Occupational Health

Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at work (i.e. in an occupation). These terms also refer to the goals of this field, so their use in the sense of this article was originally an abbreviation of ''occupational safety and health program/department'' etc.

The goal of an occupational safety and health program is to foster a safe and healthy occupational environment. OSH also protects all the general public who may be affected by the occupational environment.Fanning, Fred E. (2003). Basic Safety Administration: A Handbook for the New Safety Specialist, Chicago: American Society of Safety Engineers

Globally, more than 2.78 million people die annually as a result of workplace-related accidents or diseases, corresponding to one death every fifteen seconds. There are an additional 374 million non-fatal work-related injuries annually. It is estimated that the economic burden of occupational-related injury and death is nearly four per cent of the global gross domestic product each year. The human cost of this adversity is enormous.

In common-law jurisdictions, employers have the common law duty (also called duty of care) to take reasonable care of the safety of their employees. Statute law may, in addition, impose other general duties, introduce specific duties, and create government bodies with powers to regulate occupational safety issues: details of this vary from jurisdiction to jurisdiction.

Definition

As defined by the World Health Organization (WHO) "occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards." Health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Occupational health is a multidisciplinary field of healthcare concerned with enabling an individual to undertake their occupation, in the way that causes least harm to their health. It aligns with the promotion of health and safety at work, which is concerned with preventing harm from hazards in the workplace.

Since 1950, the International Labour Organization (ILO) and the WHO have shared a common definition of occupational health. It was adopted by the Joint ILO/WHO Committee on Occupational Health at its first session in 1950 and revised at its twelfth session in 1995. The definition reads:

Those in the field of occupational health come from a wide range of disciplines and professions including medicine, psychology, epidemiology, physiotherapy and rehabilitation, occupational medicine, human factors and ergonomics, and many others. Professionals advise on a broad range of occupational health matters. These include how to avoid particular pre-existing conditions causing a problem in the occupation, correct posture for the work, frequency of rest breaks, preventive action that can be undertaken, and so forth. The quality of occupational safety is characterized by (1) the indicators reflecting the level of industrial injuries, (2) the average number of days of incapacity for work per employer, (3) employees' satisfaction with their work conditions and (4) employees' motivation to work safely.

"Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities; and, to summarize, the adaptation of work to man and of each man to his job.

Given the high demand in society for health and safety provisions at work based on reliable information, occupational safety and health (OSH) professionals should find their roots in evidence-based practice. A new term is "evidence-informed decision making". A working definition of evidence-based practice could be: evidence-based practice is the use of evidence from literature, and other evidence-based sources, for advice and decisions that favor the health, safety, well-being, and work ability of workers. Therefore, evidence-based information must be integrated with professional expertise and the workers' values. Contextual factors must be considered related to legislation, culture, financial, and technical possibilities. Ethical considerations should be heeded.

History

The research and regulation of occupational safety and health are a relatively recent phenomenon. As labor movements arose in response to worker concerns in the wake of the industrial revolution, worker's health entered consideration as a labor-related issue.

In 1700, '' De Morbis Artificum Diatriba'' outlined the health hazards of chemicals, dust, metals, repetitive or violent motions, odd postures, and other disease-causative agents encountered by workers in more than fifty occupations. In the United Kingdom, the Factory Acts of the early nineteenth century (from 1802 onwards) arose out of concerns about the poor health of children working in cotton mills: the Act of 1833 created a dedicated professional Factory Inspectorate. The initial remit of the Inspectorate was to police restrictions on the working hours in the textile industry of children and young persons (introduced to prevent chronic overwork, identified as leading directly to ill-health and deformation, and indirectly to a high accident rate). However, on the urging of the Factory Inspectorate, a further Act in 1844 giving similar restrictions on working hours for women in the textile industry introduced a requirement for machinery guarding (but only in the textile industry, and only in areas that might be accessed by women or children).

