NATIONALITY: Indian
Hi, please take a few moments to read my profile & Credentials.
Based out of Mumbai, India.MY credentials are as below
Email; drhitesh2007@gmail.com
Mobile; 0091-7738090107
Hi, please take a few moments to read my profile & Credentials.
Based out of Mumbai, India.MY credentials are as below
- Trained in Accident &Emergency Medicine and in Occupational & Environmental Medicine. I also hold qualifications in the field of Public Health, Environmental Science & Hospital Administration (India). I have worked with several reputed organisations, to name a few, Saudi Aramco, International SOS services (India) Pvt ltd. I was the Medical Adviser for International SOS Services (India) Pvt Ltd working in the Global Medical Services, India division. I was leading the India division on Training & Occupational Health projects. During this period, I served a number of corporates to the likes of BGEPIl (British Gas), Shell, Goldman Sachs, Fidelity, JP Morgan , GM motors and others.
- An active member of Indian association of Occupational Health, and also the member of the American association of Occupational & Environmental Medicine & American college of Emergency physicians. I was appointed for the fellowship at the Alfred Hospital, in Melbourne Australia. This center is one of the largest centers in Australia for road traffic accidents. I have recently been accepted as a member of the Society of Occupational Medicine (SOM), UK.I am also a Medico-Legal expert.
- Certified Auditor for OHSAS 18001 & 18002.
- .MBA-Finance ( Master in Business Administration),to support me for any leadership role in the future.
- Extensive working experience in Ireland, Australia and the Middle East.
- Also the Brigade Commander of ST John’s ambulance, and as such was leading First-aid training services for Intl.SOS corporate customers across the country.
- Earlier DEPUTY DIRECTOR Of Inlaks General Hospital, Chembur, Mumbai.
- Emergency Specialist-Reliance Industries.
- Recently superannuated and am now a Freelance consultant, to several Corporates
Email; drhitesh2007@gmail.com
Mobile; 0091-7738090107
.
And Please Watch this website for regular updates in the comments section
Thank-you very much for you time.
And Please Watch this website for regular updates in the comments section
Thank-you very much for you time.
65 comments:
Occupational health,is a field very poorly represented in India,but a must for corporates,it is a win-win situation both for the employer and employee.
A service required by all corporates.
Occupational Health (OH) is a specialized branch of Medicine,which deals with Corporate wellness.Whenever the health of an employee is impacting his or her work or vice-versa The role of OH physician begins.
The concept of OH is very old and goes back to times of egyptian pyramid construction.In India it was legislated way back in Factories act,for the requirement of OH services,Howver the awareness of the subject is lacking at the corporate level and hence very few centres have a fully developed OH medical centre.
Occupational safety and health is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. As a secondary effect, it may also protect co-workers, family members, employers, customers, suppliers, nearby communities, and other members of the public who are impacted by the workplace environment.
Since 1950, the International Labour Organization (ILO) and the World Health Organization (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: "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."
The reasons for establishing good occupational safety and health standards are frequently identified as:
Moral - An employee should not have to risk injury at work, nor should others associated with the work environment.
Economic - many governments realize that poor occupational safety and health performance results in cost to the State (e.g. through social security payments to the incapacitated, costs for medical treatment, and the loss of the "employability" of the worker). Employing organisations also sustain costs in the event of an incident at work (such as legal fees, fines, compensatory damages, investigation time, lost production, lost goodwill from the workforce, from customers and from the wider community).
Legal - Occupational safety and health requirements may be reinforced in civil law and/or criminal law; it is accepted that without the extra "encouragement" of potential regulatory action or litigation, many organisations would not act upon their implied moral obligations.
Different countries take different approaches to legislation, regulation, and enforcement.
In the European Union, member states have enforcing authorities to ensure that the basic legal requirements relating to occupational safety and health are met. In many EU countries, there is strong cooperation between employer and worker organisations (e.g. Unions) to ensure good OSH performance as it is recognized this has benefits for both the worker (through maintenance of health) and the enterprise (through improved productivity and quality). In 1996 the European Agency for Safety and Health at Work was founded.
Member states of the European Union have all transposed into their national legislation a series of directives that establish minimum standards on occupational safety and health. These directives (of which there are about 20 on a variety of topics) follow a similar structure requiring the employer to assess the workplace risks and put in place preventive measures based on a hierarchy of control. This hierarchy starts with elimination of the hazard and ends with personal protective equipment.
In the UK, health and safety legislation is drawn up and enforced by the Health and Safety Executive and local authorities (the local council) under the Health and Safety at Work etc. Act 1974. Increasingly in the UK the regulatory trend is away from prescriptive rules, and towards risk assessment. Recent major changes to the laws governing asbestos and fire safety management embrace the concept of risk assessment.
