect their health. If the employees are mainly adolescents and young adults, health problems likely to occur with some frequency include sexually transmitted infections like syphilis, gonorrhea, HIV, pregnancy, hepatitis, drug abuse, alcoholism and other social vices. They may also be at increased risk of injury due to their inability to settle down for work, limited job training and skills, lack of experience, experimentation, impatience and inability to concentrate. The health problems that may be noticed among the middle-aged employees are heart problems like hypertension, stroke, palpitations, renal problems and cancers in most cases. They may also be at increased risk of mental depression, anxiety, and other emotional problems due to pressure of work in the families, work environment and in the society. Health problems that may occur in elderly employees over 65 years of age are reduced capacity to function, problems of musculoskeletal system, sensory impairment, poor coordination, frequent high risk occupational accidents and dementia. Factors that influence their continued desire to remain in the employment may be associated with economic constraints, loneliness and many personal problems. Another contributory problem is a situation where there is shortage of skilled manpower and inability of employers to enforce prohibition on retirement at specific age. Genetic Inheritance ------------------- Genetic inheritance factors likely to be of great importance in the workforce are those related to race, gender and genetic inheritance like sickle cell disorder. For example, in a large African American Labour force, hypertension may be prevalent. In an Asian population particularly if large numbers are refugees, communicable diseases such as Tuberculosis and parasitic diseases may be common. In underdeveloped countries like Nigeria, hypertension and mental stresses may be prevalent. The sex composition of the employees do determine the types of health problems that may occur: For example, if large numbers of employees are women of child bearing age, there is need to provide pre and postnatal services, monitor more closely environmental conditions that may cause genetic changes or damage to unborn child causing malformations and death, monitoring for infertility, spontaneous abortion, low birth weight, pre and post maturity, birth defects, chromosomal abnormalities, preeclampsia and an increased incidence of childhood cancers. If an employee has genetic inheritance like sickle cell disorder, there is need to provide an environment that discourages precipitation of painful crises such as adequate ventilation, assignment of less strenuous jobs and environment free of dust, and fumes and smokes. Monitoring for conditions that can precipitate bone pain crisis and provision of facilities for treatment of crisis before reaching the clinic for management should be in place. Physiological Factors --------------------- Conditions prevalent in occupational settings include traumatic injuries, lung diseases, cardiovascular problems, renal problems, neuro-toxic disorders, cancers, skeletal problems, injuries of all kinds, sensory impairments and many others. Other problems that may occur are the out breaks of dermatologic conditions that indicate the presence of hazards in the work environment that need control measures. They include: variety of rashes, pruritus, chemical burns and desquamations. These dermatologic problems affect seriously the production capacity and loss of income to the company. Psychological problems of anxiety and stress may manifest as a result of stressors associated with work overload, the organizational structure of the company/occupation, job insecurity, interpersonal and intrapersonal relationships with co-workers or employers or supervisors and attitudes of racial or ethnic discrimination in workplace. Other sources of stress most frequently identified by workers include lack of control over the contents, processes and pace of one\'s work, unrealistic demands and lack of understanding by supervisors, lack of predictability and security regarding one\'s job and future, and the cumulative effects of occupational and family stressors. Employers most often perceive employee\'s lifestyles, and health habits as the primary contributors to stress. The Physical Dimension Factors: ------------------------------- Physical environmental factors contribute to a variety of health problems employees' face in the work settings. The categories of the health problems include: chemical hazards, physical hazards such as radiation, noise, vibration and exposure to extremes of heat and cold; electrical hazards, fire, heavy lifting and uncomfortable working positions, and potential falls. With poor lighting or high noise levels, the employee may face the adverse effects of vision and hearing respectively. Heavy objects that must be moved may cause musculoskeletal injuries, hernia and potential for falls and exposure to excessive heat or cold in many workplaces. Other factors related to physical environment is the use of toxic substances in work performance which may be inform of solids, liquids, gasses, vapors, dust, fumes, fibers or mists. The toxic substances can cause respiratory, dermatologic and other health problems. Heavy metals like lead can cause lead poison. Other metals of concern include mercury, arsenic and cadmium. The use of heavy equipment or sharp tools can cause occupational injuries. It can also cause hand-arm vibration syndrome especially in using tools that vibrate or visual disturbances related to the use of computer display terminals. Extreme or awkward postures have been associated with low back problems and repetitive or high force movements with carpal tunnel syndrome. Social Dimension Factors: ------------------------- The social environment of the work setting can influence employee health status either positively or negatively. The nature of the influence depends on the social interactions among employees, attitudes toward work and health and the presence or absence of racial, sexual or other tensions can all affect the health status of the employees and their productivity within the occupation. Behavioural Dimension Factors: ------------------------------ Life style factors to be considered include: the type of work performed, consumption patterns, patterns of test and exercise and use of safety devices. The type of work an employee performs within the work setting can significantly influence the employee\'s health, determines the risk of exposure to various physical hazards and level of stress experienced, it influences the extent of the exercise employees obtain. The consumption patterns of interest include those related to food and