Unit 2A - Course Notes

International Diploma in Occupational Safety and Health Unit 2

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International Diploma - Course Contents Unit 2 Safeguarding People’s Health in the Workplace Element 2A – Occupational Health Development of Occupational Health

2A1

Occupational Health Provision

2A2

Hazards to Health

2A3

Occupational Diseases

2A4

Monitoring the Health of Employees

2A5

Occupational Stress

2A6

Bullying and Harassment

2A7

Shift Working

2A8

New and Expectant Mothers

2A9

People with Disabilities

2A10

Children and Young Persons

2A11

Alcohol and Drugs

2A12

Element 2B – Risks to Health at Work Manual Handling

2B1

Ergonomics

2B2

Display Screen Equipment and Workstations

2B3

Hazardous Substances

2B4

Biological Hazards

2B5

Dust

2B6

Asbestos

2B7

Lead

2B8

Radiation

2B9

Noise

2B10

Vibration

2B11

Extremes of Heat, Cold and Humidity

2B12

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit

Title

2A1

Development of Occupational Health

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THE DEVELOPMENT OF OCCUPATIONAL HEALTH ............................................................................................... 3 THE CHANGING NATURE OF OCCUPATIONAL HEALTH AND DISEASES ...................................................................................... 3 LONG PERIOD FOR IDENTIFICATION OF A NEW OCCUPATIONAL HEALTH HAZARD ....................................................................... 3 THE RELATIONSHIP BETWEEN OCCUPATIONAL AND PUBLIC HEALTH .............................................................. 4 EFFECTS OF EXPOSURE ............................................................................................................................................ 4 MITIGATION TECHNIQUES ........................................................................................................................................ 4 MONITORING ........................................................................................................................................................ 4 THE MAIN ELEMENTS OF AN OCCUPATIONAL HEALTH STRATEGY ..................................................................... 6 THE PLACE OF OCCUPATIONAL HEALTH IN A HEALTH AND SAFETY MANAGEMENT SYSTEM ............................ 7 OCCUPATIONAL HEALTH NEEDS ASSESSMENT ................................................................................................................. 7 PRE-EMPLOYMENT ASSESSMENT AND SCREENING ............................................................................................................ 7 HEALTH SURVEILLANCE (HEALTH CHECKS) .................................................................................................................... 8 IMMUNISATION...................................................................................................................................................... 8 COUNSELLING ....................................................................................................................................................... 9 DRUG AND ALCOHOL SCREENING ................................................................................................................................ 9 TRAINING ............................................................................................................................................................ 9 ERGONOMIC ADVICE ............................................................................................................................................. 11 LIFESTYLE SCREENING/ADVICE AND HEALTH PROMOTION ................................................................................................ 12 RETURN TO WORK PROGRAMMES.............................................................................................................................. 12 DEVELOPING AN OCCUPATIONAL HEALTH POLICY .......................................................................................... 13 RESPONSIBILITIES ................................................................................................................................................ 13 TRIGGERS FOR ACTION .......................................................................................................................................... 13 PROCEDURES ...................................................................................................................................................... 13 NATURE OF THE ORGANISATION ............................................................................................................................... 14 TYPICAL OCCUPATIONAL HEALTH POLICY .................................................................................................................... 14

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A1 | Development of Occupational Health Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.1.1 Describe the development of occupational health 2.A.1.2 Explain the relationship between occupational and public health 2.A.1.3 Outline the main elements of an occupational health strategy 2.A.1.4 Explain the place of occupational health in a health and safety management system

Unit 1:

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BSC International Diploma – Element 2A | Occupational Health

The Development of Occupational Health The Changing Nature of Occupational Health and Diseases It is likely that the connection between the health of an individual and that person's occupation became apparent at an early stage of social evolution. The first occupational disease could possibly have been silicosis occurring as a result of exposure to flint dust during the manufacture of flint tools. The development of domestic production of grain could also have led to cases of farmer's lung. However, it would have been the introduction of mining and metal-working that caused the first significant increase in occupational disease resulting from exposure to metal fumes and dust. There appeared at that time, though, to be little concern over the resulting heavy loss of life, due to the fact that the more onerous tasks were undertaken by slaves and prisoners. During the 16th and 17th centuries mining, metal-work and other trades flourished, particularly in Italy, following the Renaissance. The development of new trades introduced the use of new materials and processes. Some early texts on the diseases of miners appeared during the 15th and 16th centuries but the first comprehensive treatise on occupational medicine was not produced until 1700 when Ramazzini published De Morbis Artificum Diatriba, from which the modern development of occupational medicine can be directly traced. At that time there was little humanitarian sense or economic necessity to protect the life and health of workmen; consequently Ramazzini's work made little impact on the working environment. It was the onset of the Industrial Revolution that drastically changed the nature of work, with the development of a vast array of new manufacturing processes, materials and substances, and the creation of a whole range of associated health risks. At the start of this period there was still little incentive to consider the health of the worker. Consequently, conditions in factories and mines were terrible and resulted in great morbidity and mortality. It soon became apparent however, that a sick or dying employee could not work as efficiently as a healthy one and it made economic sense to try to improve the working environment. There is now recognition of the need to conserve the health and efficiency of a skilled workforce. Management and health professionals around the world are aware of the importance of the relationship between the individual and the organisation and the manner in which it may influence health and well-being. Today, issues such as organisational stress are taken seriously as an occupational health issue. The aim of the modern occupational health team is not only to prevent the adverse effects of physical and chemical agents, but also to ensure that work is adapted to both the physiological and psychological needs of the worker and that, conversely, the worker is fit to do the job.

Long Period for Identification of a New Occupational Health Hazard Health hazards often take a significant time to reveal their effects on the body, in comparison to the effects of an industrial accident. For this reason it is sometimes difficult to persuade others of the need for caution and control with occupational health hazards, due to the fact that the effects are often not immediately apparent. Sometimes they are cumulative and the final outcome may not be apparent for some time and possibly irreversible when it is detected. A good example would be asbestos-related diseases. The period between initial exposure and the onset of respiratory diseases such as asbestosis is invariably many years.

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BSC International Diploma – Element 2A | Occupational Health

The Relationship between Occupational and Public Health Many hazards that have been found to affect public health and the environment were first identified or detected in the work environment and/or in the working population. So the occupational environment may act as an "early warning system" and it often provides the information for the provision of preventative action.

Effects of Exposure A substantial number of hazardous exposures in the community environment are derived from industrial activities or from other occupational systems such as transport. Air emissions generated by vehicles are not controlled by the workplace boundary, and noise levels produced by equipment and machinery in the workplace can cause a nuisance in the nearby community. Additionally, the working population is exposed to the hazards in both the occupational environment and outside the workplace. Exposure to noise hazards outside the workplace traffic and aircraft noise being prime examples (heavy traffic (80 dB(A)), jet engines (140 dB(A)) - increase the duration and level of exposure. The cumulative effects of workplace and community exposure may increase the risks of hearing damage. An occupational health hazard may create a public health hazard. For example, a research institute which handles highly pathogenic agents such as the smallpox virus may, through inadequate control measures, allow transmission.

Mitigation Techniques There are occasions when methods to decrease exposure to hazardous substances in the workplace lead to increased exposure in the environment and the community outside the workplace. For example, where "end of pipe" solutions such as local exhaust ventilation have been utilised to control workplace exposure an emission to the external atmosphere still exists and there is usually a solid waste that requires disposal. The mitigation technique has therefore moved the hazard from the workplace to the environment and the local community. However, on the positive side, the shift from the "end of pipe" solutions to primary prevention effectively reduces not only the exposures in the workplace but also limits the numbers exposed and the extent of exposure outside the workplace with reasonable costs. For example, the reduction of noise at source within the workplace will prevent nuisance in the community. Eliminating a hazardous substance or substituting it with a less hazardous substance will remove or reduce exposure to both the working population and the public.

Monitoring Often the techniques of measurement and monitoring are similar in principle, whether they relate to workplace or public health exposure. Such techniques may include: 

Epidemiological studies, which are carried out in both the workplace and in the community to determine cause and effect relationships. Often the results of studies carried out in the workplace identify possible concerns in relation to public health. Studies carried out in both communities are able to provide information for further research and assist in the identification of preventative measures that may be applicable in both environments.

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

Toxicological data, which can be interpreted and applied to a number of situations. For example, where toxicological data determines a substance to be a possible carcinogen, it is likely to be a carcinogen whether exposure occurs in the workplace or in the community. Whilst the risk in each environment is likely to vary according to the level and duration of exposure, the hazard remains the same.

Measurement instruments and methods are similar, although interpretation of results and their application may vary slightly. For example, assessment of community noise uses noise level instruments that operate on the same principles as workplace measurement but results are interpreted differently and compared to different standards. Methods of collecting air samples, for example sampling for dusts, will involve a sampling head, pump, filter and flow meter both in the workplace and the community. The sample head, size and type of filter, the rate of air flow and therefore pump type may differ, but the principle of operation and measurement will remain the same. Many of the techniques and information available to the safety professional in relation to the workplace can therefore be applied in relation to public health.

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BSC International Diploma – Element 2A | Occupational Health

The Main Elements of an Occupational Health Strategy Health and safety at work is a general, catch-all term to cover a wide range of adverse effects which may be generated by activities and events which occur at the workplace. Exactly what is covered? We must be clear about the following important definitions: 

Occupational health relates to the physical and mental condition of all people at the workplace (employees, contractors and visitors) and their protection from harm in the form of injury or disease.



Safety relates to the conditions at the workplace and applies to the pursuit of a state where the risk of harm has been eliminated or reduced to a tolerable, if not acceptable, level.

The discipline of occupational health is concerned with the two-way relationship of work and health. We are concerned about the effects of the working environment on the health of the worker but we must also consider the influence of the worker's state of health on his/her ability to perform workplace tasks. A joint International Labour Office/World Health Organisation Committee defined the subject in 1950 as "the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations". It is therefore vital that every employer makes arrangements as are appropriate for the effective planning, organisation, control, monitoring and review of the necessary preventive and protective measures having regard to the nature of his activities and the size of his undertaking. In order to incorporate the concepts of control, monitoring and review of preventive and protective measures, an occupational health strategy must be concerned with: 

A primary element for the prevention of ill-health amongst the workforce. This element will involve a wide range of prevention strategies including engineering controls, procedural controls, workplace design, staff training and supervision.



A secondary element for the early identification of any ill-health that may develop within the workforce. This element will involve health surveillance to try to establish if workers’ health has been harmed by the workplace or its activities.



A tertiary element for the rehabilitation/return to work of any employees who suffer occupational ill-health.

These “Prevention Strategies” are a useful way of considering all aspects of control relating to the prevention of occupational ill health.

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BSC International Diploma – Element 2A | Occupational Health

The Place of Occupational Health in a Health and Safety Management System The discipline of occupational health aims to anticipate and prevent those health problems which can be caused by the types of work which people do. There is a two-way relationship between work and health; in some circumstances environmental conditions at work can aggravate a pre-existing medical condition. So we are concerned about the general health and susceptibility of the worker, as well as the workplace environmental conditions. When we refer to occupational health and hygiene, we are considering both the (occupational) health of the worker and the hygiene (environmental) conditions of the workplace. In years gone by the main emphasis in health and safety was on accident prevention and short-term safety issues. Now there is an increasing recognition of the potential detrimental effects of work on health and the need to consider longer-term occupational health issues including topics such as organisational stress. We shall now consider a number of procedures relating to occupational health which are significant elements in a health and safety management system.

Occupational Health Needs Assessment Such an assessment should follow a logical and systematic approach, involving: 

Recognition of the health hazard.



Quantification of the extent of the hazard by measuring level and/or duration, and relating the measurements to the appropriate workplace exposure standards.



Assessment of the risk to health in the workplace.



Selection and implementation of appropriate control measures.

Such an occupational health assessment requires a knowledge of the range of workplace agents which are able to cause ill-health; understanding of the mechanism of harm; the ability to identify health risks by measurement and comparison with relevant standards; and familiarity with the range of control measures to enable selection of an effective control strategy.

Pre-Employment Assessment and Screening In certain circumstances, pre-employment health screening may be appropriate to ensure that employees are fully fit at the outset and able to perform their work efficiently in the conditions: 

For new employees, or those being transferred from one type of work to another, if it is considered that the work is hazardous to health.



Where the worker has to enter a hazardous environment to which he or she has not previously been exposed.



Where there is a high risk of accidents to themselves or others, such as in transport.

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Where there is a risk of endangering others through transmission of infection.



Where the work entails high standards of physical or mental fitness.

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BSC International Diploma – Element 2A | Occupational Health

Tests and procedures for pre-employment health screening should relate to the demands of the work and the potential hazards it presents and may include vision, hearing and lung function (see below). Records of pre-employment health screening will provide a base-line measurement of an individual’s health, which can be used as a comparison for any subsequent health testing.

Health Surveillance (Health Checks) The objectives of health surveillance where employees are exposed to substances hazardous to health in the cause of their work are: 

The protection of the health of the individual employees by detection as soon as possible of any adverse changes which may be attributed to exposure to substances hazardous to health.



To assist in the evaluation of measures taken to control exposure.



The collection, maintenance and use of data for the detection and evaluation of hazards to health.

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To assess, in relation to specific work activities involving micro-organisms hazardous to health, the immunological status of employees.

Therefore, the purpose of routine health surveillance is to identify, at as early a stage as possible, any variations in the health of employees which may be related to working conditions. Where hazards are low and the likelihood of occupational disease remote, there may be no necessity for a system of regular health checks. Nevertheless, it is recommended that basic personal records should be kept for all employees, including a historical record of jobs performed, details of periods of exposure to harmful agents, absence due to sickness or injury, and cause or duration of absence. Where hazards are low but there is known to be the possibility of occupational disease leading to easily recognisable symptoms, self-checks may be acceptable. For medium range hazards checks by a responsible person, such as a supervisor, first-aider or nurse, may be required. Where there appears to be a higher level of risk, an assessment of the level of surveillance required should be made with the assistance of an occupational physician. Specific checks which may be carried out on a regular basis due to the hazards relating to certain occupations include: 

Audiometry, in order to measure the hearing sensitivity of individuals exposed to noise.



Vision screening, in order to identify any eyesight problems, and to provide effective and remedial action, e.g. providing spectacles for use when working with a VDU.

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Lung function testing and chest X-rays to screen people in dusty occupations where there is a risk of pneumoconiosis, and to establish accurate classification of the stages of the disease if it is present.

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Blood testing of red and white cell counts by automatic analysis techniques to enable early detection of anaemias and leukaemias.

Immunisation Vaccines consist of dead or live attenuated organisms that, when administered to individuals, are able to initiate immunity to potentially infectious doses of organisms that could cause ill-

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BSC International Diploma – Element 2A | Occupational Health

health or disease. Where appropriate vaccines exist, consideration should be given to the vaccination of staff at risk from exposure to harmful organisms. In some cases, e.g. clinical work where there is a Hepatitis B risk, vaccination may be a requirement before work in high risk areas is allowed to commence. However, vaccination can never be considered to be the principal defence against infection but only as a risk reduction measure. Protection can never be guaranteed since certain individuals may not develop immunity after vaccination. A further problem is the possibility of adverse reaction to the vaccine with some persons. The possible side-effects must be considered before the decision to vaccinate is taken. The following vaccinations are recommended for particular categories of staff: 

Health care workers: rubella, TB, Hepatitis B.



Sewage workers: tetanus, Hepatitis A.

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Agricultural/horticultural workers: tetanus.

Counselling It is now common for many occupational health workers to be trained counsellors. Following a traumatic incident at a workplace, these people are on hand to offer one-to-one counselling for those workers who feel they would benefit from discussing the events. Other situations where counselling may be used include the following: 

Where an employee is suffering from work-related stress.



Where an individual has been subjected to violence from a client/customer in the work situation.

Drug and Alcohol Screening Random alcohol and drug testing is sometimes undertaken as a deterrent. However, there is an issue as to how random such testing should be. It is important to ensure that employees are available to test, but equally it may defeat the purpose if a warning is given. Alcohol can be detected and measured in breath, blood and urine. Simple "breathalyser" kits are available for breath testing whereas a laboratory is necessary to quantify the amount of alcohol in blood or urine samples. Drug testing is much more difficult. Most drugs or their by-products can be measured in blood, urine and saliva. Simple test kits are now available for a range of prescribed and illegal drugs although none are entirely reliable. A positive test does not necessarily mean that the person has taken an illegal drug because the by-products which these tests detect can be formed from legitimate medication. A drug test does not prove whether the person is under the influence of drugs, or whether their ability is affected. All a drug test will do is to indicate if a person has had a certain drug in the recent past.

Training Health and Safety In most countries there is a legal requirement for employers to provide health and safety training, while in others it certainly is good practice to provide employees with health and safety training. Such training must normally be provided in working hours and not at the expense of employees.

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BSC International Diploma – Element 2A | Occupational Health

Training is perhaps one of the key weapons in the management of occupational safety and health as it can be targeted at developing the necessary understanding and skills in individuals and groups. Its success depends on identifying training needs and setting outcomes which can be demonstrated after the training has been received. The benefits which flow from this includes the following: 

New workers, both recruits to the organisation and those changing jobs within it, are able to assimilate the requirements of the job, including aspects affecting occupational health and so become effective quickly.



The correct and safe method of doing the task is learnt from the beginning and, as there is less risk of passing on bad and unsafe practices, machinery and equipment are used more effectively. This means there is less likelihood of exposure to health hazards occurring in the early stages of a worker starting a new job.



Well trained employees, who understand the processes in which they are involved and are skilled in operating them, are more productive and work to higher standards. They also tend to stay longer with the employer, ensuring future reliability and continuity.

There are a number of key points in the organisation when health and safety training is specifically required. •

Induction Training As a new recruit could be run down by a fork-lift truck on the first day, or a fire could break out soon after his/her arrival. Safety training is, therefore, a priority from the outset. The induction should also include occupational health hazards and the safe systems of work that are in place to protect employees. This may be collective protection systems such as LEV to keep dust levels down or individual protection such as gloves to prevent dermatitis when working with certain chemicals. This should precede instruction in the tasks themselves, ensuring that working safety is given precedence. Later sessions should progress to the joint responsibilities of management and employees for safe working practices and give more detailed attention to the causes and prevention of accidents and fire.

•

Job or Process Change Whenever there is a change to the job or tasks which employees are expected to perform, the employer must arrange for them to receive appropriate training. This applies when individuals change jobs or when there is a change in the nature of the job – through the adoption of new procedures or processes, or the introduction of new technology to it. This is clearly necessary in respect of acquiring the new knowledge and skills necessary for effective performance, but also relates to the implications of the change for health and safety at the workplace. In some ways, experienced workers may be in more need of this than new recruits in that they may feel that, being experienced; they are aware of all the hazards and risks and know what to do. Allied to situations where the job changes are situations where the skills necessary for effective performance for an existing job or role change. A good example of this is in respect of first aiders who need to keep their knowledge and skills up-to-date and should go on regular refresher training courses.

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BSC International Diploma – Element 2A | Occupational Health

Occupational health hazards are often less obvious than typical safety hazards, e.g. the risk from exposure to X-rays is much less apparent than that from unguarded moving machinery. It is therefore especially important for workers who are exposed to health hazards to receive explicit training and instruction on the risks to which they are exposed and the precautions that should be adopted to reduce the risk of harm. •

Changes in Legislation The area of health and safety is often regulated by the law (although this differs from country to country) and employers should ensure that they comply with its demands at all times. This means that, as laws are amended or new legislation is passed, they must set up procedures for implementing the new requirements. There are two aspects to this: −

A need to monitor developments to ensure that they are aware of impending changes and can take the necessary action.

−

A need to provide structured training to all staff – management and workers – who will be affected by it.

Manual Handling To ensure competence in manual handling techniques, appropriate instruction and training should be provided. This should be closely related to a person's job and include theoretical and practical supervised sessions using typical loads in working conditions to ensure a thorough understanding of, for example: 

The design of the tasks involved.

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Recognition of different types of load, e.g. assessing the likely weights of loads and deciding which may or may not be handled without assistance.

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The need for good housekeeping in and around the work location.

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Safe lifting and handling techniques, including the risks from careless and unskilled handling.

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Correct use of personal protective equipment.

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Correct use of mechanical aids.

First-Aid First-aid is the immediate and temporary care given to the victim of an accident or illness until the services of a qualified medical practitioner can be obtained. It can save lives and minimises the consequences of an injury until medical help is obtained, so every workplace should have sufficient trained personnel and suitable facilities to deal with any cases which occur. It also has another function - the treatment of minor injuries which would not receive or do not need medical attention.

Ergonomic Advice The ergonomic design of tools, equipment and workplaces can contribute to the reduction of risk relating to occupational health and safety. Appropriate design can reduce the levels of force required for a task, the number of highly repetitive movements, and improve posture. Mechanisation and automation and reducing machine pace can also have a major impact on the risk.

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Lifestyle Screening/Advice and Health Promotion Increasingly advice is available, and should be promoted within the workplace, on the benefits to the individual that can be gained from a "healthy" lifestyle. Campaigns to encourage individuals to stop smoking, eat healthily (five portions of fruit and vegetables a day, less fat, less salt, etc.) and drink only moderately are only some of the better known ones. Also to be promoted are certain advisory promotions (safe sex) and self-screening campaigns, such as regular examination by men for testicular cancer and by women for breast cancer.

Return to Work Programmes Employers wishing to see their staff re-introduced into the workplace following a period of absence must carefully manage the process if they are to prevent further absence due to a recurrence of the existing problem or the development of another one. There is a need for an employer to fully understand the nature of an employee’s condition in order that they can develop an agreed return to work programme that is appropriate and long lasting. Advice is often taken from the employees’ medical practitioner, via sickness absence notes or other documentation which will provide details about the ailment and any possible limitations on the individual including possible side effects of any continued treatment. It is vital that the company engage in continuous dialogue with the employee to understand the problems and to show that they care. Occasional visits by a company representative and informal meetings to discuss progress and concerns are invaluable in maintaining good relationships and helping the employee to return to work. It is often desirable to consider a phased return to work programme, which is agreed between all parties. In this way the employee can gradually be re-introduced to working life until such time as they feel comfortable working at the level they were at before their absence. This time can be very difficult for the employee, especially if they were involved in projects or committees and their place has been filled (even temporarily) by someone else. Employers d must be sensitive to this issue if they are to avoid further unrest and ill health that might be seen as a consequence.

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BSC International Diploma – Element 2A | Occupational Health

Developing an Occupational Health Policy Effective management of any issue requires the development, communication and implementation of a policy. Occupational health is no different. The O.H policy should be documented and consistent with the overall business aims and policies within the organisation.

Responsibilities The roles, responsibilities and authority of those people who manage or perform occupational health functions should be defined, documented and communicated. Ultimate responsibility for occupational health lies with top management but the responsibilities of all employees, including line managers and lower-levels of employees, need to be clearly defined. Specialist areas should not overlap and boundaries should be clear. Every person should understand their responsibilities and be competent to perform them.

Triggers for Action Depending on the organisation, the risk associated with the activities and the type and level of occupational health service, there may be a number of triggers for action. Action may be mainly reactive in nature, i.e. waiting for issues to arise before taking action, or it may be proactive by getting involved in issues such as health screening and education. Clearly, in some organisations legal requirements may well determine the triggers for action and what those actions should be. The policy should identify the services available and when they are applicable such as: 

Pre-placement screening and fitness to work.

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Sickness absence and rehabilitation.

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Education and promotion.

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Rehabilitation of people who are ill, whether or not caused by work, to keep them in work or enable them to return to work.

Procedures A major part of occupational health will be to look at all the factors of new working practices, equipment and materials. Procedures will need to be in place to identify changes in operations and to assess the risks they present to enable the occupational health service to adjust according to changing needs. Consideration should be given at the planning stage to the design of jobs and the application of ergonomic and human factor principles. Depending on the type and level of service provided procedures will need to be in place for a number of issues including: 

The identification of workplace hazards that present risks to the health of employees.

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Accessibility of the service, for both employees and for manager referrals.

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Reporting and investigation of complaints and incidents.

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Confidentiality of employee records.

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Sickness absence management including self-certification, absence review and long-term absence management.

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Disciplinary and grievance procedures.

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Mandatory and voluntary health screening requirements and options.

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Pre-employment screening.

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Education, promotion and communication.

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Rehabilitation and return to work services.

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Monitoring and review of the service and occupational health risks.

Nature of the Organisation There is no single model of what is a good occupational health scheme; each scheme depends on the nature of the organisation, its size, the kind of work involved and the service it provides. The development of the policy will need to consider these organisational factors to determine the type and level of service to be offered. Individuals with health conditions or impairments requiring additional control measures, or the existence of work activities requiring extensive physical exertion may impact service determination. The service may be provided internally, outsourced or combined. It may be appropriate to employ a single occupational health nurse or a team of occupational specialists. The variability of each organisation’s requirements makes a detailed assessment of needs important prior to developing the policy.

Typical Occupational Health Policy A typical Occupational Health Policy might include the following topic areas: 

Policy aims and objectives.

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Organisation & responsibilities of health provision.

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Risk assessment.

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Stress.

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Bullying and harassment.

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New and expectant mothers.

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Disabilities.

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Working hours.

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Children and young persons.

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Alcohol and drugs.

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Sickness absence.

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Health surveillance.

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Ill-health reporting.

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Rehabilitation/post sickness assessment.

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Employees’ occupational health surveillance questionnaire.

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Disabled employees and students.

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First aid facilities.

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Health education and promotion

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A2

Title

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Occupational Health Provision

THE COSTS AND BENEFITS OF OCCUPATIONAL HEALTH PROVISION ................................................................ 3 REDUCING COSTS BY IMPROVING HEALTH MANAGEMENT ................................................................................................... 3 COMPLYING WITH LEGAL REQUIREMENTS ...................................................................................................................... 3 MORAL DUTY OF CARE ............................................................................................................................................ 4 INTERNAL AND EXTERNAL OCCUPATIONAL HEALTH PROVISION ..................................................................... 5 INTERNAL PROVISION.............................................................................................................................................. 5 EXTERNAL PROVISION ............................................................................................................................................. 5 THE ROLES OF MEMBERS OF THE OCCUPATIONAL HEALTH TEAM ..................................................................... 7 OCCUPATIONAL HEALTH PHYSICIANS ........................................................................................................................... 7 OCCUPATIONAL HEALTH NURSES ................................................................................................................................ 8 COUNSELLORS....................................................................................................................................................... 8 PHYSIOTHERAPISTS ................................................................................................................................................ 9 ERGONOMISTS ...................................................................................................................................................... 9 OCCUPATIONAL HYGIENISTS...................................................................................................................................... 9

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A2 | Occupational Health Provision Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.2.1 Explain the costs and benefits of occupational health provision 2.A.2.2 Explain the relative benefits of internal and external provision 2.A.2.3 Describe the roles and responsibilities of members of an occupational health team

Unit 2:

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The Costs and Benefits of Occupational Health Provision Reducing Costs by Improving Health Management Ill-health can be costly and the indirect costs involved are often substantially more than direct costs. In some countries employers are required to have certain types of insurance against accidents, ill-health or other problems, such as: 

Employers' liability insurance.



Public liability insurance.



Motor vehicle insurance.

These insurances will cover some of the costs of ill-health. However, many of the costs cannot be insured against, such as: 

Lost production time.



Legal costs in defending civil claims, prosecutions or enforcement action.



Overtime and other temporary labour costs to replace the injured worker.



Time spent investigating the cause and other administration costs (including supervisor's time).

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Fines from criminal prosecutions.

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Loss of highly trained and/or experienced staff.



Effects on employee morale and the resulting reduction in productivity.



Bad publicity leading to loss of contracts and/or orders.

Any reduction in costs that can be achieved by improving health management will be of benefit to the organisation. Such reductions may be achieved, for example, by: 

Raising employees' awareness of health hazards by means of training, signs, notices, etc.



Implementing occupational health techniques such as:



−

Health surveillance.

−

Hand inspections for those who work with wet cement.

−

Using low vibration equipment.

Purchasing policies, e.g. selecting personal protective equipment that not only provides adequate protection, but is also provided in different sizes.

Measures such as these will contribute to the prevention of occupational ill-health resulting in less likelihood of civil action being taken by employees against the organisation.

Complying with Legal Requirements There are strong legal reasons for employers to manage risk by providing occupational health provision:

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Punitive - where the criminal courts impose fines and imprisonment for breaches of legal duties. These punishments can be given to the company or to individuals within the company.



Compensatory - where employees are able to sue for compensation.

The provision of occupational health services will reduce the risk of ill-health occurring amongst employees, and thus reduce the chances of legal action being taken by employees against the employer.

Moral Duty of Care It is widely accepted that moral reasons should be the prime reason for managing risk and providing occupational health care, although whether this is actually the case is open to debate in some cases. There is a need for maintaining a moral code within our global society. Without it, employers can be tempted to treat the health and safety of the workforce as being of lower importance than financial profit. Moral reasons are based on the concept of an employer owing a duty of reasonable care to his employees. A person does not expect to risk life and limb, or physical health, as a condition of employment. Society expects every employer to demonstrate a correct attitude to health and safety to his workforce. It is totally unacceptable to place employees in situations where their health and safety is at risk. In addition to the obvious duties owed by an employer to his workers, he also has a moral obligation to protect other people whose health and safety may be affected by his undertaking, e.g. contractors or members of the public.

When determining the type and level of Occupational Health provision an organisation should first carry out a needs assessment to ensure the service will meet their needs. The needs assessment can be carried out by the organisation itself or by an external provider and should consider such factors as: 

The size of the organisation.



The geographical spread of the workforce.



The variety of occupational health hazards within the organisation.



The availability of facilities.

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Available resources.

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Internal and External Occupational Health Provision There are advantages and disadvantages associated with both internal and external provision for Occupational Health services. The main advantages are as follows:

Internal Provision 

The most effective occupational health provision will be achieved where the occupational health team has a true understanding of the organisation's activities, priorities and values. An internal team is often in a better position to become an integral part of the organisation, gaining both an operational and strategic understanding which allows the service to become more tailored to the needs of the organisation.



An internal team is in a position to establish relationships within the organisation and gain best use of the internal resources available from within other areas of the business. They become familiar with organisational structures, both formal and informal, and can make effective use of working relationships.



The organisation is in a position to select occupational health professionals with personalities that meet the needs of the organisation and in-house teams can be trained and developed to the specific needs of the organisation.



An in-house occupational health team generally allows employers and employees easy access to health advice. There is also no requirement for employees to leave the workplace, reducing time away from work. However, where occupational health provision is through just one or two individuals, there is always the risk of health professionals not being available when they are needed due to absence.



Assuming staff turnover is low, an in-house team can achieve continuity as the occupational health team is likely to remain stable.



When offered internally the type or level of service is generally more flexible and is able to change frequently and with little cost when the needs of the organisation change.



An equivalent service is likely to be cheaper if provided internally, but the availability of a whole range of services from externally-sourced providers may outweigh that benefit.

External Provision 

Occupational health is a specialised area which may be difficult to manage internally; outsourcing the service removes the need to manage the service leaving only the requirement to manage the contract.



An outsourced service is likely to have access to a broader range of professionals and specialist services, with professional development likely to be an ongoing part for each professional ensuring that access to up-to-date advice is constantly available.



Where an employer uses an external company, the need to provide, maintain and equip premises are removed. In terms of financial resources this can be cost effective. In addition where an organisation is geographically spread, with employees in different parts of the company, an external provider is likely to be able to provide facilities in a number of more accessible locations.

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

Generally, access to an outside service will always be available. Whilst the individual health professional seen may vary, the outsourced company usually has the resources to cover for absence.



The levels and type of service provided by external companies are extremely varied and can be selected according to the needs of the organisation. The experience and knowledge of the external provider are likely to be of real benefit when establishing the service required.

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The Roles of Members of the Occupational Health Team The provision of an occupational health service to the workforce requires the involvement of a range of professionals including Occupational physicians, Occupational nurses, Counsellors, Occupational hygienists and Ergonomists. A hypothetical example of the combined approach working in practice could be: 

The recognition of a particular health effect by a worker, safety representative, nurse or doctor.



Diagnosis of the illness and treatment by a nurse or doctor.



Discovery of the environmental cause by a hygienist.



Implementation of controls by the employer assisted by the hygienist or ergonomist.

We shall now look at the roles of the various occupational health specialists.