In the USA, the Occupational Safety and Health Act of 1970[1]created both the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA). OSHA, in the U.S. Department of Labor, is responsible for developing and enforcing workplace safety and health regulations. NIOSH, in the U.S. Department of Health and Human Services, is focused on research, information, education, and training in occupational safety and health.
OSHA has been regulating occupational safety and health since 1971. Occupational safety and health regulation of a limited number of specifically defined industries was in place for several decades before that, and broad regulations by some individual states was in place for many years prior to the establishment of OSHA.
In Canada, workers are covered by provincial or federal labour codes depending on the sector in which they work. Workers covered by federal legislation (including those in mining, transportation, and federal employment) are covered by the Canada Labour Code; all other workers are covered by the health and safety legislation of the province they work in. The Canadian Centre for Occupational Health and Safety (CCOHS), an agency of the Government of Canada, was created in 1978 by an Act of Parliament. The act was based on the belief that all Canadians had "...a fundamental right to a healthy and safe working environment." . CCOHS is mandated to promote safe and healthy workplaces to help prevent work-related injuries and illnesses.
In Malaysia, the Department of Occupational Safety and Health (DOSH) under the Ministry of Human Resource is responsible to ensure that the safety, health and welfare of workers in both the public and private sector is upheld. DOSH is responsible to enforce the Factory and Machinery Act 1969 and the Occupational Safety and Health Act 1994.
In India it is covered in the factories act (1948)goverened by the ministry of Labour.
Occupational safety and health may involve interaction among many cognate disciplines, including occupational medicine, occupational (or industrial) hygiene, public health, safety engineering, health physics, ergonomics, toxicology, epidemiology, industrial relations, public policy, sociology, and psychology.
Hazards, risks, outcomes
The terminology used in OSH varies between states, but generally speaking:
A hazard is something that can cause harm if not controlled.
The outcome is the harm that results from an uncontrolled hazard.
A risk is a combination of the probability that a particular outcome will occur and the severity of the harm involved.
“Hazard”, “risk”, and “outcome” are used in other fields to describe e.g. environmental damage, or damage to equipment. However, in the context of OSH, “harm” generally describes the direct or indirect degradation, temporary or permanent, of the physical, mental, or social well-being of workers. For example, repetitively carrying out manual handling of heavy objects is a hazard. The outcome would be a musculoskeletal disorder (MSD). The risk can be expressed numerically, (e.g. a 0.5 or 50/50 chance of the outcome occurring during a year), qualitatively as "high/medium/low", or using a more complicated classification scheme.
Risk assessment
Modern occupational safety and health legislation usually demands that a risk assessment be carried out prior to making an intervention. This assessment should:
Identify the hazards
Identify all affected by the hazard and how
Evaluate the risk
Identify and prioritise the required actions
The calculation of risk is based on the likelihood or probability of the harm being realised and the severity of the consequences. This can be expressed mathematically as a quantitative assessment (by assigning low, medium and high likelihood and severity with integers and multiplying them to obtain a risk factor, or qualitatively as a description of the circumstances by which the harm could arise.
The assessment should be recorded and reviewed periodically and whenever there is a significant change to work practices. The assessment should include practical recommendations to control the risk. Once recommended controls are implemented, the risk should be re-calculated to determine of it has been lowered to an acceptable level. Generally speaking, newly introduced controls should lower risk by one level, i.e, from high to medium or from medium to low
The precautionary principle is an increasingly used method for reducing potential chemical or biological OSH risks.
Common workplace hazard groups
Harry McShane, age 16, 1908. Pulled into machinery in a factory in Cincinnati. His arm was ripped off at the shoulder and his leg broken. No compensation paid. Photograph by Lewis Hine.Workplace hazards are often grouped into physical hazards, physical agents, chemical agents, environmental hazards, environmental agents, and psychosocial issues.
Physical hazards include:
Collisions
Slips and trips
Falls from height
Workplace transport
Equipment-related injury
Electricity
Heavy metals
Physical agents include:
noise
vibration
lighting
barotrauma (hypobaric / hyperbaric pressure)
Chemical agents include:
ionizing radiation
lead
solvents
Environmental hazards include:
dehydration
Environmental agents include:
heat stress
particulate inhalation
Psychosocial issues include:
Work related stress, whose causal factors include excessive working time and overwork
Violence from outside the organisation
Bullying (sometimes called mobbing) which may include emotional, verbal, and Sexual harassment
Other issues include:
Reproductive hazards
Avoidance of musculoskeletal disorders by the employment of good ergonomic design
Prevention of fire often comes within the remit of health and safety professionals as well.