nutrition, smoking and drugs and alcohol use. The nutrition influence on the health status is well known. Smoking is harmful to health and may increase the adverse effects of other environmental problems particularly those that affect respiration. Over indulgence in substance abuse such as caffeine, may pose health problems to employees. Rest and Exercise: occupational places do place many physical and psychological demands on the employees. These demands result to inadequate rest and recreation. Same problem is faced by employees who work constantly to ensure progress and those who keep other jobs in an attempt to make ends meet. Many occupations are recognizing that exercise provides physical and psychological relaxation, alertness and relieve muscle tension making it ready to work again. It reduces heart attack and injury and even sleep at work and accident. It causes better coordination, reduces hazards, accidents and better work output. These benefits have made employers of labour to promote physical exercises by providing activities for recreation in work settings. **Preventive Measures of Occupational Health Problems** ------------------------------------------------------- - Pre-employment medical examination of all employees to rule out presence of any health problems and potential for hazard in the job. - Immunization of employees at risk of infections such as tuberculosis, hepatitis B and HIV, where applicable. - Periodic monitoring of all employees in all occupations especially those in high risk areas e.g. periodic x-ray examination of staff working in x-ray units, or those working in lead producing and heavy metal industries. - Regular inspection, of food preparation, servicing and storage facilities as well as inspection of food preparation environment. - Ensuring the use of wholesome water for drinking and food preparation (pathogen free chlorinated water) to avoid water borne infections and making sure that water containers are free from contamination. - General hygiene of the work environment especially that of the hospitals, schools and many others to avoid accidents and infection dissemination. - Provision of safety devices such as eye gurgle, booth, helmet, lead apron and many others. **Management of Occupational Health Problems** ---------------------------------------------- - All workers should be screened on employment and those found sick should be screened and treated properly. All those at risk of tuberculosis (TB), hepatitis B and HIV should be immunized and post immunization antibody response estimated after a stipulated interval to ensure positive result. Then such employee should be assigned to a unit in the workplace that is safe for him or her. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - All employees working in x-ray department or where there is risk of radiation hazards should be posted to another section of the unit. Special precautions should be taken by all employees working in radiation areas or handling radioactive materials to avoid exposure above the threshold limit for a specific period. The standard required for safety must never be compromised and the use of dangerous and unsafe equipment should be avoided. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - Any incident of food or water poisoning should be properly investigated and precautionary measures taken to avoid further spread and occurrence. Those already affected should be screened and properly treated before resuming duty. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - The health worker should identify the presence of any health hazards in the physical environment that contribute to health problems and then ensure that such health hazard is removed by encouraging the employers. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - Nurses who work in settings where hazardous agents are prepared and administered should seek additional education regarding their administration, in relation to the client\'s safety and personal safety. The hospital employer is responsible for providing the equipment to maintain safety when handling the agents. All employees with emotional and psychological problems or those experiencing uncomfortableness due to stresses in the work environment should be monitored, counselled and guided on ways to solve the identified cause of stresses and effort made to remove the stressors. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - Health education on prevention of stressors and their management should be intensified. Those seriously affected should be allowed off sick and then followed up for proper treatment and rehabilitation. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **OCCUPATIONAL HAZARDS** ------------------------ An occupational hazard is any workplace condition that causes a risk to employee health. Six main categories of occupational hazards have been outlined. - Safety. This category includes any condition, substance, or object that can injure a worker, like working from heights, spills on floors, machinery with moving parts, confined spaces, steep stairs, or exposed electrical wiring. - Chemical. There are many kinds of hazardous chemicals and toxins in different workplaces, including environmental smoke, cleaning products, acids, pesticides, [carbon monoxide](https://www.webmd.com/a-to-z-guides/prevent-carbon-monoxide-poisoning), and flammable liquids. Most of the chemicals which constitute health hazards are in form of vapour, gases, fumes, mists, dusts and solids. - Biological. In some settings, such as farms, zoos, hospitals or medical offices, or veterinary clinics, workers can be exposed to biological health hazards like [blood](https://www.webmd.com/heart/anatomy-picture-of-blood), fungi, [mould](https://www.webmd.com/allergies/cm/rm-quiz-indoor-allergies), viruses, animal droppings, and [insect bites](https://www.webmd.com/allergies/ss/slideshow-bad-bugs). This hazard may arise due to poor personal hygiene of the worker or lack of use of personal protective devices. Workers in the health sector are prone to infections like tuberculosis, cholera, typhoid fever and dysentery. Workers in veterinary department are exposed to anthrax, bovine tuberculosis, etc while agricultural workers are prone to fungi infections. - Physical. These are hazards in the environment that can harm your body without you actually touching it, like [radiation](https://www.webmd.com/cancer/what-to-expect-from-radiation-therapy), prolonged exposure to sunlight, extreme high or low temperatures, and loud noise. - Ergonomic. These hazards put [strain](https://www.webmd.com/first-aid/sprains-and-strains-treatment) on your body over a period of time. You may just feel sore or cramped in the short term, but repeatedly sitting