Lesson 12 – Occupational Health

Risk-Based Medical Surveillance Programme

What is a Medical Surveillance Programme?

• The Medical Surveillance Programme is designed to Collect and Evaluate Health Data from all Employees that is relevant to their actual work exposures.
• The Programme is a Risk Based and not a Broad-brush approach that the Employer needs so as to provide Medical Information relevant to each job category.

What is the Purpose of the Medical Surveillance Programme?

• It is required by Section 13 of the Mine Health and Safety Act.
• To collect baseline data for comparison to help with early recognition of work related illness.
• Prevents the recurrence of Occupational Illness in certain Job categories.
• Decreases Absenteeism which in turn Increases Productivity.
• Helps to identify Health and Lifestyle Risk Factors that may be aggravated by work conditions.
• Ensures the correct placement of workers
• Assists to detect and document pre-existing conditions of non‐occupational illnesses.

What tests can you expect during the Medical Examination?

1)Questionnaires that assist in establishing the Personal Health History of each Employee.

2)Biological Monitoring such as Urine Samples to establish Blood Sugar Levels, Alcohol or Drug Abuse

3)Physical Health Assessments that include:

• Blood Pressure and Heart Rate monitoring
• Weight & Height measurement to determine BMI
• Eye Sight Test

4)Audiometry Test to establish a Base Line for each employee’s hearing that will be compared to the results of each annual hearing test to determine if a hearing loss has occurred.

5)X‐Rays assist in detecting any lung disease prior to employment and to monitor employee lung conditions.

6)Spirometry Test to determine the Lung Capacity of Employees. It assists to detect lung deceases such as Silicosis and Tuberculosis.

Employee may Dispute Findings of Unfitness to Perform Work

1)According to Section 20 MHSA, an employee may appeal to the Medical Inspector against any decision of unfit to perform a particular category of work or any finding of a medical practitioner contained in an exit certificate in terms of section 17.

2)Appeals must be lodged with the Medical Inspector within 30days of relevant decision stating the grounds for the appeal.

3)The Medical inspector will appoint an independent medical practitioner to re-examine the employee at the Chief Inspector’s costs.

4)The employee may obtain a medical opinion from any other medical practitioner or pursue any other legal remedy.

Employee Right to have their Lungs Examined after Death.

• South African Law allows for anyone who has done Risk work on the mines of classified works to have his / her lungs removed and examined after death. This will only be done if the next of kin have given written consent.
• The lungs are then examined for the presence of certain compensable lung diseases which are caused by working in a mine or works.
• Only if the deceased had a compensable lung disease will the next of kin be compensated.

Occupational Hygiene

What is Occupational Hygiene?

Occupational Hygiene is directed at; Identifying, Evaluating, and Controlling the Environmental Factors or Stress Factors in and around the Workplace that have a Negative Effect on the Health, or Welfare of Employees and the Community.

“Stress Factors result in Physical or Mental Strain and contributes to illness or exhaustion.” 

Environmental Factors or Stresses are classified as:

• Chemical: Originates from inhaling or ingesting Fumes, Dust, Gases, Smoke, Spray or Chemicals.
• Physical: Noise, Vibration, Heat, Electro-magnetic Radiation, Lighting and Ventilation
• Ergonomical: The effect that a person’s Working Environment has on their Physical & Mental state
• Biological: Conditions of illness caused by micro-organisms in the Working Place conveyed from the   industry to the worker or from the one worker to another
• Socio-Psychological: Tension or frustration that builds up in the work environment or at home.

Chemical Stress – Toxic Fumes

What are Toxic Fumes?

• Fumes originate from combustion processes, distillation, molten metals, welding, blasting, etc.
• Fumes could be fatal if over exposed to it.

How can Dangerous Fumes be Reduced?

• Highly effective cloth filters.
• Fluid purifying units.
• Electrostatic precipitators.
• Dilution by ventilation.
• Stay out of confined spaces / containers

Chemical Stress – Dust

Dust Exposure

It’s caused by different operations, such as blasting, drilling, scraping, crushing, loading boxes, tipping, watering down, blowing out motors, transporting and tramming of ore, sweeping and cleaning materials.