Occupational Health Physicians We can divide occupational health into two convenient elements: occupational hygiene, concerned with the measurement and physical control of environmental hazards; and the discipline of occupational medicine. This is the branch of preventative medicine concerned with the diagnosis and assessment of health hazards and stresses at work. Since it is a specialist branch of the medical profession, we need a medical practitioner to carry out this function. This type of doctor is referred to as an Occupational Health Physician. The occupational health section provides a range of services, and the exact division between those which directly involve the occupational health physician and those carried out by an occupational health nurse is often not clear-cut. However, below are some common functions which the occupational health physician may carry out directly or supervise.

Statutory Medicals Certain workers are required by specific regulations to be examined periodically for occupational health reasons. Examples include ionising radiation, lead and asbestos workers.

Health Surveillance Best practice requires health surveillance in given circumstances to facilitate the early detection of disease or adverse health effects, and to assist in the evaluation of control measures. The process may involve examination of possible exposure to carcinogens, pathogens and sensitisers. Where exposure to such substances exists, the role of the occupational health physician will be to decide if health surveillance is necessary and whether a method of health surveillance is available which is capable of identifying adverse health effects related to the working environment, and which has a useful predictive value.

Pre-Employment Health Assessment One of the valuable services offered by the occupational health section to management is expert advice on the fitness of applicants and employees. Sometimes it can be done through a health questionnaire assessed by the occupational health nurse. However, where a higher level of medical fitness is a job requirement, or where a medical opinion is required in a more

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complex case, the occupational health physician will carry out a pre-employment medical examination.

Post-Sickness/Rehabilitation/Ill-Health Retirement Health Assessment In some circumstances, such as with food-handlers or after long periods of sickness absence, it may be necessary for a return-to-work examination to take place. This creates the opportunity to advise on the person's fitness to return to work, or perhaps recommend some form of rehabilitation first. In cases where persons are suffering from a medical condition likely to prevent them from continuing work, the occupational health physician will carry out a medical examination and possibly advise on ill-health retirement.

Occupational Health Nurses Occupational health nursing is a specialist branch of the nursing profession. The training which the qualified occupational health nurse undergoes enables that person to: •

Assist the employer in complying with health and safety legal responsibilities.

•

Monitor the health of employees.

•

Promote good health activities in the workplace.

The basic role, therefore, is to prevent occupational ill-health and to improve the health of the workforce generally. The training of the occupational health nurse encompasses areas of health and safety familiar to the health and safety practitioner, and also aspects of the type of workplace monitoring carried out by the occupational hygienist. Consequently, the occupational health nurse should be familiar, for example, with noise at work and be able to carry out simple noise surveys to locate areas of concern and be able to implement an audiometry programme to screen for noise-induced hearing damage. The following elements of an occupational health programme would heavily depend on the involvement of the occupational health nurse: •

Working with line managers to minimise hazards, ensure compliance with health and safety legislation and implement the organisation's occupational health policies.

•

Dealing with cases of substance abuse.

•

Advising on placement at work through pre-employment health assessments.

•

Health surveillance after return to work from accident or ill-health.

•

Managing health centre facilities, offering basic health checks and co-ordinating first-aid services.

•

Advising on ergonomic issues.

•

Promoting good health education and activities in the workplace, geared to encouraging employees to take personal responsibility for their health.

•

Providing advice and counselling.

Counsellors Trained counsellors can be of benefit to those who have been involved in traumatic situations, ranging from involvement in a major accident to suffering stress due to pressures in the work situation. Counsellors do not give advice; rather, they encourage individuals to talk about their thoughts and feelings knowing that they will not be exposed to any criticism or judgment.

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Counselling can give significant mental relief to individuals suffering in various ways.

Physiotherapists The role of the occupational health physiotherapist includes the assessment, diagnosis, treatment, evaluation and follow-up of work-related injuries and diseases. The physiotherapist provides rehabilitation in order to help injured employees back to work or to assist them to remain at work. Activities and responsibilities undertaken by an occupational health physiotherapist may include any of the following tasks: 

Workplace assessments and making recommendations for alterations.



Analysing tasks and suggesting changes in order to avoid injuries.



Education/training relating to injury prevention in the workplace, e.g. back care, manual handling techniques, etc.

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Testing a person's capacity for work.



Treatment of work-related injuries.



Planning return-to-work timetables for injured employees.



Implementing stress management and relaxation techniques.



Pain management.

Ergonomists The work of the ergonomist can have important implications for the smooth running of the workplace, with regard to efficiency, productivity, safety and health. It is the ergonomist who aims to ensure that the individual and the technological setting in which he/she works combine to get the best performance available from both resources. The ergonomist is concerned with: 

The design of equipment and systems so that they are easier to use.



The design of jobs and tasks so that they take account of human factors.



The design of equipment and the work situation in order to improve posture and strain on the body to avoid repetitive strain injury and work related upper limb disorder.



The design of work environments to ensure that elements such as lighting and heating suit the requirements of the individual whilst carrying out the necessary work.

The ergonomist works in multi-disciplinary teams which may include design engineers, industrial designers, production engineers, health and safety specialists and psychologists.

Occupational Hygienists Hygiene is generally considered to be the maintenance of health and the prevention of disease. Occupational hygiene applies this definition to the place of employment and the principal aim is to prevent occupational ill-health. The work of the occupational hygienist follows the stages used in the study of occupational health and hygiene generally: •

Identification of the hazard.

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•

Assessment of the risk.

•

Measurement of the risk and interpretation of the result.

•

Application of control measures and their maintenance.

•

Information, instruction and training.

However, the key speciality of the occupational hygienist is the measurement of risk and interpretation of results. A wide range of monitoring techniques is available, making use of special equipment and instruments. The occupational hygienist is trained in their selection and use, but most importantly, in the interpretation and evaluation of the results which they provide. As inhalation is the most important method of entry of a toxic substance into the body, much of the work of the occupational hygienist involves measurement of airborne contaminants, using personal or static samplers and comparing the results. The correct sampling instruments, methods and analytical procedures must be identified. As well as airborne dust, gas and vapour, the occupational hygienist is also concerned with measurement of heat, noise and other pollutants. Another important area of involvement is the monitoring of control measures to ensure they are working effectively. Consequently, the occupational hygienist is skilled in carrying out measurements on ventilation systems and other environmental control devices to ensure they operate at optimum performance.

The Work of an Occupational Hygienist The routine work of a hygienist is to ensure that the work environment does not cause illhealth and that levels of exposure are in compliance with the statutory limits for chemical, physical and biological agents.

Recognition of Hazards Avoidance of ill-health at work is achieved primarily by identifying the many visible and hidden environmental hazards, present or emanating from the workplace. Key categories of such hazards are: 

Chemical (dust, fumes, gases, vapours; also those harmful by skin contact).



Physical (extreme temperatures, light, noise, vibrations, ionising and non-ionising radiation and humidity).



Microbiological (bacteria, viruses).



Behavioural or psychosocial misfit (stress caused by excessive work demands beyond a person's ability to cope, violence and bullying).



Ergonomics, or physical misfit (factors affecting posture and motion, manual handling).

Hygienists need to be aware of the legal requirements and standards. They should also be aware of the environmental impact of their activities, and integrate occupational health practice with environmental protection.

Evaluation of Risks Occupational hygienists understand how hazards might affect health, and can measure how serious the effects may be. The hygienist must understand the routes of entry into the body of various agents, as well as the effects on health.

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The evaluation of risks typically comprises a study of existing plant, equipment, materials used, products and by-products, production and general working conditions. Atmospheric monitoring may be passive, i.e. using a static monitoring position, or personal, where the worker wears a detection/collection device whilst carrying out normal work practices. Risks to persons outside the workplace may also be relevant.

Control of Risks Occupational hygienists specialise in eliminating the risks to health or controlling them in practical and cost-effective ways by the application of scientific, technological and managerial principles. Any problems identified should be rectified, following a hierarchy of the most practicable controls or isolation of the hazardous agent. They should endeavour to develop strategies, if necessary working together with professionals from other disciplines, which will contain the harmful agents near to their source. Organisational measures, and education, go hand-in-hand with technical measures such as enclosure, segregation and local exhaust ventilation. The supply of suitable personal protective equipment is a last resort, as this has its own inherent problems of isolation and discomfort.

Measurement and Monitoring of Health Hazards The practical skills of occupational hygienists cover the development of technical monitoring methods, the measurement of exposure, such as required as data for a risk assessment, or to monitor the effectiveness of controls. The hygienist must interpret the results and explain them to both management and workers including those involved in personal monitoring. Monitoring and review of the organisational aspects, and of the work environment (e.g. by measuring noise, dust, etc.) together with appropriate indices of workers' health, ensure the feedback loop is closed.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit

Title

2A3

Hazards to Health

Page

THE MAIN OCCUPATIONAL HEALTH HAZARDS AND ASSOCIATED RISKS .......................................................... 3 PHYSICAL HAZARDS ................................................................................................................................................ 3 CHEMICAL HAZARDS ............................................................................................................................................... 6 BIOLOGICAL HAZARDS ............................................................................................................................................. 8 PSYCHO-SOCIAL HAZARDS ...................................................................................................................................... 10 ERGONOMICS...................................................................................................................................................... 11 LIFESTYLE.......................................................................................................................................................... 12 THE EFFECTS ON THE BODY OF THE MAIN HEALTH HAZARDS ......................................................................... 15 HUMAN PHYSIOLOGY ....................................................................................................................................... 16 RESPIRATORY SYSTEM ........................................................................................................................................... 16 DIGESTIVE SYSTEM .............................................................................................................................................. 17 CIRCULATORY SYSTEM........................................................................................................................................... 18 NERVOUS SYSTEM ................................................................................................................................................ 18 SKIN ................................................................................................................................................................ 18 THE EYE ........................................................................................................................................................... 19 THE EAR ........................................................................................................................................................... 20 EFFECTS OF OCCUPATIONAL HEALTH HAZARDS ON THE BODY ....................................................................... 21 PROCESS OF ENTRY .............................................................................................................................................. 21 ROUTES OF ENTRY ............................................................................................................................................... 23 LOCAL AND SYSTEMIC EFFECTS ................................................................................................................................ 24 ACUTE AND CHRONIC EFFECTS ................................................................................................................................. 24 TARGET ORGANS .............................................................................................................................................. 26 THE BLOOD ........................................................................................................................................................ 26 THE LIVER ......................................................................................................................................................... 29 THE KIDNEYS...................................................................................................................................................... 29 THE REPRODUCTIVE SYSTEM ................................................................................................................................... 30 DEFENCE MECHANISMS .................................................................................................................................... 31 INHALATION AND RESPIRATORY DEFENCES .................................................................................................................. 31 DEFENSIVE CELLS ................................................................................................................................................ 34 OTHER DEFENCE SYSTEMS ...................................................................................................................................... 39 THE FUNDAMENTAL ELEMENTS OF TOXICOLOGY ............................................................................................. 40 LETHAL DOSE (LD 50) .......................................................................................................................................... 40 LETHAL CONCENTRATION (LC50) AND LETHAL TIME (LT50) ............................................................................................... 42 NO OBSERVED ADVERSE EFFECT LEVEL (NOAEL) .......................................................................................................... 43 TYPES OF TOXICITY TEST ....................................................................................................................................... 43 THE FUNDAMENTAL ELEMENTS OF EPIDEMIOLOGY ......................................................................................... 45 ROLE OF OCCUPATIONAL HEALTH SPECIALISTS ............................................................................................................. 45 TYPES OF EPIDEMIOLOGICAL STUDIES ........................................................................................................................ 46 CONTROL AND PREVENTION STRATEGIES .................................................................................................................... 49

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A3 | Hazards to Health Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.3.1 Describe the main occupational health hazards. 2.A.3.2 Explain the effects on the body of the main occupational health hazards 2.A.3.3 Outline the principal elements of toxicology and epidemiology

Unit 3:

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The Main Occupational Health Hazards and Associated Risks These occupational health hazards fit into six categories: •

Physical Noise, vibration, radiation, heat, etc.

•

Chemical Liquids, gases, vapours, dusts, fibres, etc. and the associated hazards.

•

Biological Bacteria, virus, fungus, mites, insects, etc.

•

Psycho-Social Working hours, relationships, stress, etc.

•

Ergonomic Manual handling, workplace layout, etc.

•

Lifestyle Smoking, drinking, lack of exercise, dangerous sports, etc.

We shall study many of these occupational health hazards throughout this study unit.

Physical Hazards Noise We are surrounded by sound all the time – we use it as a means of communication and as a source of entertainment (music), and we also use it as a source of information about our environment. Without it, we may become disorientated. However, in certain circumstances, it can be an intense irritation and a considerable hazard at work. In such circumstances, unwanted sound is usually referred to as noise. The major problem of noise is hearing damage, but it can also cause disturbance which can impair efficiency and interfere with communication which increases the risk of accidents, and stress. In moderation, noise is harmless, but if it is too loud it can permanently damage hearing. The danger depends on how loud the noise is and how long people are exposed to it. The effects may be acute or chronic: 

Acute effects are where the peak pressure of the sound wave may be so great that there is a risk of instantaneous damage to the mechanisms of the ear. This is most likely when explosive sources are involved such as cartridge-operated tools or guns. The effects of such trauma to the hearing senses may be permanent or temporary.



Chronic effects are where constant exposure to excessive noise over a period of time gradually produces damage to the hearing senses. This form of damage may not be noticed until it has become permanent, although some effects may recede with time.

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Generally, such damage to hearing is irreversible. Surgery may reduce the damage in the case of acute injury to the eardrum, but there is no cure for hearing impairment. The effects of damage to the hearing mechanisms of the ear may take a number of forms. 

Sounds become muffled so that it is hard to tell similar sounding words apart, or to pick out a voice in a crowd and it is difficult to distinguish speech from background noise. This effect is known as “threshold shift”, indicating that the level at which sounds can be clearly distinguished has reduced. The condition may be permanent or temporary.



Noise induced hearing loss occurs where the ear is unable to respond fully to sound within the speech range. The person does not necessarily lose the ability to hear sound, but is unable to distinguish the spoken word clearly even if it is presented with a raised voice.



Tinnitus is a subjective condition where “noises in the head” or “ringing in the ear” are the descriptive symptoms. There are no observable external symptoms. This may be an acute condition which recedes with time, although the recovery period could be 12 or more hours where very high exposure levels occur. It may also occur with people who have a chronic noise-induced hearing impairment, in which case it is usually permanent.

Where conditions in the workplace are such that it is necessary to shout in order to be understood, or there is a difficulty being understood by someone about two metres away, there is likely to be a problem.

Vibration Regular exposure to hand/arm vibration can cause a range of permanent injuries to hands and arms, collectively known as hand/arm vibration syndrome (HAVS). The injuries can include damage to the blood circulatory system (e.g. vibration white finger), sensory nerves and muscles. Pain and stiffness in the hands and joints of the wrists, elbows and shoulders may also occur. The injuries can be painful and disabling, e.g. painful finger blanching attacks (triggered by cold or wet conditions); loss of sense of touch and temperature; numbness and tingling; loss of grip strength; loss of manual dexterity; and inability to pick up small objects. The condition can affect work and leisure activities. People may need to avoid further exposure to vibration, or cold and wet conditions; and have difficulty handling tools and materials and with tasks requiring fine finger manipulation.

Radiation, Ionising and Non-Ionising Radiation is a general term for the processes by which energy is emitted from a radioactive source. The energy emitted is capable of causing considerable harm, depending on its form and the length of exposure. There are two forms of radiation – ionising and non-ionising. •

Ionising Radiation This includes both the streams of particles emitted by the decay of radioactive substances (alpha- and beta-particles and gamma rays) and X-rays. The energy transmitted is powerful enough to ionise atoms in living tissue, causing chemical changes at the cellular level. At high doses, this can result in massive cell destruction, damage to organs and possibly death. At low doses, it can result in the formation of cancers. If these form in the reproductive organs, it can cause hereditary effects in descendants.

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•

Non-Ionising Radiation This form consists of lower energy electromagnetic waves whose energy decreases with increasing wavelength. There is, then, a spectrum of types of non-ionising radiation based upon the wavelength of the energy transmitted. This spectrum, together with the effects on the body, is as follows: −

Ultra-violet radiation has low penetrating power and its effects are confined mainly to the skin and the eyes. Acute effects on the skin are similar to sunburn, whereas chronic effects include premature aging of the skin and skin cancer, although this is highly unlikely to be contracted from occupational sources. The most common effect on the eyes is conjunctivitis, an inflammation of the eye often associated with welding where it is commonly known as “arc eye”.

−

Visible radiation is experienced particularly from high intensity beams such as lasers, which can cause serious burns to exposed skin tissue and is particularly dangerous to the eyes.

−

Infra-red radiation is emitted from any hot material and can cause reddening of the skin, burns and cataracts in the eyes.

−

Microwave radiation generates heat by causing the vibration of liquid molecules within tissues and exposure can, therefore, result in deep-seated burns, particularly to the eyes.

−

Radio frequency radiation can cause excessive heating of exposed tissues.

Temperature The temperature of workrooms should normally be at least 16°C although the general requirement is that it should be comfortable to work in. There will always be situations where, due to the nature of the work, workers will be exposed to temperatures far above or below what could be considered comfortable. Examples include: 

Extreme heat – working with molten metals and in foundries, or hot climates.



Extreme cold – working in cold-stores.

Prolonged exposure to excess heat or cold can lead to fatigue, a general slowing of reactions and a loss of dexterity, affecting both work efficiency and the possibility of making mistakes which can lead to accidents. Apart from the risk of burns from contact with hot materials, surfaces and equipment, working in very hot environments can cause heat exhaustion, dehydration, heat cramps and heat stroke. Exposure to extreme cold can lead to a lowering of the body’s deep core temperature, either locally (e.g. in the fingers or toes) where it may cause frostbite or more generally where it can cause hypothermia. These conditions are extremely unlikely in an occupational setting, but lesser effects include shivering, clouded consciousness, pain in the extremities of the body and reduced grip strength and co-ordination. Contact with very cold materials, surfaces and equipment can also cause burns.

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Chemical Hazards There are three basic states of matter: solid, liquid and gas, and each of these states can be in a different form.

Solids These can be a solid block of, say, wood. If it is put through a sawmill then dust is produced. Dust is a solid. Similarly, if asbestos is disturbed or damaged, tiny asbestos fibres are produced.

Liquids We can all visualise the spray coming out of an aerosol of hair spray. This is just a liquid in a different form. Another form of liquid that we should all be familiar with is a mist.

Gases These are air-like substances that move freely to fill spaces. Vapour given off from liquids can be put into this category along with gases like hydrogen, carbon dioxide, oxygen, methane, etc. Fumes can also fit into this category. A true fume is the gas-suspended particulate given off by a process, although the word is often used in a wider sense to incorporate exhaust emissions. From what we have said above, you can see that substances can be in different states/forms depending on conditions and how they are being used. All matter can be in any one of the states depending on circumstances. Temperature and pressure are two factors that can affect the state of a substance.

Temperature Take water: at low temperatures it is in a solid state, ice. As the temperature rises it melts and becomes water, a liquid. If we raise the temperature sufficiently, the water will start to vaporise and change into steam, a gaseous state.

Pressure Propane is a good example. At normal atmospheric pressure, propane is a gas. When it is compressed and stored under high pressure inside a cylinder, it becomes a liquid (LPG – liquefied petroleum gas). As soon as it is released into the atmosphere, it turns into a gas again. You should realise that whilst chemicals may not pose a significant hazard in one form or state, if that form or state is changed due to the operation that is being carried out or the surrounding conditions, then the risk posed may also change.

Classification of Chemical Hazards There are three general classifications of hazards, each of which contain a number of such categories:

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

Physico-chemical hazards that are caused by the intrinsic physical or chemical properties of the substance.



Toxicological hazards that arise from a chemical causing harmful effects to living organisms, which in practice normally means death, injury or adverse effects in humans when ingested, inhaled or absorbed through the skin. Toxic effects may be acute or chronic, local or systemic, and reversible or irreversible.



Environmental hazards that relate to the potential of a chemical to damage one or more environmental compartments (i.e. the air, soil or water, including groundwater).

The categories of danger within each classification are shown in the following table. Classification of Hazardous Substances Physico-Chemical Explosive Oxidising Extremely flammable Highly flammable Flammable

Toxicological

Environmental

Very toxic Toxic Harmful Corrosive Irritant Sensitising Carcinogenic Mutagenic Toxic for reproduction

Toxic or harmful to aquatic organisms Long-term effects such as persistence Toxic to the non-aquatic environment Dangerous for the ozone layer

The definitions of the categories of danger posed by chemicals within the general toxicology classification are set out below. •

Very toxic Very toxic substances and preparations are those that in very low quantities cause death or acute or chronic damage to health when inhaled, swallowed or absorbed via the skin.

•

Toxic Toxic substances and preparations are those that in low quantities cause death or acute or chronic damage to health when inhaled, swallowed or absorbed via the skin.

•

Harmful Harmful substances and preparations are any that may cause death or acute or chronic damage to health when inhaled, swallowed or absorbed through the skin.

•

Corrosive Corrosive substances and preparations are those that may on contact destroy living tissues. The following examples of corrosive substances may be encountered in the course of industrial processes: −

Acids – Sulphuric acid; hydrochloric acid; nitric acid; phosphoric acids.

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•

−

Alkalis – Sodium hydroxide (caustic soda); potassium hydroxide (caustic potash).

−

Gases and vapours – Chlorine, a greenish yellow gas with a choking, irritating smell, is very poisonous even if inhaled in a very small quantity. All corrosive chemicals can produce, under certain conditions, damaging corrosive vapours.

Irritant These are non-corrosive substances and preparations which through immediate, prolonged or repeated contact with the skin or mucous membrane may cause inflammation.

•

Sensitising These are substances and preparations that may cause an allergic reaction.

•

Carcinogenic Carcinogenic substances and preparations are those which if inhaled or ingested or absorbed by the skin may induce cancer or increase its incidence. For the purposes of classification, carcinogens can be divided into three categories, Cat 1 being substances which are known to be carcinogenic to humans, Cat 2 where there is sufficient evidence to provide a strong presumption of human carcinogenicity, and Cat 3 where there is concern for humans about carcinogenic effects but the available information is not adequate for making a satisfactory assessment.

•

Mutagenic Mutagens are substances and preparations that alter cell development and cause changes in future generations. As for carcinogens, there are also three categories of mutagens.

•

Toxic for reproduction These are substances which may affect male or female fertility or harm a foetus, such as teratogens which cause abnormal development of an embryo producing stillbirth or birth defects. Again there are three categories, depending on the evidence available.

Note that, in classifying a particular chemical, the hazards it presents may lie within any or all of the general classifications and more than one class of danger may be identified. Thus, nitric acid is classified as both oxidising and corrosive, and asbestos is classified as a carcinogen (category 1) and toxic.

Biological Hazards When considering biological hazards it is the considerable range of commonly encountered micro-organisms that first springs to mind. A micro-organism is a microbiological entity, cellular or non-cellular, capable of replication or transferring genetic material. There are thousands of species of micro-organisms but only a few of them are harmful to humans, and of these it is the ones that are capable of causing occupational ill-health that we are concerned with. The three main categories of microorganism that we are concerned with are fungi, bacteria and viruses.

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Bacteria Bacteria are single celled organisms that reproduce by simple cell division. They vary widely in shape (with the shape being used to classify and name types of bacteria) and include spheres (cocci), rods (bacilli) and spirals (spirochetes). Some bacilli (such as anthrax) form spores which enable them to survive adverse conditions such as heat, cold and lack of water.

Viruses Viruses are included as micro-organisms but are not strictly "alive". They are self-replicating molecules (genetic material contained in a protein shell) that invade host cells, take control of the cell material to produce more viruses, and release these viruses to enter other host cells. Hepatitis and AIDS are two diseases of occupational significance that are caused by viruses present in human body fluids.

Fungi The category of microfungi includes moulds and yeasts but excludes larger fungi such as mushrooms. Some microfungi produce toxins (mycotoxins) that are harmful to humans. Many fungi reproduce by forming spores that are released, dispersed and find a suitable environment to grow in. It is the inhalation of organic dust contaminates with fungi spores (mouldy cellulose-based material such as straw) that cause the biological pneumoconioses such as farmer's lung. Although you can draw some comparisons between health effects on the body of biological agents and of chemical agents, biological agents have the following special properties: 

They are living things and can therefore evolve and change rapidly, with new biological agents appearing regularly.



Their presence is not readily detectable.



Infectious diseases can be transmitted from person to person which poses a community risk.



Exposure to very low numbers of organisms may be sufficient to cause disease.



Initial low numbers of organisms may multiply rapidly under the right conditions to result in an infective dose.

Modes of Transmission of Disease Biological agents can gain entry to the human body via certain standard routes: •

Inhalation Bioaerosols consisting of suspensions of very small particles (bacteria, spores, organic dusts) generated when materials containing them are disturbed, can be inhaled into the respiratory tract. The usual defence mechanisms for airborne contaminants which depend on particle size apply (see later in this study unit) but both materials entrapped by the cilia, and smaller particles entering the alveoli, may initiate an infection or an allergy.

•

Ingestion Biological agents may enter the body through contaminated food and drink, or by hand contact with contaminated surfaces and then hand-to-mouth transfer. The gastric juices may be sufficient to destroy some agents but ingestion of contaminated material is a

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potential transmission route, particularly in laboratory environments where control measures prohibit consumption of food or drink. •

Skin Contact Micro-organisms are able to enter the body through cuts, scratches and abrasions. Skin is rarely completely intact and the minute size of bacteria and viruses allows entry to what might appear to be an impermeable skin barrier. A further route is that of "injection", where needle-stick injuries involving contaminated sharp implements such as needles or glassware and even bites and stings from infected insects or mites, can allow entry of biological agents through the skin.

•

Entry Through the Conjunctivae The membranes surrounding the eye are very thin and allow a route of entry to biological agents. Any contaminated fluids or aerosols which are able to contact the eye can be absorbed across the membrane.

•

Other Routes Certain circumstances may offer a combination of transmission routes, including direct contact with an infected person or animal, and contact with infected materials (blood, body fluids, tissues, organs) where the route of entry may be by any of those discussed above.

Psycho-Social Hazards Workplace psycho-social hazards are those non-physical features of the workplace that have the potential to cause harm to the worker, either physiologically or psychologically. They are concerned with the design, organisation and management of work. The effects of psychosocial hazards and health can be considered to be dependent upon the interplay between the individual and the environment. The way an individual responds or reacts to psycho-social pressures will depend on their genetics and personal experiences and therefore their ability to adopt effective coping strategies.

Working Hours It is still often the culture in many organisations to work long hours, both in the workplace and by taking work home. This can lead to work-related stress (and the associated symptoms) as can inflexible working patterns. Shift work and night work can also contribute to stress-related symptoms, when the individual finds it difficult to adjust to unusual daily/nightly routines.

Relationships For most workers, there is a significant interaction with other people in the workplace. Interactions are between colleagues, managers and subordinates and reflect components of both the formal and the informal organisation of the workplace. Poor relationships are considered to be those where there is little trust and support. Issues associated with interpersonal relationships are recognised as a significant source of occupational stress. This includes conflict between colleagues or with subordinates or superiors, or a general lack of social support which may be a result of physical, or even social, isolation. There can also be problems that arise from racial or sexual harassment, or workplace bullying. Leadership style, abrasive personalities and group pressures can all lead

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to conflict and possibly unacceptable behaviour. These issues can all create stress for the individuals involved and are often difficult to prevent or resolve. Feelings of isolation and a lack of social support in the work environment have been found to have a correlation with ill-health effects. Some research has shown that those who report low social support at work have elevated heart rates and rising systolic blood pressure levels during the working day. Some research suggests that good working relationships and therefore social support can be linked to the ability of the individual to control their work environment. Measures that can be used to try and combat these problems include: 

Training in interpersonal skills.



Effective systems to deal with interpersonal conflict, bullying and racial or sexual harassment including: −

Effective grievance procedures.

−

Proper investigation of complaints.

Stress In recent years, work-related stress has become recognised as a significant concern. Work-related stress can be defined as the adverse reaction people have to excessive pressures or other types of demand placed on them. To be set challenging targets at work can be motivating, but if demands are placed on workers which they feel they can not cope with, they will experience stress, which in turn affects morale and performance. Work-related stress is a complex subject, because it results from the interaction of organisational factors and factors which are personal to the individual employee. Work-related stress has adverse effects on the individual employee and the organisation. For the employee, the symptoms of stress may be physical or psychological, including headaches, dizziness, panic attacks, skin rashes, stomach problems, poor concentration, difficulty sleeping and increased alcohol consumption. If stress is intense or prolonged, it can lead to the onset of serious physical and mental health conditions, such as high blood pressure, heart disease, gastrointestinal disturbances, anxiety and depression.

Ergonomics Manual Handling People pick up and move objects all the time at work, and any of these actions may present a hazard. The risk is that the action will cause an injury of some kind to the person undertaking the operation or, by causing the object to fall or move, there is a risk that someone else may be injured. The extent to which there is risk associated with any form of manual handling will be the subject of a risk assessment. However, that risk does not just arise in relation to the lifting and movement of heavy loads. These do present a significant risk, but the way in which apparently light and easy objects are handled can also cause harm. There are actually four main causes of harm in manual handling operations, as follows: 

Failing to use a proper technique for lifting and/or moving the object(s) or load.



Moving loads which are too heavy.



Failing to grip the object(s) or load in a safe manner.

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

Failure to use equipment provided, in an appropriate manner, such as: −

Not using mechanical assistance when provided.

−

Not using PPE as instructed.

Note that the harm from any of these actions may be in the form of immediate injury or longer term, chronic mobility problems. Common types of injury include: 

Back injuries caused by twisting, lifting or pushing loads where the stress is borne on the spine, usually towards the base.



Muscular problems caused by stretching, lifting heavy loads or slips, trips and falls. In most cases they are acute injuries, but strains can build up over time. Some generalised lower back problems are the result of pelvic or sacro-iliac strains.



Cuts, abrasions and bruising caused by contact with the surfaces of the objects or loads being handled. The size and weight of the object is immaterial in respect of cuts and abrasions – paper is well known for producing painful cuts on the fingers.



Bone injuries such as fractures and cracks which are usually impact injuries caused by crushing part of the body, usually fingers, under a load or dropping objects on feet. They may also be caused by slips, trips and falls.

Display Screen Equipment The major risks to health in the design of workstations relate to: 

Physical stress – principally through poor posture and excessive demands on manual dexterity, but also in respect of exposure to excessive noise and vibration.



Visual problems – principally through excessive brightness or prolonged concentrated work on small objects, either on the display screen itself or in respect of components used in a work process, such as in the manufacture of electronic equipment.



Mental stress – principally through excessive demands of task performance and lack of control over working processes, but it may also be brought about by adverse organisational and physical environmental conditions.

These effects are generally all chronic effects, brought about by prolonged exposure to the activity or conditions. Specific ill-health problems include musculoskeletal disorders relating to the muscles, nerves, tendons, ligaments and joints, cartilage and spinal column; fatigue-related disorders and eye problems. Concerns relating specifically to the use of display screens relate to facial dermatitis, photosensitive epilepsy, radiation effects and effects on pregnant women, but in general, extensive research has failed to show that the complaints could be attributed to the use of such equipment.

Lifestyle Individual behaviours and lifestyle choices have real effects on people’s health and their ability to carry out normal day-to-day activities effectively. Some lifestyle choices will affect the individual’s ability in the workplace.

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Smoking There are clearly sound safety reasons why an employer may want to introduce a smoking policy in to the workplace, such as the risk of fire or of hazardous substance ingestion. However, the effects associated with smoking can impact employees’ health and, therefore, ability to work, placing a strain on the organisation's productivity. The serious health effects associated with smoking have been well documented. There are also many health effects that may have a debilitating effect on the smoker, as well as an increased risk of mortality. Some of the negative effects associated with smoking include an increased risk of developing: 

Cardiovascular disease.



Respiratory disease, such as emphysema.



Cancers of various organs including the lungs.



Cataracts.



Osteoporosis.

Other effects include elevated carbon monoxide levels (reducing the oxygen-carrying ability of the blood), poor circulation, delayed wound healing and a reduced immune response. Research has consistently shown smokers to have more ill-health absences from work, longer duration absences and to be more likely to retire earlier than non-smokers. Some of the effects may also impact the individual's fitness for work, such as breathing problems in activities that require physical exertion or poor circulation where exposure to the cold is part of the activity. Some research has suggested that smoking is a "susceptibility factor" increasing the risk for other harmful occupational exposures. Asbestos and smoking appears to be one such an example.

