OCCUPATIONAL HEALTH

AND SAFETY
INTRODUCTION:
All occupational fields have their own hazards. There are variety of hazards to
which workers may be exposed and which may cause various diseases. By following
the proper guidelines and precautions, all occupational hazards can be minimized.

OCCUPATIONAL ENVIRONMENT:

Occupational environment is meant the sum of external conditions and influences

which prevail at the place of the work and which have a bearing on the health of the
working population. Basically there are three types of interaction in the working
environment:

o Man and physical, chemical and biological agents.

o Man and machine.
o Man and man.

Man and physical, chemical and biological agents:

Physical agent - the physical factors in the working environment which may be
adverse to health are heat, cold, humidity, air movement, heat radiation, light, noise,
vibrations and ionizing radiation. The factors act in different ways on the health and
efficiency of the workers, singly or in different combinations. The amount of work and
the breathing place, toilet, washing and bathing facilities are also important factor in
occupational environment.

Chemical agents - these comprises a large number of chemicals, toxic dust and
gases which are the potential hazards to the health of the workers. Some chemical
agents cause disabling respiratory illnesses, some causes injury to health and
deleterious effect on the blood and other organs of the body.

Biological agents- the workers may be exposed to viral, rickettsia, bacterial and
parasitic agents which may result from close contact with animals or their products,
contaminated water, soil or food.

Man and machine:

An industry or factory implies the use of machines driven by power with emphasis on
mass production. The unguarded machines, protruding and moving parts, poor
installation of the plant, and lack of safety measures are the cause of accidents which
is the major problem in industries.

Man and man:

There are numerous psychological factors that operates in the place of work. These
are human relationships amongst workers themselves on the one hand, and those in
authority over them on the other hand. Examples of psychosocial factors include the
type and rhythm of work, work stability, service conditions, job satisfaction, leadership
style, security, workers participation, communication, system of payment, welfare
conditions, degree of responsibility, trade union activities, incentives and a host of
similar other factors, all entering the field of human relationships. In modern
occupational health, the emphasis is upon the people, the conditions in which they live
and work, their hopes and fears and their attitudes towards their job, their fellow-
workers and employers.

OCCUPATIONAL HAZARDS:

An industrial worker may be exposed to five types of hazards, depending upon his
occupation:

Physical hazards.
Chemical hazards.
Biological hazards.
Mechanical hazards.
Psychosocial hazards.

Physical hazards:

Heat and cold: the common physical hazard in most industries is heat. The direct
effects of heat exposure are burns, heat exhaustion, heat stroke and heat cramps; the
indirect effects are decreased efficiency, increased fatigue and enhanced accident
rates. Important hazards associated with cold work are chilbans, erthrocynosis,
immersion foot, and frostbite as a result of cutaneous vasoconstriction. General
hypothermia is not unusual.

Light: The acute effects of poor illumination are eye strain, headache, eye pain,
lachrymation, congestion around the cornea and fatigue. The chronic effects on health
include ―miner‘s nystagmus‖. Exposure to excessive brightness or ―glare is
associated with discomfort and annoyance and visual fatigue.
Noise: The effects of noise are of two types: auditory effects which consist of
temporary or permanent hearing loss and non-auditory effects which consist of
nervousness, fatigue, interference with communication by speech, decreased
efficiency and annoyance.

Vibration: Vibration usually affects the hands and arms. After some months or years
of exposure, the fine blood vessels of the fine fingers may become increasingly
sensitive to spasm (white fingers). Exposure to vibration may also produce injuries of
the joints of the hands, elbows and shoulders.

Ultraviolet radiation: occupational exposure to ultraviolet radiation occurs mainly in arc

welding. Such radiation mainly affects the eyes, causing intense conjunctivitis and
keratitis (Welder‘s flash). Symptoms are redness of the eyes pain, these usually
disappear in a few days with no permanent effect on vision or on the deeper structures
of the eyes.

Ionizing radiation: ionizing radiation is finding increasing application in medicine and

Industry, eg: X- ray and radioactive isotopes. Important radio-isotopes are cobalt 60
and phosphorus 32. Certain tissues such as bone marrow are more sensitive than
others and from genetic standpoint, there are special hazards when the gonads are
exposed. The radiation hazard comprises genetic changes, malformation, cancer
leukaemia, depilation, ulceration, sterility and in extreme cases death. The
international commission of radiological protection has set the maximum permissible
level of occupational exposure at 5 rem per year to the whole body.