• A Gravimetric Sampler is an instrument used to collect accurate samples of the airborne pollutants from the air of the working environment in order to obtain an accurate assessment of the quality of the air.
• These Samples are used to determine the amount and the type of pollutants  that a person is exposed to during their full 8 hour shift in their respective working places.

How to Eliminate / Control Exposure to Dust

• Removal of personnel during blasting periods.
• Prevention of dust from its source. This is achieved by dust suppression – watering down.
• Dilution by Ventilation or Filtration systems
• Respirators like dust masks

How Dust Effects the Human Body

• Pneumoconiosis is a lung disease caused by Respirable Dust e.g. Asbestos, Silica.
• The Lungs get fibrosis which stiffen up the lungs making it hard to breath, causes chronic coughing and a shortness of breath.
• This condition also makes a person more susceptible to Tuberculosis.

Chemical Stress – Harmful Gases

Explosive Gases

• These gases usually explode only when they are mixed with air.
• When ignited by a flame or spark.
• They can also explode without a flame or spark (spontaneously).

Toxic Gases

• Gases, if breathed in sufficient concentration for a sufficient time will disable or kill a person.
• Special Caution must be taken when entering confined spaces where gases are known to accumulate

Gases can be detected or measured by means of Electronic Instruments such as the GDI

Chemical Stress – Chemicals

What are examples of Chemical Poisoning?

Absorption of Poison can be through the following methods:

Air: Inhaling of poisonous gas and fumes which enters the lungs and thus the blood stream.

Skin contact: Liquid substance fats and oils absorbed by the skin and from there is absorbed in the bloodstream.

Digestion canal: Small amounts of very poisonous substances are absorbed without you being aware of it, by dirty hands touching the mouth or smoking in the work place.

Systemic poisoning: Different poisonous wastes affect the body and cause illnesses.

How do you prevent illness caused by Chemical Stresses?

Identification of the Risk (HIRA) to Establish Preventative Measures:

• Replacement of Hazardous Substances with less hazardous substances
• Screening of the Processes
• Screening of the Hazardous Substance by Filtering
• Employee working with substance in Isolation with the necessary Protective Gear
• Limitation of exposure time to Hazardous Chemicals

Chemical Stress – Hazardous Materials

How do you  Identify Hazardous Materials?

The label on the container usually tells you at a glance:

• What is in the container.
• What the potential health hazards are, i.e. health, fire, reactivity, etc.
• Special instructions regarding storage, ventilation, incompatibilities, etc.
• Personal Protective Equipment to be used.
• Basic first-aid.

Material Safety Data Sheets (MSDS) communicate the following information:

• What the chemical is
• Why it is hazardous
• How to work with it safely

Hazardous Materials have different requirements regarding Personal Protective Equipment.   This information is provided by the label and/or the MSDS and includes PPE such as:

• Safety glasses, goggles or face shield,
• Gloves and Protective suits
• Rubber boots or special shoes
• Respirators.

How are Hazardous Materials Controlled?

Through Engineering Controls, Safe Working Procedures and Personnel Protective Equipment, all chemicals can be handled safely. The control measures are usually contained in the MSDS’s.

How to Prevent Exposure to Hazardous Materials

• Adequate Ventilation
• Maintenance of all Containers, Control Valves, Pipelines and Hoses containing Hazardous substances.

Safe Work Procedures Include the following:

• No eating, drinking and smoking near hazardous chemicals.
• Read labels and MSDS’s before commencing work
• Do not pour water into acid
• Empty containers should be destroyed after use
• Hazardous chemicals must be stored in a designated area

Physical Stresses – Noise

What is Noise? 

• It is an undesirable sound, either potentially damaging or annoying.
• Noise is one of the most common occupational health hazards.

Noise can be Classified as:

• Continuous Noise – i.e.. Fan, Rock Drill, Pump, etc.
• Interrupted Noise – i.e.. Angle Grinder, etc.
• Impulse Noise – i.e.. Hearing Testing, etc.