General
Public safety
Material safety data sheet
Occupational Health and Safety Management Systems - OHSMS
ANSI Z10
OHSAS 18001
Government organizations
Occupational Safety and Health Administration (US)
European Agency for Safety and Health at Work (EU)
Canadian Centre for Occupational Health and Safety (Canada)
WSIB (Ontario, Canada)
Australian Safety and Compensation Council (ASCC) (Australia)
International Labour Organisation (United Nations)
Health and Safety Executive (UK)
National Institute for Occupational Safety and Health (US)
Indian association of Occupational health (IAOH)
Laws
Occupational Safety and Health Act (US)
Health and Safety at Work Act (UK)
Occupational Safety and Health Act 1994 (Malaysia)
Indonesian Act No.1/1970 about Occupational Safety at Work 1970 (Indonesia)
Timeline of major U.S. environmental and occupational health regulation.
Factories act 1948 (India)
Fields
Mine safety
Ergonomics, Participatory Ergonomics
Hazard analysis
Hazop
Industrial hygiene
Process Safety Management
Psychology
Toxicology
Epidemiology
Health Psychology
Workplace environmental standards
ISO 8518
ISO 8672
ISO 8760 - ISO 8762
ISO 9486 - ISO 9487
ISO 11041
ISO 11174
ISO 15202
ISO 15767
ISO 16107
ISO 16200
ISO 16702
ISO 16740
ISO 17733 - ISO 17734
ISO 17737
ISO 20552
Participatory Ergonomics;
Industrial Ergonomics programs seek to identify and correct factors that negatively impact the physical health of their workers. Participatory ergonomics programs seek to maximize the involvement of the workers in this process based on the simple fact that a worker is an expert on his or her job. The participatory approach to ergonomics relies on actively involving workers in implementing ergonomic knowledge, procedures and changes with the intention of improving working conditions, safety, productivity, quality, morale and/or comfort.
Implementing a participatory ergonomics program in the workplace
In order to determine if an ergonomics team/committee is right for a workplace, five factors need to be considered.
Resources and Support
A successful participatory ergonomics program requires initial and continuing resources and support from the top levels of management within the organization. The resources required include:
time for the program to develop
time to develop and implement solutions
financial resources to make meaningful changes in the workplace
management support for the individuals on the ergonomics team.
Ergo Team formation
The ergonomics committee should be composed of 6 to 8 people with the right mix of skills including technical or engineering knowledge, worker knowledge and input from an ergonomics expert. Successful, sustainable participatory ergonomics programs have an individual on the committee who takes on a leadership or "ergonomics champion" role.
Training needs
Training principles and methods are central to the success of the participatory ergonomics process. Three major aspects of training should be considered early in the process of implementing a participatory ergonomics program. Initial training in ergonomics for committee members should include ergonomics concepts and tools. Training on topics such as meeting and project management may be beneficial, depending on the past experience of committee members with committee work and implementing change. Additionally, it is important for the workforce as a whole to gain an understanding of ergonomics to improve their support for the participatory ergonomics process.
Workplace organization factors
The research literature contains limited discussion of the effect of the organization’s characteristics (culture) on the success of a participatory ergonomics intervention. The organizational climate and the timing of the introduction of the program can affect the outcome. Integrating the participatory ergonomics program into existing health and safety programs can increase the chances of success.
Involving the workforce in ergonomics
The ergonomics committee needs to respond to expectations about the ergonomics program. It is imperative to gain support or "buy in" from the workforce as most will not be directly involved with the ergonomics committee. The ergonomics program needs to be visible within the organization; this can be accomplished by ensuring that there is a focused effort to communicate with the workforce and by involving key stakeholders in all changes that are investigated and implemented.
Confidentiality of Medical Information in the Workplace;
As do all physicians, occupational and environmental medicine (OEM) practitioners rely on the patient to completely and truthfully disclose private information before rendering a professional opinion. In order for this disclosure of intimate information to occur, workers must feel that their private disclosures will be treated in a dignified and confidential manner. Because a physician must first of all do no harm, information received in confidence should be disclosed only when it is in the best interests of the patient or society, or required by applicable law or valid governmental rule or regulation.
When considering requests for job accommodation, addressing threats to health or safety, or reviewing claims for workers’ compensation benefits employers may require access to personal information. Additionally, employers shoulder an increasing responsibility for providing other types of benefits such as health and disability insurance, family medical leave, and employee assistance programs. As a result, the employer becomes inextricably and unavoidably involved in employees’ personal and medical affairs. Thus, competing interests between the worker’s desire for privacy and the employer’s legitimate interest in the health of the worker creates sensitive ethical and legal dilemmas for physicians who practice occupational medicine. Other parties, such as insurers, state and federal agencies, and accrediting organizations may also have a right to patient records, and this right must be considered and managed carefully.
The laws governing the confidentiality of employee medical information are complex and vary depending on the relationship between parties and by jurisdiction.1 Difficult ethical problems arise when the physician must attempt to balance the importance of the worker’s need and right to keep information confidential versus the employer’s need and legal right to know or the interests of other parties.