Drinking Alcohol abuse, drug abuse and smoking are recognised as being possible indicators that an individual may be experiencing stress. Alcohol is absorbed into the blood stream and carried to varying parts of the body including the brain. The blood alcohol concentration will depend upon a number of factors: 

The quantity consumed and the period of time over which it is consumed.



Whether the individual has eaten.



Size and weight of the individual.

Alcohol reduces the ability to co-ordinate and react quickly, and affects thinking, judgment and moods. Regular long-term drinking can lead to psychological problems including depression. Drinking alcohol raises the drinker’s blood pressure which can increase the risk of coronary heart disease, and the liver can also be affected with a risk of cirrhosis of the liver. Alcohol can lead to negative physical and psychological effects as well as increasing work absence and affecting productivity and safety. There are a number of reasons why people drink excessively but working conditions, such as stress, excessive work pressures and unsocial hours may be factors. Whilst it is difficult to control an individual's lifestyle habits, a programme of health education and promotion can assist in helping individuals make the right lifestyle choices.

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Lack of Exercise Regular physical activity has been found to have a number of psychological and physiological benefits, such as: 

Feeling more energetic.



Relieving stress.



Reducing feelings of anxiety and depression.



Helping relaxation.



Lowering high blood pressure and preventing the onset of high blood pressure.



Assisting in reducing weight.



Reducing the risk of cardiovascular and respiratory problems.



Increasing overall levels of fitness.

It follows that regular exercise has a positive effect on an individual’s health and, therefore, absenteeism and their ability to carry out work activities. In addition, research suggests that mental functions such as planning, decision-making and memory are improved. Exercise also helps to improve balance, co-ordination, mobility and grip and leg strength. These are all skills and abilities that may be advantageous, if not critical, in many work activities. The provision of exercise facilities in the workplace, and education and promotion in relation to the benefits of exercise, may well represent a cost effective preventative occupational health strategy of benefit to both the employee and the employer.

Dangerous Sports Many individuals participate in dangerous sports in their free time and while the employer cannot control this, it is beneficial to be aware of employee behaviour. Awareness of activities outside the workplace will assist the employer in identifying possible exacerbation of workplace injuries or enable them to identify where injuries sustained outside the workplace are likely to lead to vulnerabilities within the workplace. The employer can also have an educational role. For example, many employees will go skiing each year, a number of whom will sustain injuries resulting in lost time from work. Programmes of education and promotion on the need for fitness and stamina will reduce the likelihood of such injuries occurring. An additional area that may be of concern to the employer is that those employees who take part in dangerous sports may have a perception of risk that leads them to take unacceptable risks in the workplace. Whilst this will not always be the case, the participation in dangerous sports may indicate a need for employee behaviour, particularly in the face of danger, to be considered where safety-critical work activities are concerned. Finally, in recent years there has been a growth of dangerous sports and activities for corporate functions and team-building events, which are likely to be considered work activities. Wherever this is the case employers should risk assess activities, taking into account individual abilities and skills and the need to ensure that no pressure is brought to bear on individuals not wishing to take part.

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The Effects on the Body of the Main Health Hazards Here we will be looking in detail at the effects that harmful workplace agents can have on the body, in particular the effects of hazardous substances. We will review the main human anatomical systems likely to be affected by workplace agents. In order to understand the effects of hazardous substances on the body, we have to be familiar with the main physiological systems which are essential in maintaining health. These systems are vulnerable to the effects of hazardous substances and are also affected by physical, biological and ergonomic agents. We will outline the basic anatomy of the body in terms of critical physiological systems and investigate how hazardous substances gain entry into the body. Whilst it is not imperative that you remember every detail of the following systems, you should have a good understanding of how they work and the function each system performs.

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Human Physiology Respiratory System The respiratory system is an airway which has two main parts: the air passages (the upper respiratory tract) and the lungs (see later figure). Air breathed in through the mouth passes over the larynx (voicebox) and down the trachea which divides into two bronchi (singular: bronchus). Each bronchus branches into bronchioles, which are repeatedly branched into terminal bronchioles, which lead to an infundibulum (literally: a funnel) of alveoli, very much like a bunch of grapes from which the flesh has been removed. The alveoli (or air sacs) form the delicate lining of the lungs (one cell thick) across which gas exchange between the blood and the air takes place. The entrance to the larynx is protected by a muscular flap, the epiglottis, which closes during swallowing. Loss of control of the epiglottis allows "aspiration" (going down the wrong way) to occur. The basic structure of the airway is shown in the following figure.

(a)

The Nose, the Mouth and the Pharynx

Eustachian tube to middle ear

Air Gullet

Epiglottis (b)

Trachea

Epiglottis

The Trachea and Bronchi. Bronchioles to the Right Lung Trachea

Three lobes of right lung. The left lung has two lobes

Right bronchus

Left bronchus

Major bronchioles

(c)

Infundibulum at the End of a Bronchiole

Alveoli

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Digestive System The gastrointestinal tract extends through the body from the mouth to the anus. Its function is the control of ingested foodstuffs, which is dealt with in four main stages: 

Ingestion, via mastication and swallowing.



Digestion which involves the treatment of foodstuff for absorption into the body.



Absorption of treated foodstuffs.



Excretion of food residues and desorbed waste products.

The oesophagus is a muscular tube about 25 cm long reaching from the pharynx to the stomach. The small intestine is a muscular tube, which extends from the stomach to the large intestine. The first part of the small intestine is the duodenum. The large intestine forms the final section of the gastrointestinal tract from the small intestine to the anus. The large intestine takes no part in digestion or absorption of nutrients. Its main function is to reabsorb water from the final mixture passed from the small intestine, until the consistency is satisfactory for normal excretion. The lining membrane which covers the abdominal and pelvic cavity is a double-skinned structure called the peritoneum. Peritonitis is an inflammation of this membrane. The passage of hazardous substances into the digestive system is usually caused by poor hygiene. The following figure is a labelled schematic plan of the human digestive system.

NASAL CAVITY

TONGUE MOUTH PHARYNX EPIGLOTTIS OESOPHAGUS

TRACHEA

LIVER

STOMACH PYLORIC SPHINCTER

GALL BLADDER

BILE DUCT

PANCREAS

SMALL INTESTINE: DUODENUM ILEUM LARGE INTESTINE:

LARGE INTESTINE:

COLON CAECUM

COLON

APPENDIX

RECTUM

Schematic Outline of the Digestive System

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Circulatory System The healthy existence of every cell, tissue and organ of the body relies heavily upon a plentiful supply of oxygen and the removal of waste products. The blood, the circulatory system and the lymphatic system together provide the main body parts necessary to satisfy these requirements. Many occupational diseases, ill-health and reduced working efficiency can be attributed to reduction in the efficiency of the system by hazardous working environments.

The Blood Blood is a viscous fluid which circulates throughout most of the body structure in a network of flexible tubes known as blood vessels. There are about six litres of blood in the average adult body. Blood consists of a clear yellow fluid (plasma) in which are suspended red blood cells for oxygen transport, white blood cells for combating disease, and platelets which aid clotting. Blood is made up of approximately two thirds plasma and one third cells. The ratio of the cells in blood is 500 red cells: 1 white cell: 30 platelets. Haemoglobin is a complex chemical compound which gives the blood its red colour. The HAEM provides the 'active' part of the molecule. It is a red pigment, formed by a complex molecule of iron. The GLOBIN is formed from protein molecules. The two molecular systems are joined in such a way that they make a composite functional biochemical structure.

Transport of Oxygen Oxygen molecules (O2) from the air are inhaled into the lungs and pass through the very thin alveoli epithelium (lining) and capillary blood vessels into the blood.

Nervous System The nervous system is divided into two main parts: the central and the peripheral. The central nervous system comprises the brain and the spinal cord. The peripheral part consists of the motor (controlling movement) and sensory (controlling sensation) nerves. The basic unit of the nervous system is the neurone. Nerve impulses generated at one end of the neurone travel along the nerve fibre to release neurotransmitters at the other end. The central nervous system can be affected by organic solvents or heavy metals to produce disordered brain function ranging from mild disorder to profound coma. The peripheral nervous system is affected by neurotoxins, such as organophosphate pesticides, mercury compounds or lead and its compounds, causing sensory disturbances, motor dysfunction or both.

Skin The skin is an organ of the body, in the sense that it performs a function as well as being connective tissue. The skin forms the outer covering of the body and is continuous with the membrane lining which covers the cavities within the body structure and which have their openings at the body's outer surface. The skin is a distinctly layered structure. The epidermis forms the outermost layer of skin and is composed of: 

The horny zone, which forms the outermost layers of the epidermis.



The germinal (or living) zone, which forms the deeper level in the epidermis and consists of living cells which can reproduce and move to the horny zone.

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The dermis, or the true living skin, forms the inner part of the skin structure and consists of mainly fibrous and elastic connective tissue. The surface of the dermis (under the germinal zone of the epidermis) has groups of capillary blood vessels set out at various intervals. The flow of blood through these areas is important in the control of heat transfer mechanisms. Many sensory nerve endings are located in the dermis. The skin is a partially permeable membrane covering the external surface of the body and provides an excellent protective barrier. However, some substances may pass through the intact skin and into the underlying subcutaneous tissues, where they are absorbed into the blood capillary vessels and thence into the circulatory system, e.g. benzene. Protection of the skin is vital if it is not to be affected by damaging substances.

The Eye The eyeball (see following figure) is spherical in shape and contains a transparent medium (vitreous humour) through which light is focused by a lens on to a sensitive layer (the retina). The front of the eyeball (the cornea) is also transparent. Light rays entering the eye pass through the cornea and the aqueous humour to be focused by the lens. The light then continues through the vitreous humour and strikes the retina, where electrical impulses are generated and transmitted via the optic nerve to the brain. If the path of the light ray is interrupted by opacity (cataract) of the lens, vision may be distorted or diminished. Electromagnetic waves in the form of infra-red or laser radiation can cause damage to the lens or the retina. The eye is a very sensitive organ that can be irritated or damaged by many common workplace substances.

The Eyeball

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The Ear This organ can be divided into three main structures: the outer, middle and inner ear (see figure). Sound waves are collected by the outer ear and pass through the auditory canal to the ear drum. Changes in sound pressure cause the ear drum to vibrate in proportion to the sound intensity and frequency. The vibrations are transmitted through the middle ear by three linked bones and eventually reach the cochlea, a snail-shaped organ in the inner ear. The cochlea is a spiral tube which contains hairs that vibrate in response to the stimulus received from the middle ear. Here electrical impulses are produced which travel along the auditory nerve to the brain, where they are perceived as sound. Noise-induced hearing loss occurs when the hairs are damaged and no longer respond to stimuli. The hair cells do not regenerate, so hearing loss is irreversible. OUTER EAR

MIDDLE EAR

INNER EAR

UTRICULUS

PINNA

PASSAGE OF SOUND VIBRATIONS

Key:

1 Auditory canal 2 Auditory nerve 3 Cochlea 4 Ear drum The Ear

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Effects of Occupational Health Hazards on the Body In considering the way in which harmful agents attack the human body, it is necessary to make an important distinction. Entry can only occur by penetrating the outer cover of the body (the epidermis or epithelium); this is called the process of entry. However, before it occurs, the agent must reach the area of penetration, which is termed the route of entry. In the text which follows we will be clarifying these distinctions and explaining how each mode occurs in practice.

Process of Entry There are two main ways in which entry may occur: 

By absorption across the body's "cover", either the outer skin (epidermis) or the lining (epithelium) of the inner tract.



By direct entry into the body's structure where the "cover" is broken, i.e. via a break in the skin (e.g. when the skin is chapped and breaks up on movement, or when a pimple has been picked). Entry by this method is sometimes called injection. Be careful not to confuse the term with medical injection, where the input of the substance is deliberate, with the use of a hypodermic syringe.

Absorption of Toxic Agents Toxic agents enter the body by absorption across the body's "cover". Before considering the process in more detail, it is necessary to define what is meant by the "body's cover" and what we understand by "into the body". The outer skin is connected to the lining of the respiratory system and the gastrointestinal tract. In this way, the epidermis and the epithelium form a continuous system which covers all surfaces of the body. The epithelium covers the respiratory system and the gastrointestinal tract in the same way as the skin covers and protects the outer surface of the body; and the epithelium protects the inside of the body from the external environment. The space within the respiratory system and the gastrointestinal tract is therefore external to the body, even though it is surrounded by body structure. The mere presence of a toxic agent within this space does not in our context, constitute entry into the body - it has to pass across the epithelium for this to occur. Having defined the body's protective cover, it is easy to define "into the body" as: entry into the parts of the body which lie within that cover and contain the organs and parts essential for the complex structure of the body to function. It is the adverse action of toxic agents which have been absorbed across the cover into this complex structure which causes toxic responses.

Areas Where Absorption Occurs For our purpose, in this context of occupational health, we shall consider three areas where toxins may be absorbed, i.e. through: 

The outer skin surface.

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

The tissue covering the surfaces of the respiratory tract.



The tissue covering the surfaces of the gastrointestinal tract which extends from the mouth to the furthest extremities of the intestines.

LUNGS

EPIDERMIS

Route of entry Inhalation

Route of entry Skin Contact

GASTRO-INTESTINAL TRACT Route of entry Ingestion

Schematic Diagram of the Body The mechanisms of absorption are complex. As a general concept, we can consider the process as one of diffusion, where the molecules of a toxic agent move through the structure of the epidermis and epithelium. The diffusion process requires the presence of water (or aqueous solution). Sometimes, physical reactions are necessary, i.e. the toxin has to be loosely combined with a substance in the epidermis or epithelium, in order to make the journey across. Occasionally, chemical reaction occurs in the skin which allows for easier entry by the toxin. Once absorption has occurred, the toxin is readily dissolved in the blood, which provides a very efficient transport system around the body for the toxin to be carried to critical organs or to an area where toxic action can occur. The areas of absorption have developed specialised absorption characteristics. The epithelium of the lungs is structured for easy absorption of substances in a gaseous state, but it can accept solutions of solid particles that have dissolved in lung fluid. The gastrointestinal tract has developed mainly for absorption of substances from aqueous solution. The epidermis is not developed to absorb, but it is susceptible to the

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passage of some organic liquids; solids and gases do not, in general, pass through the epidermis.

Routes of Entry The principal routes of entry into the body are inhalation, skin contact, and ingestion.

Inhalation The lung is the most vulnerable part of the body, as it can readily absorb gases, soluble dust and fumes. Nearly every molecule which comes in contact with the lining layer passes through without much difficulty. You should note that only material in the correct physical state is able to arrive at the absorbing area. Added to the physical ability of the lining to absorb substances is the regularity of the breathing cycle. Even small concentrations of a toxic agent in the atmosphere being inhaled can, after a period, develop a build-up of toxicant in the body. This is another problem to be considered in connection with chronic toxicity. The lung also provides the largest area of epithelium for the absorption process to occur. When you are considering the risk of a material in terms of inhalation, the questions to be asked are: 

Is it a gas?



Is it a liquid that will easily give off vapours?

If it is a solid: 

Can respirable dust be generated, or vapours?

If the answers are "yes", then you will be dealing with conditions which provide the greatest risk of entry of toxicants into the body.

Skin Contact The skin is the next most vulnerable area, as it can be in contact with toxic substances which may be solid, liquid or gaseous, and in very high concentrations (i.e. in terms of quantity of substance to skin area). Fortunately, the epidermis has many layers of protection and does not allow solid or gaseous substances to be absorbed (in general), so only liquids provide a hazard. If contact between the epidermis and a toxic substance does occur, a considerable amount of contaminant can usually be removed before excessive absorption has taken place. Wearing normal clothing effectively reduces the area available for exposure to a toxic agent. However, the skin of the hands, arms and legs usually has some breaks in its surface and thus entry into the body "by injection" is always a possibility.

Ingestion In terms of occupational hazards from toxins, the gastrointestinal tract is the least vulnerable area of the body. The possibility of solid or liquid toxicants being ingested is very limited. Even if accidental ingestion does occur, the substance must be soluble in the fluids secreted by the tract to enable absorption to take place.

Aspiration is a term used to describe another route of entry which concerns the direct entry of solid or liquid into the lungs. There are two ways by which it can happen. Firstly, when substances that have been ingested are expelled in vomit and run down into the respiratory tract. Secondly, when substances are sucked directly into the lungs. A typical situation is

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when a liquid is being sucked into a pipette and the tip comes out of the liquid. The suction back-pressure is released and causes a rush of liquid past the open epiglottis. Aspiration can have serious consequences. Toxic substances could exhibit an increase in their relative hazard potential. For example, if a hydrocarbon solvent has been ingested, it is not likely to be lethal; but if aspiration occurs during vomiting, entry into the respiratory system could produce a lethal situation. Another possible route of entry into the body is via the mucous membranes of the eye. Substances in the form of dust, mist, spray, fume or vapour may dissolve in the moist covering of the eyelids and undergo absorption into the bloodstream.

Local and Systemic Effects Once in contact with the body a toxic material may have varying effects. Local effects are confined to the specific area of the body where contact with the toxic material occurs, such as the skin, eye, respiratory tract, etc. For example, a sensitiser may cause a specific allergic reaction on contact with the skin or respiratory tract. An irritant may cause local irritation to the eye or the skin after contact at those sites. Systemic effects occur at organs or parts of the body distant from the site where initial contact with the toxic substance was made. The most common target organs include the lungs, liver, nervous system, bone marrow, kidneys and skin. Thus, lead inhaled into the lungs as a fume will affect the central nervous system and blood-forming organs, and be incorporated into the bone. Carbon monoxide inhaled into the lungs will combine with the haemoglobin of the blood to inhibit oxygen transfer throughout the circulatory system.

Acute and Chronic Effects Acute health effects arise where the quantity of a toxic or harmful substance absorbed into the body produces harmful effects very quickly – i.e. within seconds, minutes or hours. In an occupational setting, acute toxicity does not often occur because the conditions required to produce it are either too complicated, or the results would be so serious that stringent safety measures are observed, thus preventing its occurrence. Gassing accidents producing toxic conditions are an exception. The term chronic toxicity describes a condition where the harmful effects of a substance absorbed into the body take a very long time to appear – months or perhaps years. The conditions produced by the toxin usually result from absorption of small quantities over a period of time. In terms of occupational safety, chronic toxicity, or at least its prevention, presents the most difficult control problems. This is particularly true if materials have little-known or poorly-documented toxicity levels, or if hygiene control strategies are breaking down. The following points illustrate how insidious are the effects of chronic toxicity and gives an indication of the difficulties of achieving effective control: 

The effects occur over a long period, so the hazard is not recognised.



The level of contamination required to produce chronic effects is often tolerated by people because they do not experience acute symptoms.

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

Symptoms occur slowly, so they are not recognised until an advanced condition of harm has developed.



When symptoms are recognised, the harm may be too advanced for full recovery – sometimes no recovery is possible.



Symptoms are often confused with “normal” ill-health or with “getting older”.



Symptoms are not always easily identifiable in groups of people with the same exposure, owing to the effect of differing “personal” metabolisms.

It is important to note that for both acute and chronic toxicity, time is involved in relation to their definition, but that the level of toxic action is not defined. Acute toxic action does not necessarily mean death. Intoxication from drinking alcohol is an acute toxic condition, but only in rare cases is it the direct cause of death. Cirrhosis of the liver related to intoxication by alcohol is a chronic toxicity condition from which death can occur. Some toxic substances, such as cyanide and paraquat, are generally considered to be acute toxins only.

Note: Students should be aware that for examination purposes, the terms “Sources”, “Pathways” and “Receptors” have been occasionally used in the place of “Sources”, “Routes of Entry” and “Target organs”.

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Target Organs The Blood We now move on to those body systems which are most affected by the absorption of toxic substances. Blood is a viscous fluid which circulates throughout most of the body structure. Blood is both a functional organ and a connective tissue, as it contains specific cells. Blood cells are suspended in a fluid plasma, which together make up the composite fluid which is called blood. Being a fluid, blood is able to take the shape of the vessels or organs in which it is contained. The lack of a specific shape enables blood to enter into any body situation where it is required to function. 

In a healthy adult, the total blood volume is about 8% to 12% of the body weight, with a volume of between 4 and 8 litres.



The basic composition of the blood is: plasma 55%, blood cells 45%.



The specific gravity of blood is about 1.055, i.e. a little heavier than water.



The blood plasma is slightly alkaline, about pH 7.4, a level which is critically maintained to ensure maximum operating efficiency.

Blood consists by weight of: 

Water

91.0%



Protein

8.0%



Salts

0.9%

The salts are mainly sodium chloride, sodium hydrogen carbonate and salts of calcium, as well as salts of phosphorus, magnesium and iron. There are traces of organic matter, such as glucose, amino acids, fats, urea, uric acid and cholesterol. The blood also carries oxygen and carbon dioxide; internal secretions such as hormones, enzymes and antigens (antibodies); and blood cells. Blood cells transported in the blood include: 

Erythrocytes (red cells).



Leucocytes (white cells).



Thrombocytes (platelets).

The ratio of the cells in blood is 500 red cells: 1 white cell: 30 platelets.

Erythrocytes These are biconcave cells (shaped like a doughnut) measuring about 7 µm in diameter and about 2 µm thick, and they do not contain a nucleus. They are made in the red bone marrow, found in the cancellous tissue of long bones, in the bones of the skull, the vertebrae, the ribs and the sternum. The erythrocytes contain haemoglobin which provides a chemical system which enables oxygen to be transported throughout the body. When oxygen obtained from the lungs is attached to the haemoglobin, it is termed oxyhaemoglobin.

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The red cells are the most numerous of the blood cells: 1 mm3 of blood contains about 5 million erythrocytes. •

Haemoglobin You will remember that haemoglobin is a complex chemical compound which gives the erythrocyte (and the blood) its red colour. The HAEM provides the "active" (or prosthetic) part of the molecule. It is a red pigment, formed by a complex molecule of iron. The GLOBIN is formed from protein molecules. The two molecular systems are joined in such a way that they make a composite functional biochemical structure.

As erythrocytes do not have a nucleus, like other cells do, they are not considered as "living" systems, i.e. they do not divide and reproduce. Red blood cells have a limited "life" of about 120 days, so the body has to mass-produce them to keep the required operational numbers. The replacement rate in a healthy body is about 1½ million per second. Fortunately, much of the raw materials are not lost from the body, so, provided the essentials are kept topped up from the diet, problems do not occur.

Leucocytes These cells, as the name implies, are white in colour. There are about 8,000 white cells per mm3 of blood. On average, they are larger than red cells, ranging from 8 µm to 20 µm in diameter. The cells contain a nucleus, so they can be considered as "living" cells. There are two main types of leucocyte which together form the main defensive system in combating disease and the effects of toxic actions: •

Granulocytes These cells constitute about 75% of the white cells. They are produced in the bone marrow and the spleen. Their defensive role involves moving in and out of the blood vessels and wandering freely through the tissues, where they ingest (or "eat") harmful micro-organisms or debris, by a process called phagocytosis (phago means "to eat"). Granulocytes concentrate at the site of infection or injury to attack foreign matter. They ingest to an extent that causes them to die and, in doing so, they form "pus" discharge. The increased microbiological action causes the site to become hot, resulting in inflammation.

•

Lymphocytes Lymphocytes make up about 25% of the leucocytes. They are derived from the lymph glands, spleen, liver and bone marrow. They are in general not able to ingest foreign matter like the granulocytes, but they protect the body by forming antibodies. An antibody is a particular protein molecule produced to neutralise the effect of a foreign protein molecule or antigen. The production of antibodies in response to an antigen is called an immune response. As the process takes time to establish, antigens may overwhelm the body and cause severe illness or death. Immunisation is the process of giving the body a store of antibodies ready to fight off infections before they become dominant in the body. An over-response by the body to antigens is commonly called an allergic, or sensitisation, reaction.

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Thrombocytes (Platelets) Thrombocytes are formed in the bone marrow. Their main function is in the clotting of blood. They are very small cells about 2 to 3 µm in diameter. One mm3 contains about ¼ million cells. The clotting of blood is a complex process depending upon many variable factors. In essence the reaction involves precipitation of a material called fibrogen from the plasma to give fibrin, a fibrous material which entangles blood cells to form a clot. Fibrin can become involved with the structural repair of tissue and form part of the resulting scar. Formation of scar tissue can be termed fibrosis.

Oxygen Transportation The oxygen transport process in the blood is associated mainly with haemoglobin in the erythrocytes. Oxygen molecules (O2) from the air are inhaled into the lungs and diffuse through the very thin alveoli epithelium and capillary blood vessels into the blood plasma. They then diffuse across the thin cell membrane of the erythrocyte cells to combine with haemoglobin and produce oxyhaemoglobin. The reaction with molecular oxygen takes place with the iron atom in the haem group. The iron atom is in its ferrous or iron (II) state. The addition of the oxygen molecule does not constitute an oxidation reaction. The oxygen molecule becomes loosely attached to the iron atom by a special type of bond. The ease with which the oxygen molecules become attached to the iron atoms in the haem, and the ease with which they become detached in other tissue, relies upon the "weakness" of this bond structure. As each haemoglobin molecule contains four haem groups, the reaction involving the attachment of oxygen molecules can be represented by a general equation: Hb + 4O2 = Hb(O2)4 haemoglobin

oxyhaemoglobin

The electron arrangement around the iron atom in the haem molecule allows for six covalent bonds to be formed, but only five are fully used. Four of the bonds are used in the red pigment, one is used to join the haem to the globin protein structure and the one remaining position is used to form the special bond to the oxygen atom. The square section with four nitrogen atoms (one at each corner) is a simplified representation of the haem structure and the four bonds form the iron atom. The bonds lie in a flat plane at right angles to the globin and oxygen molecule bonds. The two important points to note are: 

The iron atom in the haem group is in the ferrous iron (II) state.



The bond available for the oxygen molecules is not a normal covalent bond.

Both these factors are important in the mechanism of common occupational intoxications.

Carbon Dioxide The transport of carbon dioxide in the blood is more complex than oxygen transport. Carbon dioxide diffuses from tissues into the erythrocyte cells. Only a small percentage actually joins with the haemoglobin molecules. The remaining carbon dioxide is converted into hydrogen carbonate ions ( HCO3− ) and transported back to the lungs in this form. In the lung structure, reoxygenation of the haemoglobin (which has travelled back to the lungs in a special acid form) takes place and dissociation of the HCO3− occurs. Carbon dioxide is released and after diffusion in the lungs can be exhaled.

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A very small percentage of carbon dioxide (less than 5%) is transported directly by the blood plasma as HCO3− ions.

The Circulatory System In the human body the three essential parts of the distribution system are provided by the heart (the pump) the blood vessels and valves within the heart (the valves for regulating the fluid flow), and blood vessels (the pipes). As the transport of blood is in a closed system, it is termed a circulatory system.

The Heart The heart lies in the thorax, centrally between the lungs and behind the base of the sternum, but with the apex pointing to the left, i.e. the longitudinal axis of the heart is not vertical. Your heart is about the size of your own clenched fist and weighs from 240 to 270 grams. The heart is divided by a septum into right and left sides, which in effect makes it two "pumps". Each side is divided into an upper and lower chamber: the atrium, which receives blood, and the ventricle, which distributes blood.

Blood Vessels In both the systemic and pulmonary circulations of the blood, blood vessels leaving the heart are called arteries. They branch into named arteries to the organs, e.g. the right and left pulmonary arteries from the main pulmonary artery. Arteries branch into arterioles; and arterioles branch into blood capillaries, which supply substances to, and collect other material from, the cells. Blood from capillaries flows into venules and then into veins. Venous blood collects in the superior and inferior vena cava and enters the right atrium of the heart. The blood takes 15 to 26 seconds to travel around the systemic and pulmonary circulations together.

The Liver The liver is the largest organ in the body, weighing 1.5 to 1.8 kg (50 to 60 ounces). It is a solid mass of cells situated immediately beneath the diaphragm, the bulk of it lying in the right side of the abdominal cavity. The liver plays an essential role in the metabolising of hazardous substances which have been ingested, inhaled or injected.

The Kidneys The human body has two kidneys, each lying embedded in fat just below the diaphragm, behind the abdominal cavity, one on either side of and between the last dorsal and third lumbar vertebrae. The kidney on the right side of the body is lower than that on the left, because of the room taken up by the liver. The prime function of the kidneys is to help regulate the purity and composition of the blood. Involved in this process are the following operations: −

Excretion of water.

−

Excretion of salts.

−

Excretion of nitrogenous breakdown products from protein metabolism.

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−

Excretion of toxic materials or their by-products which have been taken or are absorbed from a harmful occupational environment.

−

Assisting in the control of blood pH.

The Reproductive System In relation to occupational health, the main controls related to the system are concerned with mutagenic problems resulting from the effects of ionising radiation. Controls related to the reproductive process are generally concerned with potential harm which may be suffered by female persons. This has tended to lessen awareness that male persons are also at risk. When more knowledge about the potential harm from chemicals becomes available, it seems likely the evidence will show that mutagenic effects can result from damage suffered by male persons. 

The male gonads are called the testes. The testes are contained within the scrotum. Long convoluted tubes lead from the testicle on each side and these join with the urethra at the level of the prostate gland. This gland produces seminal fluid which bathes the individual sperms during intercourse. The penis consists of the urethra surrounded by erectile tissue. The hormones which cause the testes to produce sperm are also responsible for various sex characteristics of the male, i.e. facial hair, voice.



The female gonads are called the ovaries. Under the cyclical influence of certain hormones, the ovaries produce ova (eggs). The ova pass along narrow tubes (the fallopian tubes) to the uterus. It is in this tube that fertilisation usually takes place - the joining of the sperm with an ovum and the eventual production of a new life.

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Defence Mechanisms Inhalation and Respiratory Defences Respiration not only facilitates the transport of oxygen into and carbon dioxide out of the lungs, but it also allows the ingress of harmful agents such as chemicals, physically damaging dusts and fibres, air of excessive temperature or dryness, and biological agents such as bacteria or viruses. Some of the defence processes are readily identified: 

Coughing results in the forceful ejection of inhaled substances.



Goblet cells in the conducting airways secrete mucus which, forming sputum, is expectorated or swallowed; and the nose itself filters out the largest particles.



Inhalable dust is the total amount inhaled into the respiratory system through the nose.



Respirable dust is the fraction that penetrates through to the gas exchange region of the lung.

Before we attempt to study the respiratory defence mechanisms in detail, we need to return for a moment to the respiratory tract (see the figure that follows).

Lung

Diaphragm

Human Respiratory System

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Those parts of the respiratory pathway down to and including the terminal bronchioles are the conducting airways; those beyond constitute the respiratory units, where gas exchange occurs. 

Initial filtration of particles larger than 10 µm takes place in the hairs in the nasal cavity.



Smaller particles and aerosols between 7 and 10 µm are trapped in the mucus secreted by goblet cells lining the conducting airways and then transported upwards by the ciliary escalator to the pharynx where they can be either swallowed or expectorated.

Tall cells forming the mucus lining Dusts and aerosols trapped in mucus

(Goblet cell secretes mucus)

and wafted up by the cilia

Mucus Effect on Small Particles 

Smaller particles and aerosols between 0.5 and 7 µm pass into the respiratory units where deposition takes place in the respiratory bronchioles and alveoli. Here they may be ingested as foreign bodies by macrophages, large cells normally found in tissues which produce blood cells. Macrophages may migrate back along the respiratory pathways to the ciliary escalator, ultimately to be swallowed or expectorated.