How is Noise Measured?

• A dosimeter is used to measure equivalent noise.
• The instrument is carried in the workplace to monitor the noise levels.
• Persons carrying the instrument must ensure it is kept safe and carried according to procedure
• At the end of shift, Data is downloaded to a computer and a report is filed in the person’s medical file for future reference.

Physical Stresses – Noise

How can Noise Levels be Reduced?

• Muffling at the source of noise
• Screening off the source
• Isolation of noise source

If hearing protection dies not reduce noise levels sufficiently, then the exposure time to the noise source must be reduced to ensure that the equivalent noise level of 85 dB(A) is not exceeded.

Damage to Hearing.

Exposure to load noise can damage the hearing apparatus inside the ear causing permanent noise deafness.

Temporary Hearing Loss.

Exposure for a short time to noise can result in temporary hearing loss, such as a buzzing in the ears.

Physical Stresses – Hearing Conservation

A easy way to assess noise exposure is to stand at arm length from a co-worker and if you have to shout to communicate, then the noise level in the workplace is too high and should be reduced.

How do you use and care for hearing protectors?

• Establish a good seal
• Keep your reusable ear plugs clean  
• Ear plugs work loose during the day as a result of talking and chewing.
• Reseat them as necessary.
• If your ear plugs are missing ensure that you obtain another pair immediately.
• If your ear plugs are uncomfortable, try another type or switch to ear muffs.
• Do not wear ear plugs if there is any drainage from your ear or if you have a hole in your eardrum unless you have talked with your physician

Physical Stresses – Hearing Conservation

What is the influence of Noise on your Health?

Physiological

• Noise causes tiredness, which affects a person’s working ability.
• Hearing impaired persons are slower to react to sudden incidents or alarms, making them more accident prone.

Psychological

• Noise makes people more irritable.
• Prolonged high noise levels could have negative effects such as headaches

Socio-Psychological

• A Person becomes withdrawn as they feel excluded from conversation.
• Embarrassment, shame and problems concentrating can lead to depression and low self-esteem.
• A person will often feel inferior resulting in personal problems arising at home with friends and family members.

Physical Stresses – Heat

What is Heat?

• Heat is a form of energy which is indestructible.
• Heat must not be confused with temperature which is the measurement of the hotness or coldness of a body.

How is Temperature Measured?

• Temperature is measured with a thermometer.
• The instrument commonly used to measure air temperatures in mines is a Whirling Hygrometer and Kata Thermometer.

What are the Sources of Heat?

• Auto-compression of Air
• Machinery
• Men
• Oxidation of Timber and Materials
• Explosives
• Hot pipes and Electric Cables
• Fires
• Rock surfaces

Physical Stresses – Heat Stress

What is Heat Stress or Thermal Stress?

• Working in Hot areas exerts stress on our body’s cooling system.
• When the Heat is combined with other Stresses such as hard Physical Work, Loss of Fluids, Fatigue or
• some Medical Conditions, it may lead to heat-related illness, disability and even death.
• Your body is always generating heat and passing it to the environment.
• The harder your body is working, the more heat it has to lose.
• When the environment is hot or humid or has a source of radiant heat (eg; furnace), your body must work harder to get rid of its heat.

NOTE: The Normal Body Temperature is 37°C. 

Working Places are classified into three Working Temperature Zones:

Cool –  < 25.0ºC wet-bulb and < 32ºC dry-bulb / radiant temperature (conditions not conducive to heat stroke)

Warm – 25.0 to 32.5ºC wet-bulb (conditions potentially conducive to heat stroke)

Abnormally Hot – >32,5°C wet-bulb (Risk of developing heat stroke. Unacceptable, evacuation of routine workers.  Emergency work only under strict supervision and special precautions)

Physical Stresses – Heat Related Disorders

Heat Cramps: These are painful muscle spasms caused by a loss of salts through excessive sweating.

Heat Exhaustion: This occurs when the body has lost so must water and salts as a result of excessive perspiration that Hypovolemia Shock (a lack of blood volume) occurs.

What are the signs for Heat Stroke?