ACOEM Position
The American College of Occupational and Environmental Medicine (ACOEM) acknowledged the importance of medical confidentiality with publication of its first Code of Ethical Conduct in 1976. This Code was later revised in 1993 to reflect changes in the character of the modern workplace.2 The revised Code states that physicians should:
“5. keep confidential all individual medical information, releasing such information only when required by law or overriding public health considerations, or to other physicians according to accepted medical practice, or to others at the request of the individual”; and
“6. recognize that employers may be entitled to counsel about an individual's medical work fitness, but not to diagnoses or specific details, except in compliance with laws and regulations.”
Additional Guidance on Medical Confidentiality in the Workplace;
While the ACOEM Code of Ethical Conduct provides direction, the ACOEM Committee on Ethical Practice in Occupational and Environmental Medicine believes that additional guidance on the issue of confidentiality is necessary. Therefore, in addition to Points 5 and 6 of the ACOEM Code of Ethical Conduct, the College is providing the following guidance regarding medical record confidentiality:
Legislation and local practice may treat medical records created in the context of occupational health, independent medical evaluations, and workers’ compensation cases differently from medical records created by personal health care providers. However, the physician practicing occupational medicine is advised not to make such distinctions in practice without clear legal requirements or permission from the proper parties. Confidential medical information should be treated the same as in situations where there is a clear physician-patient relationship unless there is a valid legal reason and consent to do otherwise, a health and safety risk to the client or others, or evidence of a criminal act.
Physicians should make all reasonable efforts to obtain the patient’s consent before disclosing all or any portion of his or her medical record. If disclosure is legally required or consent is not legally required, the patient should be notified of the impending disclosure unless such notification is impossible or there are overriding patient or public health concerns.
Physicians should recognize a patient’s consent-for-disclosure only if said consent is both informed and voluntary. The consent should specify the nature of the information to be released, the purposes for its release, the person to whom it may be released, and the time period for which the consent remains in effect. The consent must be signed by the worker or his or her legal guardian, or if the worker is deceased, by his or her personal representative.
Whenever physicians are aware that the results of an examination or records of a visit may be shared with a third party (e.g., in the case of an independent medical examination), it is incumbent upon the physician to properly notify the examinee prior to gathering historical or clinical data as to the nature of the evaluation, what information will be collected, and to whom it will be transmitted. The physician should not state or imply that any records will be kept confidential if this cannot be assured.
Although all personal health information should be presumed to be confidential, physicians should recognize that certain types of health information are particularly sensitive such as sexual orientation, HIV/AIDS status,4 drug and alcohol treatment, past history of physical or sexual abuse, treatment for sexually transmitted diseases, and genetic information. Physicians should be aware that a general consent for disclosure of medical records cannot be presumed to be sufficient in these situations and that specific written consent for release of such information must be obtained. This information should only be disclosed in compliance with U.S. federal and state law. Because it is often possible to infer sensitive information from other parts of the medical record, such as the medication history, the physician should treat such information in the same manner as explicitly sensitive information.
Physicians should release only the portion of a record covered by a release and not disclose the entire medical record unless indicated and permitted by the patient. Forwarding records that have been obtained from other medical providers is appropriate when that information is relevant to the specific problem in question.
Physicians should develop a written policy for the treatment of medical records in their offices, clinics, or workplaces. The policy should address such issues as where and how the records are stored; the security of medical records including computer databases; what happens in the event of employee resignation, layoff, termination, job transfer, or plant closure; and the mechanisms of employee access and consent for disclosure.
Physicians should make reasonable efforts to ensure that those under their supervision act with due care regarding the confidentiality of medical records, and act to educate fellow health care providers regarding the confidentiality of medical information. Physicians should encourage the confidential treatment of medical information by their clients and in their organization by colleagues in other departments such as personnel or benefits who may have access to such data.
Physicians should disclose their professional opinion to both the employer and the worker when the worker has undergone a medical assessment for fitness to perform a specific job. However, the physician should not provide the employer with specific medical details or diagnoses unless the worker has given his or her permission. Additionally, physicians should not disclose without permission any “non-medical” information gained in the context of a physician/patient relationship that could adversely affect the employee. Exceptions include health and safety concerns or knowledge of unlawful activity.
Physicians should notify workers of their right to obtain access to their medical records and to request correction of any inaccuracies therein.
Supervisors and managers may be informed regarding necessary restrictions on the work or duties of the employee and recommended accommodations. First aid and safety personnel may be informed, when appropriate, if a condition might require emergency treatment, in which case the employee should be informed.
Physicians should be a source of professional, unbiased, and expert opinion in the workers’ compensation or court systems and should only disclose medical information that is relevant and necessary to the claim or suit. When release of medical information is authorized or required by specific regulation, only the necessary and relevant information should be released.