or standing in awkward positions or completing the same movements over and over, across a long period of time, can lead to long-term injury and illness. - Work organization hazards. Workplace violence, discrimination, victimization, lack of respect, sexual harassment, lack of job satisfaction and other conditions are hazardous to mental, emotional, and physical health. **OCCUPATIONAL ACCIDENTS** Accident is one of the major occupational health problems of the employees. It is an unexpected and serious sudden event that can occur anywhere and then result in both bodily and property damages. It is an unexpected, unanticipated and sudden event that results in bodily injury, property damage and death. It causes both human and economic and material losses to both paid and non-paid occupations such as industries, health institutions, agricultural, educational, banking and numerous other occupations. Accidents in industries can produce the following effects: 1. Workers sustaining injuries 2. Property or equipment damaged or lost 3. Interruption in business transactions A. Unsafe Acts 1. Lack of knowledge or skills 2. Improper attitude 3. Physical or mental imbalance 4. Using unsafe equipment 5. Working on moving machinery 6. Poor work motivation 7. Alcoholism 8. Personal worries 9. Nervousness 10. Recklessness 11. Excitability 12. Ignorance of safe practices 13. use of generators, candles, insecticides pesticides etc. B. Unsafe Conditions These are existing conditions not directly caused by the worker which may cause accident. They are conditions of the work environment that can precipitate accident to workers. They include nature and man-made factors. a. Nature factors include those factors that can obscure visibility such as: rain, dust, smoke, wind, sunlight, foreign body in the eyes. Others include floods, tornados, earthquakes, land slide, extreme temperatures, and inadequate ventilation. b. Man-made factors include poor layout of the factories, poor construction and design of machines, faulty machines, locality of the work environment, physical hazards, working arrangement like time of the day and day of the week, attitude of supervisors towards work and safety in the environment where the industry is sited, slippery floor, improper storage of items, manufacturers fault, mechanical or structural failures, lack of protective devices and inadequate training. **Common Industrial Accidents** - Workers handling heavy machines in the factory - Workers in bottling and glass factories - Tired and over-worked workers - Malnourished workers - Alcoholic workers - Lonely and thoughtful workers 3). Burns and Scalds are common with: - Workers handling chemical - Mechanics - Electrical installation workers - Workers in plastic, steel and match industries 4). Needle stick injuries, sprains and cuts from sharp instruments, slip disc common among health workers due to non-availability of correct equipment and bad posture. 5). Shock and Fainting common with: - Workers in overcrowded environment - Workers in very hot environment - Malnourished workers - Tired and over-worked workers 6). Chemical Poisoning may result from inhalation or ingestion thereby causing damage to internal organs. Chemical poisoning is common with automobile electricians, laboratory workers and workers in match industries. Some chemicals that may cause poisoning include: - Arsenic - Lead - Phosphorus - Chromium - Ammonia - Mercury - Magnesium - Formaldehyde - Acids and Alkalis 7). Injury to the eye which may lead to partial sightedness or blindness is common with welders and workers in steel industries that work without eye shades. 8). Injuries to the ear that may lead to hard hearing or deafness is common with workers in steel industry, printing press, aerodrome and textile industry. 9). Radiation causes damage to body cells and is common with X-ray workers, atomic plant workers and those handling gamma rays 10). Electrocution is common with electrical installation workers. 11). Snake and scorpion bite common with farmers, soldiers and game wardens. 12). Death from attack of wild animals is common with farmers, zoo workers, soldiers, hunters and game wardens **Prevention and control of Occupational Accidents** The understanding of the causes of accidents and how the employee is affected within the environment is beneficial in prevention and control of accidents. This is also referred to as industrial safety. Industrial safety can be defined as freedom from "Man -- Equipment -- Material -- Environment Interaction" that result in accident. The following are some preventive measures: 1. Provision of safe premises, safe procedures, safe machines for workers by the employers. 2. Adequate inspection of the work place to ensure general tidiness and cleanliness. 3. Provide workers with adequate training on the importance and proper use of safety devices such as eye goggle, boots, ear plugs, hoes, cutlasses, hand gloves, face mask as the case may be according to factory rules. 4. Pre-employment and periodic examination of all employees should be ensured. This is to evaluate the health and fitness status of the employees before employment as a baseline data and also to determine what becomes of the workers' health with time due to the nature of work done. 5. Provide workers with information regarding the inherent risks of any occupation before he is allowed to work alone on the job. 6. Keep all accident records and review all investigation reports. 7. Adequate rest and good arrangement for shift duties. 8. Protective clothing should be properly designed according to the anthropometric measurement of the workers to avoid discomfort while performing tasks. This will prevent unwillingness of the workers to use the clothing properly or even do without it claiming that it is uncomfortable and makes him clumsy. Workers should also be motivated to use the clothing for safety measures. 9. Effective training and encouragement of workers on proper use of safety knowledge, skill and various work procedures. 10. There should be well defined policy guidelines on safety precautions in each plant 11. All aspects of the factory should be adequately ventilated to avoid excessive heat or humidity -- extremes of temperature. 12. Avoid pouring water, oil or other chemicals that can make the work environment slippery to cause accident. 13. Prepare and display at strategic positions within the work environment bill boards, posters, sign posters indicating danger zones, safety measures, unsafe acts in work place, the need for compliance and disciplinary measures. 14. Inculcation of personal hygiene and provision of facilities for conveniences. 