We can summarise the deposition of aerosols and particles in the respiratory system as follows: Particle Size

Deposition Site

Above 10 µm

Nasal cavity

7-10 µm

Ciliary escalator

0.5-7 µm

Respiratory bronchioles and alveoli

Below 0.5 µm

Most remain airborne and are exhaled. Some diffuse and come into contact with the airway or alveolar membrane

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Once in the bloodstream, the toxic substance may act upon the blood itself or be carried around until it affects another organ, such as the liver, kidneys or bladder. Materials swallowed may be excreted unchanged in the faeces. Others may be acted upon by enzymes, acids, and other processes in the gut, or be absorbed and pass via the portal vein to the liver. Here they may be further acted upon and metabolised or conjugated into a variety of soluble by-products to be excreted in the urine. Some toxic materials, such as lead, are initially stored in the bones of the skeleton so the toxic effects can be minimised by slowly allowing it to leach back into the bloodstream. Substances that pass through the alveolar membrane enter directly into the pulmonary capillaries or find their way into the tissue spaces of the lungs from which they are drained by the lymphatic system. Substances reaching the interstitial spaces are sometimes stored harmlessly prior to draining into the lymphatic system (e.g. tin and iron compounds), or may result in damage or set up disease processes (e.g. fibrosis or pneumoconiosis). Because the lymph glands act as filters for substances or micro-predators (such as phagocytes) which are being carried away by the lymphatic system, they are often involved in lung disease. Many cancers of the lung, for example, start in the lung's lymph glands. The following table shows nine examples of input substances, their sites of contact in the respiratory pathways, together with their principal effects. Input Substances and Their Effects Input Substance

Site of Contact

Effect

Soluble irritant gases (e.g. NH3)

Upper conducting airways

Inflammation

Low solubility irritant gases (NO2)

Lower conducting airways and respiratory units

Inflammation

Sensitising metals (Cd)

Conducting airways (depending on particle size)

Immuno-pathological reaction

Di-isocyanates (TDI)

Conducting airways

Immuno-pathological reaction (e.g. asthma)

Cotton dust

Conducting airways

Immuno-pathological reaction (e.g. byssinosis)

Silica

Conducting airways and respiratory units

Collagenous pneumoconiosis (silicosis)

Asbestos

Lower conducting airways and respiratory units

Collagenous pneumoconiosis (asbestosis)

Radio-isotopes

Conducting airways and respiratory units

Neoplasia (cancers)

Hardwood dusts

Upper conducting airways and sinuses

Neoplasia (cancers)

Cigarette smoke

Conducting airways and respiratory units

Metaplasia of bronchial lining (lung cancer)

Fibrogenic dusts:

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Defensive Cells Defensive cells are very important in protecting the body against harmful inputs of all kinds. Those associated with work and occupational illnesses make up only a small proportion of such damaging inputs with which the body has to contend. Two examples will serve to illustrate the types of defence cell which are important in occupational health and hygiene: 

Phagocytes, which play a central role in the prevention of lung diseases.



Blood-borne defensive cells, which give rise to the immune response and the inflammatory response.

Phagocytosis Phagocytosis is illustrated in the following figure:

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Phagocyte Cytoplasm -Foreign body Cell nucleus

Stage 1: Chemotaxis - proximity of foreign body stimulates movement of phagocyte towards intruder.

Lysosome

Stage 2: Adhesion of foreign body to phagocyte. It is thought the immune response (qv) is the basis for adhesion.

Stage 3: Ingestion of foreign body into the phagocytic cell, and Stage 4: inclusion of the foreign body attracts a lysosome which discharges enzymes into the phagosome, i.e. the mixture of enzymes and the foreign body.

Stage 5: Nitric oxide synthesising enzymes chemically digest the foreign body which may

Phagosome

remain in the phagocyte's cytoplasm; or the phagosome may be deposited in the surrounding tissue or fluids and thence into the lymphatic system. Alternatively, the foreign body may remain as an indigestible inclusion while the phagocyte migrates to other tissue.

Phagocytosis

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Harmful particles, micropredators and other foreign bodies engulfed by phagocytes may in this way be rendered harmless. Sometimes phagocytes may be killed by toxic action. This results in the formation of pus, which is then discharged leaving a void subsequently made good by the formation of scar tissue. In the lungs it causes fibrosis, whereby the tissues lose their elasticity and breathing becomes progressively laboured.

Inflammatory Response Inflammation is the reaction of tissue to a harmful agent which is insufficient to kill the tissue. It can follow when a foreign body enters the body by way of inhalation, ingestion, absorption, pervasion, implantation, surface penetration, trauma, or energy transformation. Although inflammation is a defensive process of great importance, if called upon to act for too long it can sometimes result in disease. •

Acute Inflammation Acute inflammation is the immediate defensive reaction of tissue to any injury and is typified by the following sequence of events:

•

−

Initially the capillary vessels in the area of tissue affected briefly constrict.

−

Then the same blood vessels dilate and the capillary walls become more permeable.

−

Protein-rich fluid (plasma) exudes from the capillaries into the surrounding tissue, causing swelling (oedema).

−

Phagocytes migrate through the capillary walls towards the harmful input, where they ingest it together with any damaged tissue.

−

Tissue-dwelling macrophages join with the phagocytes and scavenge the affected area, which is sometimes additionally bonded by fibrinogen (a protein associated with blood clotting).

Healing Process Towards the end of the inflammatory phase, cells called fibroblasts appear and secrete collagen. This is a fibrous protein which cross-links with polysaccharides (sugars) to form a meshwork of scar tissue which steadily builds up to repair the affected area. While this is going on, if the affected area is close to the skin, epidermal cells remove any final debris in the area and begin to dismantle the scar tissue.

•

Chronic Inflammation Sometimes excessive amounts of collagen are formed and in certain chronic inflammatory responses, macrophages die and other macrophages phagocytose their dead. The combination of living and dead macrophages forms structures known as giant cells. Scarring is a repair process by which gaps in tissue are made good. In some types of chronic inflammation, however, this repair process becomes disordered. The overgrowth of scar tissue, brought about by over-production of collagen, shrinks and contracts, tearing and distorting the surrounding tissues. In the lungs, this results in the condition known as emphysema and some types of pneumoconiosis result in extensive scarring and fibrosis.

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Immune Response This term describes the mechanisms concerned with defence and preservation of normal body integrity. In its classical form a wide range of chemicals and micropredators provoke an immune response which involves the production of antibodies within the space of a few days. Whenever next the antigen enters the body, it reacts with the residual antibody and the combination of antigen and antibody can be phagocytosed as detailed above. In addition to the classical disposal of antigens, two other types of immune response are recognised: •

Surveillance Sometimes dividing cells give rise to mutant forms and any excess could result in the growth of abnormal tissue (benign or malignant). Surveillance by immune response results in these mutants being recognised as alien and destroyed.

•

Self-Disposal Redundant blood and tissue cells need to be phagocytosed from the body and the immune response ensures that redundant cells are recognised as distinct from functioning cells. It is important to link the immune response with inflammatory responses, since the two can be regarded as complementary stages in a continuous process. The immune response can be regarded as the mechanism concerned with identifying and preparing any harmful inputs or the resulting damaged tissues for the inflammatory process. Harmful inputs which can provoke an immune response include: −

Micropredators and chemicals.

−

Energies which cause tissue damage.

−

Psycho-social climates (to produce, for example, asthma).

Immunity can be natural (by means of the genetic make up of the individual) or acquired (which in turn may be by artificial means, such as injections, or natural means, through contracting the disease and building up immunity).

Respiratory Inflammation The respiratory pathway is vulnerable to attack by many irritants and corrosives or any other substances which attack the skin. The terminology of the inflammatory processes follows the pathway of air into the lungs, i.e.: 

Rhinitis.



Laryngitis.



Tracheitis.



Bronchitis.

Pneumonia In extreme cases the effects of inflammation lead to swelling and exudation of fluids resulting in narrowing or even total blocking of the small conducting airways. Exudation in the alveoli leads to interference with respiratory gas exchange, even to a fatal degree. Gases of low solubility will penetrate the respiratory pathway deep into the alveoli. Such gases include

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sulphur dioxide, ozone, phosgene and oxides of nitrogen. The inflammation caused results in fluid accumulating in the respiratory units (oedema). Other irritants include metal fumes (metal fume fever) and polymer fumes (polymer fume fever).

Inflammation of the Skin Inflammation of the skin is much the same as for any other body organ; there are blood capillary changes, there is increased permeability and there is migration of cells. Inflamed skin is painful, sometimes itchy, often red and fissured, sometimes accompanied by exudate and shedding of scales. Chemicals attack the skin by pervasion or implantation, resulting in contact dermatitis, which may take a number of forms: •

Irritant Dermatitis This is caused by corrosive irritants such as acids, alkalis, detergents, oils, metallic particles, solvents, oxidising and reducing agents and some biological agents (e.g. giant hogweed). If the irritant is particularly aggressive, it can result in destruction of the skin.

•

Acute Irritant Dermatitis This is brought about by contact with acids and alkalis, for example, which result in acute inflammation.

•

Cumulative Insult Dermatitis This typically develops after repeated exposure to weak irritants over a long period of time.

•

Allergic Contact Dermatitis Also known as Contact Sensitisation Dermatitis, it is associated with a wide range of substances. Some metals, such as cobalt and nickel, produce allergic reactions. With nickel, for example, contact with its alloys or salts can result in a form of contact dermatitis which may also affect skin on other parts of the body not directly exposed to the agent. Once this sensitivity (to very small amounts) has developed, it is usually permanent. It is almost impossible to give a list of materials known to cause sensitisation dermatitis. Certainly it would be very long, but would include coal-tar products, explosives, photographic chemicals, dyestuffs and intermediates, insecticides, oils, resins, alkyd resins and plasticisers.

The following table identifies a range of hazardous substances, the occupations most at risk and details their mode of entry and target organs.

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Agent

Example Occupation

Route of Entry

Principle Target Organ

Hydrochloric acid

Chemical and laboratory workers

Contact

Skin

Inhalation

Upper respiratory tract

Ingestion

Mouth, oesophagus and stomach

Asbestos

Demolition workers

Inhalation

Lungs

Benzene

Chemical and laboratory workers

Inhalation

Blood

Hardwood dust

Furniture makers

Inhalation

Nasal passage

Carbon monoxide

Construction workers, e.g. use of a combustion engine in a confined space

Inhalation

Blood

Vinyl chloride monomer

Chemical workers

Inhalation

Liver

Leptospirosis

Sewer workers

Ingestion or through cuts

Multiple organs

Other Defence systems Digestive system The main defences for the digestive system include: 

Taste.



Vomiting.



Diarrhoea.



Stomach acids.

Eyes The main defence of the eyes are: 

Lachrymation (formation of tears).



Blinking (natural reflex).

Skin The skin can defend itself against some effects of chemicals by producing natural oils (keratin) that can help to prevent absorption. This does not mean that PPE requirements can be ignored.

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The Fundamental Elements of Toxicology “Toxicology” is the study of the adverse effects of substances which can cause harm to living organisms. It is the study of symptoms, mechanisms, treatment and detection of biological poisoning, especially the poisoning of people. New substances require a range of physico-chemical, toxicological and ecotoxicological studies. The level of testing depends on the quantity of substance that is intended to be produced but the types of toxicological studies that are required are: 

Acute toxicity: −

Oral.

−

Inhalation.

−

Cutaneous (skin).



Skin and eye irritancy.



Skin sensitisation: −

Positive result indicates potential for contact dermatitis.



Subacute toxicity (28 days).



Mutagenicity (bacterial and non-bacterial): −



Carcinogenicity: −



To determine if the substance has the ability to cause hereditable genetic damage.

If mutagenicity tests prove positive the animal is subjected to lifetime exposure to the substance and at post-mortem an examination is carried out to detect cancer.

Teratogenicity: −

To examine the effect of the substance on the development of the embryo and foetus to identify gross anatomical abnormalities.

In addition to these tests it may be necessary to repeat the studies using other species of animals and/or alternative routes of exposure.

Lethal Dose (LD 50) Toxic substances have very different effects on organisms, including the minimum level at which an effect is detectable; the sensitivity of the organism to small increases in dose; and the level at which the harmful effect (most significantly, death!) occurs. Such factors are indicated in the dose-response relationship, which is a key concept in toxicology: 

Dose is the amount per unit body mass of toxic substance to which the organism is

exposed. 

Response is the resultant effect.

In order to define a dose-response relationship we must specify the particular effect, i.e. death, and also the conditions under which the effect is obtained, i.e. length of time of administration of the dose.

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If we consider a specific example we can see that: 

At low doses no organisms will show a response, i.e. they all live.



At higher doses all organisms show a response, i.e. they all die.



In between there is a range of doses over which some organisms respond and others do not.

PER CENT EFFECT (DEATHS)

100

LD90 50 LD50

0 LOG DOSE

Dose/Response Curve The dose-response curve is S-shaped and the mid-point represents the dose which would cause an effect (in this case death) in 50% of the organisms. It is designated as the LD50. You should appreciate that LD50 is not an exact value and in recent years there has been much discussion as to its usefulness and necessity in toxicology. The LD50 values may vary for the same compound between different groups of the same species of animal. However, the value is of use in comparing how toxic a substance is in relation to other substances. The following table gives examples of LD50 values for a variety of chemical substances. LD50 Values Compound

LD50 (mg/kg)

Ethanol DDT Nicotine Tetrodotoxin Dioxin Botulinus toxin

10,000 100 1 0.1 0.001 0.00001

Once a dose-response relationship has been demonstrated there are a number of parameters that can be derived from it.

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If exposure is oral and lethality is used as the end point, LD50 can be determined as we have seen previously. LD50 is defined as "a statistically derived expression of a single dose of a

material that can be expected to kill 50% of the animals". However, the S-shaped dose-response curve can be further analysed mathematically to determine doses that have a higher or lower probability of fatality. The determination of LD90 from the dose response curve, for example, enables estimation of the dose that will kill the majority (i.e. 90%) of a sample of animals (see figure above). Remember that the LD50 classification is only a very rough guide to relative toxicity. It tells nothing about sublethal toxicity and the data is only strictly valid for the test population, e.g. rats and the route of exposure, e.g. ingestion. The LD50 tells us nothing about the shape of the dose-response curve on which it is based. It is possible for two chemicals to have the same LD50 but one may have a much lower lethal threshold and kill members of the exposed population at concentrations where the other has no effect. The use of LD50 testing has declined with the use of fixed dose testing (see later). Testing for carcinogenic potential is more complex since there is no simple dose-response relationship. It is not possible to assign a dose below which it can be said that the exposure is safe. The toxicology of carcinogens is approached in a different way but still involves exposing laboratory animals (usually rats and mice) to the chemical by oral, inhalation or skin contact techniques. There are also short-term predictive tests available which are considered to simulate potential carcinogenicity in man. They are called short term, in contrast to the usual lifetime studies in rodents which can take three to four years before a result is available. Short-term tests include: 

Those for mutation (e.g. Ames test).



Tests for DNA damage.



Tests for chromosomal damage.



Tests for cell transformation.

Lethal Concentration (LC50) and Lethal Time (LT50) When the route of exposure is inhalation and lethality is used as the end point it is the concentration of the airborne toxin that is of concern. Since the amount of toxin inhaled depends on the duration of exposure there are two ways to express this data: •

The lethal concentration can be determined for a specified duration of exposure If the median lethal concentration is determined this is designated as LC50, which is defined as the statistically derived expression of the concentration of airborne toxin that can be expected to kill 50% of exposed animals in a specified time. The resulting doseresponse relationship can be used to estimate other corresponding parameters such as LC90.

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•

The lethal time can be determined for exposure to a given concentration of airborne toxin If the median lethal time is determined this is designated as LT50, which is defined as the statistically derived expression of the exposure time necessary that can be expected to kill 50% of exposed animals at a specified concentration of airborne substance.

With all these parameters it is important to remember that they simply represent statistically determined doses, concentrations or times, derived experimentally in the manner described above. Their use in comparing the "toxicity" of different substances and consequently their potential to cause occupational ill-health must be qualified by a clear understanding of the limitations of the method by which this statistical data is derived.

No Observed Adverse Effect Level (NOAEL) We made reference earlier to the concept of a dose below which no effect or response is measurable. This is termed the threshold dose and can be clearly demonstrated with responses such as lethality. This concept of a threshold dose for the toxic effect is an important one and implies that there will be a dose at which the response does not occur in any member of the population. This is shown in the Dose/Response Curve figure earlier, where the dose response curve shows no deviation from the x-axis (% effect = 0) until log dose reaches a value of 5 units. The term for this is the no observed adverse effect level or NOAEL. We have already discussed the converse of this with carcinogens where a threshold dose cannot be established and therefore it must be assumed that any exposure to carcinogenic substances has the possibility of an adverse effect. The NOAEL is important for setting exposure limits such as workplace exposure limits which are designed to represent a level of exposure at which there is no evidence of harm.

Types of Toxicity Test Toxicity tests tend to share certain basic principles. They usually involve exposing experimental animals to the test substance under controlled conditions. For existing chemicals, toxicological information may also be obtained from epidemiological data such as human exposure in the workplace or humans and animals exposed in the general environment. So, for example, workplace exposure may be determined from the measurement of potentially toxic substances or their metabolites in human body fluids. Similarly environmental exposure to pesticides may be determined in the field by measurement of pesticide levels in wild birds. The main types of toxicity tests are described below.

Acute Toxicity Tests These are designed to determine the effects which occur within a short period after dosing. These tests can determine a dose-response relationship and the LD50 value.

Fixed Dose Testing In this procedure the test substance is administered to the test animals at one dose level which has been selected from regulatory classifications. The animals are then observed for 14 days and the dose at which toxic signs are detected is used to rank or classify the test materials. The initial tests will involve increasing the dose to a sample of animals by successive orders of magnitude (factors of 10) in order to establish the range of toxic effects. Once this has been

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established a study similar to that outlined in the following table can be carried out in order to classify the substance. Note that the criterion used is 90% survival. Investigation of Acute Oral Toxicity Test Dosage

Result

Action/Classification

5 mg/kg

< 90% survival > 90% survival but toxicity > 90% survival no toxicity

Very toxic Toxic Retest at 50 mg/kg

50 mg/kg

< 90% survival > 90% survival but toxicity > 90% survival no toxicity

Toxic, retest at 5 mg/kg Harmful Retest at 500 mg/kg

500 mg/kg

< 90% survival or toxicity > 90% survival no toxicity

Harmful, retest at 50 mg/kg Unclassified

If a large enough sample of animals is used at each dosage level the LD50 value can be determined from analysis of the data. The initial test dose should be chosen to identify toxicity without mortality occurring. So if a group of test animals is tested with an oral dose of 500 mg/kg body weight and no signs of toxicity appear, the substance should not be classified in any of the categories of toxicity.

Subacute Toxicity Tests These involve exposing animals to a substance for a prolonged period of one or three months, which enables toxic effects which have a slow onset to be detected. This type of exposure provides information on the target organs affected by the substance and the major toxic effects. Such tests also allow measurement of the substance in blood and tissues. The information gained can be used in the design of the next type of test, the chronic toxicity test.

Chronic Toxicity Tests These tests involve lifetime exposure of animals to the substance under study. Similar measurements to those described for subacute toxicity tests can be made throughout the study to identify the development of pathological changes which can then be detected in a post-mortem. Other long-term changes in measurements such as food and water intake, body weight, and behavioural changes can serve to indicate harmful effects. These types of study are important in determining possible effects of long-term occupational exposure or environmental exposure to low levels of chemicals. For all types of toxicity test the following parameters should also be considered: 

Type of chemical under study (new compound or in use for some time).



Selection of doses (quantity; single dose or repeated doses).



Species and strain of animal (extrapolation to human exposure).



Exposure route (comparable with likely occupational exposure route).



Method of exposure (physical and/or chemical properties of substance).



Experimental observations and measurements to be made (similarities with other compounds of known toxicity).

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The Fundamental Elements of Epidemiology Role of Occupational Health Specialists Epidemiology is concerned with the distribution of a particular occupational disease and the search by occupational health specialists to identify the factors that may be involved (i.e. determining the cause having first observed the effects). The main occupational health expert involved in this will be the epidemiologist, who will be an expert in the study of the causes, distribution and control of diseases in populations. He/she will be supported in their research by occupational hygienists, toxicologists, occupational health physicians, and any other occupational health specialists as required. There are five main uses of epidemiology in occupational health and hygiene: 

Primary monitoring to identify hazards. Population studies are frequently the only way of identifying an occupational risk of disease such as lung cancer, coronary heart disease, varicose veins, or rheumatic disorders, because they are common in the general population.



Secondary monitoring to keep known hazards under control. Surveillance of a group of workers exposed to recognised hazards identifies any susceptible individuals and assesses the value of preventive measures and the effectiveness of control measures.



Determining causes helps to establish health standards. Studying groups of workers may lead to a determination of the association with the exposure to a contaminant such as a dust or vapour, leading to the establishment of the cause and occupational hygiene standards such as workplace exposure limits (WELs).



Community studies reveal how many people are affected and how seriously. Priorities can then be established enabling preventive action to be taken when and where it is needed.



Evaluating health services to find out how they are used, their success in reaching certain standards and the value attached to them by the population they serve.

In terms of the practical application of epidemiological methods to occupational health and hygiene, secondary monitoring is particularly important. Primary monitoring, the recognition of hazards, may be said to be a consequence of good primary procedures. Thus, if some workers begin to exhibit symptoms of dermatitis where no previous incidence has been recognised, there is a strong possibility that it has been caused by a change either in the process or in work patterns, or by the introduction of a new or replacement raw material. Having observed the effect it should be possible to determine the cause by studying work patterns and raw materials. A number of important criteria must be satisfied in order to establish a definite relationship between a disease’s cause and effect: 

Strength: the relative incidence of the disease in exposed and unexposed groups.



Consistency: observing the disease in different places and at different times by different observers.



Specificity: where the association (between cause and effect) is limited to specific workers and to a particular type of disease there is a strong argument in favour of causation.

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

Biological gradient: if an increase in dose or exposure brings about an increase in incidence then there is strong evidence of causation.



Biologically plausible: the relationship should not conflict with known facts of the natural history and aetiology of the disease.



Analogy: similar chemicals, biological agents and physical inputs being likely to have similar effects.



Preventive action: if the preventive action works, i.e. there is a reduction in the effect, then it is likely the cause was correctly identified, e.g. a reduction in an atmospheric contaminant affecting the frequency or severity of the disease or other associated event. It is perhaps this final criterion which may be said to be the definitive “proof of the pudding”.

Types of Epidemiological Studies As we have seen the purpose of the epidemiological study is to establish the distribution of health-related events or states in a specified population and also the factors responsible. This information can then be applied in the control of the particular health problem. Prevention strategies can be developed from a sound understanding of the issues and a range of studies can be undertaken to help with this. The main problems of epidemiological studies, include: 

The "healthy worker" effect, whereby the control group has a different health status compared with the cases to be studied (pre-employment health screening has the effect of excluding less healthy individuals and consequently raising the general health of employed persons in comparison to those not in work).



A poor response rate which reduces the sample size and its statistical significance.



A high turnover of study populations.



The latency period between exposure and effect is longer than the study period.



Poor quality of health affects data and/or exposure data.



No effect of exposure noted which may be a consequence of a poor or small study population.

For an epidemiological study to be effective the following factors should be addressed: 

Clearly formulated hypothesis and study objective.



Appropriate study design.



Collection of good quality health effects and exposure data.



Valid population choice for case study and control.



High response rate and good sampling strategy.



Population size large enough and correct statistical techniques used.



No-effect study result investigated for validity and/or statistical significance.

In this way the cause-association hypothesis that aims to relate occupational exposure to incidences of ill-health should be able to be validated, either positively or negatively. We have already noted that epidemiology is concerned with the distribution of a particular occupational disease and the search to identify the occupational factors that may be involved.

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We can therefore see that a representation of the workplace situation involves individuals of different age, sex, occupation, race and duration of employment experiencing continually varying exposures to workplace agents. Within this changing workplace population, occupational ill-health may occur either during employment, during future employment or after retirement. From this complicated picture, which is changing with time, the epidemiologist must try and design studies which will establish a cause and effect relationship between workplace agents and occupational disease. If we wish to investigate this process and/or the population there are two basic studies that we can make.

Cross-Sectional Studies The cross-sectional study involves a "snapshot in time" of the relevant workforce. A section of the workforce is examined over a short period of time. The advantage of this type of study is that it is a quick and cheap opportunity to study the problem in hand, but the disadvantage is that the population at risk is assessed over a narrow time frame. This means that the investigators cannot look at exposure and the resulting outcome over a period of time. The cross-sectional study therefore tends to be: 

Outcome-selective: the study examines the prevalence of a particular occupational condition within the population.



Exposure-selective: the study examines a particular population that has been exposed to a specified occupational condition.

For this reason cross-sectional studies are also known as prevalence studies. The design of a cross-sectional study involves the following main stages: 

Establishing precise aims.



Defining the study population.



Determining the sample size - important for statistical purposes.



Recruitment of all relevant cases in the sample.



Analysis - prevalence rates in relation to sample groups.

Longitudinal Studies The longitudinal study involves investigation of the workforce over a significant period of time. This type of investigation takes longer to carry out and is more expensive, but, because it takes place over a period of time rather than at a specific point in time, it provides the opportunity to study exposure and its outcome as a time-related chain of events. Two types of longitudinal studies are commonly employed: •

The Case-Control Study This type of study is retrospective, beginning with a definition of a group of cases and relating these (along with non-cases or controls) to the past exposure history. The main drawback of this type of study is obtaining accurate exposure history which may need to go back as far as 40 years. With the case-control study the investigation compares a group of individuals who have the disease or condition with another group who do not. The comparison is made with respect to past characteristics of both groups and, unlike the follow-up study (see below), the outcome is known.

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The case-control method may be used, for example, to investigate the frequency of asbestos workers who have respiratory problems or lung disease against a control group drawn from the general population. It is quicker and less expensive than a cohort study (see below) and is often used as the first step to see if there may be an association between a suspected cause and a known effect. It is also useful in investigating a disease of low prevalence. Unfortunately, however, case-controlled studies are generally less informative than cohort studies and spurious associations are likely to occur. •

The Follow-Up Study This study takes a group of exposed (and possibly non-exposed control) persons where the exposure is defined and accurately known. The group is then followed up over an appropriate period of time to assess the eventual outcome of the exposure. This method is prospective (following the group forward in time) and avoids the problem of tracing exposure history retrospectively, as with the case-control study. Follow-up studies are useful for: −

Special exposure (e.g. Japanese atomic bomb survivors).

−

Ease of follow up (e.g. hospital patients, professional groups).

−

Geographical groupings (e.g. migrant studies).

A cohort study is a specific type of follow-up study where a population is defined in advance for exposure characteristics, followed for a period of time and then the outcome measured. Follow-up studies are designed to observe incidence of occupational ill-health and should, naturally, extend over a period of time longer than that required for the outcome to develop. Such studies are used to determine whether there is an association, for example, between exposure to asbestos (the cause) and the incidence of lung cancer (the effect) and uses two groups (cohorts) of subjects: −

Exposed.

−

Unexposed (the control group).

The incidence of lung cancer is then calculated for each group and if significantly more people suffer in the exposed group then there is strong evidence for cause and effect. In cases where there is not sufficient past data to work on it will be necessary to set up a prospective study. Cohort studies are concerned with the relationship between the cause, as evidenced by the history and nature of the exposure, and the effect, i.e. the presence of the disease. The advantages of cohort studies are that they provide: −

A more accurate account of exposure related to deaths or disease and a direct estimate of the risk associated with the causal factors.

−

Information on secular trends which reveal changes in the degree of risk.

Against this must be set the following disadvantages: −

It may be necessary to wait many years for the development of the disease (mesothelioma might take as long as 40 years to manifest itself).

−

Some of the cohort may be lost over the period of study.

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Of course, some useful information can be obtained from available statistics. The main national records available for study are: •

Death Certificates These provide a reasonably accurate and quantifiable measure of serious illness. However, problems occur with:

•

−

The accuracy of the cause of death (this relies on the physician's decision as to the ultimate cause of death).

−

The occupation of the deceased (this may be the occupation at the time of death but not necessarily the one that caused the death).

Birth Certificates These can be used in conjunction with data on congenital malformations and pregnancy complications to study the effect of parents' occupations on these conditions.

Control and Prevention Strategies In some situations, occupational health specialists are able to identify causal factors quickly. For example, in the original 1976 outbreak of Legionnaires Disease in America, the health investigators identified causal factors relating to strength, consistency, specificity, biological gradient, biological plausibility, analogy and preventive action. The success of their preventive action was proof that the epidemiologists had correctly identified the cause of the disease, together with the events and circumstances necessary to link causes with effect. However, it is not always the case that control measures are speedy, simple and effective. Sometimes, the interval between implementation of control measures and an observed decline in the incidence of a disease may cover many years. In these circumstances it is inevitable that doubts will arise as to the effectiveness of the control measures and consequently as to the actual cause. Some UK examples will serve to illustrate the point. 

Lead poisoning became notifiable in the potteries in 1896, when there were 351 cases out of some 5,000 at risk. Although the overall rate began to fall almost immediately, the number of deaths remained fairly constant for a number of years afterwards. Lead poisoning became notifiable in all factories in 1899 and the cases of poisoning fell from more than a thousand in 1900 to 55 in 1960; but again the death rate did not follow a similar pattern. Indeed, it increased in some years. In the electric accumulator industry the incidence of lead poisoning rose from 1900 until the passing of the Lead Accumulator Regulations in 1924, after which there was a decline in the incidence of poisonings. Once again the death rate remained relatively constant.



Diseases such as mesothelioma may have a latency period of as much as 40 years between exposure and diagnosis, so we must expect to diagnose causes of the disease well into this century, even though asbestos has been subject to tight controls since the 1970s.



With diseases such as dermatitis, where the victim may become sensitised, the disease may “flare up” again following only very small exposure to the harmful agent or to another agent which is chemically analogous.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit

Title

2A4

Occupational Diseases

Page

THE CHRONIC AND ACUTE NATURE OF MOST OCCUPATIONAL DISEASES ......................................................... 3 DIFFICULTIES IN IDENTIFYING CHRONIC DISEASE ............................................................................................................. 3 REPORTING OCCUPATIONAL DISEASES ............................................................................................................. 4 EXTERNAL REPORTING ............................................................................................................................................. 4 INTERNAL REPORTING ............................................................................................................................................. 5

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A4 | Occupational Diseases Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.4.1 Explain the chronic and acute nature of occupational diseases 2.A.4.2 Apply the requirements for reporting occupational diseases internally and externally

Unit 4:

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The Chronic and Acute Nature of Most Occupational Diseases Difficulties in identifying chronic disease Chronic diseases often have a long latency period and are often irreversible. This means that exposures to harmful substances can lay dormant for a long time (in some cases many years as with asbestos fibres) in a person’s body, often without symptoms. During this dormant period, the infected person may be involved in many activities at home and at work (including job changes) which may have led to exposure to a wide range of agents able to cause similar effects or to act synergistically as a catalyst to trigger response in the body, which would be very difficult to trace. As an example a worker may have been exposed to oxides of lead many years ago during ship repair work and then many years later, after starting smoking and changing jobs twice he starts to suffer from palsy. This original cause may be very difficult to prove. The designation of a disease as an occupational disease can be also complicated. Examples of contributory factors include the following: 

Deafness may be due to aging, or to exposure to high level noise exposure at work, or proximity to a noisy environment, i.e. indirect contact.



Diagnosis may be difficult as there is no specific clinical test in the early stages of the disease itself.



Under-reporting of disease due to, for example, no medical surveillance or the reluctance of individuals to complain of a problem.



Inaccurate collection of data, e.g. benefit not paid until there is a high level of hearing loss.



Incorrect diagnosis.



The exposure originally occurred in another workplace some time ago and the workplace has closed and there are no records available.



A lack of/limited/unrepresentative workplace surveys.



Poor legislative control/enforcement especially in the early stages of the disease, e.g. asbestosis.

Certain diseases as was mentioned, may have a long latency period, i.e. time between exposure and eventual diagnosis/onset of the condition, e.g. asbestosis between 15 and 60 years, with death occurring within a two year period; noise-induced hearing loss (NIHL) due to noise exposure over a period of time, and similarly hand arm vibration (HAVS).

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Reporting Occupational Diseases External Reporting External reporting refers to the requirement to report cases of occupational disease to bodies outside of the organisation. There will be varying reasons for external reporting occupational disease. In some countries there will be legal requirements to report diseases and the data will be used for identifying national trends and developing national strategies for prevention. The requirements in respect of reporting certain types of diseases within the UK are specified by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These apply to all places of work, to employers and self-employed persons. RIDDOR places a duty on the employer to report certain specified diagnosed diseases or ill health conditions. These diseases are only required to be reported if there is a reasonable chance that they are caused by work. Failure to notify a reportable disease in the UK can lead to prosecution and a significant fine. There is a set, prescriptive procedure in place for this legal requirement including the use of a prescribed report form; and the reporting information will include information such as details of the affected person, the nature of the disease being reported and the work that led to the disease. Other information required for such external reporting will likely include: 

The date the disease was diagnosed.



The occupation of the person affected.



The date on which the disease was first reported to the relevant enforcing authority.



The method by which the disease was reported.

The information received from the employer enables the enforcement and policy development agencies to take preventative action on a nationwide scale by the recommendation of new legislation or codes of practice, by deterring breaches of legislation by prosecuting offenders, and to raise awareness of commonly occurring hazards by campaigns, publicity and information.