Physicians should exercise caution whenever presented with a request or subpoena for medical records that does not include a written authorization for release by the worker, or when the records requested contain information about HIV status, drug and alcohol treatment, or genetic information. It may be appropriate to seek legal advice in these situations.
Physicians should withdraw or decline services when faced with an irresolvable ethical conflict or an unethical request by a client or employer. In many instances, the medical record will be the property of an employer. This ownership does not abrogate any of these principles. Each employer that owns medical records should designate a custodian of the records. Access by employer officials (e.g., employee relations, legal counsel) should proceed via the same process as requests by those outside the employer through the custodian.
Because OEM physicians work in a wide variety of practice situations and must respect the laws and customs of many countries.
Occupational Health Laws in India;
The Constitutional aspects of Employees’ right to health:
Article 21 of the Indian Constitution guarantees the protection of life and personal liberty of a person. Various Supreme Court judgments have, under this "right to life" upheld the right to employees’ health. For instance, in the case of Consumer Education Research Center Vs. Union Of India3 the Supreme Court has held that, "Occupational accidents and diseases remain the most appalling human tragedy of modern industry and one of its most serious forms of economic waste." Further the judgment says, "Therefore, we hold that right to health, medical aid to protect the health and vigor to a worker while in service or post retirement is a fundamental right under Article21, read with Articles 39(e), 41, 43, 48A and all related Articles and fundamental human rights to make the life of the workman meaningful and purposeful with dignity of person."
The Indian Constitution has shown notable concern to workmen in factories and industries as envisaged in its Preamble and the Directive Principles of State Policy. The Directive Principles of State Policy provide:
a) For securing the health and strength of workers, men and women,
b) That the tender age of children is not abused,
c) That citizens are not forced by economic necessity to enter avocations unsuited to their age or strength,
d) Just and humane conditions of work and maternity relief are provided and,
e) That the Government shall take steps, by suitable legislation or in any other way, to secure the participation of workers in the management of undertakings, establishments or other organizations engaged in any industry.
Hence, the Government, Central or State, while drafting policies for the safety and health of workers must keep in mind the Directive Principles in accordance with the nature of employment and must be in consultation with workers' welfare organisations, environmental activists, etc.
Occupational health Laws:
The Factories Act, 1948, the Mines Act, 1952,The Dock Workers (Safety, Health & Welfare) Act, 1986 are some of the laws, which contain provisions regulating the health of workers in an establishment. Whereas the Employees State Insurance Act, 1948 and the Workmen’s Compensation Act, 1923 are compensatory in nature.
Health Provisions under the Factories Act, 1948:
The Factories Act, 1948 was enacted with the object of protecting workers from subjecting to unduly long hours of bodily strain or manual labour. It lays down that employees should work in healthy and sanitary conditions so far as the manufacturing will allow and that precautions should be taken for their safety and for the prevention of accidents.
The Act defines a ‘worker’ as any person employed directly or through any agency (including a contractor), whether for remuneration or not in any manufacturing process or in any work incidental to or connected with the manufacturing process. It is required that work performed should be connected with the product which is produced in the manufacturing process.
Section 10 of the Act lays down that a State Government may appoint qualified medical practitioners as ‘certifying surgeons’ to discharge the following duties:
a) Examination and certification of young persons and examination of persons engaged in ‘hazardous occupation’.
b) Exercising medical supervision where the substances used or new manufacturing processes adopted may result in a likelihood of injury to the workers.
c) Exercising medical supervision in case of young persons to be employed in work likely to cause injury.
Chapter IX of the Act lays down in detail the provisions relating to the health, safety and welfare measures, namely, cleanliness, level of ventilation, diversion of dust and fumes, provision of artificial humidification, sanitation, fencing of machinery, among others. There are also provisions that prohibit women n\and children from working in certain occupations.
27 processes and operations have been identified as dangerous in The Maharashtra Factories Rules, 1963. These Rules lay down detailed instructions regarding preventive measures, protective devices, cautionary notices as well as medical examination of workers. The State Governments have adopted these rules depending on their local needs. The Act lists 29 occupational diseases and obliges the manager of a factory and medical practitioners to notify the Chief Inspector of Factories if any worker contracts any of the diseases. The Rules are very comprehensive in laying down special provisions with respect to health, safety and welfare of workers including medical examinations, setting up of Occupational Health Centers, etc. The only lapse has been its ineffective implementation since most of the discretionary powers lie in the hands of the Inspectors and occupiers. Although very few cases of occupational diseases are reported in factories, the working conditions in most of the factories handling hazardous chemicals have higher risk potential.
The Employees’ State Insurance (ESI) Act, 1948:
It is a social security legislation enacted with the object of ameliorating various risks and contingencies sustained by workers while serving in a factory or establishment.
It is designed to provide cash benefit in the case of sickness, maternity and employment injury, payment in the form of pension to the dependents of workers who died of employment injury and medical benefit to workers. It recognizes the contributory principle against such contingencies, provides protection against sickness, replaces lump sum payments by pension in the case of dependents benefit and places the liability for claims on a statutory organization.
