Transcript Workplace Health Hazard Surveillance

Injury and Illness Surveillance
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Global Burden Non-fatal Occ
Illness & Injury, WHO
SKIN
NON-FATAL OCCUPATIONAL INJURY
DUST/LUNG
12%
12%
1%
4%
1%
4%
RESP TOX
POISONING
66%
TRAUMATIC INJURY
PHYSICAL
AGENTS
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What is Occupational Surveillance?
• Systematic monitoring of:
– Hazardous exposures
– Adverse health events
FOR THE PURPOSE OF
• Prevention and control of:
– Occupational hazards
– Occupational diseases and injuries
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Types of Prevention
Primary – Target: those with potential for
exposure; no disease yet.
Goal: change exposure conditions
Secondary – Target: those with early stage of
disease, no symptoms yet
Goal: reverse disease, delay symptom onset
Tertiary – Target: those with clinical disease
Goal: cure or control of disease.
Types of Prevention
Primary- aimed at the individual who has
potential for exposure; has not yet developed
the disease. Goal is to change exposure
conditions
Secondary- focus is the individual in whom
the disease has started but the symptoms have
not appeared. Goal is to reverse symptoms
Tertiary- aimed at individuals in whom the
disease is symptomatic. Goal is cure or
control of disease.
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Opportunities for Prevention
Primary
Secondary
Tertiary
Prevention
Prevention
Prevention
Healthy
Asymptomatic
Symptomatic
time
Worker
Disease
Disease
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Why might you start an occupational
surveillance program?
• Identify a problem and estimate its magnitude
• Identify groups at risk
• Monitor illness/injury trends in time and
geography
• Identify cases, workplaces, and industries for
attention
• Identify new illnesses
• Identify new hazards
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How might you use a
surveillance program?
• Prioritize health problems
• Determine whether you need an
intervention program
• Evaluate progress, success, or failure of an
intervention program
• Provide planning data for cost-effectiveness
and benefit analysis
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Surveillance Techniques
• Keep log of new injuries and illnesses
• Examine existing databases for specific,
sentinel diseases
• Conduct questionnaire survey of workers
• Conduct physical examinations
• Conduct laboratory examinations
• Conduct job hazard analysis
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How would you organize surveillance?
HEALTH BASED
HAZARD BASED
• Characterize hazards • Acute or chronic
injuries/illnesses
– Observation/checklist
• List of insurance claims
• Monitor environment
• Death certificates
• Test workers
• Health questionnaire
• Physical examination
• Lab testing for disease
markers
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Techniques: Keep Log
Name
Date of
Injury
Diagnosis
Causative
Factors
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Techniques: Examine existing
databases
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Death certificates
Hospital Discharges
Laboratory reports
Workers compensation reports
National surveys
Clinics that treat workers
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Techniques: Questionnaire
Survey
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Demographic variables
Work history: job tasks, hazards
Health history: current, prior
Symptoms
Social, confounding factors
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Techniques: Physical
examination
• Respiratory
• Skin
• Others
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Techniques: Laboratory Reports
• Require labs to report abnormal results
above a specific level (e.g., Pb>25mg/dl)
– May tie lab certification to reporting
• Set up reporting agency protocol (e.g.,
health department accepts reports on premade forms or electronically)
• Decide what level will trigger an
intervention
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Techniques: Workplace
investigation
• Investigate and record information about
fatal injuries (i.e., accident investigation)
• Visit industries with a particular hazard
• Require reporting of certain injuries and set
up a mechanism for reporting, however do
not have to get every event to have an
effective surveillance program
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What are the components of a
surveillance system?
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•
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Gather information on exposure & disease
Analyze data
Disseminate data in an organized form
Use data to target or evaluate an
intervention
• On-going
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Case Studies
For each of the cases, ask these questions
1. What is the sentinel health event of
interest
2. What is the best way to collect
information about it? (consider cost, time
it takes to collect, how you will use
results)
3. How could you use these results?
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Case One
You have heard about a small, rural
community where most of the adults
work in agriculture. There is concern
about pesticide poisoning among
adults and children because housing
is located right next to farms.
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Case One
• Sentinel event: pesticide poisoning
• Collect information:
– Questionnaire of community
– Blood testing of community
– Reports from local hospitals/clinics
• Use results:
– For example, design pre and mid season cholinesterase
testing. Remove workers with decrease.
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Case Two
A scaffold fell off the side of a
building on a windy day. Two
workers were killed.
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Case Two
• Sentinel event: death
• Collect information:
– accident investigation
– review logs or medical records of injuries
• Use results:
– Policy change to improve enforcement
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Case Three
A group of rubber workers notice that
several of their co-workers have
developed leukemia. They are
concerned about the hazards of their
industry.
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Case Three
• Sentinel event: Leukemia
• Collect information:
– medical records of workers, if possible
– conduct survey of workers
– compare rates to those expected
• Use results:
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If elevated rates, determine related exposure
reduce hazard
collect ongoing CBCs to follow trend;
inform workers of results of study
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