• Early symptoms are the same as for “Heat Exhaustion” above. Later the heat regulating mechanism of the body fails and sweating stops. The symptoms are a hot, dry skin, muscle spasms, vacant staring of the eyes. The victim could, collapse and die if their body temperature is not cooled down.

What factors influence the Risk of getting Heat Exhaustion?

• The Body’s Metabolic rate
• The Temperatures of the Working Environment
• The Type of Clothes that are worn
• The Body’s ability to Radiate Teat or Expel Heat through Evaporation

Physical Stresses – Burns

How are Burns Wounds Classified?

How to treat Burn Wounds:

• Seek immediate medical treatment for 3rd degree and large 2nd degree burns.
• Rinse Chemical Burns under cold water for 10-15 minutes
• Immerse skin or apply cold water until pain stops
• Do Not break or burst any blisters
• Apply sterile non-stick pads
• If you are unsure about the severity of a burn wound, notify a doctor or hospital immediately.
• A doctor should also be notified if a burn is not healing or if there are signs of complications such as a fever or infection.

Remember: A first aider is not allowed to treat burn wounds.  He/she must only stabilizes the patient and treats for shock

Physical Stresses – Lighting

Light can be defined as “Visually Evaluated Radiant Energy”

What is the measurement of illumination?

• Illumination levels are measured with a luxmeter (lux).
• An Object’s Surface Brightness depends on the intensity of the light striking it and the amount of light that is reflected.
• Physical brightness can be measured the eye and varies from individual to individual.
• Brightness that causes discomfort, interference with vision or eye fatigue is called Glare.

How can illumination levels be Improved?

• Installing the correct type of light Filament lamps, Fluorescent lamps, Mercury vapor lamps or Sodium Vapor lamps
• Positioning the light correctly
• Reducing glare
• Cleaning and maintaining light installation

Ergonomical Stresses – Working Areas and Tools

Ergonomic Stress is the effect that the Working Environment has on a person’s body. What strains are put on a person’s body from adjusting in order to perform the work effectively.

Common Injuries / Diseases relating to Ergonomic Stress

• Poorly designed work conditions can lead to injury of the hands, wrists, back or other body joints
• Vibration, repetitive work, twisting, awkward work position, excessive force or pressure, lifting or pushing can all cause injuries and diseases to develop
• Poorly designed tools and workstations can develop Injuries or illnesses over time

Workplace Design Factors to consider

• Head height
• Shoulder height
• Arm reach
• Elbow height
• Hand height
• Leg length
• Hand and body size

Hand Tool Design Factors to consider

• Tools to be light enough to prevent fatigue if used for long periods
• Grip Size to be correct size for the hand
• Grip Shape must be comfortable
• Wrist must always be straight during operation
• Tool must be balanced
• Trigger Pressure must be comfortable

Ergonomical Stresses – Manual Material Handling

Manual Material Handling tasks that exceeds a worker’s Physical Capacity or the Poor Layout of the Workplace are the most common causes of back injuries.

Negative Effects of Manual Material Handling:

• Accidental injuries and fatigue
• Sharp Surfaces result in wounds, cuts or bruises
• Falling or Colliding with objects
• Chronic back pain from strained back muscles
• Tears in back muscle’s tendons
• Sprains and tears of the Back’s Ligaments
• Damage to the Spine Vertebrae or Spinal Discs

Work Factors that cause Back Injuries

• Weight of the load lifted
• Range of the lift
• Location of the load in relation to the body
• Size and Shape of the load
• Number and Frequency of lifts performed
• Poor Layout of the Workplace.

80% of Injuries could be prevented by lifting a load with your legs …not your back.

Ergonomical Stresses – Lifting Heavy Loads

The Correct Procedure to Lift a Load.

• Take time to plan the lifting and movement of the load
• Stand close behind the load.
• Straddle the load, placing the leading foot flat beside the load in the direction of travel.
• Bend the hips and knees.
• Keep your back straight.
• Grasp the load with elbows inside the thighs.
• Grasp with one hand at the top outer corner, over the leading foot and the other hand on the lower opposite corner.
• Stand up with the back leg and continue  in an upward and forward direction.
• Keep the load close to the body.
• Move off without twisting the body.