The Act does not cover ‘seasonal employments’. It defines ‘employment injury’ as personal injury to employees, caused by accident or occupational diseases, in an insurable employment.
The Act lays down provisions to set up an ESI Corporation, to promote measures to improve health and welfare of insured persons and a Medical Benefit Council to advise the Corporation on medical benefits, certification, etc. The Medical Boards have to ascertain the percentage of disability of injured workers before submitting their report to the Corporation in order to grant compensation to the workers. An injured worker has to wait for months before the Medical Board calls him for a check-up.
The main source of revenue for the ESI Fund is the Contribution paid by the employers and the employees. The purposes for which the Fund is to be used are numerous. It includes payment of benefits, provision of medical treatment to insured families, meet charges in connection with medical treatment, maintenance of hospitals, dispensaries, etc. In existing conditions there is gross misuse of these funds.
The discretionary powers with respect to using the Fund amount lie solely with the Corporation along with the State Governments. According to the Occupational Health and Safety Center, Mumbai, the Corporation has only 4 occupational disease centers for workers.
Section 39 of the Act makes the employer primarily liable for the payment of contribution on behalf of himself and his employees towards the ESI Fund. In case of misuse of the contribution by employer, the employee can sue the employer in the Employees’ State Insurance Court set up by the respective State Government.
Where an employee makes a claim on the grounds of sickness, disablement or maternity, it has to be made against the ESI Corporation and not against the employer. The process involved to obtain the compensation, is tedious. Such a lapse renders the very object of the Act to provide for quick claims as unreal.
Under the Workmen’s Compensation Act, 1923, there exists a legal obligation on the employer to pay compensation to workmen involved in accidents arising during the course of their employment. The prerequisites for payment of compensation to such workmen are as follows:
* Personal injury must be caused.
* There must be temporary, total or partial disablement due to an accident, which also includes occupational diseases.
The State Government is to appoint a Commissioner to decide the liability of an employer to pay compensation, the amount and duration of compensation, among other issues. An appeal may lie to the High Court in case the applicant is grieved with the Commissioner’s orders.
Compensation is decided on the nature of injury caused. Where the injury from an accident results in the death of the workman, the minimum compensation payable is around Rs.50, 000 and the maximum may extend to Rs. 3 lacs. In case of permanent total disablement and permanent partial disablement, compensation may extend to Rs.60, 000, depending on its nature. Further the amount of compensation is calculated on the wage-group to which the workman belongs and the time-period for which he has worked.
There is no comprehensive law on occupational health, though the Central Government has in its various policies stressed the need to effectively implement the existing laws.
Conclusion:
A broad insight into the existing occupational health laws in India explicably brings out the verity of non-implementation of such laws, considering the present scenario with respect to the workmen’s health conditions. The workmen in dangerous employments are exposed to substances like asbestos, chromium and silica dust and are vulnerable to respiratory diseases and cancer. There is need to preserve the good health of workmen by ensuring safe and healthy working conditions and provide prompt compensation on account of injury or occupational disease.
Cont….from previous comment;
India is one of the largest and the most important developing countries of the world. In this country, public health emphasizes more on communicable diseases, malnutrition and reproductive healthcare. Majority of the population is working in industrial sector. Industrial revolution as well as globalization is increasing the burden of occupational hazards and changing occupational morbidity drastically. Still occupational health is seen as a secondary issue while formulating health policy and health-related programmes.
As per the Director General of Factory Advisory Services and Labour Institutes Report (1998), there were 300,000 registered industrial factories and more than 5000 chemical factories in India, employing over half a million workers. Approximately 8.8 million workers were employed in various factories.In India, occupational health is more than simply a health issue, which includes child labour, poor industrial legislation, vast informal sector, less attention to industrial hygiene and poor surveillance data.Statistics for the overall incidence and prevalence of occupational disease and injuries for the country is inadequate. The major occupational diseases morbidity of concern in India include silicosis, musculoskeletal injuries, coal workers' pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis, pesticide poisoning and noise-induced hearing loss. According to Leigh et al. , the annual incidence of occupational disease was between 924,700 and 1,902,300, leading to over 121,000 deaths in India.According to a survey of injury incidence in agriculture conducted in Northern India, an annual incidence of 17 million injuries per year (2 million moderate to serious events), and 53,000 deaths per year was estimated. While India experiences an economic transition, occupational research approach should balance between understanding the modern industrial exposures and health risks of traditional sectors like agriculture and plantations. Lack of education, unawareness of hazards in one's occupation, general backwardness in sanitation, poor nutrition and climatic proneness to epidemics aggravate worker's health hazards in the work environment. Despite the existence of law that prohibits a paid work from children under the age of 14 years, an estimated 70-115 million children are part of the Indian workforce. Child labour in the agriculture sector accounts for 80% of child labourers in India and 70% of working children globally.