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Internal Reporting At all times the company should be alert to the risks/dangers of employees developing occupational diseases to which their employees are exposed. New risk assessments may have to be carried out, if there is a chance that existing preventive/precautionary measures are deficient; measurements, such as atmospheric or health monitoring, must be taken and analysed regularly; training in the correct use of personal protective equipment must be updated. Accident book entries should be completed when an occupational disease is known to have caused the injuries. This could be related to a disease like vibration white finger where an employee has suffered severe pain in their hands and cannot grip the tools he works with. It is vitally important that companies are aware of the need to carry out strict and regular monitoring of any employee who works at an activity in which they are vulnerable to developing an occupational disease. Routine health surveillance must be carried out for those likely to be exposed to occupational diseases, such as asthma, dermatitis and many others. Management should analyse, on a regular basis, any relevant information they have available to them with the objective of identifying any indications of changes that need to be attended to. Management should react positively to complaints received by the workforce received either during consultation or on a piecemeal basis to find suitable cost effective remedies to occupational health issues. Management should carefully monitor the ill health of employees who self report their condition, to see if there are any occupational health issues that need addressing. Sick notes should also be monitored to identify obvious signs of occupational health issues.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A5

Title

Page

Monitoring the Health of Employees

BENEFITS OF A HEALTH SURVEILLANCE PROGRAMME ...................................................................................... 3 WHEN HEALTH SURVEILLANCE IS APPROPRIATE .............................................................................................. 4 THE MAIN METHODS OF MONITORING THE HEALTH OF EMPLOYEES ................................................................ 5 REVIEW OF ACCIDENT, ILL-HEALTH AND ABSENCE RECORDS ............................................................................................... 5 INSPECTION OF READILY DETECTABLE CONDITIONS ......................................................................................................... 5 ENQUIRIES ABOUT SYMPTOMS ................................................................................................................................... 5 MEDICAL SURVEILLANCE TECHNIQUES .......................................................................................................................... 6 HEALTH SURVEILLANCE RECORDS ................................................................................................................... 14

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A5 | Monitoring the Health of Employees Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.5.1 Explain the benefits of a health surveillance programme 2.A.5.2 Recommend when health surveillance is appropriate 2.A.5.3 Describe the main methods of monitoring the health of employees

Unit 5:

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Benefits of a Health Surveillance Programme Monitoring the health of employees can involve a number of actions such as assessments for fitness for work, monitoring sickness absence, use of health promotion screening clinics for cholesterol and blood pressure, as well as health surveillance. In this study unit we particularly look at health surveillance. Health surveillance is defined as ‘putting in place systematic, regular and appropriate procedures to detect early signs of work-related ill health among employees exposed to certain health risks; and acting on the results’. Health surveillance has a number of benefits to the organisation, such as reduced absenteeism, increased productivity, improved morale, reduced costs, etc. but the two main benefits are: •

Early Identification of Symptoms Health surveillance provides information that can assist in the detection of health effects at an early stage. This helps to protect the health of employees and is also a method for ensuring that employees remain fit for the relevant work. It also gives an opportunity for employees to raise and discuss any concerns they may have about the effect of the work on their health.

•

Establish a Prevention Strategy Results can help check that control measures and prevention strategies that are already in place are effective and assist in the identification of new controls where necessary.

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When Health Surveillance is Appropriate Every employer should ensure that his employees are provided with such health surveillance as is appropriate, having regard to the risks to their health and safety as identified by a risk assessment. There are certain workplace situations that specifically require health surveillance, such as chemical safety. A programme of Health surveillance must be introduced where the following criteria are met: 

There is an identifiable disease or adverse health condition related to the work concerned.



Valid techniques are available to detect indications of the disease or condition.



There is a reasonable likelihood that the disease or condition may occur under the particular conditions of work.



Surveillance is likely to further the protection of the health and safety of the employees to be covered and be of low risk to the employees.

An example of where these criteria would apply is in relation to workplace exposure to noise. There is a known adverse effect on hearing. Audiometry is a valid technique used to establish the effect on hearing; employees working in noisy environments are likely to develop hearing loss, and surveillance would benefit the employee by identifying those at risk at an early stage and allowing preventative action to be taken. In determining the likelihood of an identified adverse effect consideration would need to be given to: 

The type and extent of exposure.



Assessment of the current scientific knowledge such as: −

Available epidemiology.

−

Information on human exposure.

−

Human and animal toxicological data.

−

Extrapolation from information about similar substances or situations.

Valid health surveillance techniques need to be sufficiently sensitive and specific to detect abnormalities related to the type and level of exposure concerned. Clearly health data needs to be interpreted correctly and must be comparable with normal values. Action levels may need to be set.

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The Main Methods of Monitoring the Health of Employees Review of Accident, Ill-Health and Absence Records Underlying causes identified as a result of accident investigation and accident trends can help identify health problems in areas of the organisation or in relation to an individual. For example, an accident investigation might have identified the cause of an accident as being due to a lapse in concentration by a worker. This may have been due to excess working hours or even exposure to a solvent vapour. Another method of monitoring the health of employees, and in fact identifying the need for more specific health surveillance, is the review and assessment of ill health and absence records. The quality of records will, of course, determine how effective the review of records will be. Sickness absence patterns may be reviewed to determine the duration and frequency of absences. Absence records may help in identifying a factor which is triggering episodes of ill health, e.g. exposure to a sensitising agent resulting in asthma; workplace stress; or musculoskeletal problems related to manual handling. Individual departments may show higher than average absence rates for the organisation, highlighting a possible problem in that area. Where ill-health medical or self-certification certificates give clear details of the ill health reasons for absence it may be possible to obtain an indication of broad employee groups which may be of concern. Individual sickness records might indicate whether work is affecting an individual’s health and may indicate appropriate preventative initiatives. For example, high amounts of sickness absence for low back pain may indicate an ergonomic problem with lifting and handling.

Inspection of Readily Detectable Conditions Where there are readily detectable conditions it may be appropriate to identify a responsible and competent person to inspect for symptoms. The responsible person does not necessarily need to be medically qualified but should be competent in recognising the relevant symptoms. An example of where this type of health monitoring can be useful is in the detection of symptoms, e.g. dermatitis where employees are exposed to dermatitic-causing substances, such as wet cement, solvents, etc.

Enquiries about Symptoms Enquiries are usually made by a qualified person (an occupational health nurse or a suitably qualified occupational physician) and involve asking employees, individually, about symptoms of ill health. For example, where there is exposure to a substance known to cause asthma it may be appropriate to use enquiries to seek evidence of respiratory problems related to work. Respiratory problems are usually clearly identifiable to the employee and he/she can be asked a number of simple questions, such as: 

Have you had any episodes of wheezing or chest tightness?



Have you taken any treatments for your chest?



Have you woken from your sleep with a cough or chest tightness?

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

Have you had any episodes of breathlessness?



Have you had any time off work with chest illness?



Have you developed chest tightness or breathlessness after exercise?

Enquiries can help identify the onset of respiratory problems as well as establish those individuals who may be more at risk. A positive response to any of the questions above should lead to a more detailed investigation. Appropriate questionnaires enquiring about health matters and an individual’s medical history can also be distributed for completion; subsequent analysis by occupational health specialists may highlight possible employment-related health problems.

Medical Surveillance Techniques Medical surveillance is usually conducted by a qualified doctor and may involve clinical examinations and biological or biological effect monitoring, e.g. audiometry, spirometry or blood testing, chest X-rays, liver function tests, etc.

Audiometry This involves the measurement of hearing performance in order to detect actual noise induced hearing loss. The most commonly used assessment of hearing is the determination of the threshold of audibility, i.e. the level of sound required to be just audible. This level can vary for an individual over a range of up to 5 dB from day to day and from determination to determination, but it provides an additional and useful tool in monitoring the potential ill effects of exposure to noise. Before carrying out a hearing test, it is important to obtain information about the person’s past medical history, not only concerning the ears but also other conditions which may have a bearing on possible hearing loss detected by an audiometric test. Noise Induced Hearing Loss (NIHL) Noise induced hearing loss is a condition which results from failure of the hair cells in the Organ of Corti to respond fully to sound intensities having frequencies within the speech range. The person does not necessarily lose the ability to hear sound, but is not able to distinguish the spoken word clearly, even if it is presented with a raised voice. The hearing loss is usually bilateral, but variations in each ear have been observed. Wax in the ear can also cause hearing loss, so the ear should be examined to see if syringing is needed; also to determine if the eardrum has suffered any damage which may reduce the ability of sound to be transported to the cochlea. The audiometric test can be carried out using automatic or manual audiometers, but the essential test procedure is the same: 

The subject is asked to remove anything which might upset the test results, e.g. spectacles, earrings, hearing aids.



Instructions are given about the test procedure and the subject is required to indicate whether he/she can just hear or cannot hear a certain sound (the sound level may be increased from a very low level or reduced from a high level).



Earphones are fitted carefully over the ears and the test is then carried out on each ear.



Firstly, a threshold test is undertaken in which each ear is subjected to sound at a frequency of 1 kHz at varying levels of intensity ranging from low to high and high to low.

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The procedure is repeated several times so that an average threshold can be derived for the test. Thresholds can vary due to slight changes in the procedures adopted in setting up the test, e.g. variation of the position of the earphone on the ear. 

Following this pre-check, both of the subject’s ears are tested through a range of frequencies (usually 0.5, 1, 2, 3, 4 6 and 8 kHz) and hearing loss recorded for each frequency, again via a series of sound exposures. From them an average result can be computed.



When the test is completed, a second threshold check should be carried out to see that no errors have crept in during the test. Both threshold checks should agree within a maximum of 10 dB. If they do not, a re-test must be performed.

The accuracy of audiometry can be affected by a number of factors, including: 

Equipment limitations - how accurately can either the frequency or the hearing level be determined?



Learning effect - the first ear tested sometimes appears worse than the second one since the individual becomes more proficient at detecting the threshold.



Headphone fit - some of the variation in threshold measurement has been attributed to differences in the location of the headphones, which in turn affect the detection of the threshold.



Background noise – audiometric tests should be carried out in a sound-proof chamber to eliminate external sounds from influencing the test.

A further complication of audiometric testing is that it is subjective and relies on the cooperation of the subject. If the subject is unable or unwilling to co-operate with the test then unrepresentative results will be obtained. The technique described above enables us to compare the threshold of hearing of the individual undergoing audiometry with a reference value at a range of octave band frequencies (125, 250, 500, 1000, 2000, 4000, 8000 Hz). From this data a pictorial representation, an audiogram, of hearing loss at various frequencies is produced. Some examples of audiograms reflecting different levels of NIHL are shown below. •

Temporary Threshold Shift (TTS) A temporary threshold shift occurs after exposure to a high noise level; hearing acuity returns with time. The condition has been described as a fatigue of the hair cells in the Organ of Corti. The level of the shift is expressed in terms of the raising of sound intensity required to hear a given sound level, e.g. a 20 dB shift means the sound pressure level has been increased by a value of 20 dB. If a person is subjected to a high sound level, say 85 dB or over for a short period, and then has an audiometer test, a dip in hearing acuity occurs at 4000 Hz. It is often described as the “4 kHz dip” for acoustic trauma. The amount of “dip” from the 0 dB average level is used to specify the amount of threshold shift. For TTS, the amount of 4 kHz dip lessens with time as recovery from exposure occurs. An audiogram illustrating the 4 kHz dip is given in the following figure.

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THRESHOLD SHIFT (dB)

-20

NORMAL HEARING

-10 LEVEL OF SHIFT

0 10 20

TEMPORARY THRESHOLD SHIFT

30 40 50 60 70 80

125

250

500 1000 2000

4000 8000 FREQUENCY (Hz)

The recovery time from a TTS is illustrated in the next figure. Note the recovery is first rapid and then proceeds at a much reduced rate. The higher the noise exposure, the longer the recovery time.

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TEMPORARY 40 THRESHOLD SHIFT (dB) 105 Db 30

20

93 Db 10

0 TIME

•

Permanent Threshold Shift (PTS) Permanent threshold shift is the term used to describe the condition where there is a permanent 4 kHz dip in a person’s audiogram. It is a non-reversible condition where the threshold shift does not return to the accepted norm as in TTS. It is generally accepted that PTS is a condition which follows from continual TTS exposures. PTS is illustrated in the figure which follows.

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THRESHOLD SHIFT (dB)

-20 -10

NORMAL HEARING

0

LEVEL OF SHIFT

10 20 30

PERMANENT THRESHOLD SHIFT

40 50 60 70 80

125

250

500 1000 2000

4000 8000 FREQUENCY (Hz)

A common use of audiometric testing is at the pre-employment stage. This serves two purposes: the first is that it enables an initial assessment of hearing ability to be made in order to establish a base-line, which can be measured by future audiometric tests. The other purpose is to detect any signs of noise induced hearing loss arising from previous employment. If this is detected and documented it can serve to safeguard the employer against any false accusations that hearing loss might have been due to this employment rather than previous ones.

Spirometry A spirometer is a device that measures the amount of air that you exhale. The spirometer is concerned with lung function and involves the employee breathing in fully and sealing their lips around the mouthpiece of the spirometer. The most common measurements made are: 

FEV1 – Forced Expiratory Volume in one second. This is the amount of air you can blow out from your lungs in one second. Normal healthy lungs should be able to blow out most of the air in that time.



FVC – Forced Vital Capacity. This is the total amount of air that can be blown.



FEV1/FVC. This is the proportion of air in your lungs which can be blown out in one second.

A graphic representation in the form of a spirogram is usually included in the results.

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Spirometry readings will vary according to age, size and sex, medical conditions, previous employment experience (e.g. inhalation of dust) etc., and charts are available with normal lung function readings against which a comparison can be made. Where an individual has narrowed (obstructive) airways, e.g. due to asthma, or chronic obstructive pulmonary disease, the FEV1 will be low but the FVC will be relatively normal, i.e. the amount of air that can be blown out quickly is reduced. Conditions such as fibrosis or pneumoconiosis that affect the lung tissue itself or affect the capacity of the lungs create a restrictive pattern and will reduce the FVC, but the FEV1 will remain normal. It follows that where both a restrictive and obstructive pattern exist, both the FEV1 and FVC will be reduced. Spirometry is an effort-dependent test that requires careful instruction and the co-operation of the test subject. Therefore, like audiometry, if the subject is unable or unwilling to co-operate with the test then unrepresentative results will be obtained. Also, like audiometry, lung function tests may be carried out at the pre-employment stage and can also be used as a benchmark for future comparison.

Vision Screening/Eye Tests Vision screening/eye tests are important, relating to the demands of the job and the potential hazards involved: 

Near vision acuity is important for dangerous machine operations.



Far vision is essential for crane operators, train drivers, etc.

Some of these checks can be carried out by occupational health nurses, but a full sight check, would need to be carried out by an optician.

Dermatological Testing Regular dermatological testing by means of skin checks and patch testing can identify adverse skin reactions to sensitising agents.

Chest Radiography The principal use for chest radiography is for screening people in dusty occupations where there is a risk of pneumoconiosis. Although mass radiography has been used to advantage in identifying tuberculosis in the population at large, pneumoconioses require X-ray films of greater definition to establish accurate classification of the stages of the disease. It also has uses in investigating symptoms which become apparent in the upper respiratory system. However, the use of X-ray techniques for screening for lung cancer (either occupational or nonoccupational) is more doubtful.

Biological Monitoring Biological monitoring involves the measurement and assessment of workplace agents in tissues, secretions, excretions or expired air to evaluate exposure and health risk compared to an appropriate standard. Biological tests are used for the early detection of occupational disease and its precursors and include periodic examinations of blood or urine samples to detect excessive absorption of potentially toxic substances; analysis of gases and vapours in exhaled breath; chest X-rays; liver function; renal function and nerve condition. Biological monitoring takes into account routes of absorption, effects of workload, and exposure outside the workplace. The following are the most commonly used techniques.

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•

Blood /Urine Sampling There are a number of situations where blood or urine testing may be appropriate, one example being where exposure to lead occurs. Employers must ensure that each of their employees who is or is liable to be exposed to lead is under suitable medical surveillance by a relevant doctor. The frequency of blood sampling may well be established by the risk assessment but in some cases, for example in relation to lead, local regulations may specify the frequency of testing. Other situations, for example where exposure to organophosphates occurs, will require blood testing as the means of monitoring.

•

Urine Tests and Renal System The kidneys play a central role in dealing with toxins in the body. Consequently urinary concentrations of certain metals such as lead, cadmium and mercury, and also the metabolites of certain organic compounds, can be used to assess exposure and absorption of those substances. Screening for occupational renal disease is of two types. The first involves measurement of toxic substances or metabolites in body fluids (particularly urine) to assess exposure; the second involves monitoring renal function by screening for protein and sugar. Heavy proteinuria (high concentration of protein in urine) is a sign of major renal failure which can be caused by prolonged exposure to industrial toxins.

•

Liver Function The liver is another organ which plays a central role in metabolic processes and is susceptible to the effect of absorbed toxic substances, especially if they are fat soluble. Damage can be to the liver cells themselves or to the transport mechanisms to and from the liver. There is a considerable list of occupational hepatotoxins (toxins which can damage the liver), including organic compounds (alcohol included), antimony, arsenic and yellow phosphorus; and infective agents such as serum hepatitis. Screening techniques for occupational liver disease also fall into two groups: those related to the measurement of exposure to and absorption of hepatotoxins; and those which monitor general liver function. Tests involve monitoring levels of specific metabolites such as bilirubin and gamma-glutamyl transferase to assess liver function.

•

Nervous System Toxic damage to the nervous system may affect the peripheral nervous system (motor and sensory function) or central nervous system (brain function and impairment of consciousness). There is a range of neurotoxins which produces peripheral neuropathy (arsenic, lead and mercury) or behavioural changes (carbon disulphide, methylene chloride, toluene); thus there is a need for medical and environmental control of persons working with known neurotoxins, including regular biological monitoring. Tests include visual testing, nerve transmission tests (electomyography, neuromuscular transmissions) and assessment of intelligence, personal and psychological tendencies.

The advantages of biological monitoring include the following: 

It can help to demonstrate whether personal protective equipment (e.g. gloves, masks) and engineering controls (e.g. extraction systems) are effective in controlling exposure.

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

It measures individual exposure to a chemical by all routes of entry.



It identifies what has been absorbed by the body (unlike airborne monitoring).



It shows how effective improvements in control measures have been in reducing exposure.



It gives reassurance to workers that their individual exposure is being monitored.

The disadvantages of biological monitoring include the following: 

Sampling may require blood to be taken which would require a physician or nurse.



Measurements relate to individuals, so confidentiality and data protection issues need to be addressed.

Biological Effect Monitoring This involves the measurement and assessment of early biological effects that are not harmful in themselves but are an indication of a workplace agent causing detectable (and, therefore, presumably unwanted) biochemical alterations. For example, the detection of free erythrocyte proto-porphyrin (from the breakdown of haemoglobin) is not an indication of biological harm but does indicate excessive exposure to, and absorption of, inorganic lead.

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Health Surveillance Records Employers must keep an up-to-date health record for each individual employee placed under health surveillance. The information that is typically recorded on health surveillance records is 

Surname;



Forenames;



Gender;



Date of birth



Permanent address or postcode;



Date when present employment started; and



A historical record of jobs in this employment involving exposure to identified substances requiring health surveillance



Results of other health surveillance procedures and the date on which they were carried out;



Records of decisions or conclusions of medical inspectors for any previous health surveillance

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit

Title

2A6

Occupational Stress

Page

WHAT IS OCCUPATIONAL STRESS? .................................................................................................................... 3 DEFINITIONS OF STRESS .......................................................................................................................................... 3 POSITIVE/NEGATIVE STRESS OR PRESSURE/STRESS ......................................................................................................... 3 EFFECTS OF STRESS ON ORGANISATIONS ...................................................................................................................... 3 THE PHYSICAL AND PSYCHOLOGICAL EFFECTS OF OCCUPATIONAL STRESS .................................................... 4 EMOTIONAL (FEELINGS) ........................................................................................................................................... 4 COGNITIVE (THINKING) ........................................................................................................................................... 4 BEHAVIOURAL (ACTIONS) ......................................................................................................................................... 4 PHYSIOLOGICAL ..................................................................................................................................................... 5 POTENTIAL CAUSES OF OCCUPATIONAL STRESS ............................................................................................... 6 CONTROL ............................................................................................................................................................ 6 DEMANDS ............................................................................................................................................................ 6 SUPPORT ............................................................................................................................................................. 6 RELATIONSHIPS ..................................................................................................................................................... 7 ROLE.................................................................................................................................................................. 7 CHANGE .............................................................................................................................................................. 7 MANAGING OCCUPATIONAL STRESS .................................................................................................................. 8 RISK ASSESSMENT.................................................................................................................................................. 8 SELECTION AND IMPLEMENTATION OF SUITABLE CONTROL MEASURES.................................................................................... 9 MONITORING AND EVALUATION OF CONTROL MEASURES ................................................................................................. 11 REHABILITATION.................................................................................................................................................. 11

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A6 | Occupational Stress Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.6.1 Describe the nature of occupational stress 2.A.6.2 Outline the causes of occupational stress 2.A.6.3 Describe and explain the physical and psychological effects of occupational stress 2.A.6.4 Advise employers on their responsibilities in relation to occupational stress 2.A.6.5 Advise employers on managing occupational stress

Unit 7:

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What is Occupational Stress? Definitions of Stress In recent years, work-related stress has become recognised as a significant concern. Some experts define stress as "the physical, emotional, behavioural and cognitive reactions people have to demands or changes in their environment". Other psychologists define stress as "strain experienced by an individual over a period of time which impairs the ability of the individual to perform his or her role". Stress can produce physical or mental symptoms and can be generated by pressures and problems in the work situation. Furthermore, such symptoms of stress such as tiredness, headaches and irritability can lead people into other problems like heavy drinking or excessive smoking, which set up a vicious circle by creating even worse physical problems.

Positive/Negative Stress or Pressure/Stress The term "stress" in engineering denotes a force which produces a strain. Psychological stress in the working environment relates to workplace conditions that have the potential to create harm. Under normal conditions the demands made on the individual in an occupational setting are met by his/her physical and psychological resources. Where there is a balance between demands and resources there is an optimal state of health and well-being and the individual is able to function at optimal performance. When, however, the demands made upon the individual exceed available resources the resulting imbalance produces a state of psychological stress. This imbalance can also be produced when demands made on the worker are not enough to utilise available resources. Consequently stress-related problems can result as much from non-demanding monotonous work as from highly demanding and pressurising work. A certain amount of stress can be beneficial in stimulating work performance but when stress levels rise to the point where an individual cannot cope with them, there are harmful results. The stereotype of the overworked executive as being the prime candidate for stress does not carry through in real life; often more lowly employees have higher stress levels. Top people can compensate for the demands of their jobs by greater autonomy, more support from colleagues and greater financial security.

Effects of Stress on Organisations Because stress is a major cause of sickness absence among employees, it represents a significant cost to employers. Losing even one employee because of a stress-related illness can also have a dramatic effect on output and result in additional costs if a replacement has to be brought in to cover their job. Work-related stress also affects morale and motivation, which can result in lower productivity, reduced performance, tensions between colleagues and increased incidence of industrial relations problems. In the long term, it may cause workers to leave, with the consequential costs of recruiting and training replacements.

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The Physical and Psychological Effects of Occupational Stress Stress is often classified under two headings: 

Psychological stress, which manifests itself in feelings of emotional distress, like anxiety, excessive worry and depression.



Physiological stress, which manifests itself in pain or physical discomfort. Physical symptoms like abnormal blood pressure or heart-beat can be detected.

Stress is therefore a complex problem, both in terms of its causes and effects.

Emotional (Feelings) The emotional effects that stress can cause include: 

Irritability.



Anxiety.



Irrational fear.



Feelings of hopelessness.



Aggressiveness.



Resentment.



Depression.

Cognitive (Thinking) The cognitive effects (in the mind) that stress can cause include: 

Inability to concentrate.



Inability to make decisions.



Low esteem.



No self-confidence.



Memory lapse.



Misperception.



Loss of perspective.

Behavioural (Actions) The behavioural effects that stress can cause include: 

Increased alcohol consumption.



Increased smoking.



Difficulty sleeping.



Poor concentration.



Inability to cope with everyday tasks and situations.

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These symptoms may be short term in response to an isolated finite period of excess pressure, or long term if the pressure is unabated.

Physiological The physical effects of stress in the workplace can involve a range of symptoms which include: 

Raised heart rate.



Increased sweating.



Headaches.



Dizziness.



Blurred vision.



Aching neck and shoulders.



Skin rashes.



Lowered resistance to infection.

These symptoms are usually short-lived, depending on the nature of the stressful condition. However, prolonged exposure to stress can lead to more serious ill-health conditions. Stress is also associated with a number of serious ill-health conditions that may result from prolonged chronic exposure. Examples of these are: 

High blood pressure.



Heart disease.



Anxiety and depression.



Ulcers.



Thyroid disorders.

We can see, therefore, that chronic stress may lead to a range of ill-health conditions and diseases, and must therefore be treated seriously as a workplace agent capable of causing occupational ill-health.

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Potential Causes of Occupational Stress To be set challenging targets at work can be motivating, but if demands are placed on workers which they feel they cannot cope with, they will experience stress, which in turn affects morale and performance. Work-related stress is a complex subject, because it results from the interaction of organisational factors and factors which are personal to the individual employee. There are several categories of causes of work-related stress as follows:

Control Stress used to be regarded as something which primarily affected senior managers in highly responsible positions, but research has shown that lack of control over work is a more significant cause, and this is more likely to be found in jobs lower down the organisation. Senior managers often have considerable discretion in deciding which tasks they will undertake and when, whereas subordinates are likely to be subject to greater control and to work to more rigid timescales. Lack of control is particularly acute in jobs where the pace of work is set externally to the employee, e.g. by a production line or the demands of customers.

Demands Demands on the individual employee are often regarded as the main cause of work-related stress. Stress can arise either if a worker is allocated too much work to do with insufficient resources (e.g. where it is not possible to complete a task within the time available) or if the work is too difficult and the worker has not received appropriate training or the task is beyond their capability. Employers must also introduce special safeguards for young people – an employer must not employ a young person for work that is beyond their psychological capacity, such as dealing with people who are aggressive or abusive. The physical and psychosocial environment in which work is carried out can also be a source of stress. Aspects of the physical environment which affect workers include temperature, noise, vibration, light, ventilation and workstation design. A significant factor in the psycho-social environment is the risk of violence, e.g. for workers who have to deal face-to-face with angry members of the public. Work underload, when an employee does not have enough to do, or feels insufficiently challenged by their work, can also result in stress. An employee must receive sufficient training to be able to undertake the main functions of their job. If an employee is not given basic induction training when they start a new job or additional training when changes are made, such as the introduction of new working methods or a new piece of equipment, they will struggle to carry out their duties effectively, inducing feelings of worry and anxiety.

Support An employee receives support formally from management and informally from colleagues and others with whom they interact at work. If the employee feels unsupported – because, for example, they feel that the problems they face are not appreciated by management or there is a lack of social support from colleagues – they are more likely to experience work-related stress.

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Relationships There is a wide variety of different people with whom we interact at work, including managers, colleagues, subordinates, customers, suppliers and members of the public. Often such relationships can be an important source of support, but they can also cause stress, e.g. if there is interpersonal conflict. Harassment and bullying are particularly important causes of stress and if they are not tackled can lead to stress-related illness. Harassment and bullying is defined as offensive behaviour involving an abuse of power by one person over another. This may arise as a result of prejudice based on factors such as gender, ethnic origin, religion or disability, or from other sources of power, such as a person's hierarchical position in the organisation, age, length of experience, educational background, social class, etc. Harassment and bullying can take place at all levels in the organisation and may be perpetrated by a manager towards a subordinate, between colleagues or by a subordinate towards their manager. Obvious examples of harassment and bullying include racist abuse, requests for sexual favours, spying and pestering, but it can also take more subtle forms, such as persistent belittling in front of others, excessive supervision, withholding information or social isolation.

Role If a worker's role in the organisation is unclear, because they are unsure of the scope, responsibilities and requirements of the job, or they are subject to conflicting demands, this is a significant source of stress.

Change Organisations are constantly having to adapt to changing external and internal conditions, such as new technology, political regulation and competition. Their response may include restructuring, downsizing and new ways of working. Such changes can have a beneficial impact for individual employees by making their work more interesting and enabling greater job satisfaction, but change can also cause worry, anxiety and feelings of insecurity, particularly if there is a threat of job losses.

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BSC International Diploma – Element 2A | Occupational Health

Managing Occupational Stress Risk Assessment The difficulty in identifying stress as a potential workplace agent is that it is not easy to predict what will cause harmful levels of stress. Different people respond to pressure in different ways and a stressful situation to one person might be seen simply as a stimulating challenge to another. Personal factors such as experience, personality, motivation and also the degree of support within and outside the organisation have a bearing on the likelihood of a particular situation being perceived as stressful. The conditions referred to above give us an idea of the signs and symptoms that may give an indication of a stress problem in the workplace. Exposure to high levels of stress is likely to have direct consequences for the health and performance of the workforce. However, it is difficult to make a definite causal link between the presence of potential stresses in the workplace and levels of staff health or performance. Nevertheless, any attempt to monitor stress levels or assess the degree to which the organisation has a stress problem is likely to use work performance, sickness absence data and staff behaviour as indicators. •

Work Performance The detrimental effect of stress on work performance may manifest itself as:

•

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Reduction in output or productivity.

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Increase in wastage and errors.

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Deterioration in planning and control of work.

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Poor decision-making.

Relationships Deteriorating relationships at work can result in:

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Tension and conflict between colleagues.

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Poor relationships with clients.

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Increased incidence of industrial relations or disciplinary problems.

Staff Attitudes and Behaviour The behavioural aspects of high stress levels that we noted earlier can result in the direct workplace effects of:

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Loss of motivation and commitment.

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Erratic or poor timekeeping.

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An increase in working hours but with possibly less output.

Sickness Absence The range of ill-health conditions attributable to stress is likely to cause an increase in general sickness absence but the main increase is usually that of frequent short periods of absence.

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BSC International Diploma – Element 2A | Occupational Health

Selection and Implementation of Suitable Control Measures As with all control measures, strategies to tackle work-related stress should be based on a risk assessment and apply the principles of best practice: 

Avoiding the risks, e.g. by establishing a positive organisational culture where working long hours or taking work home is not encouraged.



Combating the risks at source, e.g. by using effective recruitment and selection procedures to ensure that recruits have the requisite skills and experience to undertake the job, e.g. by giving employees freedom to plan their work to meet the deadlines required and catering for individual differences in a team.



Developing collective measures, e.g. by attending to such factors as working conditions, the organisation of work and relationships.

Many of the actions which an employer can take to address work-related stress can simply be described as good management practice. We shall look first at these six areas which we have already identified as causes of stress in the workplace, and then consider control measures relating to the culture of the organisation, training and factors unique to the individual.

Control Control relates to the influence that the individual has on the way he/she does their work. Employees should be able to have a say about the way they do their job. Employees should be encouraged to have more say in how their work is carried out, e.g. in planning their work, making decisions about how it is completed and how problems will be tackled. Staff should be encouraged to use their initiative and to take an interest in developing new skills that will enable them to face new challenges in the workplace. Consultation with staff over work patterns will help to make the individual feel that they have control and influence over their work situation.

Demands In this area, which concerns issues such as workload, work patterns and the working environment, employees should be able to cope with the demands of their job. The employer should ensure that demands on staff are not excessive in relation to the agreed hours of work, and should be prepared to re-prioritise tasks or re-negotiate deadlines to ensure that no employee is put under undue pressure. Staff with the appropriate skills for the job should be employed. Risk assessments should be undertaken to control physical and psychosocial hazards.

Support Support in the workplace relates to the help that employees receive in terms of encouragement and resources from colleagues at every level of the organisation. Employees should receive adequate information and support from their colleagues and superiors. Feedback to employees is an important way of improving performance and maintaining motivation. All feedback should be positive, with the aim of bringing about improvement, even if it is challenging. Feedback should focus on behaviour, not on personality. Managers should ensure that feedback is given for tasks which have been performed well, not only when there are problems.

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BSC International Diploma – Element 2A | Occupational Health

Employees should also be made aware of the support that is available to them within the organisation, whether from line managers, particular colleagues, the Human Resources Department or any other source, and how to access it if necessary.

Relationships Tension, conflict and unacceptable behaviour in the workplace all lead to a stressful work environment. Employees must not be subjected to unacceptable behaviour, such as bullying. In order to achieve this, clear standards of conduct should be communicated to employees, with managers leading by example. The organisation should have policies in place to tackle misconduct and harassment and bullying. It is important that employees are encouraged to report behaviour that is unacceptable in the workplace without feeling intimidated.