15. All defective machines and equipment should be repaired or replaced to avoid accidents. Modification in the use of dangerous machinery and hazardous operations should be adhered to. 16. The use of worn-out hand tools, e.g., hammers, Chisel should be discouraged. Proper design and shielding of all machinery with efficient interlocks may eliminate completely the risk of damage to the worker from splashing chemicals or damage from flying objects thereby avoiding accidents. 17. All staff in health institutions should adopt the stringent measures in the use and disposal of needles and sharp objects. 18. Full concentration at work with adequate nutrition 19. General discipline among workers and compliance with rules and regulations. 20. Workers' metabolic demands for a job done in hot and humid environments should be evaluated to recommend a work-rest regime that will prevent heat stress. Recreational facilities and canteen for feeding should be provided. **Treatment of Occupational Accidents** --------------------------------------- 1. Establishment of an occupational health service at workplace to ensure a healthy workforce. 2. Effective first aid services. There should be groups of workers selected from each work section to be trained as first-aiders for early treatment of accident cases. First aid boxes should be placed at strategic positions within the work environment. 3. Prompt referral of serious cases to appropriate hospitals. 4. Rehabilitation of injured and reabsorption into the occupation. 5. Training of a rescue team in high risk places e.g coal mining industries. 6. Keeping accidents records to determine trends of accidents and for comparison. This should be analysed periodically to discern trends and evaluate the efficacy of the counter measures. **Rehabilitation of Accident Victims** -------------------------------------- **OCCUPATIONAL DISEASES** An occupational disease or industrial disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of [occupational safety and health](https://en.wikipedia.org/wiki/Occupational_safety_and_health). An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations. Occupational health disease can be defined as a compensable disease contacted by the worker due to exposure to hazards in the work places. It is any condition arising from work place exposures which compromises worker\'s physical, mental and social wellbeing. It can also be defined as those diseases which occur with characteristic frequency and regularity in occupations where there are specific hazards. The [first such disease to be recognized](https://en.wikipedia.org/wiki/Chimney_sweeps%27_carcinoma), [squamous-cell carcinoma](https://en.wikipedia.org/wiki/Squamous-cell_carcinoma) of the [scrotum](https://en.wikipedia.org/wiki/Scrotum), was identified in [chimney sweep](https://en.wikipedia.org/wiki/Chimney_sweep) boys by [Sir Percival Pott](https://en.wikipedia.org/wiki/Percivall_Pott) in 1775. Under the law of [workers\' compensation](https://en.wikipedia.org/wiki/Workers%27_compensation) in many jurisdictions, there is a presumption that specific diseases are caused by the worker being in the work environment and the burden is on the employer or insurer to show that the disease came about from another cause. Diseases compensated by national workers compensation authorities are often termed occupational diseases. Classification of Occupational Diseases --------------------------------------- Occupational diseases can be classified in different forms. 1. Occupational diseases of the respiratory system 2. Occupational diseases of the liver 3. Occupational diseases of the cardiovascular system 4. Occupational diseases of the Gastro-intestinal system 5. Occupational diseases of the Genito-urinary system 6. Occupational diseases of the skin or dermatologic system 7. Occupational diseases of the musculo skeletal system 8. Occupational diseases of the haemopoietic system 9. Occupational diseases of the physical agent. **Occupational Respiratory Diseases** ------------------------------------- They are diseases that can affect the organs of the respiratory system such as the nose, nasal cavity, the trachea, the bronchus, and the Lungs. Such diseases include: acute inflammatory diseases eg rhinitis, pneumonia asthma, [Occupational asthma](https://en.wikipedia.org/wiki/Occupational_asthma) has a vast number of [occupations at risk](https://en.wikipedia.org/wiki/Occupational_asthma#Occupations_at_risk). cough which can be dry and productive, pleural plague diseases, cancers, farmers lung disease, black lung (coalworker\'s pneumoconiosis) among [coal miners](https://en.wikipedia.org/wiki/Coal_miner) anthracosis, silicosis, among miners and quarrying and tunnel operators [byssinosis](https://en.wikipedia.org/wiki/Byssinosis) among workers in parts of the cotton textile industry. asbestosis among [asbestos](https://en.wikipedia.org/wiki/Asbestos) miners and those who work with friable asbestos insulation, bagassosis, tabacosis The diseases can cause impairment of air entry into the lungs by either narrowing the airways or producing ventilatory failures. Some of the respiratory diseases can cause permanent damage to the respiratory systems especially the lungs. They can affect the worker by gradually reducing the working capacity thereby causing serious setback in industrial production. Bad [indoor air quality](https://en.wikipedia.org/wiki/Indoor_air_quality) may predispose to diseases in the lungs as well as in other parts of the body. **Occupational Diseases of the Liver** -------------------------------------- Industrial or occupational diseases that affect the liver gain access into the body through the skin abrasions and alimentary track to the liver cells to cause the following disease hepatitis, cancer, hepatomegaly, multilobular cirrhosis of the liver, fatty degeneration of the liver, uremia. **Occupational Diseases of the Cardio-vascular System** ------------------------------------------------------- They are disease conditions that affect the heart and the blood vessels. Such diseases include: hypertension, anaemia, heart failure, angina pectoris, myocardial infection, stroke, leukemia, arrhythmias, coronary heart diseases and other cardiac anomalies. Most of these diseases incapacitate the workers especially the chronic ones. **Occupational Diseases of the Gastro-intestinal System** --------------------------------------------------------- Common diseases of gastro-intestinal track reported by workers include: diarrhoea, vomiting, typhoid, gastritis, gastric ulcer, constipation, cancer, gastro enteritis, oesophageal fistulae and many others. The diseases mostly occur through ingestion of substances, chemicals and through starvation or wrong timing of feeding. **Occupational Diseases of the Genito Urinary System** ------------------------------------------------------ Common diseases affecting the system included: Cancers, diabetes mellitus, renal stone, renal failure, haematuria, kidney failure, typhoid fever, acute nephrosis, nephrotic syndrome and many others. **Occupational Diseases of the Skin (dermatologic)** ---------------------------------------------------- These diseases include: irritant contact dermatitis, allergic diseases, skin cancers, acne, skin pigmentation, thickening of the skin, skin manifestation of systemic toxicity, heat and cold damages, parasitic diseases such as mites. These are common diseases experience by workers in different occupations and they can be quite incapacitating. Occupational skin diseases are ranked among the top five occupational diseases in many countries. They are generally caused by chemicals and having wet hands for long periods while at work. [Eczema](https://en.wikipedia.org/wiki/Eczema) is by far the most common, but [urticaria](https://en.wikipedia.org/wiki/Urticaria), [sunburn](https://en.wikipedia.org/wiki/Sunburn) and [skin cancer](https://en.wikipedia.org/wiki/Skin_cancer) are also of concern. [Contact dermatitis](https://en.wikipedia.org/wiki/Contact_dermatitis) due to irritation is [inflammation](https://en.wikipedia.org/wiki/Inflammation) of the skin which results from a contact with an irritant. There have been studies to support that past or present [atopic dermatitis](https://en.wikipedia.org/wiki/Atopic_dermatitis) is a risk factor for this type of [dermatitis](https://en.wikipedia.org/wiki/Dermatitis). Common irritants include detergents, acids, alkalies, oils, organic solvents and reducing agents. The acute form of this dermatitis develops on exposure of the skin to a strong irritant or caustic chemical. This exposure can occur as a result of [accident](https://en.wikipedia.org/wiki/Accident) at a [workplace](https://en.wikipedia.org/wiki/Workplace). The irritant reaction starts to increase in its intensity within minutes to hours of exposure to the irritant and reaches its peak quickly. After the reaction has reached its peak level, it starts to heal. This process is known as decrescendo phenomenon. The most frequent potent irritants leading to this type of dermatitis are acids and alkaline solutions. The symptoms include redness and swelling of the skin along with the formation of blisters. The chronic form occurs as a result of repeated exposure of the skin to weak irritants over long periods of time. Clinical manifestations of the contact dermatitis are also modified by external factors such as environmental factors (mechanical pressure, temperature, and humidity) and predisposing characteristics of the individual (age, sex, ethnic origin, pre-existing skin disease, atopic skin diathesis, and anatomic region exposed. Another occupational skin disease is Glove related hand urticaria. It has been reported as an occupational problem among the health care workers. This type of hand urticaria is believed to be caused by repeated wearing and removal of the gloves. The reaction is caused by the latex or the nitrile present in the gloves. High-risk occupations include: - - - - - - - **Occupational Diseases of the Musculo Skeletal System** -------------------------------------------------------- They include: osteoporosis, muscular pains, and rickettsiae 8. **Occupational Diseases of the haemopoetic system** include leukaemia, anaemia, lymphopenia, thrombocytopenia. 9. ### **Other diseases of concern.** - ### [Overuse syndrome](https://en.wikipedia.org/wiki/Overuse_syndrome) among persons who perform repetitive or forceful movements in constrictive postures - ### [Carpal tunnel syndrome](https://en.wikipedia.org/wiki/Carpal_tunnel_syndrome) among persons who work in the [poultry](https://en.wikipedia.org/wiki/Poultry) industry and information technology - - - **Causes of Occupational Diseases** 1. Lack of provision of protective (safety) devices by the employers of labour. 2. Inadequate or non-use of safety devices by the respective worker. The non- compliance to company rules can predispose the worker to various illnesses. 3. The health status of the worker. A worker who is ill and stressed up is likely to be affected. A worker who is anemic due to ill-health like malaria or due to poor nutrition is likely to develop further complications. 4. Poor personal and environmental hygiene. 5. Lack of periodic medical investigation or examinations of the workers to identify those likely or already developing ill-health so that treatment can be started early. Types of medical examination should include X-ray and laboratory investigations. 6. Lack of practice of most containment and preventive measures. 7. Exposure to defective equipment and instruments. 8. Exposure to dermatologic agents which could be endogenic. 9. Ingestion of toxic substances and dangerous agents such as contaminated food substances, vegetables and fruits. 10. Exposure to hazards like lead, toxic materials, fumes, dust and other substances. 11. Inhalation of gases, fumes, organic substances like silica sulphate, iron dusts, coal dusts and others. 12. Carelessness of workers and hazardous life styles like excessive smoking, alcohol intake and ingestion of non-prescribed and adulterated and fake drug. Inability of the worker to go for medical check-up as preventive measure. **Methods of Detection of Occupational Diseases** Since some health hazards responsible for occupational health diseases are known and documented while some are largely unknown, there is need to attempt to identify the unfamiliar and unknown hazards in the work places in order to control them. The methods of detection include: biological monitoring, epidemiological methods, and environmental measurements. Biological Methods ------------------ This takes the form of pre-employment medical examination for basic data, and periodic medical examinations and laboratory tests to detect diseases if any. Laboratory tests can take the form of hematological studies, urine tests, and stool analysis while medical examination can be chest-x-ray. Those with suspected cases of dermatitis should be kept away. The tests do help to detect early the presence of diseases and to plan appropriate preventive and curative intervention programmes to curtail the spread and damage to the health status of the individual. Epidemiological Methods ----------------------- Epidemiology in an industrial setting aims at studying the determinants, distribution and deterrents of diseases among workers. Epidemiological studies therefore help to detect both the occupational and non-occupational work-related diseases among workers for effective preventive measures to be planned. Example of work-related association between stressful occupations and diseases can