In India, occupational health is not integrated with primary healthcare, and it is the mandate of the Ministry of Labour, not the Ministry of Health. Occupational health in India has to compete with primary health and curative health for its budget. In the context of legislations, the major legal provisions for the protection of health and safety at workplace are the Factories Act and Mines Act. The Factories Act, 1948, deals with occupational health and safety as well as welfare of workers employed in a factory. However, more than 90% of the Indian labour force does not work in factories; hence, they fall outside the purview of the Act.A broad insight into the existing occupational health laws in India explicably brings out the verity of non-implementation of such laws, considering the present scenario with respect to the workers' health conditions.
Occupational health not only deals with work-related disorders or diseases, but it also encompasses all factors that affect workers' health. With changing scenario, there is need to understand the risk factors of modern occupational hazards. India urgently requires modern occupational health safety (OHS) legislation with adequate enforcement machinery and establishment of centres of excellence in occupational medicine to catch up with the rest of the world.
What's Wrong With the Chair:
Sitting and the New Ergonomics;
Back pain is epidemic in the world.It costs us over $4 billion each year and, aside from the common cold, keeps more people away from work than any other single cause. Diverse evidence from many cultures shows that sitting has been associated with numerous problems: back pain of all sorts, fatigue, varicose veins, stress, and problems with the diaphragm, circulation, digestion, elimination, and general body development. Ergonomic researchers believe if they could only invent the perfect chair, all this would be solved.
Dr. Galen Cranz’s, revolutionary book The Chair: Rethinking Culture, Body and Design offers another hypothesis.
After extensive research, she has reached the conclusion that no amount of ergonomic tinkering can correct the classic right-angle seated posture which is intrinsic in chairs. The problem with chairs, according to Cranz and other radical ‘somatic’ practitioners who practice ‘new ergonomics,' is that we have been forced into a 'table and chair' culture, where many activities take place in a right-angled seated position. This position forces the body into a C-shaped slump and this places uneven pressure on the vertebral disks of the lower back. With time, the spine can become deformed and erode disks.
Dr. Cranz proposes all this effort could be better directed toward inventing an entirely new system to promote movement at work and at schools.
When a person leans into the chair back, there is both a backward and a downward force. The downward force pushes the bottom of the pelvis forward. Eventually, the sitter finds himself sitting on his tailbone at the edge of the chair with the spine as a whole transformed into a C-shaped slouch. Of course the next step is to pick oneself up and lean back into the chair again. This only starts the whole process over again. ‘Sitting up straight’ has to be forced, and is probably worse than the slouch.
People in third world countries do not use chairs but sit on the ground or floor instead. These peoples have retained the ability to sit upright without back support--otherwise known as 'autonomous' sitting. And history shows us evidence of autonomous sitting. Jesus’ last supper was actually not held at a table but in the typical Roman fashion of reclining in a U-shaped ‘triclinia.’ The host and guests ate while lying on their sides, propped up by a pillow. The term “sitting Indian style” comes from Native Americans who honor the earth by sitting on her. And the Buddha attained his enlightenment by just sitting (perhaps meditating) for several days with absolutely no back support.
So why is it so hard? Have you ever tried just sitting on the floor or ground? You must have noticed the body tends to fall down towards the back. You must have noticed that tremendous effort is needed to pull oneself forward to keep this from happening. A lifetime of using chairs and back support is all the difference. We are locked into a bad habit that saps energy, circulation, and strength. And on top of that, standard exercises can actually exacerbate the situation. The internal muscles of the pelvis and torso are toned only by using them in natural ways--e.g. sitting autonomously. Many callisthenic exercises such as sit-ups can create imbalance because all the muscles are not strengthened and toned evenly. In fact, the internal muscles may not be reached at all.
The answer lies in re-educating the body to move the way it was designed. Simply by using the body properly, the muscles are toned and ‘autonomous’ sitting can be regained. In America many people are now trying autonomous sitting for meditation. It has long been known that autonomous sitting can enhance the meditation experience. It does this by freeing circulation and breathing, which in turn helps induce relaxation. Back pain can hamper or even prevent one from meditation practice. People beginning meditation often encounter one or all of these challenges:
1) Being new to the ‘sport’, internal torso and pelvic muscles are atrophied and cannot support the body very long.
2) With meditation comes body awareness. A lot of people notice back pain where it might have been before but they hadn't noticed it.
3) Improper ‘use’ of the body, or simply not having knowledge of good sitting technique, can cause worsening of a problem.
4) Sitting improperly with back support all day does not give the body much opportunity to learn new patterns.
5) A back that is out of alignment will be noticed once one starts sitting this way. Intervention such as chiropractic or rolfing may be necessary.
