RESPIRATORY PROTECTION IN THE WORKPLACE (Medical surveillance)

1. RESPIRATORY PROTECTION IN THE WORKPLACE(Medical surveillance) Dr ZiyaadEssop 2 Military Hospital

2. DEFINITION • The purpose of medical surveillance is to monitor the health of employees who work in settings where they may be exposed to occupational hazards. • Besides monitoring it serves as a preventative measure against injuries and diseases

3. Medical Surveillance Program • It is essential to understand environmental conditions in the workplace and to measure and evaluate possible worker exposure • You need to know the type , amount and exposure effects on the human body(target organs) Egs (mainly lungs) • Asbestos • Silica • Coal • Substances that can cause Occupational asthma

4. employees are screened • medical history • occupational history • medical examination • Special investigation(CXR, Bloods ) • initial baseline of the employees health is established • used to monitor their future health if they are exposed to potential occupational hazardous agents.

5. 5 components of a medical surveillance program a) pre-employment and pre-placement medical examinations b) periodic medical examinations c) clinical tests d) health education e) record keeping

6. ASBESTOS • An employee is exposed or is likely to be exposed to asbestos dust exceeding the OEL for asbestos • An occupational medicine practitioner certifies that the relevant employee should be under medical surveillance

9. ASBESTOS • Review of medical(TB, smoking,COPD) and occupational history. • Review of a respiratory disease questionnaire • Physical exam with emphasis on the respiratory system, the cardiovascular system and digestive tract. • Chest XRAY • PFT • FVC ( Forced vital capacity) • FEV1 (Force expiratory volume in one second) • FEV1/FVC ratio • Annual lung function results are compared to try and determine trends • Any other tests deemed necessary by the examining • doctor

11. Silica • Medical surveillance is required for employees who may be exposed to silica above OEL • Review of medical(TB, Smoking,COPD) and occupational history. • Focus on TB(synergstic effect ) • Review of a respiratory disease questionnaire • Physical exam with emphasis on the respiratory system • CXR • PFT • FVC ( Forced vital capacity) • FEV1 (Force expiratory volume in one second) • FEV1/FVC ratio • Annual lung function results are compared to try and determine trends • Any other tests deemed necessary by the examining doctor.

12. OCCUPATIONAL ASTHMA • Various substances can lead to occupational asthma very broad. • Program would depend on workers environment • If substance has the potential for asthma • IgE and skin prick test are done(very expensive)

13. OCCUPATIONAL ASTHMA • Medical history (atopy/allergies) • Occupational History • Respiratory questionnaire • Physical Examination • 6 monthly questionnaires, at least 2- yearly spirometry. • Physician referral: symptoms or 15% fall in FEV1 or FVC • Serial peak flow measurement during work time, as well as away from work for a period of at least 3-4 weeks. • Lung function determination both pre- and post - bronchodilator

14. COAL • Review of medical(Tb, Smoking, COPD) and occupational history. • Review of a respiratory disease questionnaire • Physical exam with emphasis on the respiratory system, the cardiovascular • Chest Xray • PFT • FVC ( Forced vital capacity) • FEV1 (Force expiratory volume in one second) • FEV1/FVC ratio • Annual lung function results are compared to try and determine trends • Any other tests deemed necessary by the examining Doctor

15. PREVENTION PREVENTATIVE MEDICNE HEALTH PROMOTION

16. PRIMARYPrimary prevention strategies intend to avoid the development of disease 1 2 3

17. HEALTH PROMOTION(Primary) • ENABLING PEOPLE TO HELP THEMSELVES/Co Worker • DIFFERENT ROLE PLAYERS • MANAGEMENT, LOCAL , • EDUCATION AWARENESS TRAINING (RULES REGULATON, EFFECTS ON BODY /HEALTH)

18. SECONDARY • Secondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity • Halts the progress of a disease • Early diagnosis and treatment

19. TERTIARY • These treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications • Alternative placement • Worker compensation • Disability limitation, and Rehabilitation

20. COMPENSATION Worker in the mining industry compensated for contracting cardio- respiratory diseases, i.e.: • Pneumoconiosis(Silica, Asbestosis) • Pneumoconiosis /tuberculosis • Tuberculosis • Perm airway obstruction • Permsystemic sclerosis • Manganese poisoning • Platinosis • Mesothelioma(e.g Asbestos etc) • Lung cancer in mine workers Done under the Compensation of Occupational Diseases in Mines and Works Act , No. 78 of 1973.

21. Worker outside the mining industry is compensated for any respiratory disease according to Schedule 3 of the Compensation of Occupational Diseases and Injuries Act, No 130 of 1993). [COIDA]

22. According to S.A. legislation (Occupational Diseases in Mines and Works Act) a medical practitioner must organize a post mortem (with consent of the family) for a deceased patient suspected to have died of a cardio-respiratory ailment related to mining exposure with no previous documentation • If it is shown that the worker did have a compensable disease, his / her family will be compensated (funeral cost , benefits/ pension payout) • More detail in 5th year

23. THANK YOU

24. Hypoxia =internal causes(brain hypoxia etc) • Asphyxia=through external sources (chemical