Chemical hazards:
There is hardly any industry which does not make use of chemicals. The
chemical hazards are on the increase with the introduction of newer and complex
chemicals. Chemical agent acts in three ways: local action, inhalation and ingestion.
The ill-effects produced depend upon the duration of exposure, the quantum of
exposure and individual susceptibility.

Local action: some chemicals cause dermatitis, eczema, ulcers and even cancer by
primary irritant action; some causes dermatitis by an allergic action.

Inhalation: Dusts are produced in a number of industries- mines, foundry, quarry,

pottery, textile, wood or stone working industries. The most common dust disease in
this country are silicosis and anthracosis.

Gases: Gases are sometimes classified as simple gases(eg; oxygen, hydrogen),

asphyxiating gases (e.g. carbon monoxide, cyanide gas, sulphur dioxide, chlorine) and
anesthetic gases (eg; chloroform, ether, trichloroethylene) carbon monoxide hazards
is frequently reported in the coal-gas manufacturing plants and steel industries.
Metals and their compounds: a large number of metals and compounds are used
throughout industry. The chief mode of entry of some of them is by inhalation as dust
or fumes. Metals may be of antimony, arsenic, beryllium, cadmium, cobalt,
manganese, mercury, phosphorus, chromium, zinc and others.

Biological hazards:
Workers may be exposed to infective and parasitic agent of the place of work.
The occupational disease in this category are brucellosis, leptospirosis, anthrax,
hydatidosis, psittacosis, tetanus, encephalitis, fungal infections, schistosomiasis and
a host of others. Persons working among animal products (eg; hair, wool, hides) and
agricultural workers are specially exposed to biological hazards.

Mechanical hazards:
The mechanical hazards in industry centre round machinery, protruding and
moving parts and the like. About 10% of accidents in industry are said to be due to
mechanical causes.

Psychosocial hazards:
The psychosocial hazards arises from the worker‘s failure to adapt to the alien
psychosocial environment. Frustration, lack of job satisfaction, insecurity, poor human
relationship, emotional tension are some of the psychological factors which may
undermine both physical and mental health of the workers.

The health effects can be classified in two main categories: psychological and
behavioural changes- including hostility, aggressiveness, anxiety, depression,
tardiness, alcoholism, drug abuse, sickness, absenteeism. Psychosomatic ill-health:
including fatigue, headache, pain in the shoulders, neck and back; propensity to peptic
ulcer, hypertension, heart disease and rapid ageing.

OCCUPATIONAL DISEASE:

Occupational diseases are usually defined as diseases arising out of or in the

course of employment.

Disease due to physical agent:

o Heat- heat hyperpyrexia, heat exhaustion, heat syncope, heat cramps,

burns and local effects such as prickly heat.
o Cold- trench foot, frost bite, chilblains
o Light- occupational cataract, miner‘s nystagmus
o Pressure- caisson disease, air embolism, blast(explosion)
o Noise- occupational deafness
 o Radiation- cancer, leukaemia, aplastic anaemia, pancytopenia
o Mechanical factors- injuries, accidents
o Electricity- burns

Disease due to chemical agents:

o Gases: Co2, Co, HCN, CS, NH3, N2, H2S, HCL, SO2- these causes gas
poisoning.
o Dusts (pneumoconiosis)
o Inorganic gases: coal dust-anthracosis; silica-silicosis; asbestos-
asbestosis, cancer; iron-siderosis.
o Organic (vegetable) dusts: cane fibre-bagassossis; cotton dust-
byssinosis; tobacco-tobacossis; hay or grain dust-framers lung.
o Metals and their compounds: toxic hazards from lead, mercury,
cadmium, manganese, beryllium, arsenic, chromium etc.
o Chemicals: acids, alkalies, pesticides
o Solvents: carbon bisulphide, benzene, trichloroethylene, chloroform, etc.

Disease due to biological agents:

Brucellosis, leptospirosis, anthrax, actinomycosis, hydatidosis, psittacosis, tetanus,
encephalitis, fungal infections, etc.

Occupational cancer: Cancer of the skin, lungs, bladder.

Occupational dermatosis: Dermatitis, eczema
Disease of psychological origin: Industrial neurosis, hypertension, peptic ulcer, etc.