Ergonomical Stresses – Moving Heavy Loads

The Correct Procedure to Pull or Push Load.

• Ensure the path behind you is clear
• Ensure a sound footing
• Pull off using you front leg
• Always be aware of what is behind you

• Ensure a sound footing
• Push off with your back leg
• Never push a load faster than you can comfortably walk

Biological Stresses

Biological Hazards are conditions of illness caused by Micro-Organisms.

These Micro-Organisms can be conveyed to you in the following ways:

• From the industry to the worker,
• From the one worker to another

What is Legionella?

• It is the inhalation of aerosol, which contains specific bacteria.
• It has the same effects and symptoms as Pneumonia.
• It is mostly found where an isolated water ventilation system is used.

What is Food Poisoning?

• Infection of food found in the nose, in septic wounds and boils.
• Multiplies in warming ovens where food is kept for quite some time.

Biological Stresses – Tuberculosis

What is Tuberculosis?

• Tuberculosis is caused by inhaling the infected breath drops or coming into contact with sputum of another person who is infected with T.B.
• Germs then develop in the lungs and destroy the lung tissue.

Sign and Symptoms of Tuberculosis include:

• Prolonged coughing with the production of bloody sputum
• Loss of appetite and weight loss
• Tiredness and night sweats
• Loss of body strength

Biological Stresses – HIV/AIDS

What is HIV/AIDS? (Acquired Immune Deficiency Syndrome)

• AIDS is a condition caused by a virus called HIV.
• The HIV Virus is a virus like the flu or cold virus that attacks the immune system.
• When the immune system breaks down, you lose this protection and can develop many serious, often deadly infections and cancers.
• The HIV mostly infects white blood cells that turn the immune system on to fight disease.
• Once inside the white blood cell, HIV starts producing millions of viruses, which eventually kill the cell and then go out to infect other cells.

Biological Stresses – HIV/AIDS Wellness Strategy

Objectives of the HIV / AIDS Wellness Strategy

• A program geared towards managing the business in the context of life-threatening health issues.
• A way in which EGM (MPC) will obtain knowledge on preventing/managing chronic   illnesses/diseases, especially HIV/AIDS.
• To continuously encourage employees to adopt/maintain safe and healthy life styles, in order to minimize their risk of exposure to/contracting of these diseases.
• To integrate the wellness programs in order to promote total employee wellness.

Key Principles of the EGM (MPC) HIV / AIDS Wellness Strategy

Employment and HIV Testing: Applicants for employment are required to pass a pre-employment medical examination.

Non-discrimination against Employees: Non-discrimination against employees diagnosed with a chronic disease/illness in the workplace, provided that the illness does not affect the employee’s work performance negatively.

Employee Benefits: An employee will not be refused development or promotion due to their HIV, chronic illness or disease status.

Dismissals: No employee shall be dismissed based on a chronic illness/disease or being infected with HIV/AIDS.

Confidentiality: Employees are not obliged to inform management of a chronic disease/illness, but should they be informed, all precautions will be taken to ensure that such information is kept in the strictest confidence.

Contingency Planning:  A contingency plan will be developed and updated as soon as it becomes clear that a skills shortage may occur in a particular job category due to HIV/AIDS.

Intervention / Management Programmes:  EGM (MPC)  will intervene in the management of chronic illnesses, diseases and  HIV/AIDS in the workplace as these impact on an employee’s productivity and total wellness.

Key Features of the EGM (MPC) HIV / AIDS Wellness Strategy

Education and Awareness Information: Employees educated on wellness issues, are better equipped to make sound and informed decisions for themselves and their families.

Business Impact Assessments: We stay informed on HIV/AIDS trends in SA in order to align the Company’s HIV/AIDS strategy accordingly.

Voluntary Participation: The decision to participate in the EWP is voluntary regardless of referral.