Role It is important that an individual understands clearly their role within the organisation. Role conflict can contribute significantly to occupational stress. Employees should understand their role and responsibilities. An employee’s role in the organisation should be defined by means of an up-to-date job description and clear work objectives and reporting responsibilities. If employees are uncertain about their job or the nature of the task to be undertaken, they should be encouraged to ask at an early stage.

Change The management of change has become increasingly important as organisations develop and restructure to cope with internal and external pressures. Change can be stressful for anyone at any time, but particularly so in the workplace when an individual’s employment may be threatened. The organisation should involve staff frequently when change is being implemented. If change has to take place, employees should be consulted about what the organisation wants to achieve and given the opportunity to comment, ask questions and get involved. Any possible impact on jobs should be explained, training should be available if required, and staff should be made aware of the timescale involved. Employees should be supported before, during and after the change.

Culture An organisation has a positive culture when there is open communication and trust between employer and employees. Workers should be encouraged to raise any problems, knowing that they will be recognised and dealt with promptly. There should be recognition of the importance of striking the right work-life balance. Work-related stress should be treated seriously, with the employer responding positively to any concerns.

Training Employees need to be competent and feel comfortable about doing their jobs. Induction training should be provided to new employees and the training needs of all workers be regularly assessed to ensure that they are equipped to deal with new challenges. There is a range of ways in which training can be provided, both on and off the job.

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Factors Unique to the Individual The employer should take into account that people's skills and the way they approach their work will differ and try as far as possible to cater for individual differences when allocating and managing work.

Monitoring and Evaluation of Control Measures The best method of monitoring and evaluating control measures that are implemented is to look again at the indicators that were used when carrying out a risk assessment.

Work Performance 

Has the output or productivity improved?

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Is there a decrease in wastage and errors?

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Is there an improvement in the planning and control of work?

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Is there better decision-making?

Relationships 

Has tension and conflict between colleagues eased?

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Are there better relationships with clients?

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Are there fewer industrial relations or disciplinary problems?

Staff Attitudes and Behaviour 

Has motivation and commitment risen?

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Is there better timekeeping?

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Has productivity improved in the usual working time limits?

Sickness Absence Has general sickness absence been reduced, particularly short periods of sick leave?

Rehabilitation Even after implementing such measures, there may be some sources of stress which are unavoidable and efforts should therefore be directed towards helping the individual employee to cope, by means of appropriate supervision, workplace counselling and stress management training. In some case, particularly if there has been significant absence from work, a gradual reintroduction to the work place with shorter hours and additional general training may be beneficial to the individual and the organisation.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A7

Title

Page

Bullying and Harassment

THE NATURE OF BULLYING AND HARASSMENT ................................................................................................. 3 DEFINITIONS ........................................................................................................................................................ 3 THE EFFECTS OF BULLYING AND HARASSMENT ON AN ORGANISATION .................................................................................... 4 THE IMPLICATIONS OF BULLYING AND HARASSMENT AT WORK............................................................................................. 5 RECOGNISING BULLYING OR HARASSMENT IN THE WORKPLACE .................................................................... 6 STAFF SURVEYS ..................................................................................................................................................... 6 EMPLOYEE FEEDBACK FACILITIES ................................................................................................................................ 6 COMMUNICATION/CONSULTATION ............................................................................................................................... 6 MANAGING BULLYING AND HARASSMENT IN THE WORKPLACE ....................................................................... 7 DEVELOPMENT OF STAFF SURVEY................................................................................................................................ 7 ANALYSIS AND INTERPRETATION OF COMPANY DATA ........................................................................................................ 7 DEALING WITH COMPLAINTS ..................................................................................................................................... 7 DEVELOPMENT OF POLICY......................................................................................................................................... 8

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A7 | Bullying and Harassment Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.7.1 Explain how bullying and harassment can affect an organisation 2.A.7.2 Recognise instances of bullying or harassment in the workplace 2.A.7.3 Advise the employer on the management of bullying and harassment

Unit 8:

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The Nature of Bullying and Harassment Bullying and harassment of any kind should not be tolerated in the workplace and can have a detrimental effect on individuals, their families and organisations. Personnel making such complaints define bullying or harassment as something that has happened to them that is unwelcome, unwarranted and causes a detrimental effect. Any employee who makes such a complaint has a grievance, which must be dealt with, regardless of how the individual defines the event that has led to the complaint. Bullying and harassment are not necessarily face-to-face incidents; they may be by written communications, electronic (e) mail (sometimes called ‘flame-mail’), phone, and automatic methods, e.g. computer recording of downtime from work, or recording of telephone conversations, especially if this is not universally applied to all workers. Bullying and harassment can often be hard to recognise and may be seen as normal behaviour within a particular workplace. Individuals do not want to appear weak, incapable of doing their job, or be in fear of retribution or of over-reacting. They may worry that they won’t be believed if they do report incidents in intimidating situations. Work colleagues themselves may be reluctant witnesses, as they may fear any personal consequences and may collude with the bully to avoid attention.

Definitions Bullying The purpose of bullying is to hide inadequacy. The focus of such bullying is often competence-based, often believed to be due to the lack of competence of the individual being bullied. In reality, the target of bullying is often competent and popular, and the bully is aggressively projecting their own social, interpersonal and professional inadequacies. Such inadequacy might be to avoid facing up to their problems or accepting responsibility for their behaviour, or to distract and divert attention away from their own incompetence. Bullies are typically aggressive, cowardly, impulsive and dominating. Bullying is often psychological but rarely physical, except where males are involved. The bully may be a compulsive liar, with a deceptive nature - in such cases their word, even under oath, is questionable. Such bullies tend to remain in their positions within a company if it is a badly managed or insecure workplace. There are various types of bullying, e.g. pressure (shouted or sworn); corporate (snooping or spying on employees); institutional (entrenched in the culture of the organisation); cyber bullying (by misuse of the e-mail system), etc. A common definition of bullying may be "offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient." Bullying can take many forms, e.g. verbal abuse, violent gestures, physical violence, allocation of blame and 'picking on' workers unfairly, public humiliation of workers, or a more 'subtle' war of words to undermine the worker's confidence. It is regular intimidation that undermines the confidence and capability of the individual. Extreme cases of bullying are easily spotted but more subtle incidents may be hard to identify as specific behaviour. While bullying is the common feature of all harassment, discrimination, abuse, conflict and violence, bullying varies from harassment in many ways.

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Harassment Harassment is unwanted, unwelcome, unacceptable or intimidating conduct affecting the dignity of men and women in the workplace. It may be related to age, sex, race, disability, religion, nationality or any personal characteristic of the individual, and may be persistent or an isolated incident. Such actions or comments are seen as demeaning and unacceptable. Typical examples might be: 

Any physical contact which is unwanted, e.g. sexual advances.

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Coercion, isolation or 'freezing-out'.

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The display of offensive material, e.g., 'pin-ups'.

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Offensive or racist jokes.

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Unwelcome remarks about a person's dress, appearance, race or marital status.

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Shouting at staff.

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Personal insults, verbal abuse, etc.

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Persistent criticism.

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Setting impossible deadlines.

The Effects of Bullying and Harassment on an Organisation In addition to the effects on individual workers, bullying at work can also have a major effect on an organisation. Victims of bullying are likely to suffer from stress-related illnesses leading to significant levels of sickness absence. Given that a third of all sickness absence in the UK is stress-related, this can have an immense effect on organisations. In addition, where employers base recruitment and promotion decisions on sickness absence levels, bullying and harassment can have a major impact on the career of individuals. Harassment can come from various sources, e.g. colleagues, management, members of the public, etc., for various reasons, e.g. sex of the victim, race, ethnic origin or nationality, etc. Such behaviour may lead to grievance and/or disciplinary procedures and to increasing stress in the workplace. Remedies within the law can result in the loss of time, money and effort to employer and employee, and lead to bad publicity for the organisation. Bullying and harassment are not only unacceptable on moral grounds but may, if unchecked or badly handled, create serious problems for an organisation including: 

Loss of respect for managers and supervisors.



Damage to the company's reputation.

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Tribunal and other court cases and payment of unlimited compensation.

It is in every employer’s interests to promote a safe, healthy and fair environment in which people can work. Harassment and bullying at work can cause fear, stress, anxiety and physical sickness amongst employees and may affect the victim's personal and family life.

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High Absenteeism Bullying or harassment at the workplace may result in increased levels of employee absenteeism. Trends can be identified by looking at absence records, especially for shift workers who have been regular attendees but suddenly start showing high levels of absenteeism, possibly due to a change of shift supervisor or shift personnel. Great care is required in dealing with such situations as it can lead to the resignation of the person involved.

Poor Morale For the employer the result of bullying and harassment is not just poor morale amongst the workforce, but it can also lead to high staff turnover, reduced productivity, lower efficiency and a divided workforce with an apparent lack of commitment.

Poor Quality and Output Businesses are constantly striving to achieve high levels of output and performance from employees in an increasingly competitive marketplace. Stakeholder pressure and business competition have led to companies pruning, reducing, downsizing or restructuring operations, thus seeking greater profit margins with reduced staff numbers. The situation has led to a great deal of pressure on the workforce, which allied with differing management styles, e.g. autocratic or divisive styles of management, can lead to harassment and bullying in the workplace.

Increased Accident Rate Bullying can also affect an individual in their job and may result in loss of concentration and perception of safety due to the constant bullying and harassment or pressure to perform a particular job well. Such problems are normally aimed at the person’s competence to do a particular job.

The Implications of Bullying and Harassment at Work Bullying and/or harassment at work may lead to cases of stress, i.e. the adverse reaction a person has to excessive pressure or other types of demand placed upon them. It is important therefore for employers to look after the health of employees, including taking steps to make sure that employees do not suffer stress-related illness as a result of work. Bullying is a cause of stress and employers should ensure that action to eliminate bullying at work is included in their occupational health policies. Depending on the country’s legislative requirements, employers may be liable for the actions of their workers at work or in a work-related situation (e.g. a social event) unless they can prove that they have taken all reasonable steps to prevent bullying and harassment occurring. The ‘serial’ bully is a danger to the health and safety of any individual and therefore it is good practice for employers to make an assessment of the risks to the health and safety of their employees. This is to ensure that both preventative and protective measures are taken against such problems occurring. A risk assessment for stress involves: 

Looking for pressures at work which could cause high and long-lasting levels of stress: who might be harmed by it and whether the employer is doing enough to prevent that harm.



If necessary, the employer must then take reasonable steps to deal with those pressures.

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Recognising Bullying or Harassment in the Workplace As we discussed earlier, the implications of bullying and harassment in any organisation can have a detrimental effect on its employees, their families and the organisation as a whole. It is therefore crucial that bullying or harassment in the workplace is recognised quickly. However, these problems are sometimes difficult to identify and therefore a variety of methods are available to help organisations to identify bullying and harassment in the workplace. The following are some methods that can be used to recognise bullying and harassment at work.

Staff Surveys Staff surveys regarding the subjects of bullying and harassment may be a useful tool against their occurrence in the workplace. The surveys could be informal or formal - whatever their format valuable information may be obtained. Typical information that might be asked relates to its seriousness, main sources, the form it takes, frequency, time taken off, causes, availability of counselling, etc. Any such surveys should be anonymous and confidential. This should be made clear to all staff who take part in the survey. It is also important that management is seen to support the survey, emphasising their opposition to bullying and harassment in the workplace.

Employee Feedback Facilities Suggestion boxes or information/help lines at work may also be helpful in alleviating bullying and harassment at work. Such information may be fed back via staff representatives. Working groups can also provide useful information, which can be reported back to employers or their representatives. “Whistle blowing” (where a junior employee reports or informs on his/her superior’s misconduct) should be actively encouraged.

Communication/Consultation A significant problem with regard to bullying and harassment is that those who are subjected to it feel particularly vulnerable and are often reluctant to complain. It is therefore important that all staff are encouraged to use whatever communication channels are available within the organisation in order to highlight any problems that exist. Management therefore has a responsibility to attempt to establish appropriate methods of communication to deal with such problems. Signs on notice boards, confidential counselling, advice and support services, continuous expression by whatever communication method is available of what the organisation considers to be unacceptable behaviour, and readily accessible information on how to make complaints are all important. Widespread availability of the company policy on bullying and harassment is also essential. Consultation by management with employee representatives offers an opportunity for any concerns to be expressed on both sides. Team briefs, one-to-one discussions (not just when appraisal is due), newsletters, etc. are all forms of communication that can be used to spread knowledge and information about concerns relating to unsuitable behaviour in the workplace, which will hopefully encourage victims to come forward with any complaints.

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Managing Bullying and Harassment in the Workplace Employers should make employees aware of what is regarded as unacceptable behaviour in their organisations, e.g. 

Spreading malicious rumours, or insulting someone (particularly on the grounds of race, sex, disability, sexual orientation and religion or belief).



Copying memos that are critical about someone to others who do not need to know.

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Ridiculing or demeaning someone – picking on them, or setting them up to fail.

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Exclusion or victimisation.

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Unfair treatment.

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Overbearing supervision or other misuse of power or position.

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Unwelcome sexual advances – touching, standing too close, the display of offensive materials.

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Making threats or comments about job security without foundation.

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Deliberately undermining a competent worker by overloading them with work and constant criticism.



Preventing individuals progressing by intentionally blocking promotion or training opportunities.

There are a number of ways that can be used to manage such unacceptable behaviour at work.

Development of Staff Survey Staff surveys or questionnaires are useful devices that can show where problems are occurring. Confidentiality is paramount in such surveys and the wording of the survey needs to be carefully thought out. Similarly the actual distribution, collection, processing and publishing of results must be impartial, accurate and carefully carried out. A cross-section of the workforce is likely to be asked to complete such a survey, and processing should be carried out under the supervision of a senior member of the organisation. This will show the commitment of the company to dealing with any bullying or harassment problems that are exposed.

Analysis and Interpretation of Company Data Analysis of company-held data can show where and within which departments problems relating to bullying or harassment occur. Simple analytical trends relating to absenteeism, performance, productivity, tribunal/court cases or the payment of compensation are all relevant sources of information.

Dealing with Complaints Unacceptable behaviour due to bullying or harassment, whether or not a complaint is made, must be treated seriously and immediate and effective action taken to eliminate the problem.

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It is usually best to attempt to deal with complaints internally on an informal basis. In this manner the problem can be dealt with both speedily and effectively. This can minimise a potentially embarrassing situation and prevent a breach of confidentiality. However, if an informal approach is ineffective, and it is a serious case, e.g. assault, or if the individual prefers, formal action may be required. Such formal action must take place within the company's normal disciplinary procedures/guidelines. Such policies should give the complainant the right to register their complaint with someone outside their direct management line since the complaint may be against their line manager.

Development of Policy A formal policy relating to bullying and harassment is sometimes useful but often firms tend to include the topic within other personnel policies; staff should be involved in the development of such policies. A useful starting point may be a simple checklist which might include: 

A statement of commitment from senior management.



An acknowledgment that bullying and harassment are problems for the organisation.



A clear statement that bullying and harassment will not be tolerated.

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Examples of unacceptable behaviour.

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A statement that bullying and harassment may be treated as disciplinary offences.

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The steps the organisation takes to prevent bullying and harassment.

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Responsibilities of supervisors and managers.

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A statement regarding confidentiality for any complainant.

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Reference to grievance procedures (formal and informal), including timescales for action.

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Details of investigation procedures, including timescales for action.

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Reference to disciplinary procedures, including timescales for action, counselling and support availability.



Training for managers.

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Protection from victimisation.

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How the policy is to be implemented, reviewed and monitored.

The company must initially make it clear that bullying and harassment are unacceptable and will not be tolerated and provide definitions of bullying and harassment at work and notification that they are disciplinary offences. The policy should apply to all staff on and off company premises, and include personnel working away from their base as well as contractors and visitors. As such, the policy should contain clear responsibilities for employers, management and employees under any applicable health and safety at work legislation. The company should avoid an authoritarian and confrontational style of management and nurture one of consultation. The policy should have and maintain a confidential, clear and fair grievance and disciplinary procedure which allows the company to deal quickly and effectively with complaints of bullying and harassment.

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Standards of behaviour at work should be made clear to all staff by means of an organisational statement. This may be supplemented by guidance booklets, a staff handbook, and awareness training sessions or seminars. Complaints of bullying and/or harassment, or information from staff relating to such complaints, must be dealt with fairly and with appropriate confidentiality and sensitivity. The role of safety representatives in such proceedings should be made clear. They have a dual role, i.e. educating the workforce about inappropriate behaviour as well as receiving complaints from employees. A specific policy relating to bullying and harassment has a number of advantages, e.g. it helps good relationships in the workplace, promotes equality of opportunity and social justice, avoids stress and hostility and promotes formal procedures for creating a safer, healthier and happier workplace. An effective policy is one that is legal (where applicable), agreed, and produced as a result of proper consultation and negotiation between unions and employers. The policy should be widely known and put into practice. There should also be a procedure to review and monitor the policy, including any complaints made. Other measures it may include are opportunities for the appropriate training of all employees and managers in the conduct of hearings, as well as providing trained counsellors. The policy should be included in recruitment or induction packs. Such a policy should include details of an independent person who may provide help and support for those being bullied or harassed. A bullying and harassment policy should include the following specific areas:

Scope The policy should give guidance on all aspects of bullying including definitions, company commitment, individual responsibilities, appropriate complaints and disciplinary procedures and penalties/action that might be taken. The policy should cover all staff including managers, contractors, visitors and members of the public, as well as information on where to get assistance, counselling, etc.

Rationale The underlying principle or reasons for such a policy must be clearly laid out, e.g. bullying/ harassment is unacceptable in the workplace. Employers have a responsibility towards their employees in this respect. Bullying and harassment as such can have a detrimental effect not only on the individuals concerned, but also on their families and the organisation itself.

Management Responsibilities The ultimate responsibility for such a policy procedure rests with the managing director, board of directors or the management board, as appropriate. Similarly in smaller organisations it may be the senior partner who is responsible. Good practice involves appointing such a person to be responsible, accountable and with appropriate authority for such a policy. In such a case they might need to ensure that the policy and procedures are fully developed, implemented and appropriately carried out in all areas of the organisation, e.g. reporting complaints, disciplinary procedures, counselling, etc. Where appropriate the responsible person might need to appoint a competent person to deal with such measures. Other management responsibilities include ensuring that the policy achieves all its objectives, and any monitoring, review and reporting to senior management as required.

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Triggers for Action The use of staff surveys, complaints procedures and the analysis of company data on staff absences, sickness, tribunal action, etc. may assist and be a trigger for action with regard to bullying and harassment in a company.

Disciplinary Procedures Initially the complaint must be investigated promptly and objectively, and the complaint taken seriously. The investigation must be seen to be objective and independent. Decisions can then be made as to what action needs to be taken, e.g. initially counsel bullies to enable them to change their offensive behaviour. This might rectify matters informally in a way that provides a confidential and informal approach. In this way the complaint may be resolved without further action taking place. However, if bullying continues then an investigation must be carried out, and if necessary, disciplinary action taken at the appropriate level of the organisation’s disciplinary procedure. The procedure followed must be fair to both the complainant and the person accused. Briefly, a disciplinary procedure should: 

Provide for matters to be dealt with quickly.



Ensure that individuals are made fully aware of what their disciplinary offence is.



State the type of disciplinary action and who can take it.

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Provide for a full investigation which gives individuals an opportunity to state their case.

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Allow individuals to be accompanied by an employee representative or a colleague.

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Not permit dismissal for a first offence (except for gross misconduct).

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Ensure an explanation is given for any disciplinary action taken.



Specify an appeals procedure.

In cases which appear to involve serious misconduct, and there is reason to separate the parties, a short period of suspension of the alleged bully/harasser may need to be considered while the case is being investigated. This should be with pay unless the contract of employment provides for suspension without pay in such circumstances. A suspension without pay, or any long suspension with pay, should be exceptional as such action in itself may amount to a disciplinary penalty. Do not transfer the person making the complaint unless they ask for such a move. Written warnings, suspension or transfers are examples of disciplinary penalties that might be imposed. Care must be exercised when a possible suspension or transfer is considered (unless contracted to) as this could breach the employee’s contract, e.g. transfer to a different location, which means additional expense or a less responsible job. Where gross misconduct is involved dismissal without notice may be appropriate, but must follow a laid down procedure. It is important that the disciplinary system is always strictly adhered to and that the procedure is followed correctly and fairly. Because of its very nature a disciplinary procedure is often seen to be part of the management system. It is also often the case that managers are the cause of bullying and harassment in the workplace because of their status and power. The disciplinary procedure must therefore be seen to be working fairly and must give both the complainant and the accused every opportunity to put forward their cases.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A8

Title

Page

Shift Working

SHIFT WORKING: BACKGROUND....................................................................................................................... 3 THE HEALTH EFFECTS OF SHIFT WORK .............................................................................................................. 3 PHYSICAL EFFECTS ON EMPLOYEES .............................................................................................................................. 4 PSYCHOLOGICAL EFFECTS ON EMPLOYEES...................................................................................................................... 5 QUALITY OF LIFE ................................................................................................................................................... 5 THE EMPLOYER’S RESPONSIBILITIES RELATING TO SHIFT WORKERS ............................................................. 5 ASSESSMENT OF PARTICULAR RISKS OF SHIFT WORK........................................................................................................ 5 EDUCATION OF SHIFT WORKERS................................................................................................................................. 6 ORGANISING SHIFT PATTERNS ................................................................................................................................... 7 CONSULTATION WITH SHIFT WORKERS......................................................................................................................... 8 HEALTH ASSESSMENTS ............................................................................................................................................ 8

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A8 | Shift Working Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.8.1 Explain the health effects of shift work 2.A.8.2 Determine, implement, evaluate and maintain measures for controlling risks associated with shift working

Unit 9:

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Shift Working: Background The requirements of a ‘24 hour’ society means that more individuals now work at night or on shifts. Although there may be no precise definition of shift work it is generally considered to be a work activity scheduled outside standard daytime hours, where there may be a handover of duty from one individual or work group to another, or where there is a pattern of work where one employee replaces another on the same job within a 24-hour period. Shift work, in particular night work, and rotating shifts can have negative impacts on the health and well-being of workers, some of which we discuss below.

The Health Effects of Shift Work The findings of epidemiological studies can, sometimes, be limited by the presence of compounding factors. In fact, early research sometimes found shift workers to be ‘healthier’ than day workers, possibly due to such factors. However, continued research is beginning to identify some strong associations with negative impacts on health. In 2003 the International Labour Organisation (ILO) produced a study examining the impact that different types of work patterns can have on the well-being of workers who experience them. In their report, Working Time: Its impact on Safety and Health they review the research information available and draw a number of conclusions. In relation to shift work and health: 

Strong evidence exists of gastrointestinal disorders.



Strong evidence exists of cardiovascular disorders.



Some evidence exists of reproductive disorders.



In most cases, night work increases the risks of health disorders.



Except for sleep disorders, the underlying cause of any association is not fully understood.



Individual differences in physiology, attitudes and behaviour are likely to be important in modifying the health effects of shift work.

In relation to shift work and safety: 

Data relating to both shift work in general, and night work in particular, are inconsistent and inconclusive.



Despite lack of consistent and conclusive data it should not be assumed that shift work is safe.

One of the main reasons for negative health impacts is that human physiological functions are aimed towards daytime activity and night-time rest. These functions are regulated by internal biological clocks and fluctuate in cycles, or rhythms. The main physiological functions, such as core body temperature, hormone production, heart rate, blood pressure, gastric activity and sleep/wake cycle all have rhythms of approximately 25 hours. They are synchronised by the internal biological clock and reset to the 24-hour day/night cycle by external factors such as lighting levels. These rhythms are known as circadian rhythms. Certain rhythms, for example core body temperature, tend to operate with peaks and troughs during the 24-hour period. Core body temperature peaks at around 11.30 hours and 19.00 hours and troughs at around 04.00 hours and 14.00 hours. During the troughs, the body most wants to sleep.

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When shift workers adjust their sleep/wake cycle, circadian rhythms do not adjust quickly enough, with each rhythm adjusting at a different rate. Some take a week or more to adjust completely, by which time shift workers are often changing to another shift pattern. How quickly the circadian rhythms adjust depends on individual factors such as age, gender, physical health and chronotype (the scientific name for the individual circadian rhythm pattern). Some people are more prone to ‘morningness’ (larks) and others to ‘eveningness’ (owls). Others fall in to neither category.

Physical Effects on Employees Fatigue Shift work usually results in individuals trying to sleep in the daytime, when the body is at its most alert, and working when the body is preparing to sleep. This imbalance with the normal circadian rhythms can result in disrupted sleep patterns leading to an overall reduction in the actual hours of sleep and broken sleep resulting in a cumulative sleep deficit. A European Survey of Working Conditions (Shift work and Health. A.Wedderburn), carried out in 1996 found that 14% of shift workers reported sleeping problems compared to 5% of day workers. Fatigue can lead to poor performance, lack of concentration and poor motivation, and increase the likelihood of errors occurring, reduce vigilance and decrease reaction time. Clearly, in safety critical tasks sleep deprivation could lead to serious consequences. Sleep difficulties are often seen as the root cause of many other problems associated with shift work but the area is complex and causal links have not yet been fully established.

Digestive Problems A number of studies have shown a greater prevalence of gastrointestinal disorders, such as appetite disturbances, bowel irregularity, peptic ulcers and colitis in shift workers. As gastric function is affected by the internal body clock, perhaps such findings are not surprising. However, shift workers usually also have disrupted mealtimes, with food being eaten hurriedly and in less than comfortable surroundings. It is also often the case that good catering facilities are not available during the night shift, possibly resulting in a poorer diet. Gastrointestinal disorders appear to be the most reported health effect of shift work, both anecdotally and scientifically.

Cardiovascular Disease The 2003 ILO study we considered earlier indicates an association between cardiovascular disease and shift work although this could be confounded by the fact that shift workers may be of a lower socio-economic status than day workers. Behavioural factors, such as the frequent consumption of high fat/carbohydrate meals, smoking, alcohol intake and the irregular timing of meals may all be contributory factors. Heart disease is also often associated with factors such as anxiety, stress and sleep disorders, conditions that tend to be linked to shift work.

Respiratory Problems Lung function may well decline at night, especially for those with a chronic respiratory condition. Asthma attacks and allergic reactions may become worse at night.

Reproductive Problems Recent research is beginning to show links between women working shifts, particularly rotating shifts, and a number of reproduction issues including:

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Irregular menstrual cycles and pains.

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A higher risk of miscarriage.

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A lower rate of pregnancy.

Whilst it is early yet to draw absolute conclusions in relation to the shift work effects on female reproduction, this is clearly an area where future research is likely to concentrate.

Psychological Effects on Employees Shift workers have been reported to complain more frequently than day workers of symptoms related to chronic fatigue, nervousness, anxiety, sexual problems and depression. Research also suggests there is a greater reliance on the use of sleeping pills and tranquillisers. There is limited research in this area and again the possibility of self-selected groups’ may introduce a confounding factor. Depressive patients have been shown to often have a circadian dysfunction and it follows that such persons could be more vulnerable when working shift work. Those individuals with neurotic tendencies or who are introverted by nature seem to have a greater intolerance of shift work. The pressures of sleep deprivation and domestic conflict can often lead to poor morale and job dissatisfaction.

Quality of Life Shift work not only causes desynchronisation with the internal biological clocks but also with social life. The constraint that shift work imposes on one individual also tends to impact the social and family life surrounding them. Free time with families, particularly children, can be limited and shift workers may alter their sleep patterns to fit in with family life, leading to further sleep deprivation. The shift worker is often prevented from entering in to the formalised frameworks of their social environment and may have less of a role in decision-making in the household, possibly introducing the feeling of isolation. Time spent with partners tends to be limited and the quality of any time spent together can be questionable. Shift workers often find it difficult to fulfil parenting and social responsibilities, e.g. a parent working a late shift may find it difficult to attend a school open evening. The resultant psychological tensions can further exacerbate any physical or mental conditions experienced by the shift worker. The extent of the impact on the quality of life tends to be determined by age, number and age of children and to some extent the personality of the individual.

The Employer’s Responsibilities Relating to Shift Workers Assessment of Particular Risks of Shift Work There are two areas that need to be considered when assessing the particular risk of shift work: the design of the job, and the characteristics of the individual. In terms of the individual's characteristics the following may need to be considered dependent upon the shift patterns worked and the critical safety of the operation: 

Personality type: introverts are more shift work intolerant.

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Neurotic (anxiety, restless, moody)/ stable (calm, reliable) personality: those with neurotic tendencies tend to be less able to cope with shift work.

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‘Morningness’ or ‘eveningness’: those people exhibiting ‘morningness’ tend to have problems adapting to shift work and have an inability to cope with night work.



Age: while older individuals are more experienced, better at coping and have fewer domestic pressures, they tend to become more shift work intolerant beyond the age of 40. This may be a reflection of the tendency of the individual to become more of a ‘lark’ as he/she gets older. There is a school of thought that over 40 years of age, night shift should be on a voluntary basis only.



Existing medical conditions: some conditions, such as an existing gastrointestinal or cardiovascular problem, may result in the individual being more vulnerable to the risks associated with shift work.

One of the most important factors in relation to the organisation of the work to be considered is the shift pattern. Any assessment would need to consider: 

The possibility of increased risk of accidents and injuries caused by sleep deficit and fatigue. Consideration will need to be given to: −

The type of shift pattern and the frequency of rotation.

−

Any increased risk of physical effects caused by the disruption of the internal body clock and disturbed eating patterns.

−

Any increased risk of psychological problems resulting from the biological disruptions and the pressures and conflict created with social and family life.

In addition, consideration should be given to: 

Whether any other occupational hazards, the risk from which is increased while working shift work, exist.

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That adequate workplace facilities are available.

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Workplace conditions, such as heating, lighting and ventilation, which should be at an optimal level to maintain alertness.



The regularity of health assessments.

Unlike normal hazards it is not possible to refer to existing agreed standards. The health effects of shift work are complex and, as outlined above, some evaluation of the individual is therefore required. A Standard Shift Work Index (SSI) has been developed (Barton et al, 1995), which is a tool which utilises self-report questionnaires aimed at determining the physical and psychological risks to the health of shift workers. The SSI relates to characterising the work context, effects on health and well-being and individual differences, which may modify those effects. There are other questionnaires available, all of which are useful tools to assist in the risk assessment process.

Education of Shift Workers Whilst the physiological effects of shift work cannot be changed by educating the worker, the recognition of fatigue and awareness of the effects of shift work will assist the individual in implementing coping strategies. Employees should be given guidance on sleep management, diet content and the need for regular meals, and the positive effects of regular exercise.

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For example, education on the practical means of achieving effective sleep may be beneficial, as people's circadian rhythms are to some extent reset by external factors such as sunlight; thus avoiding bright light as far as possible following the night shift is advisable. Simple measures such as the importance of sleep routines, signage on front doors at home to prevent daytime callers, turning the telephone on to the answerphone/turning the mobile phone off, and avoidance of caffeine prior to sleep will all assist in achieving effective sleep. Healthy eating rules are the same as for day workers, but shift workers tend to eat at irregular times. Alcohol and caffeine can have a disruptive effect on sleep at the end of a shift. As the circadian rhythm for gastrointestinal function is at a minimum during the night certain foods will cause problems if eaten during the night, and there are often less nutritious foods available to the night worker. The benefits of regular exercise are well known but shift workers often find it more difficult to establish a regular exercise regime due to their shift pattern. Generally exercise just prior to the shift is likely to be more beneficial than exercise prior to sleep, which is likely to increase alertness.

Organising Shift Patterns Whilst it is unlikely that an ideal shift system, which perfectly matches the needs of the organisation and the individual, will exist, the use of poor shift schedules can be reduced. When identifying the shift pattern various parameters need to be considered: 

Fixed or rotating shifts.

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Direction (forward rotating or backward rotating) and speed of shift change.

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Length of shifts.

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Starting time of shifts.