IMPORTANT OCCUPATIONAL DISEASE AND THEIR PREVENTION

MEASURES:
1. PNEUMOCONIOSIS:
Dust within the size of 0.5 to 3 micro is a health hazard producing, after a
variable period of exposure, a lung disease known as pneumoconiosis, which
may gradually cripple a man by reducing his working capacity due to lung
fibrosis and other complications. The hazardous effects of dusts on the lungs
depend upon a number of factors such as:

o Chemical composition
o Fineness
o Concentration of the dust in the air
 o Period of exposure
o Health status of the person exposed.
2. SILICOSIS:
Among the occupational disease, silicosis is the major cause of permanent
disability and mortality. It is caused by inhalation of dust containing free silica
or silicon dioxide. Pathologically, silicosis is characterized by a dense
―nodular‖ fibrosis, the nodules ranging from 3 to 4mm in diameter. Some of
the early manifestations are irritant cough, dyspnoea on exertion and pain in
the chest.

3. ANTHRACOSIS:
Anthracosis exhibits two general phases in coal miners pneumoconiosis:
the first phase is labelled as simple pneumoconiosis which is associated with
little ventilator impairment. This phase may require 12 years of work exposure
for its development. The second phase is characterized by progressive
massive fibrosis; this causes severe respiratory disability and frequently
results in premature death.

4. BYSSINOSIS:
It is due to inhalation of cotton fibre dust over long periods of time. The
symptoms are chronic cough and progressive dyspnoea, ending in chronic
bronchitis and emphysema.

5. BAGASSOSIS:
Is the name given to an occupational disease of the lung caused by
inhalation of bagasse or sugar-cane dust. It was first reported in India by
Ganguli and Pal in 1955 in a cardboard manufacturing firm near Kolkata. The
sugarcane fiber which until recently went to waste is now utilized in the
manufacture of paper, cardboard and rayon. The symptoms consists of
breathlessness, cough.

6. ASBESTOSIS:
Asbestos are silicates of varying composition(magnesium, iron, calcium,
sodium, aluminium). Asbestos is of 2 types – serpentine (hydrated magnesium
silicate) and amphibole type (contain magnesium). Asbestos is used in the
manufacture of asbestos cement, fire proof textiles, roof tiling, brake lining,
etc.
Asbestos enters the body by inhalation, and fine dust may be deposited
in the alveoli. The disease is characterized by dyspnoea, clubbing of fingers,
cardiac distress and cyanosis. Chest x- ray shows a ground-glass appearance
in the lower two third of the lungs. It causes pulmonary fibrosis leading to
respiratory insufficiency and death, carcinoma of the bronchus and
gastrointestinal tract.
Preventive measures:
Use of safer types of asbestos(chrysolite and amosite)
Substitution of other insulants – glass fiber, mineral wood, calcium
silicate, plastic foams.
Dust control and biological monitoring(x-ray, lung function)
Periodic examination of workers and continuing research.

FARMER’S LUNG:
It is due to the inhalation of mouldy hay or grain dust which contains
micropolyspora faeni , the main cause of farmer‘s lung. Its growth is encouraged
by moist hay or grain dust. The disease is characterized by respiratory
symptoms and finally leads to pulmonary fibrosis and pulmonary damage.

OCCUPATIONAL CANCER

The characteristics of occupational cancer are:

 They appear after prolonged exposure
 The period between exposure and development of disease may be 10 to 25
years.
 The disease may develop even after cessation of exposure.
 The localization of tumours is remarkably constant in any one occupation.

SKIN CANCER:- Skin cancer is a main occupational hazard among gas workers,
oven workers, tar distillers, oil refiners, dye-stuff makers, road makers and in industries
associated with the use of mineral oil, tar and related compounds.

LUNG CANCER:- It is an occupational hazard in gas industry, asbestos industry,

nickel and chromium work and in mining of radio-active substances. The main
carcinogens in these areas are nickel, chromates, asbestos, coal tar, etc.

BLADDER CANCER: - The industries associated with bladder cancer are the dye-
stuffs and dyeing industry, rubber, gas, and the electric cable industries. The major
bladder carcinogens are benzidine, auramine, beta-naphthylamines, etc.
 LEUKAEMIA: - Exposure to benzol, roentgen rays and radio-active substances
give rise to leukaemia. Benzol is a dangerous chemical and is used as a solvent in
many industries.

CONTROL OF INDUSTRIAL CANCER:

 Elimination or control of industrial carcinogens – well-designed building or

machinery, closed system of production.
 Medical examinations and Inspection of factories.
 Notification and licensing of establishments
 Personal hygiene measures
 Education of workers and management and research

OCCUPATIONAL DERMATITIS:
Occupational dermatitis is a big problem in many industries. The causes may be

 Physical- heat, cold, moisture, friction, pressure, x-rays

 Chemical- acid, alkalies, dyes, solvents, grease, tar, chlorinated phenols
 Biological- living agents such as bacteria, virus, fungi, parasites.
 Plant products- leaves, vegetables and its dust , flowers and pollen grains.