be peptic ulcer, hypertension, gastric upset and others. The assessment aims at prevention of spread of the disease. Environmental Measurement ------------------------- These are used to detect agents of known hazards in the work place before the diseases occur. This helps to identify the hazards early enough in order to prevent or reduce the adverse effects of such hazards. Example, dust sampling and measurement in a coal mine or cement industry can reduce the incidence of Pneumoconiosis in coal workers. Noise measurement with meters in manufacturing industries would help reduce the incidence of defeaness and use of gas detectors to measure the level of various gases like carbon monoxide can help reduce carbon monoxide poisoning. **Prevention and control of Occupational Diseases** --------------------------------------------------- The practice of making prevention a priority in different occupations is of primary importance in occupational practice. This is because work-related illnesses are frequently irreversible. For example, development of a mesothelioma from asbestos exposure is a condition for which there is no cure. Same applies to other conditions. Some can even lead to morbidity and mortality. Prevention is the only answer. The preventive measures aimed at complete elimination of hazardous agents can be achieved through the following methods. Substitution of the Process: This means replacing the harmful substances by the less harmful ones which are equally effective or nearly so. Example, the use of fiber glass instead of asbestos in the production of roofing sheets or the substitution of noisy machinery with less noisy ones. Change of Work Process: ----------------------- Example, the use of scanning technique instead of x-ray in carrying out investigations. Containment Measures: --------------------- This involves containment at the source of the hazards. It is a method of getting rid of dusts, vapors and fumes from a point source. Example, the use of exhaust ventilation in chemical laboratory, wet drilling in mixers or wet mining in coal mines. Total Enclosure of Hazards: --------------------------- This involves preventive measures when the work process is enclosed to avoid exposure. It is relevant to work groups like radiation workers such as x-ray and transformer station workers. The radioactive material is enclosed in a lead shield, thereby preventing the associated hazards to the worker. Partial enclosure of hazards of dangerous machine process section. That is, isolation of such machines. Limitation of Time of Exposure: This is usually the practice in situations where radiation or noise is the hazard. The maximum tolerance daily dose should be known and the hours of work arranged so that no worker stays longer than the prescribed period of time. Segregation of Hazardous Processes: By this method, those not concerned with its operation are protected thereby reducing the number of those at risks. In operations involving emission of irritant gases, workers should be made to use breathing apparatus like protective mask and respirators for prevention. Adequate Ventilation in the Work Environment: --------------------------------------------- This reduces high temperature by air movement, maintains adequate dilution of atmospheric contaminants, and reduces the nuisance or harmful effects of such contaminants in the air. Ceiling fans fixed at appropriate places in sufficient numbers will be of help in maintaining adequate ventilation. Cleanliness of the Workplace also called Good Housekeeping: ----------------------------------------------------------- This is very essential especially in hospital environments, as it eliminates the accumulation of dangerous materials in the workplace. Sweeping and washing of the floor with disinfectant should be carried out at regular times daily, preferably at the end of the day's work or before the start of business in the mornings. Protective devices should include face masks, hand gloves, goggles, boots, helmets, apparels and many others. Personal Cleanliness: Personal hygiene contributes in avoiding accidental consumption of dangerous substances. Preferably, workers employed in inherently dirty jobs should come to work in their clean clothes while their working apparels should be kept and laundered in the work environment. The employers should contribute by providing facilities for changing and washing of the working apparels. Workers should also be provided with specific places for eating and smoking during recreation periods. There is need for massive health education and campaign on the need and how to use those devices, followed by adequate supervision to see that such workers put on those protective devices, if much success is to be recorded. There is also the need for the industries especially manufacturing and service industries like hospitals to provide all the needed protective devices to avoid things like the individual workers buying inferior protective devices himself because of cost. Legislation: ------------ This can be used to eliminate or reduce exposure of workers to occupational hazards. This is because, if the industrialists are not legally compelled to protect the workers, they may not do anything to help prevent workers\' exposure to hazards, especially when they still make their profits and workers are always there to be hired and dismissed at will with the slightest flimsy excuses. Workplace safety and Insurance Bureau (WSIB, 2007), recommend that occupational diseases can be prevented by: 1. Finding out what materials and substances were being used in their workplace with the aim of ensuring safety provisions. Finding out how to work safely around materials and equipment in their workplace. 2. Use protective equipment provided by their employer. Make sure that they know how to use the facilities if not ask questions. 3. Be alert to the symptoms of change in your health status and be able to report on time. 4. Always tell the company doctor where they work, what they do and what substances they work with because this information will help in making accurate diagnosis. 5. Keep records of all jobs and industries that they worked with in order to find the cause of the illness. 6. Periodic health education of all the workers to provide them with adequate knowledge of all the hazards that can cause disease associated with their occupation and the preventive measures to adopt, as well as the importance of keeping safety rules of the occupation. 