INDUSTRIAL HYGIENE PERSPECTIVE IN HEALTH SURVEILLANCE NRG SHE CONFERENCE 10-11 July 2017 Sunway Convention Centre, Seberang Jaya,Penang 1 DR.IBRAHIM ZUBIL AB RAHMAN OCCUPATIONAL HEALTH PHYSICIAN
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INDUSTRIAL HYGIENE PERSPECTIVE IN HEALTH SURVEILLANCE
NRG SHE CONFERENCE
10-11 July 2017
Sunway Convention Centre,
Seberang Jaya,Penang
1
DR.IBRAHIM ZUBIL AB RAHMAN
OCCUPATIONAL HEALTH PHYSICIAN
OBJECTIVE
1. To explain the fundamental of IH
2. To recognise health surveillance components
3. To appreciate medical surveillance as per USECHH regulation
4. To relate IH with medical surveillance
2
INTRO: OCCUPATIONAL DISEASES & IH
Exposure to chemical, physical or biological hazards can cause occupational diseases.
Occupational diseases are acute or chronic (gradual or delayed) reactions and are very diverse.
To avoid occupational diseases the exposure should be prohibited, regulated, restricted, limited or controlled by industrial hygiene practices & IH-programs.
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OSH MP 2020
Target of OSH MP 2020 – to reduce the burden of occupational diseases
Strategy- to mainstreaming industrial hygiene practice
Aim – to promote greater professionalism in work safety culture
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INDUSTRIAL HYGIENE
Industrial Hygiene is the art and science of the anticipation, recognition, evaluation, and control of environmental health hazards arising in or from the workplace.
Safety = prevention of accidents / incidents
IH = prevention of occupational illnesses
( one component of the broader spectrum of OH)
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FUNDAMENTALS OF INDUSTRIAL HYGIENE
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Basics
IH
Identification
Evaluation
Control
Identification of hazards
Theoretical assessment of
exposure
Measurement strategy
Monitoring
Evaluation results
Report
Respect hierarchy
of controls
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HEALTH SURVEILLANCE
4 in FMA , 1 in OSHA
Chemical in air
Absorption
Distribution
Biotranformation
Binding to target
organ
Adverse effects
excretion
Pathway of a xenobiotic from the environment to the target organ
Body
Expo
su
re m
on
ito
rin
g
He
alth
su
rve
illa
nce
Me
dic
al
mo
nito
rin
g
Hygiene
medical
Health surveillance components
Lead in the air
- Air monitoringHealth surveillance
1. Exposure monitoring
•measuring the present of
toxicant
- air (air monitoring)
- metabolites in body
fluid/hair (biological
monitoring)
- biochemical parameters
(not toxicant/metabolite)
2. Medical monitoring
- measuring the health
effects
Blood lead
(Biological monitoring)
Symptoms
review
Physical
examination
Specific Ix
Enzyme ALA dehydratase
(bio. effect monitoring)
EXPOSURE MONITORING
One of the major component of HS(3/4 in USECHH)
Domain of IH rather than medical
Investigation specific to OH practice
An important tool that can be used to provide a reliable estimate of exposure to workplace contaminant
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EXPOSURE MONITORING
Three types
1. Environmental monitoring
2. Biological Monitoring
3. Biological Effect monitoring
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Chemical in air
Absorption
Distribution
Biotranformation
Binding to target
organ
Adverse effects
excretion
Air / Environmental
monitoring-
- On contaminated air &
on person exposed
Pathway of a xenobiotic from the environment to the target organ
Body
Expo
su
re m
on
ito
rin
g
He
alth
su
rve
illa
nce
Me
dic
al
mo
nito
rin
g
Intake
uptake
effect
ENVIRONMENTAL MONITORING
Measurement and assessment of agents (physical, chemicals, biological) in the workplace to evaluate inhalation exposure/intake levels and health risks compared with an appropriate standards
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intake uptake effect
Exposure phaseToxicokinetic phase
Toxicodynamic phase
Environmental monitoring biomonitoring - Medical
survillence
chem
env
person
- BEM
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ENVIRONMENTAL MONITORING METHOD
Two stages
1. Sampling
2. Analysis
- on contaminated air@ area monitoring (static)
a) Instantaneous monitoring (direct reading)
b) Integrated or continuous sampling
- on person (Personal sampling)1. Personal exposure monitoring (integrated)
CHEMICAL MONITORING
Filter media
pump
tubing
Chemical exposurein environment
Chemical uptake
Environmentalmonitoring
Biologicalmonitoring
inhaled orswallowed