The dermatitis producing agents are further classified into:

 Primary irritants – acids, alkalies, dyes

 Sensitizing substances – allergic dermatitis.

PREVENTION:

 Pre-selection - the workers should be medically examined before employment.

 Protection – protecting clothing, long leather gloves, aprons, boots, barrier
creams.
 Personal hygiene – supply of warm water and adequate washing facility, soap,
towels.
 Periodic inspection – medical check-up and early detection, transfer from risky
area, proper education of workers to identify skin irritation.

RADIATION HAZARDS:
 A number of industries use radium and other radio-active substances. X-rays are
used both in medicine and industry. Exposure to ultraviolet rays occurs in arc and
other electric welding processes. Infrared rays are produced in welding and glass
blowing. The main effects of radiation are acute burns, dermatitis malignancies,
genetic effects etc. Preventive measures:

 Shielding of workers in x-ray field, so that direct contact to skin can be avoided.
 The employees should be monitored at intervals not exceeding 6 months.
 Suitable protective clothing
 Adequate ventilation in work place to prevent inhalation of harmful gases and
dust.
 Replacement and periodic examination of workers in every 2 months.

LEAD POISONING:
Lead is used in variety of industries such as manufacture of storage batteries,
glass manufacture, ship building, printing and potteries, rubber industry etc.
Thousands of tons of lead every year is exhausted from automobiles. All lead
components are toxic – lead oxide, lead carbonate, lead arsenate, etc. Lead has an
effect on membrane permeability. Mode of absorption is of 3 ways – inhalation,
ingestion and absorption through skin. Normal adult ingest about 0.2 to 0.3 mg of lead
per day from food and beverages. Confirmation of lead poisoning shows a blood count
more than 70 mue gm. /100 ml and urine lead more than 5mg/lt.
The toxic effect of inorganic lead exposure are abdominal colic, constipation, loss
of appetite, blue-line on the gums, anaemia, wrist drop and foot drop. The toxic effects
of organic lead compounds are mostly on the CNS- insomnia, headache, mental
confusion, delirium, etc.

Preventive measures:
 Substitution of lead with less toxic materials.
 Isolation of all processes which gives rise to lead dust and fumes.
 Local exhaust ventilation.
 Personal protection, personal hygiene and good housekeeping
  Periodic examination of workers and health education.
 Medical management- saline stomach wash if ingested, d-penicillamine.

MEASURES FOR HEALTH PROMOTION OF WORKERS:

The aim of occupational health is ― the promotion and maintenance of the highest
degree of physical, mental and social well-being of workers in all occupations‖. The
measure for the general health protection of workers was the subject of discussion by
an ILO/WHO Committee on Occupational Health in 1953. The committee
recommended the following:
NUTRITION:
In many developing countries malnutrition is an important factor contributing to poor
health among workers and low work productivity. Malnutrition may also affect the
metabolism of toxic agents and also the tolerance mechanisms. Under the Indian
Factories Act, every industry should provide a canteen when the numbers of
employees exceed 250. The aim is to provide balanced diets and snacks at
reasonable cost under sanitary control. It is important to combine this action with the
education of the workers on the value of a balanced diet.
COMMUNICABLE DISEASE CONTROL:
The industry provides an excellent for early diagnosis, treatment, prevention and
rehabilitation. There should be an adequate immunization program against
preventable communicable diseases. The communicable diseases of special
importance in India are tuberculosis, typhoid fever, viral hepatitis, amoebiasis,
intestinal parasites, malaria and venereal diseases.
ENVIRONMENTAL SANITATION:
Within the industrial establishment, the following needs attention for the prevention
of spread of communicable diseases;
 Water supply
 Food
 Toilet
 General plant cleanliness
 Sufficient space
 Lighting , ventilation , temperature
 Protection against hazards
  Housing
MENTAL HEALTH:
Industrial workers are susceptible to the effects of love, recognition, rejection, job
satisfaction, rewards and discipline. The goals of mental health in industry are;
 To promote the health and happiness of the workers
 To detect the signs of emotional stress and strain and to secure relief
 The treatment of employees suffering from mental illness
 Rehabilitation of those who become ill

MEASURES FOR WOMEN AND CHILDREN:

Expectant mothers are given maternity leave for 12 weeks, of which 6 weeks
precede the expected date of confinement they are allowed maternity benefit with cash
payment.( ESI act, 1948)

 Provision of free antenatal, natal and postnatal services.