7. All the workers should be trained and retrained periodically on how to use the protective devices provided by the management in the language familiar to them; regular supervision and monitoring to ensure compliance to the proper use of the devices; information on safety provisions and their importance should be displayed on the posters and notice boards and the sign posts mounted at strategic positions in the company. **Implications of Occupational Health Diseases** ------------------------------------------------ Occupational health diseases have implication(s) to both the employers and the employees. To the Employees; 1. The disease condition can seriously affect them physically, mentally, socially and psychologically and that of their family well-being. 2. Such disease conditions like hypertension and stroke can lead to permanent disability to the employee thereby making him or her nonproductive and may reduce his life span. 3. There could be increased morbidity and mortality among workers. 4. The ill-health can lead to low productivity with decreased income 5. It could lead to reduced work force. 6. Respiratory diseases can cause permanent damage to the respiratory systems especially the lungs. 7. The diseases can create physical and emotional problems that can affect the general behavior of the worker. **Reporting of Occupational Diseases** -------------------------------------- In Nigeria, the following diseases occurring in occupational settings are reportable by Law by the factory owners: 1. Lead poisoning, including poisoning by any preparation or compound of lead or their squeal. 2. Phosphorus poisoning by phosphorus or its compounds or their sequelae 3. Mercury poisoning, by mercury, its amalgams and compounds and their sequelae. 4. Manganese poisoning by arsenic or its compounds and their sequelae 5. Carbon bisulphide (disulphide) poisoning 6. Benzene poisoning, including poisoning by any of its homologies, their nitro and amido derivatives or their sequelae. 7. Chrome ulceration due to chronic acid or bichromate of potassium, sodium or ammonium, or any preparation of these substances. 8. Anthrax 9. Silicosis 10. Pathological manifestations due to: a) radium or other radio-active substances b) X- rays 11. Toxic jaundice due to tetrachlorethane or amido derivatives of benzene or other poisonous substances 12. Toxic anemia 13. Primary epitheliomatous ulceration of the skin due to the handling or use of tar, pitch, bitumen, mineral oil, paraffin or the compounds, products or residues of these substances. 14. Poisoning by halogen derivatives of hydrocarbons of the aliphatic series. 15. Compressed air illness (cassion disease) 16. Asbestos. OCCUPATIONAL HEALTH POISON ========================== Poison is any substance that can impair function, injure the body, destroys body organs or body systems. ======================================================================================================== Sources of Industrial Poison include: 1. Heavy metals like all lead compounds. Example lead oxides, lead carbonate, lead sulphide. Among these lead compounds the most dangerous is lead carbonate while lead sulphide is the least toxic. Metallic mercury from industries that manufacture batteries, lead smelting, lead ores, pipes, paints, solder, rubbers, and shoe makers. Health workers are likely to come contact with such. 2. Chemicals: Strong acids, concentrated alkalis in the work environment. Chemicals in the form of dust, gases, fumes. Dusts causing poison include: a. Inorganic dusts such as asbestos, coal mining dust, silica dust, arsenic dust from mine, textile, construction, acetaldehyde, butyl alcohol, paint, rope and string in thermal insulation, floor tile, cement, and removal of sludge from tank that held sulphuric acid. b. Organic dusts such as vegetable dust, cotton dust, sugar cane dust. 3. **Gases:** arsine, aniline, carbon tetrachloride, carbon monoxide, hydrogen cyanide, hydrogen sulphide. These can be gotten from insecticides, leather, smelter, dyes, perfumes, pharmaceutical products, dry cleaning agents. Fumes -- arsine 4. Organic compounds like phosphorus, ammonia can be gotten from fertilizers, pesticides used in agriculture, organic phosphorus insecticides. 5. Other compounds include benzene, carbon tetrachloride, manganese toluene, and xylene. Workers at Risk of Occupational Poisons --------------------------------------- 1. Health workers - Nurses, laboratory scientist, radiographers, doctors, anesthetists etc. 2. Employees in mining industries, coal miners, quarry industries. 3. Employees at cosmetic industries due to dye, spray, perfumes. 4. Employees in laundries and dry-cleaning establishments. 5. Carpenters, welders, bankers. 6. Farmers, veterinary workers. 7. Workers in textile, construction companies. 8. Employees in cement, asbestos industries. 9. Employees in oil refineries. 10. Aerospace workers. 11. Employees in ceramics, glass producing industries. 12. Shoemakers **Clinical Manifestations of some Occupational Health Poison** -------------------------------------------------------------- This depends on the types of poison and the parts of the body affected **Clinical Features of Lead Poisoning:** Abdominal colic, loss of appetite, obstinate constipation, blue line on the gum, anemia, wrist drop. Organic lead poisoning affects most central nervous system causing insomnia, headache, mental confusion, delirium. Encephalopathy following exposure to organic lead compounds is characterized by mental dullness, loss of ability to concentrate, loss of memory, tremor, deafness, convulsion, aphasia, coma especially with severe poisoning. **Clinical Features of Asbestosis** 1. Progressive breathlessness 2. Initially unproductive cough which becomes mucoid or mucopurulent at late stage 3. Listlessness 4. Loss of weight suggestive of malignant changes 5. Cyanosis in advance cases 6. Dull on percussion in advanced stage 7. Dullness is suggestive of pleural effusion If the haemopoietic system is involved it presents the following signs and symptoms. Their effects when mild are sudden and are characterized by malaise, nausea, and vomiting, shivering, giddiness and epigastric pain, haemoglobinuria, anaemia due to powerful haemolytic nature of arsine. Pot wine urine and jaundice are present. In severe cases there is blockage of renal tubules with anuria and hepatic damage. **Clinical features when mucocutaneous tissues are affected:** In sub-acute poisoning there is catarrhal inflammation of mucous membranes, conjunctivitis, laryngitis, tracheitis, eczema, tons skin lesions at skin folds and other moist areas. Arsine dust produces perforation of nasal septum. Chronic poisoning produces dermatitis, ulcer, trophic changes in the nails and loss of hair and bronzing. In mild cases the bronzing is best seen in the eyelids, temples, neck and nipples in fair-coloured individuals. In people with dark skin it may be difficult to see even in severe cases. Changes may occur with intellectual impairment, memory