In 1840 a Royal Commission published its findings on the state of conditions for the workers of the mining industry that documented the appallingly dangerous environment that they had to work in and the high frequency of accidents. The commission sparked public outrage which resulted in the Mines Act of 1842. The act set up an inspectorate for mines and collieries which resulted in many prosecutions and safety improvements, and by 1850, inspectors were able to enter and inspect premises at their discretion.

Otto von Bismarck inaugurated the first social insurance legislation in 1883 and the first worker's compensation law in 1884 – the first of their kind in the Western world. Similar acts followed in other countries, partly in response to labor unrest.

Workplace hazards

Although work provides many economic and other benefits, a wide array of workplace hazards (also known as unsafe working conditions) also present risks to the health and safety of people at work. These include but are not limited to, "chemicals, biological agents, physical factors, adverse ergonomic conditions, allergens, a complex network of safety risks," and a broad range of psychosocial risk factors. Personal protective equipment can help protect against many of these hazards. A landmark study conducted by the World Health Organization and the International Labour Organization found that exposure to long working hours is the occupational risk factor with the largest attributable burden of disease, i.e. an estimated 745,000 fatalities from ischemic heart disease and stroke events in 2016. This makes overwork the globally leading occupational health risk factor.

Physical hazards affect many people in the workplace. Occupational hearing loss is the most common work-related injury in the United States, with 22 million workers exposed to hazardous noise levels at work and an estimated $242 million spent annually on worker's compensation for hearing loss disability. Falls are also a common cause of occupational injuries and fatalities, especially in construction, extraction, transportation, healthcare, and building cleaning and maintenance. Machines have moving parts, sharp edges, hot surfaces and other hazards with the potential to crush, burn, cut, shear, stab or otherwise strike or wound workers if used unsafely.

Biological hazards (biohazards) include infectious microorganisms such as viruses, bacteria and toxins produced by those organisms such as anthrax. Biohazards affect workers in many industries; influenza, for example, affects a broad population of workers. Outdoor workers, including farmers, landscapers, and construction workers, risk exposure to numerous biohazards, including animal bites and stings, urushiol from poisonous plants, and diseases transmitted through animals such as the West Nile virus and Lyme disease. Health care workers, including veterinary health workers, risk exposure to blood-borne pathogens and various infectious diseases, especially those that are emerging.

Dangerous chemicals can pose a chemical hazard in the workplace. There are many classifications of hazardous chemicals, including neurotoxins, immune agents, dermatologic agents, carcinogens, reproductive toxins, systemic toxins, asthmagens, pneumoconiotic agents, and sensitizers. Authorities such as regulatory agencies set occupational exposure limits to mitigate the risk of chemical hazards. International investigations are ongoing into the health effects of mixtures of chemicals, given that toxins can interact synergistically instead of merely additively. For example, there is some evidence that certain chemicals are harmful at low levels when mixed with one or more other chemicals. Such synergistic effects may be particularly important in causing cancer. Additionally, some substances (such as heavy metals and organohalogens) can accumulate in the body over time, thereby enabling small incremental daily exposures to eventually add up to dangerous levels with little overt warning.

Psychosocial hazards include risks to the mental and emotional well-being of workers, such as feelings of job insecurity, long work hours, and poor work-life balance. A recent Cochrane review – using moderate quality evidence – related that the addition of work-directed interventions for depressed workers receiving clinical interventions reduces the number of lost work days as compared to clinical interventions alone. This review also demonstrated that the addition of cognitive behavioral therapy to primary or occupational care and the addition of a "structured telephone outreach and care management program" to usual care are both effective at reducing sick leave days.

By industry

Specific occupational safety and health risk factors vary depending on the specific sector and industry. Construction workers might be particularly at risk of falls, for instance, whereas fishermen might be particularly at risk of drowning. The United States Bureau of Labor Statistics identifies the fishing, aviation, lumber, metalworking, agriculture, mining and transportation industries as among some of the more dangerous for workers. Similarly psychosocial risks such as workplace violence are more pronounced for certain occupational groups such as health care employees, police, correctional officers and teachers.

