Occupational health, safety and wellbeing teams must work together to form truly multidisciplinary teams within an organisation. Understanding how and where occupational hygiene fits within this is a critical part of this process, argues Dr Aseni Wickramatillake.
Occupational health professionals, including nurses, physicians and safety advisers, require an understanding of the principles of occupational hygiene to appreciate how the health of employees might be adversely affected by the work that they do.
This was of particular importance during the Covid pandemic. A knee-jerk reaction in many healthcare settings involved simply issuing personal protective equipment (PPE) such as clothing, masks and eye protection.
Issuing PPE is one approach, but this should be the last resort as it is at the bottom of the hierarchy of controls, with engineering and managerial controls more valuable in ensuring minimal risk to workers (Sehgal and Milton, 2021).
It is important to appreciate the principles of both safety and occupational hygiene. A hygienist can advise on the most appropriate engineering controls – which in the case of a hospital during the Covid-19 pandemic should have started with appropriate ventilation systems.
The case for action
In Great Britain, 1.8 million working people suffered from new or long-term work-related illness in the year 2021/2022. Approximately 13,000 deaths in the UK have been estimated each year due to exposure to chemicals or dust (HSE, 2020 a) and, globally, 2.3 million deaths a year are associated with work-related diseases (ILO, 2014).
The cost of injury and illness to the UK economy is staggering; £18.8bn was the total cost of self-reported workplace injuries and illnesses for the year 2019/2020, 60% of which was due to ill health while the other 40% was due to injury (HSE, 2022).
Occupational hygiene
Occupational hazards are conditions within a work environment that increase the probability of injury, illness or death to a worker. Hazards can be categorised into various forms, such as chemical, physical, biological, mechanical, psychosocial and ergonomics.
Occupational ill health is dependent on the type of hazard, the dose, duration and frequency of exposure and the individual susceptibility. Past hazardous work exposures can lead to the development of present work-related ill health, and current exposures can lead to work-related illnesses immediately or in the future, depending on the latency period (HSE, 2022).
Asbestos is an example of an exposure with a long latency period. Despite the ban on use of asbestos in 1999 (Public Health England, 2020), 2,544 people in the UK have died of mesothelioma, a condition that is known to be caused by exposure to asbestos (HSE, 2020 a).
Occupational hygiene contributes significantly to recognising the hazard and evaluating the magnitude of the exposure. It is also known as industrial hygiene, and involves anticipating, recognising, evaluating, and mitigating the exposure to hazards in workplaces.
Irrespective of the type of workplace, employees may be exposed to a multitude of hazards. These exposures may lead to acute or chronic ill health. The health hazards in the workplace and their risks may not be readily apparent to management or employees.
Some occupational hazards may not be noticeable for many years, especially the hazards causing diseases with long latency periods.”
The potential risk of exposure, as well as qualitative and quantitative analysis of the hazard, can indicate the severity of the risk and potential dangers to human health.
Some occupational hazards may not be noticeable for many years, especially the hazards causing diseases with long latency periods. Conversely, others may be noticeable only after a gradual increase of toxicity within the body over a certain period of exposure.
The Health and Safety Executive (HSE) has developed a list of substances that are hazardous to health, and workplaces are expected to control exposure to these hazardous substances under the COSHH regulations (HSE, undated).
Exposure to hazardous substances can primarily be through inhalation, then through absorption from the skin and through the gastrointestinal tract. Other methods of exposure, such as through injection, mother to foetus, and bodily fluids, are comparatively rare in many workplaces. For healthcare professionals, occupational exposure to contaminated needles and bodily fluids can be significant.
To protect workers, HSE has developed workplace exposure limits (WEL) (HSE, 2020 b). However, substances that are known to be carcinogens, mutagens and teratogens must be controlled to a level as low as is reasonably practicable.
Risk assessments
Identification of occupational hazards and associated health problems can be conducted through an inter-relationship between systematic environmental assessments, detailed exposure history, relevant biological monitoring, structured health and medical surveillance and epidemiological methods.
Risk assessment is important to determine a hazard’s potential to cause harm, the likelihood of harm, and the severity of harm (Alli, 2008).
Risk analysis can be qualitative or quantitative or both. Qualitative risk analysis of hazards can have good operability, ease of use, cover a broad scope of evaluated substances, and can be applied in various industries and applicable to SMEs.
However qualitative risk analysis requires professional knowledge, which can be a subjective judgement with a danger of overestimating the risk. Quantitative risk analysis is reliable due to its use of epidemiological and toxicological data. However, in the event of exposure to multiple hazards, the risk levels of different exposures may be difficult to identify (Tian, 2018), possibly having a synergistic effect.
A precautionary approach
Precautionary measures should be implemented to foresee the level of harm. Sometimes substances are disregarded due to inadequate data, lack of scientific validation, or unavailability of other types of evidence. By the time of evidence is recognised many people may have suffered irreversible health consequences or even death (Alli, 2008).
Health surveillance entails a systematic procedure of detection of early signs and identification of any health anomalies in a worker. This surveillance includes keeping a good record of exposure history, clinical examination, biological monitoring and radiological examinations.
Health surveillance is an integral part of risk management and confirmation of exposure to workplace hazards, the effectiveness of existing control measures and the status of health among the working population (Lele, 2018).
Once the hazards are recognised and the level of harm to human health is evaluated, exposure to the hazards should be controlled as best as possible. In occupational safety and health, the hierarchy of control is a framework used to best control exposures based on the effectiveness of the solution and its feasibility for implementation (CDC, 2023).
The descending order of effectiveness at minimising exposure risk is elimination, substitution, engineering controls, administrative controls and personal protective equipment.
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Elimination of the hazard from exposure and substitution of hazards for less harmful hazards are the most effective control measures. This can protect almost all workers.