Evidence tells us that the common weekly shift rotation is most likely to cause problems. Circadian rhythms take at least a week to begin to adjust, just in time for the sleep/wake cycle to change again and the need for the circadian rhythms to adjust back. The weekly shift schedule has also been found to build up a substantial sleep deficit. Shift rotation should either be quicker or shorter than the traditional weekly rotation. Rapid rotating shifts mean that the circadian rhythms remain day orientated, causing limited disruption, but the disadvantage is that alertness during the night shift is likely to be poor. Forward rotating shifts, i.e. morning, afternoon then night, and shifts of eight hours or less duration, have been found to be the least disruptive. An early start to shifts, e.g. 06.00 hours, can be problematic and consideration should be given to starting the morning shift at 07.00 or 08.00 hours. To help determine the best shift schedule the HSE have published a report Validation and development of a method for assessing the risks arising from mental fatigue (Contract Research Report 254/1999). Information is available at: www.hse.gov.uk. This document introduces the concept of a Fatigue Index calculation. The purpose of the fatigue index is to allow the comparison of two or more shift patterns to determine that which is least likely to cause fatigue. The calculation of five figures is required: 

F1 - Shift Start Time.



F2 - Shift Duration.

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F3 - Rest Period Between Shifts.

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

F4 - Breaks During Shifts.



F5 - Cumulative Fatigue.

The total of the scores gives the index for a particular shift schedule. There are additional calculations where work requires extensive mental or physical stamina.

Consultation with Shift Workers Attitudes appear to play an important role in determining whether physical and/or psychological effects occur as a result of shift work. It is therefore good practice to consult workers about the organisation of their working time. The best combination of the flexibility of the employer and the needs of the employee will result in a shift pattern that is accepted by employees with the least possible negative health effects. In addition, night shift workers often feel isolated from the rest of the organisation. They have less easy access to; for example, human resources, pay roll enquiries, and general health and safety information. Shift workers should be consulted on all aspects of the organisation that affect their work and should be included in briefings, presentations, and other employee initiatives.

Health Assessments Health assessments should be carried out before workers begin shift work and at regular times after starting employment. Identification of individual characteristics which are associated with poor tolerance with shift work, particularly night work, can assist partly in the selection of suitable employees and also with the coping strategies applicable to the individual. The frequency of regular assessments is likely to be determined by the risks associated with the particular shift pattern and the characteristics, including age and fitness, of the individual. Evaluation of lifestyle behaviours, such as the use of alcohol, tobacco, caffeine and sleeping pills may be appropriate. Other measures of blood pressure, cholesterol levels and weight and body fat assessment may be appropriate. Reference to a worker's previous health records/medical history may also be useful. Where a health assessment identifies certain medical conditions, it would be advisable for the employer to move an individual to a day shift where possible. Such medical conditions may include: 

Diabetes, particularly where treatment with insulin or a strict timetable is required.



Some heart and circulatory problems.

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Stomach or intestinal problems.

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Medical conditions affecting sleep.

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Some chronic chest disorders.

The UK’s Health and Safety Executive has developed useful guidance regarding the management of shift work. HSG256 can be downloaded from www.hse.gov.uk and is useful background reading.

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C O N T E N T S Study Unit 2A9

Title

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New and Expectant Mothers

BACKGROUND ..................................................................................................................................................... 3 THE MAIN HAZARDS TO NEW OR EXPECTANT MOTHERS ................................................................................... 4 PHYSICAL AGENTS .................................................................................................................................................. 4 BIOLOGICAL AGENTS ............................................................................................................................................... 5 CHEMICAL AGENTS ................................................................................................................................................. 5 ERGONOMIC HAZARDS AND WORKING CONDITIONS.......................................................................................................... 6 CONTROLLING RISKS TO NEW OR EXPECTANT MOTHERS ................................................................................. 8 RISK ASSESSMENT FACTORS ...................................................................................................................................... 8 PROVISION OF REST FACILITIES ................................................................................................................................. 8 ALTERING THE WORKING CONDITIONS ......................................................................................................................... 8 PROVIDING ALTERNATIVE WORK ................................................................................................................................ 8 SUSPENSION FROM WORK ........................................................................................................................................ 9 POSSIBLE REMOVAL FROM NIGHT WORK ....................................................................................................................... 9

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A9 | New and Expectant Mothers Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.9.1 Describe the main hazards to new and expectant mothers and explain how they may cause harm 2.A.9.2 Advise employers on their responsibilities in relation to new and expectant mothers

Unit 10:

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Background A new or expectant mother is considered to be an employee who is pregnant, who has given birth within the last six months or who is breast-feeding. There are many women who work while they are pregnant and who return to work while they are breast-feeding. In many work situations there are risks to both the mother and unborn child, which may affect their health and safety. In this respect the working conditions of a woman while she is pregnant or breast-feeding need to be considered closely. Employers have a responsibility to protect new and expectant mothers at work, and in many countries legislation governing new and expectant mothers will in place to ensure that risks are properly managed. Due to signs of pregnancy not being immediately apparent in all cases, notification to employers (at the earliest possible time) that a worker may be pregnant or breast-feeding is important to enable any adjustments to be made to safeguard the mother and the child and protect them from harm.

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The Main Hazards to New or Expectant Mothers New and expectant mothers may be at risk from various Physical, Biological, Chemical and Ergonomic hazards in the workplace as well as from unsuitable working conditions. Some of the more common risks are discussed below.

Physical Agents Certain physical agents may cause problems during pregnancy.

Vibration Regular exposure to shocks, low frequency vibration, e.g. driving or riding in off-road vehicles, or excessive movement may increase the risk of a miscarriage or low birth weight for the baby. These sorts of problems can occur when travelling inside or outside of work.

Noise Excessively noisy workplaces and prolonged exposure to loud noise may lead to increased blood pressure and tiredness. In this respect there are no particular problems for women who have recently given birth or who are breast-feeding.

Radiation Significant exposure to certain ionising and non-ionising radiation is known to be harmful to the unborn child. Work procedures and codes of practice should be adopted to keep exposure as low as reasonably practicable. Pregnant women should have any such possible exposure reviewed and control measures should be adopted according to the risk assessment. Anyone at risk to such radiation should be moved to another part of the work system for the duration of the pregnancy and consequent period of breast-feeding. Radioactive material can be ingested or inhaled by the mother and then transferred to the unborn child, or may irradiate the unborn child through the wall of the womb. Similarly, radioactive material may pass into the milk of a breast-feeding mother and hence to the child. Radioactive contamination of the skin may also present a direct radiation hazard to the suckling infant. Pregnant or breast-feeding mothers are at no greater risk than other workers to optical radiation. Exposure to electric and magnetic fields (e.g. radio-frequency radiation) is not known to cause harm to the unborn child or the mother. However, extreme over-exposure to radio-frequency radiation could cause harm by increasing body temperature.

Temperature Working in high or low temperatures can also give rise to certain problems and care must be taken that the woman wears appropriate clothing and that suitable rest facilities and refreshments are provided. Pregnant women feel the heat easily and possible fainting or dehydration may occur due to heat stress. Such effects may also impair someone who is breast-feeding and has recently given birth.

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Biological Agents Exposure to infectious diseases can infect the unborn child if the mother is infected during pregnancy, e.g. hepatitis B, HIV/AIDS, herpes, TB, syphilis, chickenpox, typhoid, rubella (German measles), toxoplasmosis transmitted from undercooked meat, contaminated soil or Chlamydia (from sheep). Clearly, due to the type of work certain occupations are at more risk than others, e.g. laboratory workers, people looking after animals, etc.

Chemical Agents Problems in pregnancy, etc. may be caused by chemical handling or through skin absorption, etc. (handling drugs or specific chemicals such as pesticides, herbicides, insecticides and fungicides, lead and lead derivatives, mercury and mercury derivatives, etc.) including chemical agents that have specific risk phrases assigned to them that indicate a risk to the mother or the child. Typical chemicals that present a risk include: 

Substances labelled R40, R45, R46, R61, R63 and R64.



Carbon monoxide (see below).



Lead and lead derivatives (see below).



Mercury and mercury derivatives (see below).



Chemical agents of known and dangerous percutaneous absorption.

Carbon Monoxide (CO) Carbon monoxide is produced from petrol, diesel and liquefied petroleum gas (LPG) engines and domestic appliances. There is a risk when engines or appliances are operated in enclosed or confined spaces. Pregnant women and unborn children may exhibit effects from CO which can result in the unborn child being starved of oxygen. Both the level and duration of the mother's exposure are important in the effect on the unborn child. There is no indication that breast-fed babies suffer adverse effects from their mothers' exposure to carbon monoxide, nor that mothers are significantly more sensitive to carbon monoxide after giving birth. Risk assessment and prevention of high exposure to carbon monoxide are identical for all workers and may be complicated by active or passive smoking or ambient air pollution.

Lead Exposure to lead and lead derivatives by pregnant women has been associated with abortions, miscarriages, stillbirths and infertility. There are strong indications that exposure to lead, either before or after birth via the mother or during early childhood, can impair the development of the child’s nervous system. Lead can be transferred from blood to breast milk and hence to the child.

Mercury Mercury metal has long been known to have effects on individuals and to target certain systems within the human body, e.g. the nervous system. Exposure to organic mercury can cause problems for unborn children, e.g. affecting an unborn baby's growth and nervous system, as well as having effects on the expectant mother. Inorganic mercury compounds, on the other hand, do not seem to have such effects.

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Ergonomic Hazards and Working Conditions Manual Handling Manual handling problems, especially lifting/carrying of heavy loads, are of great risk to pregnant women due to hormonal changes/effects on ligaments in the body. Clearly there will be increased problems as the pregnancy progresses. In particular, a woman's shape will change and consequently she will find it more difficult to carry out such tasks. Similar risks may also be present for new mothers who have recently given birth. Health professionals tend to advise against any such activity, especially if a woman is breast-feeding, as it is thought to have an effect on breast milk production. It is important that employers ensure that pregnant workers or those who are breast-feeding are prevented from such lifting and handling where possible. Employers should also carry out a risk assessment if such tasks cannot be avoided, as well as taking steps to reduce risks to as low as reasonably practical. During manual handling, increased risk of postural problems/backache can occur for a pregnant woman or there may be limitations of ability when the woman has had a Caesarean section. Poor balance in later stages of pregnancy can increase the risks from slippery surfaces, especially if any manual handling/lifting is carried out. Such work may increase the risks of premature birth or even low birth weight for the baby.

Static Postures Standing or sitting for long periods of time, e.g. at production lines and during DSE work may lead to certain problems e.g. varicose veins, blood may pool in the legs, stress, postural problems, etc. To avoid such problems a risk assessment should be undertaken.

Stress Unusually stressful work, e.g. too much work, too little time to complete work, sustained high levels of work, and autocratic management styles, may cause work-related stress and subsequent ill-health, e.g. raised blood pressure, increased heart rate, headaches, dizziness, various aches and pains, poor concentration, etc. Such stress, in addition to that caused by being pregnant, e.g. financial consequences, may result in further anxiety and the situation becoming untenable. Hormonal, physiological and psychological changes occur, and sometimes change rapidly during and after pregnancy, possibly affecting a woman's susceptibility to stress, or leading to anxiety or depression in certain individuals. The situation needs to be carefully monitored and reviewed as the pregnancy develops. It may be that stress can be reduced by removing the person from their usual work, by adapting the job itself to the individual's needs, or by providing counselling. Stress has been linked to an increased incidence of miscarriage and also with impaired ability to breast feed.

Lack of Facilities (Including Rest Rooms) Tiredness increases during and after pregnancy and may be made worse by work-related factors. The need for adequate rest facilities, i.e. physical and mental, is essential. Hygiene facilities and toilets are required to be easily accessible at work, as there may be increased risks to health and safety, including risks of infection and kidney disease to the new or expectant mother. Pregnant women and breast feeding women often have to go to the toilet more frequently and more urgently than others. Facilities should be available for breastfeeding mothers and for the safe storage of breast milk.

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Miscellaneous Conditions Other work conditions that can cause problems include: 

Lone working may be a problem for pregnant women as they are more likely to need urgent medical attention.



Passive smoking, as well as smoking by pregnant women, has been shown to have effects on the individual, e.g. possibility of lung cancer for the woman and low birth weight for the unborn child.



Work at heights is hazardous for pregnant women, e.g. on ladders or platforms, due to their increased size. Increased size may also affect a pregnant woman's agility, coordination and reach/balance.



Problems due to increasing size may cause any personal protective equipment not to fit properly, or may make work in confined spaces impossible.



A pregnant woman may be considered more vulnerable to violence at work if she is in a job where she has contact with clients/customers/patients that may have aggressive tendencies.



Stressful travelling conditions may cause difficulties for pregnant women, especially in the latter stages of pregnancy.



Morning sickness may be a problem arising from early shift work or associated with nauseating smells.



New and expectant mothers who work in compressed air are at risk of developing decompression illness (DCI), i.e. the bends. Potentially the unborn child could be seriously harmed by such an illness. Pregnant women normally are advised not to dive at all during pregnancy due to the possible effects we have noted above.

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Controlling Risks to New or Expectant Mothers In determining and implementing control measures for new or expectant mothers it is vital that the employer first assesses the risks that the worker may face. Any significant risks should be either eliminated or where this is not possible, reduced to an acceptable level through sufficient control measures that are designed to protect the expectant or new mothers in the workplace. On receiving written notification from a woman that she is pregnant, the employer should conduct a risk assessment specific to the woman's job. If an unacceptable risk is identified, the employer should take the following action: 

Action One: temporarily adjust the woman's working conditions and/or hours of work; or if it is not reasonable to do so, or would not avoid the risk, then



Action Two: offer the woman suitable alternative work (at the same rate of pay) if available; or if that is not feasible, the employer should



Action Three: suspend the woman from work on paid leave for as long as necessary to protect the woman's health and safety, and/or that of the unborn child.

Risk Assessment Factors Risk assessments should be carried out for all of the hazards we have mentioned. The risk assessment should take into account not only the hazard itself, but should also be monitored and reviewed as the pregnancy progresses or when the new mother returns to work and is possibly breast-feeding.

Provision of Rest Facilities Many pregnant women feel tired and need to rest. Breast-feeding mothers need a clean, private place to express and store their milk. In some countries, such as the UK, employers have a legal duty to provide suitable rest facilities for workers who are pregnant or breastfeeding. However, it is not suitable for toilets to be used for this purpose.

Altering the Working Conditions The working conditions and tasks required of new and expectant mothers and, in particular, first time mothers need to be carefully monitored. Suitable and sufficient risk assessments should be completed, monitored and reviewed in light of the pregnancy, and as it progresses. We have already discussed the suitability of such working conditions.

Providing Alternative Work Employers should carry out a specific risk assessment for the woman concerned. In addition, doctors are required to record advice given to patients about their ability to perform their own work on medical statements. Employers should ask the woman to help with the risk assessment. If risks are identified which go beyond the level of risk found outside the workplace but which cannot be removed, employers should adjust the woman’s working conditions or hours. If there is still a risk, she must be offered suitable alternative work or, if that is not possible, suspended on full pay for as long as is necessary to protect her and her child’s health. It is

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also important to discuss the new or expectant mother’s working conditions with her. This is to help identify any risks which may cause health problems for her or her child.

Suspension from Work If adjustments of the woman's working conditions and/or hours of work still does not control the risk adequately and suitable alternative work (at the same rate of pay) is not adequate or available, then the employer should suspend the woman from work on paid leave for as long as necessary to protect the woman's health and safety, and/or that of the unborn child.

Possible Removal from Night Work A risk assessment should be carried out on any possible night shift work. If there is a specific work risk and a medical practitioner or midwife has provided a medical certificate stating that an employee must not work nights, then it is important that the employer offers suitable alternative day work on the same terms and conditions. If this is not possible, then suspension from work on paid leave for as long as necessary to protect the health and safety and/or that of both mother and child is the next available option. Students are encouraged to download and review the HSE’s publication HSG 122 "New and

Expectant Mothers at Work" available at: www.hse.gov.uk.

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C O N T E N T S Study Unit 2A10

Title

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People with Disabilities

TYPES OF DISABILITY ........................................................................................................................................ 3 PSYCHOLOGICAL IMPAIRMENT .................................................................................................................................... 3 PHYSICAL IMPAIRMENT ............................................................................................................................................ 3 EMPLOYERS’ RESPONSIBILITIES ....................................................................................................................... 4 REASONABLE ADJUSTMENTS ...................................................................................................................................... 4 ADAPTING THE WORK ENVIRONMENT ........................................................................................................................... 5 STAFF TRAINING .................................................................................................................................................... 7 SUPERVISION AND SUPPORT ...................................................................................................................................... 8

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A10 | People with Disabilities Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.10.1 Outline the effects of disability on the person 2.A.10.2 Advise employers on their responsibilities in relation to people with disabilities 2.A.10.3 Describe reasonable adjustments for a range of disabilities

Unit 11:

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Types of Disability A disabled person is generally considered to be a person who has a physical impairment, e.g. including sensory such as those affecting sight or hearing, or psychological impairment, e.g. including learning disabilities or clinically well recognised mental illness, i.e. one classified in the International Classification of Diseases and which has a substantial and long-term adverse effect. In this respect there is more than a minor or trivial limitation on the person’s ability to carry out normal day-to-day activities. This may include their mobility, manual dexterity or physical co-ordination; speech, hearing or eyesight, and perception of risk or danger. It applies where the disability has lasted 12 months or is expected to last 12 months or more or for the rest of the person’s life, e.g. impaired vision. Excluded from this definition of disability are addicts, e.g. alcohol, nicotine, etc., those with personality disorders, arsonists or persons with a tendency to steal or carry out physical or sexual abuse of other persons, etc., those with seasonal hay fever and similar conditions, or individuals with severe disfigurement, such as tattoos, piercings, etc. However, the definitions of disability will of course vary from country to country.

Psychological Impairment This would cover mental or psychological impairment, including learning disabilities or clinically well recognised mental illness, such as one classified in the International Classification of Diseases which has a substantial and long-term adverse effect. Here there would be more than minor or trivial limitation on the individual's ability to carry out normal day-to-day activities. Factors that might influence the person's response to the work itself and the workplace conditions include the design of the job itself, its organisation and management allied with the social environment at work, e.g. the response of individuals, management, etc. to disabled workers. In particular repetitive, monotonous tasks or work that is not particularly demanding may affect the individual involved. Similarly work that is isolated from the mainstream with the consequent lack of involvement and communication might well cause problems leading to stress, etc. at work for the disabled person.

Physical Impairment Clearly certain jobs are outside the physical capabilities of people with particular disabilities, including wheelchair users, where their manual dexterity and physical coordination might cause problems. Sensory disabilities affecting sight or hearing would make certain types of work a problem for the individual's own particular safety, e.g. in emergency situations where emergency lighting only is activated or obstructions are in place, or details are relayed via tannoy systems. Appropriate design of tasks and workstations and the use of ergonomic tools and equipment can help disabled workers. In manual handling situations limiting the size, weight or number of loads, or providing manual handling aids, would help disabled persons.

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Employers’ Responsibilities Employers must not unfairly discriminate against any person due to a disability. Measures must be taken to make any reasonable adjustments as necessary to services and premises to allow access to all persons who need to use them.

Reasonable Adjustments If an employer fails to make a "reasonable adjustment" to the working arrangements or physical features of premises which place a disabled person at a substantial disadvantage compared to a non-disabled person, and cannot be justified, it may be regarded as discrimination. The requirement to make reasonable adjustments is in three main areas: 

Changing practices, policies and procedures, i.e. what the employer does (practice); what the employer intends to do (policy); and the employer's plans to go about it (procedure).



Providing auxiliary aids and services, e.g. provision of information on audio tape and or a sign language interpreter. There are many examples of auxiliary aids or services for those who have hearing disabilities or visual impairments, but consideration should also be given to how communication barriers can be overcome for people with other disabilities, e.g. a customer with a learning disability may be able to access a service by the provision of documents in large, clear print and plain language or by the use of colour coding and illustrations. Deafblind people (individuals who have a severe combined sight and hearing impairment) may require other assistance, e.g. information leaflets produced in braille or Moon, good lighting and acoustics, induction loop systems, etc.



Overcoming a physical feature by removing the feature or altering or avoiding it, or providing services by alternative methods.

When an employer becomes aware of an employee's disability, certain adjustments that could be considered reasonable are: 

Adjustments to premises or workstations.



Allocating some of the disabled person's duties to another person.

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Transferring the employee to another post.

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Altering working hours.

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Assigning the employee to a different place of work.

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Allowing time off for rehabilitation, assessment or treatment.

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Giving, or arranging for the employee to receive, training.

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Providing training for other employees.

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Acquiring or modifying equipment.

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Modifying instructions or reference manuals.

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Modifying procedures for testing or assessment.

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Providing a reader or interpreter.

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Providing supervision.

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Any reasonable adjustment will take regard of certain criteria with regard to the adjustment, such as: 

Its effectiveness.

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Its practicability.

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Its financial and other costs.

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The extent of any disruption caused.

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The extent of the employer's financial or other resources.

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The availability of financial or any other assistance.

It is good practice for the employer to discuss the adjustments with the disabled person, as the individual is often the best person to identify what is needed. In emergency situations a disabled person's safety may be aided by certain adjustments such as: 

Fire alarms fitted with flashing lights or the provision of a vibrating pager to alert a hearing impaired employee.



Assigning work colleagues to alert and assist in an emergency.

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Making sure that employees with learning difficulties fully understand safety procedures and fire regulations.

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Ensuring first-aiders are fully conversant with the first aid implications of, for example, diabetes and epilepsy; and ensuring that a thorough lifting and handling assessment has been carried out and that the appropriate equipment is purchased.

Reasonable steps should be taken to provide an alternative method for making services available to disabled people, where a physical feature makes it impossible or unreasonably difficult for them to use these services.

Adapting the Work Environment Removing Barriers Whenever building or refurbishment work is being carried out, e.g. extending existing premises or making structural alterations to an existing building, great care should be taken to remove or alter physical features which create a barrier to access for disabled people or to consider providing a reasonable means of avoiding it. Another option is to provide a service by an alternative method, i.e. to access the service without unreasonable difficulty. However, if it is still unreasonably difficult for a disabled person to make use of the service, then the onus is to show that the feature could not have been reasonably removed or altered or a reasonable means of avoiding it provided, and cost may be a consideration here. On the other hand, if no action is taken it will have to be shown that there were no steps which could reasonably have been taken. Physical features include steps, stairways, kerbs, exterior surfaces and paving, parking areas, building entrances and exits (including emergency escape routes), internal and external doors, gates, toilet and washing facilities, public facilities (such as telephones, counters or service desks), lighting and ventilation, lifts and escalators, floor coverings, signs, furniture, and temporary or movable items (such as equipment and display racks) etc.

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Providing Easy Access It is important that employers make reasonable provision for disabled persons to gain access and use of any building including sanitary conveniences; this applies to their mobility, impaired hearing and sight. External steps and stairs should: 

Be well lit.

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Have tactile warning strips of a bright colour on all nosings.

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Have slightly pitched treads to allow excess water to drain away from the steps.

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Not have a rise of flight exceeding 1.2 m.

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Have an unobstructed width of 1.2 m.

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Have a uniform rise of tread not exceeding 150 mm.

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Have a continuous handrail at both sides of the ramp.

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Have tactile surfaces at the top and foot of the stairs.

It is important that service providers do not assume that the only way to make services accessible to disabled people is to make a physical alteration to the premises (such as installing a ramp or widening a doorway). Often minor measures such as allowing more time to serve a disabled customer will help disabled people to use a service. Disability awareness training for staff is also likely to be appropriate. However, adjustments in the form of physical alterations may be the only answer if other measures are not sufficient to overcome barriers to access. A service provider should be able to identify the more obvious physical or other barriers or impediments to access by disabled people to its services. Regularly reviewing the way in which it provides its services to the public, e.g. via periodic disability audits, might help to identify any less obvious or unintentional barriers to access for disabled people.

Extra Lighting Good lighting is essential for everyone for visibility and safety and more especially for disabled persons. All types of lighting must be carefully designed and located to avoid creating hazards or obstacles to people moving through any buildings or facilities. All lighting, including natural light, should be controllable/adjustable where possible to suit the needs of the individual. Good light levels are particularly important in potentially hazardous areas, e.g. stair wells or changes in level along a route, such as changes in height of a ramp. Lights should be positioned where they do not cause glare, reflection, confusing shadows or pools of light and dark and misleading visual effects. Passive infrared sensors can be used to detect dim light and activate booster lighting. Keeping windows, blinds and lamps clean maximises the amount of light available. Uplighters placed above a standing person's eye level can deliver a comfortable, glare-free illumination. Care should be taken with fluorescent lights as they create a magnetic field which causes a hum in hearing aids, as can the main power supply cables into a building. The lighting design should control the location, quantity and quality of both natural and artificial light and any changes in lighting levels must be gradual throughout the workplace and relatively even, giving good differentiation of surfaces and levels without glare. Staircases must be well illuminated – a good rule of thumb is 100 lux at tread level.

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Indirect rather than direct lighting is the most comfortable form of lighting. Particular care must be taken with the design of lighting in areas with shiny surfaces, while glazing at the end of corridors should be avoided; side lighting is preferable.

Width of Aisles Clearly the width of aisles for access/egress is important especially for wheelchair users and particularly in the event of an emergency. Building and fire, planning regulations should dictate such widths.

Induction Loop Systems Induction loops help hearing impaired people obtain information, e.g. at reception counters, in meeting rooms and in dance and exercise areas. They are normally well signposted and located not to cause an obstruction. Sound from the speaker is transmitted by a microphone and rebroadcast via a loop aerial. Most hearing-aids nowadays have a switch marked M and T. The T position is for receiving the sound via an induction coil which is built into the hearing-aid. In recent years induction loop systems have begun to be provided in public places such as churches, cinemas, theatres and even in the home, where the T facility is used to listen inductively without the interference of airborne background sound. The MT position, which is provided on some hearing-aids, allows listening simultaneously to both airborne sound via the microphone and inductively transmitted sound via the induction loop.

Hearing Impairment Preventing Communication of Instructions/Warnings There is a wide range of auxiliary aids or services which it might be reasonable to provide for those with hearing disability, in order to give them instructions, information or warnings, such as: 

Written information, i.e. leaflet or guide.



Induction loop systems.

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Subtitles/teletext displays.

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Information displayed on a computer screen.

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Audio-visual telephones.

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Audio-visual fire alarms.

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Qualified sign language interpreters or lip speakers.

Staff Training Disability training should be part of any training policy and plan and is an important factor in providing "reasonable adjustments". Employees should be aware of the requirements of disabled customers and potential customers and colleagues and how to respond to requests for reasonable adjustments. They should know how to provide an auxiliary service and how to use any auxiliary aids which the service provider offers. Employees can also be encouraged to acquire additional skills in serving disabled people, e.g. communicating with hearing impaired people and those with speech impairments by taking disability etiquette into account. Training can be delivered by disabled people; which gives a valuable insight into how disabled people experience certain problems.

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There are many misconceptions and wrong assumptions, e.g. visual impairment is frequently equated with blindness and little attention is paid to colour or tone contrast to help orientation at work. There are also misconceptions about the high cost of providing good communications for people who are hard of hearing. Well-trained staff will be more resourceful in developing access solutions and in tailoring services to meet the needs of specific individuals or groups of disabled people. Specific training such as deaf awareness may be required. If awareness training is impairment-specific and emphasises medical conditions, it may inadvertently reinforce the medical model of disability. Training is sometimes provided by a non-disabled person, and in awareness training, simulation may be used. This involves participants using a wheelchair or blindfolds, distorting glasses or ear defenders. A comprehensive disability training programme may cover many topics, such as the context of disability today, including history, politics, society, health, education, media, family, and cultures; and the legal requirements, such as all barriers: sensory, physical, intellectual, institutional, attitudinal, customer care, etc. Training at all stages should be considered, including induction, on the job, and retraining. Training may need to involve the disabled person's lack of experience in a certain task/job or lack of awareness of potential risks/hazards involved. Such training may also need to consider their possible lack of maturity.

Supervision and Support Well-managed buildings require experienced, trained and competent supervisors. All staff should be trained in the specifics of working with disabled customers and colleagues and the issues involved in ensuring the delivery of good customer service to people with disabilities. Information in various formats must be made available so that visually impaired people can use it. Mechanisms and procedures should be in place for providing different formats and support of all kinds to the disabled person: e.g. information in tape, Braille, large print or webbased formats.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A11

Title

Page

Children and Young Persons

THE VULNERABILITIES OF CHILDREN AND YOUNG PERSONS IN THE WORKPLACE ......................................... 3 INEXPERIENCE AND IMMATURITY................................................................................................................................. 3 INADEQUATE PERCEPTION OF RISK .............................................................................................................................. 5 POORLY DESIGNED WORKSTATIONS AND EQUIPMENT ....................................................................................................... 6 REDUCED PHYSICAL CAPABILITY ................................................................................................................................. 7 REDUCED ATTENTION AND CONCENTRATION SPAN ........................................................................................................... 8 INADEQUATE KNOWLEDGE OF WORK ACTIVITIES, HAZARDS AND RISK CONTROLS ..................................................................... 8 MANAGING THE RISKS TO CHILDREN AND YOUNG PERSONS .......................................................................... 9 RISK ASSESSMENTS PARTICULAR TO CHILDREN AND YOUNG PERSONS.................................................................................... 9 RESTRICTING WORK ............................................................................................................................................... 9 TRAINING AND SUPERVISION ..................................................................................................................................... 9 INFORMATION FOR YOUNG PEOPLE AND FOR THEIR PARENTS/CARERS ................................................................................... 10

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A11 | Children and Young Persons Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.11.1 Outline the particular vulnerabilities of children and young persons in the workplace 2.A.11.2 Advise employers on their responsibilities in relation to children and young persons

Unit 12:

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The Vulnerabilities of Children and Young Persons in the Workplace Inexperience and Immaturity People of any age, including young people, bring to their job their own personal mix of physical characteristics, knowledge and skills, attitudes, habits and personality, any or all of which may be strengths or weaknesses depending on the task demands. These individual characteristics influence behaviour in complex and significant ways, and it is important, therefore, that individuals are appointed to jobs and roles to which they are individually suited. Some of these characteristics are fixed and cannot be changed, or at least not easily or in the short term, e.g. physical characteristics and personality. Others, though, may be altered, adapted and enhanced through learning. This applies to an individual’s knowledge and skills, attitudes and habits – all attributes that contribute significantly to competence in the job or role. People can, therefore, be developed in their jobs to become more effective. This is likely to be especially true of young persons, who are unlikely to have the experience and maturity of outlook than an employer would expect from an older worker. Accident rates tend to vary with the experience of operatives – the more experienced the employee, the better the safety record. This is not hard to understand, since with experience should come a better understanding of risks and greater appreciation of safety measures. This points to a need for good induction procedures when new and young entrants are introduced to a workplace. Note, though, that it is experience, which is the key, not necessarily age. Young persons, perhaps starting work for the first time, are obviously the most inexperienced, but older people starting work in a new environment are also likely to lack understanding of the particular risks associated with that environment. In addition, younger workers are not as susceptible to death or permanent disablement due to injury at work as older workers are, perhaps due to their greater agility (both physical and mental). Aptitude refers to an individual’s ability in respect of something – their knowledge and skills, and general ease of learning and understanding, about it. People have different aptitudes. For example, some people have an aptitude for using computers or for manipulating numbers or for using words effectively, whilst others do not seem to have these abilities. Whilst it is undoubtedly possible for everyone to learn them, it appears that certain skills come more easily to some people than others do. It is likely, therefore, that although there may well be certain skills that young persons may find difficult to learn/absorb due to their experience and lack of maturity, there may well be others (e.g. motor skills, computer skills, etc.) which a young person will master more quickly than an older recruit. All jobs require a certain level of mental and social skills. There will be large individual differences in the psychological capacity of young persons, based on differences in their training, experience, skills, personality and attitudes. However, there are some areas of work that could be beyond a young person’s mental and emotional coping ability, such as dealing with violent and aggressive behaviour, and decision-making in stressful situations. For example, in a situation where an accident has occurred and a person injured, due to his/her inexperience/immaturity a young person may panic or make the wrong decision when not in full control of all the relevant facts. A lack of training in a particular aspect of the use of a

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machine/the operation of certain equipment, etc. can also cause problems and mistakes may be easily made. Furthermore the influence of peer group pressure could lead to children and young persons being influenced in their attitude/approach to their work. Individuals are employed by organisations, but in the work situation individuals invariably work together in groups. Even if the work does not require people to work together in this way, individuals establish informal social relationships with the other people they come into contact with in the work situation (their peers). The influence of groups on the behaviour of individuals, and how they relate to the organisation as a whole, has been the subject of a great deal of research and writing by management experts over many years. All groups, whether they are formal work groups within the organisation or informal groups (e.g. a group of friends who go out for a drink every week after work), establish a pattern of attitudes, behaviours, values and beliefs, etc. – known as group norms – to which members are expected to conform. The pressure to conform can be very strong and comes from the need for approval and acceptance (and the converse needs to avoid disapproval and rejection). Thus, these norms are immensely powerful influences on behaviour. Group norms develop through the informal processes of social interaction to support the shared goals of the members of the group. Even within formal work groups, these goals may not necessarily coincide with the organisation’s goals for the group – they are likely to include the organisation’s formal goals, but may well extend beyond those into meeting other needs. For example, a particular group within an office may be quite happy to meet whatever production targets are given them, but always organise their work to enable them to finish early on a Friday so they can go for a drink together. In order for the organisation's own values and expected behaviours to be adopted by the group, they must be accepted as appropriate to the needs of the group. This has considerable implications for health and safety in that it would appear that, in order for individuals to conform to the organisation’s policy and practices, these policies and practices have to be accepted as part of the norms of the groups to which they belong. If these norms are oriented in favour of encouraging good health and safety practices in the workplace, an individual within that group will normally react or respond by accepting those same values. However, if the group norms dictate that, for example, wearing protective clothing or following safety codes is silly, individuals will be reluctant to conform to the organisation’s policy, or if they do, may seek to find ways around it. Young persons are particularly vulnerable to such peer group influences since they are likely to be impressionable and to lack the maturity and confidence to stand up to peer group pressure. It is therefore vital that employers particularly assess the risks to young and inexperienced workers. With increasing experience we would expect an employee to become more competent at their job and to have developed an ability to cope with issues such as health and safety. However, there is also the risk of complacency and a tendency to cut corners may become apparent. Age and experience are correlated with differences in accident susceptibility as the graph below indicates. Though its exact shape will vary with circumstances, the curve will remain roughly the same, with the greatest susceptibility to accidents occurring with lack of experience and in the younger age groups.