loss, insomnia, anxiety. Poisoning from organic compounds affect nervous system more than inorganic mercury. **Clinical Features of Organic and Phosphorus Compounds Poisoning:** Include the following: Initial symptom may be mild or non-specific. There may be headache, nausea, unusual fatigue. Taking food or smoking makes symptom worse. Diarrhea, vomiting, pinpoint pupils, convulsion are signs of pulmonary congestion. It occurs in a matter of 2 - 8 hours. Death may result shortly after appearance of symptoms. **Diagnostic Procedures for Detecting Occupational Poisons** ------------------------------------------------------------ Some occupational poisons are known and documented while some are not known. It therefore becomes important to detect the unfamiliar and unknown in order to control them. This can be achieved by the following: Biological Monitoring --------------------- This takes the form of pre-employment health assessment, pre-placement assessment, and periodic health assessment. Basic health data are collected through history and laboratory tests. Chest X-rays are also utilized. The hallmark of biological monitoring is for early detection of poisoning and to plan appropriate preventive and curative measures to curb the spread and damage. Epidemiological Methods ----------------------- This aims at studying the distribution, determinants and deterrents of disease and ailment among segments of work force. It detects both occupational poisons and non- occupational ones among workers through association between condition and certain diseases. Environmental Measurements -------------------------- It is used to detect agents of known hazards in the work site before the risks occur. It is particularly very relevant in disabling and irreversible diseases. For example, dust measurements in coal mine would help reduce the incidence of pneumoconiosis. **Prevention of Occupational Health Poisoning** ----------------------------------------------- 1. This includes pre-employment, pre-placement health assessment as well as periodic medical examinations to exclude any underlying health problems that may predispose an employee to hazards in the work process or environment. Also helps for early detection of pathological changes and institute measures to avert such. 2. Work environment must be inspected from time to time. This aims at ensuring safe work environment and promotes and protects health of employees. 3. Employers must ensure that his plant is well designed and meet the safety requirement specifications and his work process. 4. Inherent risks of any process must be explained to the workers before he is left alone on a job. 5. Double standards of safety should not be condoned. 6. Design of protective clothing should be in line with the anthropometric measurements of the workers. 7. Well planned and executed education of workers should be carried out in a language the workers understand. 8. Vague concepts of safety and accidents prevention should be avoided. 9. Hazards and consequences of negligence should be made as concrete as possible through life case studies and factual material drawn from work situations in which the people are employed. 10. Safety training should be integrated into the actual situation so that the worker is constantly reminded of the need to practice safety measures. 11. Guard for dangerous parts of machinery. 12. Regular inspection and repair of machines should be documented in a book when such has been done and found in order. **Implications of Occupational Poisoning on the Employees** ----------------------------------------------------------- Disabilities/deformities: ------------------------- An employee affected with occupational poisoning may come down with minor or permanent disablement. Example, contact with corrosive acids may leave contracture, and physiological dysfunction of organs and systems. The employee may be left with permanent disability even after recovery. The disability sustained may be so severe that life of such employee is at jeopardy, loss of job will compound his health problems and hasten death. Psychological Trauma/Depression: -------------------------------- Distortion in the body image or appearance carries a lot of emotional depression, as the employee thinks on how to cope with altered body image. Where the employee is single, there is fear of getting wife/suitor of choice, ability to bear children, how to carry on family responsibilities among other things. Social Isolation: ----------------- Disability depending on the nature and site may hinder the employee from attending social functions or may withdraw from other people. This results in loss of acquaintances and social isolation with its resultant affects the worker. Economic Implications: ---------------------- Financial losses occur following occupational poisoning. Even though the employer pays compensation, the employee may have some other things he does outside factory work. In that case he can no longer attend to that resulting in economic loss. Recovery from such hazard may result in shift from former trade of the employee to a less skilled one with low remuneration. The employee may not be able to take care of him/herself and this amounts to heavy financial involvement to the family. **OCCUPATIONAL HEALTH AND SAFETY** ---------------------------------- Occupational health and safety is a discipline with a broad scope involving many specialized fields. It should aim at: 1. The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; 2. The prevention among workers of adverse effects on health caused by their working conditions; 3. The protection of workers in their employment from risks resulting from factors adverse to health; 4. The placing and maintenance of workers in an occupational environment adapted to physical and mental needs; 5. The adaptation of work to humans. In other words, occupational health and safety encompasses the social, mental and physical well-being of workers, which is the "whole person". Successful occupational health and safety practice requires the collaboration and participation of both employers and workers in health and safety programmes, and involves the consideration of issues relating to occupational medicine, industrial hygiene, toxicology, education, engineering safety, ergonomics, psychology, etc. **Poor working conditions affect worker health and safety:** 1. Poor working conditions of any type have the potential to affect a worker\'s health and safety. 2. Unhealthy or unsafe working conditions are not limited to factories. They can be found anywhere, whether the workplace is indoors or outdoors. Fo

Occupational Health Nursing Lecture Notes PDF

Document Details

Tags

Related

Summary

Full Transcript