skin
throughclothing
skin
Chemical in air
Absorption
distribution
Biotranformation
Binding to target organ
Cellular/molecular changes
Adverse effects
excretion
Biological
monitoring
Pathway of a xenobiotic from the environment to the target organ
Expo
su
re m
on
ito
rin
g
Chemical in body
Intake
Uptake
Air / Environmental
monitoring-
- On contaminated air & on
person
Measurement of a substance or its metabolite in biological materials in order to provide a quantitative estimate of its uptake into the body by all routes of exposures
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Definition
CONCEPT
Biological monitoring attempts to
estimate the internal dose/uptake
Internal dose:
1.Amount of chemical recently absorbed
2.Amount of chemicals stored in one or
several compartments or in whole body
3. Amount of chemical bound to critical
sites of action21
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uptake
Toxicokinetic phase
biomonitoring
Chemical in air
Absorption
Distribution
Biotranformation
Binding to target
organ
Adverse effects
excretion
Air / Environmental
monitoring-
- On contaminated air &
on person
Biological
monitoring
Pathway of a xenobiotic from the environment to the target organ
Body
Expo
su
re m
on
ito
rin
g
He
alth
su
rve
illa
nce
Me
dic
al
mo
nito
rin
g
Medical surveillance
MEDICAL SURVEILLANCE
Monitoring of a person for the purpose of identifying changes in health status due to occupational exposure to chemicals hazardous to health at regular interval
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Toxicodynamic phase
- Medical survillence
- BEM
Medical surveillance focus
at target organs effect
Basically it is a medical examination
consisting of
▪History taking
▪Physical examination specific to the target
organs
▪Investigation like CXR, blood tests, urine
tests etc.
Legal mandated medical surveillance
Medical examination stipulated by the law
OBJECTIVE OF MEDICAL SURVEILLACE
To ensure the health program and control for health risks are effective
To identify sensitive individuals
To meet legal requirement:
FMA 1967- Noise, Asbestos, Mineral Dust,
Lead
OSHA 1994- USECHH Reg.
LEGAL PROVISIONS
Medical Surveillance
When assessment indicates necessity (by assessor)
Medical surveillance to be carried out by OHD
Frequency of health surveillance every 12 months (sch:2)
Record to be kept for 30 years from the date of last entry
Accessible to employees28
➢Sec 28 OSHA
➢Part IX Reg. 27 USECHH
EXPOSURE MONITORING RESULT
INTERPRETATION
Interpretation of the air sampling and biological monitoring results
must be compared with occupational exposure standard
(OES)
o Guidance value
- concept similar to normal value in clinical
practice
Value set by the government i.e DOSH and mandatory to follow:
for airborne particles, called PEL
for absorbed toxicants (biological monitoring) called BEI
OES
3 types a) Ceiling level
b) 8 hr TWA
c) Maximum exposure limit
PERMISSIBLE EXPOSURE LIMIT (PEL)
Comparison of results with standards
Three basic conclusions
1. Exposure > PEL : Need to identify the reasons for the results & the steps required to control the exposure
2. Exposure well below the PEL – control needs to be maintained
3. Insufficient information to decide whether above or below the PEL
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DATA INTERPRETATION
EXPOSURE FOR ABSORBED TOXICANTS
1. Biological monitoring
2. Biological effect monitoring
Compare the data with Reference limits i.e Biomonitoring action levels (BALs)
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INTERPRETATION OF BIOLOGICAL MONITORING DATA
Biomonitoring action levels (BALs)
The reference values at or below which the
adverse health effects do not appear in most
workers who are exposed to the chemicals.
ACGIH (USA)Biological Exposure Indices (BEIs)
DFG (Germany)Biologischer Arbeitsstoff-Toleranz-Wert (BAT)
FIOH (Finland)
HSE (UK)
JSOH (Japan)Occupational Exposure Limit Based on Biological Monitoring (OEL-B)
BALs in different countries
• Intended as GUIDE LINE ref .value
for potential health hzd ( ACGIH)
• Represent determinants likely to
be observed to the same extent as
with inhalation exposure
• Does not make conclusion as
having disease or non disease
BIOLOGICAL EXPOSURE INDEX (BEI)
CONCLUSION
➢ Health surveillance is a joint responsibility between hygiene and medical practice
➢ OSH MP 2020 emphasizes more prominent role for IH
➢ Occupational diseases to be reduced using IH principles
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