 Night work between 7 pm to 6 am is prohibited.(Factories Act)
 Provide crèches in factories where more than 30 women workers are employed.
 The Indian Mines Act 1923, prohibits work under ground.

 No child below the age of 14 shall be employed to work in any factory or mine
or engaged in any other hazardous employment.

HEALTH EDUCATION:
It is an important health promotional measure. It should be given in all levels –
management, supervisory staff, workers, trade union leaders and community.

PREVENTION OF OCCUPATIONAL DISEASES:

The various measures for the prevention of occupational diseases may be grouped
under 3 headlines:
 Medical measures
 Engineering measures
 Legislative or statutory measures

MEDICAL MEASURES:
  Pre-placement examination
 Periodical examination
 Medical and health care services
 Notification
 Supervision of working environment
 Maintenance and analysis of records
 Health education and counselling

ENGINEERING MEASURES:
 Design of building
 Dust – enclosure and isolation
 Good housekeeping
 Local exhaust ventilation
 General ventilation
 Protective devices
 Mechanization
 Environmental monitoring
 Statistical monitoring and research
LEGISLATION:
The most important factory laws in India today are ;
 The Factory Act , 1948
 The Employees State Insurance Act , 1948

Some of other specialized acts adapted to the particular circumstances of the industry
are – The Mines Act, The Plantation Act, The Minimum Wages Act, The Maternity
Benefit Act, etc. OHSMS:
In the changed industrial scenario, an emphatic worldwide Endeavour is visible in
improving quality in all functions of an organization. Recognizing that the workplace
safety and health is a decisive factor in an organizational effectiveness, several
management frameworks have been proposed to implement cost-effective
occupational health safety(OHS) in preventing work place aliments and promoting
health and welfare of workers resolving around the international standards
organization families of management standards(e.g.: ISO 9000 and 14000).
Broadly, an ideal OHS management system (OHSMS) should provide a structured
process to minimize potentials of work-related injuries and illness, increase
productivity by reducing the direct and indirect cost associated with accidents, and
increase the quality of manufactured products for rendered services. It must provide a
direction to OHS activities, in accordance with organizational policies, regulatory
requirements, industry practices and standards, including negotiated labour
arguments. Therefore, conforming to an OHSMS may be significant value to an
organization. This approach has drawn significant attention among the standard
organizations, the accreditation and certification bodies and the national agencies in
formalizing, implementing and evaluating OHSMS.

The framework for certification of OHSMS, namely occupational health and safety
assessment series (OHSAS) specification (OHSAS 18001; 1999) has been developed
by an association of national standards and certification bodies, and specialist
consultants. It has been developed to be compatible with the ISO 9000 (quality) and
ISO 14000 (environment) standards in order to align and integrate quality,
environment and OHS, management systems in organizations.

The organization which has established, implemented and maintained OHSMS

meeting the specification, is eligible to apply for certification. The scheme is
established with the aim that upon receiving the certification, the organization will
become more aware and self-regulating in promoting health and safety at their work
places. The certification offers independent verification and auditing that an
organization has taken reasonable measures to minimize workplace risks and injuries.

IMPORTANCE OF OCCUPATIONAL HEALTH IN HOSPITALS

Hospitals are large, organizationally complex, system driven institutions
employing large numbers of workers from different professional streams. They are
also potentially hazardous workplaces and expose their workers to a wide range of
physical, chemical, biological, agronomical and psychological hazards. Thus
Occupational Health and Safety issues relating to the personal safety and protection
of its workers is a very important Environmental Health concern for hospitals.
Radiation Exposure
There is a wide range of radiation hazards related to medical imaging (x rays,
nuclear scans utilizing radioactive isotopes) and radiation oncology which utilizes
ionizing radiation from a variety of sources to treat a range of malignant tumors. These
sources include (i) sealed sources containing radioactive material such as isotopes of
radium, cobalt and strontium, and (ii) linear accelerators emitting short wave length
gamma waves.

Licensing users of this technology is strictly controlled (i) appropriate training,

certification and credentialing of users (ii) demonstrated implementation of safety
precautions related to storage, use and shielding of non-target personnel (iii) regular
inspection, maintenance and certification of equipment by the Department of Physics
within Queensland Health, and (iv) ongoing monitoring of radiation exposure of staff
using the equipment.