Construction

Construction is one of the most dangerous occupations in the world, incurring more occupational fatalities than any other sector in both the United States and in the European Union. In 2009, the fatal occupational injury rate among construction workers in the United States was nearly three times that for all workers. Falls are one of the most common causes of fatal and non-fatal injuries among construction workers. Proper safety equipment such as harnesses and guardrails and procedures such as securing ladders and inspecting scaffolding can curtail the risk of occupational injuries in the construction industry. Due to the fact that accidents may have disastrous consequences for employees as well as organizations, it is of utmost importance to ensure health and safety of workers and compliance with HSE construction requirements. Health and safety legislation in the construction industry involves many rules and regulations. For example, the role of the Construction Design Management (CDM) Coordinator as a requirement has been aimed at improving health and safety on-site.

The 2010 National Health Interview Survey Occupational Health Supplement (NHIS-OHS) identified work organization factors and occupational psychosocial and chemical/physical exposures which may increase some health risks. Among all U.S. workers in the construction sector, 44% had non-standard work arrangements (were not regular permanent employees) compared to 19% of all U.S. workers, 15% had temporary employment compared to 7% of all U.S. workers, and 55% experienced job insecurity compared to 32% of all U.S. workers. Prevalence rates for exposure to physical/chemical hazards were especially high for the construction sector. Among nonsmoking workers, 24% of construction workers were exposed to secondhand smoke while only 10% of all U.S. workers were exposed. Other physical/chemical hazards with high prevalence rates in the construction industry were frequently working outdoors (73%) and frequent exposure to vapors, gas, dust, or fumes (51%).

Agriculture

Agriculture workers are often at risk of work-related injuries, lung disease, noise-induced hearing loss, skin disease, as well as certain cancers related to chemical use or prolonged sun exposure. On industrialized farms, injuries frequently involve the use of agricultural machinery. The most common cause of fatal agricultural injuries in the United States is tractor rollovers, which can be prevented by the use of roll over protection structures which limit the risk of injury in case a tractor rolls over. Pesticides and other chemicals used in farming can also be hazardous to worker health, and workers exposed to pesticides may experience illnesses or birth defects. As an industry in which families, including children, commonly work alongside their families, agriculture is a common source of occupational injuries and illnesses among younger workers. Common causes of fatal injuries among young farm worker include drowning, machinery and motor vehicle-related accidents.

The 2010 NHIS-OHS found elevated prevalence rates of several occupational exposures in the agriculture, forestry, and fishing sector which may negatively impact health. These workers often worked long hours. The prevalence rate of working more than 48 hours a week among workers employed in these industries was 37%, and 24% worked more than 60 hours a week. Of all workers in these industries, 85% frequently worked outdoors compared to 25% of all U.S. workers. Additionally, 53% were frequently exposed to vapors, gas, dust, or fumes, compared to 25% of all U.S. workers.

Service sector

As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems such as the growing rate of obesity and issues relating to occupational stress, workplace bullying, and overwork in many countries have further complicated the interaction between work and health.

According to data from the 2010 NHIS-OHS, hazardous physical/chemical exposures in the service sector were lower than national averages. On the other hand, potentially harmful work organization characteristics and psychosocial workplace exposures were relatively common in this sector. Among all workers in the service industry, 30% experienced job insecurity in 2010, 27% worked non-standard shifts (not a regular day shift), 21% had non-standard work arrangements (were not regular permanent employees).

Due to the manual labour involved and on a per employee basis, the US Postal Service, UPS and FedEx are the 4th, 5th and 7th most dangerous companies to work for in the US.