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Experience

Age/frequency curve

Frequency of Accidents

Experience/frequency curve

Age

Accident Susceptibility in Relation to Age and Experience

Inadequate Perception of Risk Perception is the process by which, using our senses and comparing the information we receive with our existing knowledge and attitudes, we give meaning to events, situations and other people. This process is highly subjective and, hence, the way in which different people perceive the same situation can vary enormously. This can be very important to health and safety where a hazard or risk may not be recognised as such. The way in which people perceive things not as they actually are, but in other ways, is known as distortion. This can arise from two main sources: 

From not noticing certain things at all – perhaps due to a failure of the senses (i.e. noticing the smell of gas), but more likely due to such factors as selectivity and familiarity. If we were to absorb every item of information our senses perceive and try to make sense of each part of this massive input, we would almost certainly overload our mental systems. Thus, we tend to be selective in those things which we consciously perceive, often ignoring the familiar. For example, failure to notice that a foreign object is lying across electrical connections or that a scaffolding joint is not secured may occur because of the familiarity of the other factors in the situation.



From interpreting them in a different way, based on the person’s knowledge and attitudes about the event or situation. This may be because the person has little or no prior knowledge about the hazard and, therefore, cannot understand the danger or make the connection between an event and its consequences. This is the case with young children encountering situations for the first time and not understanding the risk posed by, say, an electrical socket. It also applies to inexperienced and young workers. Different interpretations may also arise from allowing other factors to cloud judgments about the event or situation. Thus, in the workplace, management may see risks in a different light to workers due to their different priorities, and workers may see risks differently at different times when, for example, bonus payments are involved. Research has shown that there is a clear distinction between how we perceive risks to personal safety, general dangers to health, and dangers to society. Individuals who engage in hazardous sports and activities may be very reluctant to take even a small risk in the work situation.

Distortions affecting the perception of risk can be minimised with increasing knowledge and experience, and vigilance. This latter factor derives very much from the culture of the organisation – where health and safety is a priority, it is likely to be second nature, but where

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there is a negative view of health and safety measures, the opportunities for distortion are high. Knowledge, experience and a sense of vigilance are often, of course, attributes that young persons in the workplace lack. If there are problems with a person's basic perception of a situation, then there are obviously going to be errors in his/her perception of risk. In many situations when assessing a risk there is safety in numbers. Faulty perception of a risk could be corrected by another person’s clearer perception of an issue. Perception also depends upon knowledge and experience. A group will usually have more to contribute than an individual, and an older person more than a younger one.

Poorly Designed Workstations and Equipment The design of tasks and workstations has been given a high priority in recent years by the introduction of display screen equipment (DSE) in virtually all areas of work. The key consideration is that, whenever possible, equipment should be adjustable to suit the needs of the user and where, of necessity, equipment is in a fixed position, it should be positioned so that the user is able to reach and use it with comfort. This principle applies to all manual activities where the worker is essentially in one position for most of the time. There may be a physical mismatch between the size of the person and the actual task to be completed, e.g. machinery designed for adults may be too large or heavy for young persons still developing to handle safely. Workstations comprise the totality of equipment used at a fixed point by an individual user, including any display screen equipment, tables and chairs, storage facilities and other plant and equipment used as part of the work activities. Ergonomics is the study of the way in which people interact with equipment in their working environment with the objective of improving their comfort, safety and productivity. It involves the application of anatomical, physiological and psychological knowledge to the practical aspects of work, such that tasks may be fitted to the needs of the person. This involves putting the person at the heart of both task and workstation design, and building the working environment around his/her needs, rather than fitting the person into a predesigned working environment built around the needs of the task. The starting point for this is to see the work setting as being made up of three elements: 

A worker with a range of physical and mental characteristics – size, strength, range of motion, intellect, expectations, etc. In the case of a young person, size may be small, strength may be lower than average, range of motions may be reduced, and expectations may be different to those of an adult.



Physical objects comprising the furniture, working equipment (DSE, tools, etc.), working surfaces and parts used in the task.



The local environment created by physical conditions such as lighting, temperature, noise, vibration, etc., as well as the organisational culture and management which determines interpersonal relationships, attitudes towards work, etc. in the workplace.

The interaction of these elements determines the manner in which the task may be performed, and it is this interaction which needs to be optimised in order to ensure maximum comfort, safety and productivity. The major risks to health in the design of tasks and workstations, for young persons as well as adults, relate to:

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

Physical stress, resulting in injury or general fatigue – principally through poor posture and excessive demands on manual dexterity, but also in respect of exposure to excessive noise and vibration.



Visual problems – principally through excessive brightness or prolonged concentrated work on small objects, either on the display screen itself or in respect of components used in a work process, such as in the manufacture of electronic equipment.



Mental stress – principally through excessive demands of task performance and lack of control over working processes, but it may also be brought about by adverse organisational and physical environmental conditions.

These effects are generally all chronic effects, brought about by prolonged exposure to the activity or conditions. A machine, workstation or piece of equipment must be designed for a person. No two people are alike in terms of shape, size and range of joint movements and as such machines are required to suit or be able to be adapted for a wide range of individuals. Poorly designed workstations, i.e. normally designed for the average person, need to be adjustable. Typically an unsuitable workbench height may cause young people to adopt unnatural positions leading to discomfort and possible neck, shoulder and back problems. Similarly repetitive movements using force or awkward movements may cause the individual to have problems with their joints, e.g. tenosynovitis – inflammation of the sheath surrounding the tendon causing pain, tenderness and swelling over the tendon. The characteristics of the equipment used in the performance of work activities can themselves increase the risk of harm by putting extra strain on the body, particularly a body that is still developing, in two main ways. 



The physical characteristics of the equipment itself, e.g.: −

By being difficult to manipulate, such as handles being too small or too large to grip easily, or drawers being too tight to move easily.

−

By encouraging poor posture, such as non-adjustable seats or connecting cables being too short and restricting the position in which, say, an iron can be used.

The position of the equipment in relation to the worker in the position he/she normally occupies, e.g.: −

Requiring the worker to work bent over in order to handle items on a conveyor belt.

−

Continually having to reach down to pick up items from a low position, particularly when sitting.

−

Continually having to get up from a sitting position to reach equipment.

Reduced Physical Capability Young persons may not be physically capable of driving or operating machinery designed for adults; they may not have the strength to operate the controls with ease because of their size, physique, general health, age, gender and (lack of) experience. Consequently many accidents, injuries, etc. can occur at work where repetitive or forceful movements are carried out by young persons. These types of accidents happen particularly when such movements are combined with awkward posture or insufficient recovery time, i.e. rapid pace of work on a production line.

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Reduced Attention and Concentration Span Young persons and children are known to have limited attention and concentration spans. This is more noticeable in some young persons rather than others, and may depend on their interest in a particular situation, task, etc. Consequently when such spans are small the ability of the individual to assimilate all the necessary information about a task will be limited. Importantly, some aspects/hazards/risks/dangers may be missed or not fully understood. A lack of understanding of the risks/dangers involved in certain work situations is particularly important in high risk areas or particular industries/activities where a full appreciation of the health and safety implications and consequences of thoughtless actions is vital e.g. control rooms.

Inadequate Knowledge of Work Activities, Hazards and Risk Controls Competence may be considered in respect of general work-related abilities and specific, technical knowledge and skills. This whole area is receiving great attention due to the need for skilled staff at all levels of organisations, and this applies as much to health and safety as to work-related abilities. There is also a general duty on employers to ensure that staff are generally competent to work safely, and to appoint "competent" persons in respect of specific health and safety roles. There is, therefore, a very strong pressure on employers to provide their staff with the necessary health and safety training to achieve the level of competence required throughout the organisation. This training should be appropriate to the nature of the individual’s health and safety role – whether as an operative needing to understand working practices and safety measures, or safety representatives or first aiders, etc. needing skills in their own particular area. The employer must ensure the competence of those appointed to these roles, and should pay particular attention to the needs of young persons within the field of health and safety training.

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Managing the Risks to Children and Young Persons Risk Assessments Particular to Children and Young Persons Before employing children or young persons, it is vital that the employer conducts an assessment into the risks of the workplace. The assessment should ideally take the following specific factors into account: 

The fitting-out and layout of the workplace and the particular site where they will work.



The nature of any physical, biological and chemical agents they will be exposed to.



For how long and to what extent they will be exposed.



What types of work equipment will be used and how this will be handled.



How the work and processes involved are organised.



The need to assess and provide health and safety training.

Generic Assessments Providing a current risk assessment takes account of the characteristics of young persons and of the specific factors outlined above, there is no need to carry out a new risk assessment each time a young person is employed, i.e. an employer can use and develop generic risk assessments. Such assessments can be modified to deal with particular work situations, i.e. temporary or transient work. Irrespective of this, the risk assessment needs to be reviewed if the work changes or if there is reason to believe that it is no longer valid, etc.

Restricting Work The extent of the risks identified in the risk assessment will determine restrictions on the work of the young persons employed. It is important that young persons are not employed in the following activities where significant risks to their health and safety cannot be avoided: 

Work beyond their physical or psychological capacity.



Work in which there is a risk to their health from extreme cold or heat, or from noise or vibration.

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Work involving their harmful exposure to radiation.

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Work involving their exposure to agents which are toxic, carcinogenic, cause heritable genetic damage, or harm to the unborn child or which in any other way chronically affect human health.

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Work involving the risk of accidents which it may be assumed cannot be avoided by young persons owing to their insufficient attention to safety or lack of experience or training.

Training and supervision Young people need training most when they first start a job; they need it to increase their capabilities and competencies to a level where they can do the work without putting themselves and others at risk. It is not enough to make training available; you should make sure that it is undertaken and also check that key messages have been understood. Young people will also need training and instruction on the hazards and risks present in the workplace, and on the preventive

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and control measures put in place to protect their health and safety. This training should include a basic introduction to health and safety, eg first aid, fire and evacuation procedures etc. As well as training, you will need to bear in mind that young people are also very likely to need more supervision than adults. Effective supervision will also help to monitor the effectiveness of the training young people have received, and there will be clear benefits in assessing whether a young person has the necessary capacity and competence to do the job.

Information for young people and for their parents/carers You must tell all your employees, including young employees, about the risks to their health and safety identified by the assessment, and the measures put in place to control them. You also need to tell them about the procedures to be followed in the event of serious and imminent danger. Before you employ children or offer them a work experience placement, you must let their parents or carers know the key findings of the risk assessment and the control measures you have taken. You may also consider giving this information to trade union safety representatives, or employee representatives for health and safety.

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BSC International Diploma | Unit 2 Element 2A: Occupational Health

C O N T E N T S Study Unit 2A12

Title

Page

Alcohol and Drugs

OVERVIEW .......................................................................................................................................................... 3 HOW ALCOHOL AND DRUGS CAN AFFECT AN INDIVIDUAL ................................................................................ 3 REDUCED CONCENTRATION ....................................................................................................................................... 4 REDUCED PERCEPTION OF RISK .................................................................................................................................. 4 REDUCED INHIBITIONS ............................................................................................................................................ 5 INCREASED SUSCEPTIBILITY TO CERTAIN SUBSTANCES ...................................................................................................... 5 HOW ALCOHOL AND DRUGS CAN AFFECT AN ORGANISATION .......................................................................... 5 HIGH ABSENTEEISM ................................................................................................................................................ 5 POOR MORALE ...................................................................................................................................................... 6 POOR QUALITY AND OUTPUT ..................................................................................................................................... 6 INCREASED ACCIDENT RATE ...................................................................................................................................... 6 MANAGING THE RISKS FROM THE MISUSE OF ALCOHOL AND DRUGS .............................................................. 8 RISK ASSESSMENT RELATING TO THE USE OF ALCOHOL OR DRUGS ....................................................................................... 8 CONTROL STRATEGIES............................................................................................................................................. 8 CONSULTATION WITH THE WORKFORCE OR THEIR REPRESENTATIVES .................................................................................... 9 ALCOHOL AND DRUGS POLICY .................................................................................................................................... 9 ALCOHOL OR DRUGS TESTING PROGRAMMES ................................................................................................................ 10

BSC International Diploma – Element 2A | Occupational Health

BSC International Diploma | Unit 2 Element 2A: Occupational Health Study Unit 2A12 | Alcohol and Drugs Learning Outcomes When you have worked through this Study Unit, you will be able to:

2.A.12.1 Explain how the misuse of alcohol and drugs may affect an individual 2.A.12.2 Explain how the misuse of alcohol and drugs may affect an organisation 2.A.12.3 Advise the employer of their responsibilities in relation to alcohol and drugs

Unit 13:

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Overview "Abuse" has been defined as "persistent or sporadic excessive…use inconsistent with or unrelated to acceptable medical practice". Drug “misuse” refers to the use of controlled (illegal) drugs as well as the misuse, whether deliberate or unintentional, of medically prescribed drugs and substances such as solvents. Remember that alcohol is just another drug. Alcohol or drug abuse in the workplace can cause significant problems both socially and in regard to health. An intoxicated worker or one who is under the influence of drugs can be a danger both to himself and to others, e.g. a drunk-driver may endanger the lives of all his passengers as well as his own. Alcohol is, in reality, just another type of drug. However, historically, the society in many countries has often viewed alcohol differently.

How Alcohol and Drugs Can Affect an Individual The effects of alcohol and drugs on the human body can lead to a number of related problems, namely alteration of personality, reduced reactions, lack of awareness, a change in attitude to danger, hallucinations, blurred vision, hostility or extreme friendliness, reduced efficiency, absenteeism, dishonesty and theft, poor time-keeping and misconduct. Different drugs will have different effects and the effect may differ between individuals, i.e. individual susceptibility varies. Similarly, a drug may have different effects due to its purity. Generally speaking, drugs can be classified as stimulants, depressants and hallucinogens. Some drugs are particularly addictive, e.g. heroin, and can produce immediate adverse medical effects (such as death from respiratory depression with heroin) or can damage health over a period of time (such as lung and heart disease from smoking tobacco). Certain drugs injure health as a secondary consequence of the way in which they are used; such as the sharing of needles to inject heroin, leading to infections such as human immunodeficiency virus (HIV) and hepatitis. A number of drugs cause physical or mental dependence which can distort the life of the user so that they endanger themselves or others in their attempts to obtain supplies of their drug. Long-term damage can result from just single use, (e.g. infection with HIV from a single injection); whereas other problems may emerge only after extended use of large amounts of drug, (e.g. cannabis dependence). Clearly, differentiation is required between prescribed and non-prescribed (controlled) drugs. In the case of prescribed drugs, the correct dosage and time intervals must be adhered to, as this might also affect performance, e.g. cause drowsiness, make driving unsafe, etc. Any employee who is in a safety critical job should be reminded by their employer of the importance of informing their General Practitioner of their workplace responsibilities and to ask for drugs which do not lead to drowsiness. Some jobs require employees to notify their employer of any drugs that they are taking, and some organisations have a huge database of drugs listings. Notification by the employee of legitimate drug use allows the employer to assess whether or not the employee is safe to work. Excessive or binge drinking can also lead to long-term medical problems, e.g. cirrhosis of the liver. Problems can also occur due to the rate at which the body disposes of alcohol or drugs, i.e. "the morning after the night before". People who drink excessively or take drugs pose problems/are a danger to themselves and other members of the workforce. Certain substances can be detected a significant number of hours after they have been taken, e.g.

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alcohol up to ten hours after, amphetamines one to two days after, cannabis up to five weeks after, etc. Guidance on sensible drinking gives specific situations of when not to drink at all, e.g. before or during driving; using machinery, electrical equipment or ladders; when working or in the workplace. The health and safety of drinkers and drug-takers themselves and others could be compromised by all these possible effects, e.g. increased risk of accidents when working with machinery, hand tools or driving. It is imperative that during their time at work there is a clear distinction between individuals' possible addiction, dependence, intoxication, tolerance, overdosing and recreational use of both alcohol and drugs. Importantly problems at work may not only be introduced by the use of alcohol and drugs, but the effects of withdrawal can also have similar damaging effects. Many people take a number of such drugs and the consequences of a synergistic effect arising need to be taken into account.

Reduced Concentration Alcohol or drugs tend to reduce an individual's concentration span. Safety-critical jobs, e.g. control room operators, train operatives, pilots, crane operators, bus drivers, etc. may therefore compromise not only their own safety but also that of other individuals, groups of workers and organisations that they work for.

Reduced Perception of Risk An individual's perception of risk is influenced by his/her knowledge, attitudes and experiences, and therefore has a highly subjective element to it. Different people view the same situation in very different ways. One person's interpretation of a hazard or danger is not necessarily the same as that of their work colleague. Distortion is defined as “the way in which people perceive things not as they actually are”. Distortion mainly occurs due to two main causes: 

Failure to notice things. This may be due to failure of the senses (e.g. not noticing a particular smell, or seeing a particular warning sign) or more usually because of selectivity and familiarity (being selective in those things we pay attention to and tending to ignore the familiar and routine). Failure in our senses and in recognition of the familiar (e.g. ignoring routine safety procedures) can be influenced by the effects of alcohol and drug use/misuse, as well as by fatigue, overwork, stress, etc.



Different interpretations. This may be due to individual knowledge (or lack of it) and attitudes towards a particular event or situation. Different interpretations may also arise from allowing other factors to cloud judgments about the event or situation. Research has shown that there is a clear distinction between how we perceive risks to personal safety, general dangers to health, and dangers to society and the use/misuse of drugs or alcohol may impair such judgments.

Distortions affecting the perception of risk can be intensified by the use/misuse of alcohol or drugs especially where health and safety is a priority, and possible distortions may have disastrous effects.

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Reduced Inhibitions Another possible side effect of alcohol or drug abuse is that inhibitions are reduced with an associated lessening of people's attitude to safety, especially in positions which require a high level of alertness in relation to the job taking place. Such problems can affect the mood and expectations of individuals and others at work. The implications to safety of a train driver operating a main line train at speeds of up to 120 m.p.h. with a reduced level of alertness to hazards and dangers would be horrific.

Increased Susceptibility to Certain Substances "Synergism" means that two or more drugs work together against one target, producing an effect that is greater than the individual effects of the drugs added together, i.e. one drug could enhance or multiply the effectiveness of another. Synergistic interactions can be beneficial, and treatments may be deliberately chosen for this effect, e.g. many anti-HIV drug combinations seem to be synergistic in their effects against the virus. Individuals who smoke appear to be more vulnerable to the effects of exposure to asbestos. Similarly a person who has an alcohol problem may be more vulnerable to the effects of the use of solvents at work. The damaging effects of alcoholism on the body are fairly obvious; the mechanisms by which that damage occurs are less apparent. Chronic abuse of alcohol may lead to a deficiency in thiamine (Vitamin B1). This deficiency can cause brain problems. Recent research has shown that chronic alcohol consumption and thiamine deficiency combined may have a synergistic and even more devastating effect on the brain and mental capacities. Clearly the effects of drugs and/or alcohol in the work environment can be problematic even if such drugs are prescribed, where any of these may cause additional problems. Taking alcohol with any prescribed or over-the-counter drug, e.g. medicine can also be dangerous and normally such dangers are highlighted on the labelling or leaflets inside such medicines.

How Alcohol and Drugs Can Affect an Organisation As was discussed, drug misuse can harm the individual both physically and mentally and, through the actions of those who misuse drugs, other people and the environment. However, such misuse can also have an adverse effect on the organisation that the individual works for.

High Absenteeism The majority of people who have a drinking problem are in work and some hold down responsible positions. People with drink problems can and do reduce their intake, but proactive behaviour, i.e. before problems occur, can be productive. This approach is often more effective than dealing with a problem that has become too serious to ignore. Irrespective of size, businesses can take practical steps to minimise the risks associated with inappropriate drinking/drug use. Monitoring absences and sickness rates is one way of gathering information about potential problems in this area. The information required is likely to be collected by the organisation for its human resource management function. It is not easy to interpret absence records in order to identify alcohol and drug-related problems. One indication may be a high incidence of absences on Mondays. Certain individuals view the weekend as a time to relax from the pressures of the working week by perhaps drinking to excess, or using recreational drugs.

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Feeling unable to cope with the workplace on a Monday morning may manifest itself by a significant number of absences at the beginning of the week. However, it is also possible that arriving home in the evening after a pressurised day leads to one drink to relax, followed by more, with the after-effects being felt the following morning and the associated ill-health effects. Short-term absences (one or two days, particularly at the beginning of the week) rather than longer-term absences are more likely to reflect an alcohol or drink problem in the individual. However, always remember that this is not an easy area in which to make clear judgments. Ill-health as a result of alcohol or drug misuse may take some time to become evident and it is not always obvious that it is caused by activities at the workplace, but could be due to problems outside work itself, e.g. family problems/personal relationships leading to increased alcohol consumption.

Poor Morale A high staff turnover is a general indicator of problems in the workplace. One such problem may manifest itself due to the use/misuse of alcohol and/or drugs. There may be many reasons for this – pay, poor morale, lack of training, lack of opportunities, work conditions problems at home, etc. Some of these may have implications for, or be a reflection of, the health and safety culture and, again, it is important that management is clear about the underlying causes and what they may imply for health and safety. Exit interviews are increasingly used by many organisations to identify why employees want to leave or are asked to leave and the results from these may provide indicators of the state of health and safety in the organisation. Thus, for example, reasons such as excessive workloads or lack of training may indicate conditions which give rise to high levels of stress or a lack of appreciation and skills in respect of safety procedures. Alcohol and drug use may be seen as a way out of such problems. Low morale may also be of concern since this is often associated with an apathetic attitude towards safety.

Poor Quality and Output Alcohol/drug consumption may result in reduced work performance, damaged customer relations, and resentment among employees who have to "carry" colleagues whose work declines because of their drinking or drug abuse.

Increased Accident Rate There are no precise figures on the number of workplace accidents where alcohol is a factor, but alcohol is known to affect judgment and physical co-ordination. Drinking even small amounts of alcohol before or while carrying out work that is "safety sensitive" will increase the risk of an accident, e.g. when working with machinery, hand tools or driving (a criminal offence). The level of accidents in an organisation clearly has something to say about the state of health and safety within that organisation. Accident data is readily available – it has to be collected, and is required as the basis of risk assessment and statistical analysis can provide information about trends and comparisons with other, similar organisations, e.g. look for accidents on Monday mornings; after lunch; following a big sporting event the night before; or possibly as the result of an individual coming to work with a hangover. However, whilst a poor accident record may indicate a need to address particular safety issues, it does not necessarily mean

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that the health and safety culture is also poor. Similarly, the absence of accidents is not, on its own, a clear indicator of a positive culture. Accidents do happen. What is important is why they happen. Thus, accident reports need to be clear about the causes of accidents, not simply their outcomes in terms of injuries caused. In this case, then, near misses are just as important. If they show a regular pattern of similar causes, then that may indicate a cultural problem in that the causes are not being addressed. Accidents and their causes represent a learning opportunity for the organisation – to prevent it happening again. If that challenge is not being picked up, it may be because health and safety is not a sufficient priority. Other ways of analysing accident data may also indicate problems. It may be that a certain level of accidents is normal in an organisation or a particular type of work – not necessarily a high level, but an average of one or two incidents a month on, say, a large construction site. If this level is exceeded, then there may clearly be problem. However, a lower level may also indicate a problem in that accidents may not be being reported. If there is a very low incidence of accidents in the workplace, it is important to know why. Many organisations have very low levels of risk (compare office work with, say, mining), and slack attitudes to safety may not necessarily result in accidents, or even near misses. It is not always possible to know to what extent a condition is due to activities within or outside the workplace. Employers cannot be held responsible for ill-health arising from the personal life styles of their employees (such as smoking, diet, alcohol and other drug abuse, lack of exercise or dangerous sports). An ill-health condition caused by an activity other than work can, though, be made worse by an industrial situation, although compensation is only paid for work-related conditions.

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Managing the Risks from the Misuse of Alcohol and Drugs Risk Assessment Relating to the Use of Alcohol or Drugs The overall aim of a risk assessment is to ensure that no-one is exposed to unacceptable risks as a result of workplace activities. The drivers for this are the moral, legal and economic imperatives for ensuring health and safety of employees and others. The drivers for elimination/reduction of risks arising from psycho-social agents like drugs and alcohol are no different. We have already seen earlier in this unit that people who partake in drug or alcohol abuse put not only themselves at risk but also their colleagues and perhaps also contractors, customers and members of the public. You will be aware from earlier study units that a workplace risk assessment must be suitable and sufficient. This involves identifying significant risks. The sufficiency and suitability of such risk assessments must address the possibility of problems relating to alcohol/drugs misuse. Examining data on absenteeism, productivity, accidents and disciplinary records may indicate such a problem. Useful also is any data on local cultural attitudes to drinking/ taking drugs and typical local consumption rates (this may come from national or local surveys or from surveys carried out in similar companies). Such data may indicate whether there is a problem and, if so, the scale of it and any particular groups that may be a priority. There are a number of reasons why an individual may develop an alcohol/drugs problem, that is evident in the workplace: 

Working conditions - stress, excessive work pressure, unsocial hours or monotony - may be factors in an individual starting to drink excessively.

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Opportunity can also be a factor, e.g. in jobs where there is ready access to alcohol or where drinking and entertaining is a normal part of doing business.

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Lack of supervision, combined with opportunities to drink during working hours, may mean that a drinking problem goes unnoticed.

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Social factors - opportunity, culture, peer group pressure, etc.

Control Strategies Certain control strategies could help employees and also the business: 

Identification of the scope of the problem within the organisation.

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Identification of the problem from the effects on the individual noted earlier or through identification by another employee or self-admission.

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Treatment and rehabilitation of those affected, taking care with regard to confidentiality.

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Counselling procedures, e.g. through various agencies such as Alcoholics Anonymous, the Samaritans, etc.

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Consultation with the employees concerned.

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Training of supervisors and managers in identifying and addressing drug or alcohol misuse problems.

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

Training/awareness programmes for all other employees.

Consultation with the Workforce or their Representatives In deciding how to cope with the problem consultation with individuals and their staff representatives, trade union representatives, occupational health practitioner, etc. is vitally important. Some organisations set up a working party led by a senior manager to look at the issue of alcohol/drugs as it affects the business. Although this might prove difficult in smaller businesses, only through such consultation will the problem be addressed. Regular consultation with employees about the effects of alcohol on health and safety, or their attitude to drinking alcohol during working hours and their understanding of safety policy, restrictions or rules on alcohol at work is essential in such situations.

Alcohol and Drugs Policy A written policy should be developed in consultation with the workforce. Consultation with medical personnel is also desirable. This may be included in the company health and safety policy or be a stand-alone document. The basic elements are a statement of aims and objectives, defining the responsibilities (who does what) and describing the arrangements (the rules). Arrangements might include: 

Measures to reduce alcohol/drug-related problems through: −

Improved working conditions (poor conditions can contribute to such problems).

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Proper management and supervision (not encouraging behaviour which incites misuse of alcohol/drugs).

−

Proper arrangement of work (not placing a rehabilitated worker in a situation which may have contributed to the problem).

−

Consultation between management and workers.

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Prohibition/restriction of the availability of alcohol/drugs on the premises (e.g. no alcohol allowed to be brought on site) and making alternative soft drinks available.

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Education programmes (information, instruction, training) including: −

Providing details of effects of alcohol/drugs on health.

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Training for supervisors/managers on identification/counselling/confidential referral of individuals with alcohol/drugs issues.

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Rules to be followed and consequences of non-compliance.

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Identification, assessment and referral of individuals with alcohol/drug issues. This may also include alcohol/drugs testing of individuals – particularly in safety-critical jobs. However, this subject needs to be handled delicately since it is an emotive issue with moral, legal and ethical consequences.

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Treatment and rehabilitation programmes – treatment and re-integration into the workforce.

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Rules governing conduct and disciplinary measures for their infringement (including dismissal). Employers have the right to discipline workers for employment-related misconduct related to drug/alcohol misuse. However, treatment should be preferred unless a worker refuses to co-operate in the treatment programme.

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

Equal opportunities – the worker should not be discriminated against.

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Confidentiality – the employer should maintain confidentiality when alcohol/drug misuse is identified or declared.

Alcohol or Drugs Testing Programmes Alcohol and drug screening are sensitive issues. Most companies, particularly those in safety-sensitive industries, use screening and testing as a way of controlling alcohol/drug problems. It can be used in a number of ways: 

As part of the pre-selection process for a job.

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Routinely, or on a random basis, testing all or part of the workforce in specific circumstances such as:



−

After an accident or incident.

−

Where there is evidence of drinking that contravenes the company's regulations.

−

As part of an aftercare rehabilitation programme.

−

To monitor a problem, e.g. employees reporting for work with alcohol in their bloodstream from the previous night.

As a deterrent.

However, there is an issue as to how "random" such testing should be. It is important to ensure that employees are available to test, but equally it may defeat the purpose if a warning is given. Alcohol can be detected and measured in breath, blood and urine. Simple "breathalyser" kits are available for breath testing whereas a laboratory is necessary to quantify the amount of alcohol in blood or urine samples. Drug testing is much more difficult. Most drugs or their by-products can be measured in blood, urine and saliva. Simple test kits are now available for a range of prescribed and illegal drugs although none are entirely reliable. A positive test does not necessarily mean that the person has taken an illegal drug because the by-products which these tests detect can be formed from legitimate medication. A drug test does not prove whether the person is under the influence of drugs, or whether their ability is affected. All a drug test will do is to indicate if a person has had a certain drug in the recent past and this might have no bearing on the person's work. Testing is no substitute for an effective alcohol and drugs policy. Securing the agreement of the workforce to testing is essential, because of the practical and legal issues involved. Screening is only likely to be acceptable if it can be seen to be part of a company's occupational health policy and is clearly designed to prevent risks to others. Cost is another consideration because of the need to ensure the accuracy and validity of test results. Screening by itself will never be the complete answer to suspected alcohol/drug problems and must always be supplemented by a professional assessment of the employee. Agreement to screening must be incorporated in each member of staff's contract of employment. If an employer tried to force a test on an unwilling employee, the employee could resign and claim constructive dismissal. In addition to changing the contract of employment to incorporate a screening process, it is necessary to obtain the written consent of the individual for each test. This consent applies only to tests relating specifically to alcohol and to no other substances, condition or disease.

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Where more extensive testing is required (i.e. for drug abuse), further consent may be required. Medical confidentiality should be paramount at all times. Testing is a complicated procedure and must be carried out under strict conditions to ensure correct samples are taken and no tampering takes place. Testing for alcohol and drugs must be included in the company's health and safety policy and must be applicable to all employees, including management. Agreement in this area is important, as it can include pre-, periodic, random or rehabilitation testing. The employees should be aware of the need for compliance and enforcement and the consequences of any non-compliance. The policy might include selection of staff, inclusion in contracts, medical surveillance, alcohol/drug testing, forbidding drinking at work, inclusion in accident investigation procedures, disciplinary procedure, etc. The policy must be known to all employees, contractors, subcontractors and temporary staff.

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