Back Injury
Hospital staff and particularly nurses are prone to back injury from the need to lift
and roll immobilized or disabled patients for toilet, washing, dressing and pressure
care. Hospitals are now required to give training on back care to all new staff. This
training, combined with the use of wards persons to assist nurses and the use of
hydraulic lifting devices, has decreased the risk of back injury considerably.

Burns due to Steam Sterilizing

Larger hospitals now have Central Sterilizing Departments utilizing appropriately
trained, dedicated staff that are familiar with and follow set policy and procedure. This
type of specialized set up minimizes risk of physical injury from hot equipment.
However, smaller peripheral steam sterilizers are still required in some departments
such as the Operating Theatres. Where possible many smaller satellite hospitals now
use the Central Sterilizing Department of their larger referral Base Hospital for their
sterilization needs.

Laser Burns
 Lasers are now frequently used in Operating Theatres and appropriate protective
equipment must be used, especially eye protection to prevent retinal burns. The use
of this equipment is covered by set protocols.

Electrical Defibrillators
Use of this equipment is restricted to those staff who have undergone competency
based training and certification.

Personal Violence
Risk of injury from personal violence is an important hazard in Emergency
Departments who at times deal with mad, bad or intoxicated patients. Similarly,
Psychiatric Units who have to look after the psychotically disturbed are also at risk.
Again, staff education and set policy and procedure needs to be in place for dealing
with aggressive patients. Personal security alarms, a system for rapidly mobilizing
ancillary staff, and a set approach to safely restraining, immobilizing and sedating
violent patients are all important components.

Personal (Staff) Protection – Biological Hazards

Management of biological hazards should be comprehensively covered in the
hospital‘s Infection Control Manual, with the policies and procedures developed and
monitored by an Infection Control Committee chaired by an Infection Control Nurse.
There are 3 important modes of disease transmission from patients to staff:

Airborne and droplet aerosol exposure - includes viral upper respiratory

tract infections, measles and TB. Preventative measures include (i) keeping distance
(>1m) from frontal coughing as much as possible (ii) wash hands after every patient
contact and especially avoid rubbing eyes before washing (iii) high filtration face
masks (where applicable - generally not practical in the outpatient setting) (iv) isolate
inpatients in a negative air pressure room.

Skin contact exposure - includes Staphylococcus aureus and Varicella.

Prevention requires protective gown and gloves.
 Exposure to infectious fluids via broken skin, eyes, mucous membranes,
and parenteral exposure - includes hepatitis B, hepatitis C, and HIV from all body fluids
except sweat, as well as gastroenteritis and hepatitis A from fecal fluid. Preventative
measures include universal precautions (gloves, gown, goggles and mask), and
appropriate management of sharps, spills, and contaminated waste.
If acute exposure to a biological hazard does occur, staff members need to be aware
of relevant policies and procedures for appropriate management of the exposure. This
will include:

 Appropriate washing for mouth, eyes or skin exposure

 First aid for penetrating sharps injury
 Prophylaxis for high risk exposure
 Testing of the source if possible
 Testing and follow up of exposed staff
 Incident reporting.

Personal (Staff) Protection – Psychological Hazards

Hospitals are stressful places for sick and injured patients and their families. However
they can also be stressful for staff due to such factors as:

Shift work, on call duty, fatigue and ―burn out‖.

High workload and demand.
High or unrealistic patient expectations.
Verbal abuse or threats from disgruntled or intoxicated patients.
High or unrealistic expectations from supervisors and management.
Problematic interpersonal work relationships.
Frustrations due to limited resources, especially staffing levels.
Poor organizational climate with low staff morale.

Hospitals are part of a high demand, high expectation service industry and are heavily
reliant on staff for the friendly, safe, effective and efficient delivery of services. To
optimize productivity and attitude of staff, senior management must be committed to
ensuring a conducive organizational climate with high staff morale. Clear priorities and
direction, realistic performance goals and workloads, commitment to continuing
education and quality assurance, reception to staff feedback, and support with
counselling services for stressed staff are all important components.

Evacuation Plans for Internal Emergencies

Various internal emergencies including fire, explosion and bomb threat may
require evacuation of all or parts of the hospital. Well-documented and rehearsed
evacuation plans are required to ensure the safe evacuation of disabled, immobilized
or otherwise helpless patients. In critical care areas this will include manual back up
for life support systems.

Food Safety
Hospital kitchens prepare meals for inpatients and in many cases prepare meals
for the staff canteen. It is obviously imperative that food storage, handling and
preparation is done to the highest standards and poses no risk to already sick or
compromised patients.