Biological Stresses– Employee Wellness Program

Key Features of the EGM (MPC) HIV / AIDS Wellness Strategy

Momentum: Office on site which may be visited weekly for quieries and general information with regards to the Health Scheme.

Labour Relations: No disciplinary action can result from refusal to accept referral to OMP.

Confidentiality: All OMP records shall be treated as confidential.

Relationship with Disciplinary and Performance Management: Utilization of OMP services through self-reporting shall not influence the incumbent’s job security or promotion in the process.

Referral: Referrals to the OMP may take different forms and will dependent on the situation and are made as follows:

• Self-referral
• Informal referral
• Formal referral

Socio-Psychological Stresses – Tobacco Smoking

What is Psychological Tension (Stress)?

• Tension, Stress or frustration builds up in the work environment or at home in the social environment.  This leads to a lack of motivation, aggression and a drop in productivity.   It often leads to the escape through smoking of Tobacco, Drugs or Alcohol resulting in addiction and complications

What is the background to Anti-smoking Legislation?

• Medical research has shown that smoking and exposure to second hand smoke is a health hazard.
• Short term effects include irritation to eyes, throat and respiratory tract.
• Long term effects including impaired lung function and lung cancer.
• Both smoking and passive smoking pose a serious and substantial threat to public health.
• The Company has a duty in terms of the OHS Act to provide a healthy and safe working  environment for all employees and requires employers to draw up a written policy on smoking.
• Against a background of increasing concern about the health effects of tobacco smoke and legislative requirements, the Company has endorsed a smoking policy

Socio-Psychological Stresses – Smoking Policy

IT IS THE POLICY OF THE COMPANY;

• To establish and maintain high standards of occupational health & safety, with respect to potential risks associated with the smoking of tobacco products.
• To respects the rights of people to choose to smoke tobacco products, but:

-Priority must be given to individuals who wish to be protected from the risk of exposure

-Smoking of tobacco products must be controlled to eliminate the risk of fire, explosion etc.

• To Not Permitted Smoking in the workplace.
• To Not Permit Smoking on company premises except in designated ‘Smoking Areas‘.
• Provide staff who do not smoke with working conditions unaffected by tobacco smoke.
• Provide those who smoke wherever possible with opportunities to do so, without affecting others.
• To ensure smoke breaks are taken for a reasonable periods as prescribed by Managers of Departments on site.
• To encourage employees who wish to give up the habit
• That any employee may approach another employee who is contravening this policy, and respectfully request compliance to the rules.
• To take disciplinary action against an employee who smokes and fails to comply with the policy and its rules.
• That the littering of cigarette butts, packets and matches are expressly forbidden.

Socio-Psychological Stresses – Alcohol & Drugs

A Policy of Zero Tolerance to Alcohol and Drugs will be applied.

Physical Screening Processes – Blood and Breath Tests.

• Screening tests to be done by the Security Department.
• Screening by Health Professionals will only be with informed consent of the individual.
• This will be done in the presence of a Health and Safety Representative or Union Representative or a Fellow Employee.
• Positive test will be verified by a second test if requested by the employee
• Measures to preserve chain of custody of specimen will be taken.
• Result will be communicated to clinic for verification.
• Result to be communicated to individual preferably before communicated to supervisor.

Indicators of possible Drug and Alcohol Abuse:

• Increased absenteeism, notably on Monday mornings
• Poor productivity, Procrastination and Indecisiveness
• Increased accidents
• Smell of alcohol, Redness of the eyes and Stuttered speech
• Tremulousness with Poor coordination
• Withdrawn or aggressiveness

Procedure if a person is suspected of being under the influence.

• Their direct supervisor or designate will escort them to security.
• The person will be assessed/screened.
• Refusal of testing will be deemed to be admission of guilt.
• If the assessment shows the employee is incapable, the person must be taken to the OMP for verification screening.
• The disciplinary code must be applied.
• Medicine containing alcohol or impairing drugs being used should be brought under the attention of the supervisor.
• If the employee is not under the influence of drugs or alcohol and the person is capable of doing his/her job, then the employee must be allowed to return to work.

Socio-Psychological Stresses – Fatigue Management