Mining and oil and gas extraction

The mining industry still has one of the highest rates of fatalities of any industry. There are a range of hazards present in surface and underground mining operations. In surface mining, leading hazards include such issues as geological stability, contact with plant and equipment, blasting, thermal environments (heat and cold), respiratory health (Black Lung) In underground mining operations hazards include respiratory health, explosions and gas (particularly in coal mine operations), geological instability, electrical equipment, contact with plant and equipment, heat stress, inrush of bodies of water, falls from height, confined spaces. ionising radiation

According to data from the 2010 NHIS-OHS, workers employed in mining and oil and gas extraction industries had high prevalence rates of exposure to potentially harmful work organization characteristics and hazardous chemicals. Many of these workers worked long hours: 50% worked more than 48 hours a week and 25% worked more than 60 hours a week in 2010. Additionally, 42% worked non-standard shifts (not a regular day shift). These workers also had high prevalence of exposure to physical/chemical hazards. In 2010, 39% had frequent skin contact with chemicals. Among nonsmoking workers, 28% of those in mining and oil and gas extraction industries had frequent exposure to secondhand smoke at work. About two-thirds were frequently exposed to vapors, gas, dust, or fumes at work.

Healthcare and social assistance

Healthcare workers are exposed to many hazards that can adversely affect their health and well-being. Long hours, changing shifts, physically demanding tasks, violence, and exposures to infectious diseases and harmful chemicals are examples of hazards that put these workers at risk for illness and injury. Musculoskeletal injury (MSI) is the most common health hazard in for healthcare workers and in workplaces overall. Injuries can be prevented by using proper body mechanics.

According to the Bureau of Labor statistics, U.S. hospitals recorded 253,700 work-related injuries and illnesses in 2011, which is 6.8 work-related injuries and illnesses for every 100 full-time employees. The injury and illness rate in hospitals is higher than the rates in construction and manufacturing – two industries that are traditionally thought to be relatively hazardous.

Occupational exposures in dentistry

Dental professionals and their teams encounter multiple exposures daily to occupational hazards in dentistry. These occupational exposures are detrimental to their health, especially when they are chronic in nature.

* Exposure to noise: Any undesirable sound present in the working environment is referred to as occupational noise. According to the OSHA, when working five days a week in any environment, the international standard of the eight-hour daily occupational exposure should not be greater than 85 decibels (dBA), and anything above this could cause noise-induced hearing loss. Hearing loss due to irreversible injury to the inner ear from chronic, cumulative exposure to loud sounds is called noise-induced hearing loss (NIHL). Buzzing and ringing of the ear, also called tinnitus, and dulled hearing are symptoms of NIHL. Several health problems arise due to overexposure to loud noises such as stress, disruption in sleep patterns, cardiovascular disorders, anxiety, fatigue, and depression. Dental professionals are exposed to noise generated by a wide variety of instruments like ultrasonic scalers, suction, and air rotor handpieces. The recommended maximum exposure limit to sound in an 8-hour workday is 85 dBA. In a study, unobstructed suction noise levels had a range of 75–79 dBA, while obstructed suction had a noise level of 96 dBA, and it was recommended that professionals should not have an exposure of more than 1 hour in such a workplace. High-intensity sounds from ultrasonic scalers range between 69 and 84 dBA within the safe 8-hour limit for occupational noise. Threshold shift, the reduction in hearing due to reduced sensitivity level of ears due to noise exposure, occurs due to the use of an ultrasonic scaler, and although this is found to last between 16 hours to almost 2 days, it could cause irreversible damage. In a study conducted in the Dental School of Prince of Songkla University, Thailand, noise annoyance in the dental clinic has been reported by 80% of dental students. The highest percentage of noise dose exposure is found in clinics for pediatric patients.
* Exposure to inhalational anesthetics: Several inhalational anesthetic agents are used in dentistry nowadays like isoflurane, sevoflurane, desflurane, and halothane. But we are most concerned about gaseous sedative, nitrous oxide. Long-term exposures to nitrous oxide may lead to adverse effects on human health such as infertility, neurologic disorders, blood disorders, and spontaneous abortion