ROLE OF OCCUPATION HEALTH NURSE:

Occupational health nurses, as the largest single group of health care
professionals involved in delivering health care at the workplace, have responded to
these new challenges. They have raised the standards of their professional education
and training, modernized and expanded their role at the workplace, and in many
situations have emerged as the central key figure involved in delivering high quality
occupational health services to the working populations. Occupational health nurses,
working independently or as part of a larger multi professional team, are at the frontline
in helping to protect and promote the health of working populations.

DEFINITION:-
Occupational Health Nurses (OHN) s are registered nurses who independently
observe and assess the worker's health status and to respect them from job tasks and
hazards. Using their specialized experience and education, these registered nurses
recognize and prevent health effects from hazards exposure.
SCOPE

Educationally prepared to recognize adverse health effects of occupational exposure

and address methods for hazard abatement and control, OHNs bring their nursing
expertise to all industries such as meat packing, manufacturing, construction as well
as the health care industry.

Role of the Occupational Health Nurse in Workplace Health

Management:
The occupational health nurse may fulfil several, often inter related and
complimentary, roles in workplace health management, including:
 Clinician
 Specialist
 Manager
 Co-ordinator
 Adviser
 Health educator
 Counsellor
 Researcher

CLINICIAN:

Primary prevention - The occupational health nurse is skilled in primary

prevention of injury or disease. The nurse may identify the need for, assess and
plan interventions to, for example modify working environments, systems of work
or change working practices in order to reduce the risk of hazardous exposure.

Emergency care - The occupational health nurse is a Registered Nurse with a

great deal of clinical experience and expertise in dealing with sick or injured people.
The nurse should provide initial emergency care of workers injured at work, transfer
of the injured worker to hospital and emergency services. Occupational health
nurses employed in mines, on oil rigs, in the desert regions are more responsible
for this work.

Treatment services - In some countries occupational health services provide

curative and treatment services to the working population, in other countries such
activities are restricted.

Nursing diagnosis - Occupational health nurses are skilled in assessing client‘s

health care needs, establish a nursing diagnosis and formulating appropriate
nursing care plans, in conjunction with the patient or client groups, to meet those
needs. Nurses can then implement and evaluate nursing interventions designed to
achieve the care objectives. The nurse has a prominent role in assessing the needs
of individuals and groups, and has the ability to analyse, interpret, plan and
implement strategies to achieve specific goals.

Individual and group care plan - The nurse can act on the individual, group,
enterprise or community level.

General Health advice and health assessment - The occupational health nurse
will be able to give advice on a wide range of health issues, and particularly on
their relationship to working ability, health and safety at work or where
modifications to the job or working environment can be made to take account of
the changing health status of employees.

SPECIALIST:
Occupational health policy, and practice development, implementation and
evaluation- The specialist occupational health nurse may be involved, with senior
management in the enterprise, in developing the workplace health policy and
strategy including aspects of occupational health, workplace health promotion and
environmental health management.

Occupational health assessment - Occupational health nurses can play

an essential role in health assessment for fitness to work, pre-employment or pre
placement examinations, periodic health examinations and individual health
assessments for lifestyle risk factors.

Health surveillance - Where workers are exposed to a degree of residual risk

of exposure and health surveillance is required by law the occupational health
nurse will be involved in undertaking routine health surveillance procedures,
periodic health assessment and in evaluating the results from such screening
processes. The nurse will need a high degree of clinical skill when undertaking
health surveillance and maintain a high degree of alertness to any abnormal
findings.

Sickness absence management - Occupational health nurses can

contribute by helping managers to manage sickness absence more effectively. The
nurse may be involved in helping to train line managers and supervisors in how to
best use the occupational health services.

Rehabilitation - Planned rehabilitation strategies, can help to ensure safe

return to work for employees who have been absent from work due to ill health or
injury. The occupational health nurse is often the key person in the rehabilitation
programme who will, with the manager and individual employee, complete a risk
assessment, devise the rehabilitation programme, monitor progress and
communicate with the individual, the occupational health physician and the line
manager.

Maintenance of work ability - The occupational health nurse may develop

pro-active strategies to help the workforce maintain or restore their work ability.

Health and safety

Hazard identification - The occupational health nurse often has close contact
with the workers and is aware of changes to the working environment. Because of
the nurses expertise in health and in the effects of work on health they are in a
good position to be involved in hazard identification.
Risk assessment - Legislation is increasingly being driven by a risk
management approach. Occupational health nurses are trained in risk assessment
and risk management strategies depending upon their level of expertise.