Even though engineering controls do not eliminate the hazard, they can highly be effective in reducing the exposure risk to individuals independent of their own behaviour (Sehgal, 2021).
Minimising exposure risk by altering individual behaviour via policies and directives is done by administrative controls. However, its effectiveness is dependent on the compliance of the control measures.
The use of personal protective equipment is the least effective control measure due to its high dependency on correct and effective use (Gandhi, 2021).
According to the World Health Organization (WHO), health is not the mere absence of disease but the physical, mental and social wellbeing of a person.
Occupational ill health is a consequence of exposure to hazards or poor lifestyle due to work. The provision of occupational health services at a national level is key to ensuring sustainable health and wellbeing with adequate engagement at work (Jain, 2021).
Strengthening the provision of occupational health services can improve the health of workers and their ability to work (Rantanen, 2012). WHO (2002) states the objectives of occupational health are:
- The maintenance and promotion of workers’ health and working capacity.
- The improvement of working conditions and the working environment to become conducive to safety and health.
- The development of healthy organisational and working cultures that include effective managerial systems, HR policies, principles for participation, and voluntary quality-related management practices to improve occupational safety and health.
These objectives lay the foundation to promote and maintain the highest degree of physical, mental and social wellbeing of workers in all occupations.
The safety officer, industrial hygienist and the occupational health specialist complement each other’s work to ensure the safety and health of all employees”
With an ageing population, the retirement age is rising. More people will be at work for longer durations. Hence, the need is much greater than before to ensure a sustainable healthy working population.
Pre-employment evaluations, periodic medical assessments, assessments when returning to work after prolonged absence due to illness, and medical surveillance, should be considered important to ensure the long-term good health of the workforce.
Occupational health, safety and wellbeing comprise of a multidisciplinary team within an organisation. It is an integrated and comprehensive team with varying expertise and experiences to prevent, protect and promote worker’s health, safety and wellbeing (ILO, 2009).
The safety officer, industrial hygienist and occupational health specialist complement each other’s work to ensure the safety and health of all employees.
References
Alli B and International Labour Organization (2008). ‘Fundamental principles of occupational health and safety.’ Second edition. ILO Publications. Available at: https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/—publ/documents/publication/wcms_093550.pdf
CDC (2023). ‘Hierarchy of Controls’. NIOSH, CDC (2023). Available at: https://www.cdc.gov/niosh/topics/hierarchy/default.html
Gandhi M and Marr L C (2021). ‘Uniting Infectious Disease and Physical Science Principles on the Importance of Face Masks for COVID-19’. Med, 2(1), pp. 29-32. Available at: https://doi.org/10.1016/j.medj.2020.12.008
Health and Safety Executive (2020 a). ‘Health and safety statistics (2020)’. Available at: https://www.hse.gov.uk/statistics/
Health and Safety Executive (2020b). EH40/2005 ‘Workplace exposure limits’. Fourth edition. TSO (The Stationery Office), part of Williams Lea. Available at: https://www.hse.gov.uk/pubns/priced/eh40.pdf
Health and Safety Executive (2022). ‘Statistics – Costs to Britain of workplace injuries and new cases of work-related ill health (2022).’ Available at: https://www.hse.gov.uk/statistics/cost.htm
Health and Safety Executive (2022). ‘Costs to Britain of workplace fatalities and self-reported injuries and ill health, 2019/20’. HSE. Available at: https://www.riskex.co.uk/hse-work-related-ill-health-and-injury
Health and Safety Executive (undated). ‘Working with substances hazardous to health: A brief guide to COSHH’. Available at: https://www.hse.gov.uk/pubns/indg136.htm
ILO (2009). ‘Occupational health services as a key element of national occupational safety and health systems’ (2009). Available at: https://www.ilo.org/global/topics/safety-and-health-at-work/resources-library/publications/WCMS_110416/lang–en/index.htm
ILO (2014). ‘Safety and Health at Work: A Vision for Sustainable Prevention’ (2014). Available at: http://www.ilo.org/safework/info/publications/WCMS_301214/lang–tr/index.htm
Jain A et al (2021). ‘The Role of Occupational Health Services in Psychosocial Risk Management and the Promotion of Mental Health and Well-Being at Work’. International Journal of Environmental Research and Public Health, 18(7), p. 3632. Available at: https://doi.org/10.3390/ijerph18073632
Lele D V (2018). ‘Occupational Health Surveillance’. PubMed, 22(3), pp. 117-120. Available at: https://pubmed.ncbi.nlm.nih.gov/30647512/
Public Health England (2020). ‘Asbestos: general information’ (2020). Available at: https://www.gov.uk/government/publications/asbestos-properties-incident-management-and-toxicology/asbestos-general-information
Rantanen J, Lehtinen S, and Iavicoli S (2012). ‘Occupational health services in selected International Commission on Occupational Health (ICOH) member countries’. Scandinavian Journal of Work, Environment & Health 39(2), pp. 212-216. Available at: https://doi.org/10.5271/sjweh.3317
Sehgal N, and Milton D (2021). ‘Applying the Hierarchy of Controls: What Occupational Safety Can Teach us About Safely Navigating the Next Phase of the Global COVID-19 Pandemic’, Frontiers in Public Health, 9. Available at: https://www.frontiersin.org/articles/10.3389/fpubh.2021.747894/full#B6
Tian F et al (2018). ‘Qualitative and quantitative differences between common occupational health risk assessment models in typical industries’. Journal of Occupational Health, 60(5), pp. 337-347. Available at: https://doi.org/10.1539/joh.2018-0039-oa
WHO (2002). ‘Good practice in occupational health services: a contribution to workplace health’. WHO Regional Office for Europe: Copenhagen. Available at: https://apps.who.int/iris/handle/10665/107448
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