MANAGER:

Management - In some cases the occupational health nurse may act as the
manager of the multidisciplinary occupational health team, directing and co-
ordinating the work of other occupational health professionals. The OH nurse
manager may have management responsibility for the whole of the occupational
health team, or the nursing staff or management responsibility for specific
programmes.

Administration - The occupational health nurse can have a role in

administration. Maintaining medical and nursing records, monitoring expenditure,
staffing levels and skill mix within the department, and may have responsibility for
managing staff involved in administration.

Budget planning - Where the senior occupational health nurse is the budget
holder for the occupational health department they will be involved in securing
resources and managing the financial assets of the department. The budget holder
will also be responsible for monitoring and reporting within the organization on the
use of resourses.

Marketing
Quality assurance
Professional audit
Continuing professional development

CO-ORDINATOR:
 Occupational health team - The occupational health nurse, acting as a
coordinator, can draw together all of the professionals involved in the occupational
health team. In many instances the nurse will be the only member of the team who
is permanently employed by the institution.
Worker education and training - The occupational health nurse has a role in
worker education. This may be within existing training programmes or those
programmes that are developed specifically by occupational health nurses to, for
example, inform, educate and train workers in how to protect themselves from
occupational hazards, workplace preventable diseases or to raise awareness of
the importance of healthy practices.
Environmental health management - The occupational health nurse can advise
the enterprise on simple measures to reduce the use of natural resources,
minimise the production of waste, promote re-cycling and ensure environmental
health.

ADVISER:
To management and staff on issues related to workplace health management -
Occupational health nurses act as advisers to management and staff on the
development of workplace health policies and practices, and can fulfil an advisory role
by participating in, for example, health and safety committee meetings, health
promotion meetings, and may be called upon to provide independent advice to
managers or workers who have specific concerns over health related risks.
As a conduit to other external health or social agencies - Occupational health
nurses act in an advisory role when seeing individuals who may have problems that,
whilst not directly related to work may affect future work attendance or performance.

HEALTH EDUCATOR:
Workplace Health promotion - Health education as one of the key prerequisites of
workplace health promotion is integral aspect of the occupational health nurses‘ role.
In some countries the nurse is required to support activities aimed at adoption of
healthy lifestyles within on-going health promotion process, as well as participate in
health and safety activities. Occupational health nurses can carry out a needs
assessment for health promotion.
COUNSELLOR:
Counselling and reflective listening skills - Where the nurse has been trained in
using counselling or reflective listening skills they may utilise these skills in delivering
care to individuals or groups.

Problem solving skills - Due to the close working relationship which occupational
health nurses have with the working population, and because of the nurses‘ position
of trust, occupational health nurses are often approached for advice on personal
problems.

RESEARCHER:
Research skills - Nurses are becoming increasingly familiar with both
quantitative and qualitative research methodologies, and can apply these in
occupational health nursing practice. In the main, occupational health nurses
working at the enterprise level, are more likely to use simple survey techniques, or
semi-structured interviews, and to use descriptive statistical techniques in their
presentation of the data. Evidence based practice - Occupational health nurses
are skilled in searching the literature, reviewing the evidence available, which may
be in the form of practice guidelines or protocols, and applying these guidance
documents in a practical situation. Occupational health nurses should be well
skilled in presenting the evidence, identifying gaps in current knowledge.

Epidemiology - The most widely used and accepted form of investigation into
occupational related ill health and disease is based on large-scale epidemiological
studies.

ETHICS IN OCCUPATIONAL NURSING

The International Commission on Occupational Health (ICOH) has published
useful guidance on ethics for occupational health professionals. This guidance is
summarized in the following three paragraphs;
Occupational Health Practice must be performed according to the highest
professional standards and ethical principles. Occupational health professionals must
serve the health and social wellbeing of the workers, individually and collectively. They
also contribute to environmental and community health
The obligations of occupational health professionals include protecting the life and
the health of the worker, respecting human dignity and promoting the highest ethical
principles in occupational health policies and programs. Integrity in professional
conduct, impartiality and the protection of confidentiality of health data and the privacy
of workers are part of these obligations.
Occupational health professionals are experts who must enjoy full professional
independence in the execution of their functions. They must acquire and maintain the
competence necessary for their duties and require conditions which allow them to
carry out their tasks according to good practice and professional ethics.

CONCLUSION:

Occupational diseases should not be neglected and should give proper attention at
time. It is the main role of a nurse to work as an educator and protector in the field of
occupation. Early detection and timely management can control occupational
diseases.