Since the human body is designed for movement, it doesn’t fit in well with the many hours of sitting required for the average American lifestyle. Most back pain is caused by the repetitive activity of sitting. We sit at home, in the car, at work or school, in the movies, with bodies bent into a right-angled position.
When people begin to meditate on a zafu or kneeling bench they are often completely unprepared. Five or ten minutes can be difficult. Also, it can seem uncomfortable and the meditation can become a struggle just to keep upright. Yet, if we don't make the transition to autonomous sitting (for meditation or other activities), we will be forever victims of the common chair, prone to medically untreatable and mysterious back pain, injuries and spinal deformities.
The Alexander Technique is a remedy for the problems caused by improper use of the body. Today the Alexander Technique is especially used in dancing, acting, and sports for coordination and efficiency of movement. However it is useful to all of us for re-educating the body about natural movement which doesn’t strain the back and neck-- simple every day activities like bending, reaching, walking and sitting. The A.T. involves ‘lessons’ where the teacher helps reeducate the body/mind into ‘good use.’ The backbone (pardon the expression) of the Alexander Technique is how the head, neck and torso are used. More specifically, that the head should be held in such a way (forward and up) that the length of the spine and neck are not shortened or curved. This goes for any activity whether sitting, speaking, or reaching.
According to Dr. Galen Cranz in The Chair, even ergonomics only perpetuates the problems and misconceptions of sitting. “Ergonomics researchers assume, like most of us, that right-angle sitting is rational, that we need back support, and that we all value comfort. These assumptions get them into trouble--spawning contradictory concepts, invalid research methods, and conflicting recommendations.”
The controversy perhaps begins with the fact that there is no universally accepted operational definition of ‘comfort’. In fact, there are two conflicting points of view. The traditional ergonomic researchers believe comfort is achieved when no muscles are working. Practitioners of the New Ergonomics (including A.T. practitioners) believe comfort happens when an equal amount of work is performed by complimentary muscle groups, also referred to as ‘tonus’.
The ‘no-work’ school is responsible for chairs that ‘cradle’ the body or otherwise force the spine into a C shaped slump. The ‘Tonus’ school hold the radical view that back support is not necessary at all. However, in order for this to work, the legs should be at an angle of 135 degrees to the spine. This keeps the pelvis and therefore the spine in a similar position as walking. At this angle the work of sitting upright is distributed between the front and back of the spine and along its length most evenly. In the early 1970’s Peter Opsvik created the Norwegian Balans Chair™ in response to this knowledge. It is the first chair which allows the 135 degree leg angle in the West. This chair and cheap variations are now seen in offices throughout America, mostly used for computer work. Heeding the call, there have since been some other backless chairs introduced, such as the Bambach Saddle Seat™ and the Shaker style Tilt Seat™ by Carolina Morning Designs. The Tilt Seat™ has the advantage of no pressure on the knees, the ability to shift positions, and to get up and down easily. A similar effect can be accomplished by placing a zafu on a standard flat surfaced wooden chair or stool.
Asians have had a completely different approach to sitting and furniture. For centuries Orientals have designed homes and work spaces around floor furniture. We mostly think of Japan and their tatami mats and corresponding futons which get rolled up by day and tucked in closets. You may have seen Japanese sitting neatly in rows like we sit in auditoriums, only they are flat out kneeling on their knees and legs. They also use other furniture or sitting devices called zafus and zabutons. Zafu (za’foo) translates to ‘sewn seat’ and is an oval shaped cushion placed on a zabuton. Zabuton (za’boo tan) translated to ‘sitting mat’ (futon is ‘sleeping mat’). When using a zafu and zabuton, one achieves the desired 135 degree leg-to-spine sitting angle. Also, this is the best position to allow ease of movement, either to get up or to change the angle or direction slightly. The ‘seiza’ or kneeling bench also allows the 135 degree leg-to-spine angle only without the need to cross the legs. Today in America many people who have been introduced to these ‘devices’ or ‘furniture’ for meditation are finding them completely suitable for other purposes. We received an e-mail by someone who was fed up with his ‘table and chair’ lifestyle that was hurting his back. He wanted advice on creating a computer work station on the floor. “Respond quickly,” he wrote, “I am sharpening my saw to cut the legs off of my desk.”
The New Ergonomics calls for a complete rethinking of the way we design and use furniture. The aim is to incorporate movement and wise use of the body into every activity. Here are some principles and guidelines:
1) Practice sitting without back support. This will necessitate a forward sloping seat of some kind. Start a few minutes a day and increase gradually.
2) Start replacing furniture in the house using principles of the New Ergonomics. Planar surfaces instead of contoured, firm instead of overstuffed, a variety of chairs and benches to accommodate different sizes, places to lie down.
3) Whenever you are tired and begin to slump, lay down a few minutes to regain energy. Prop your feet up if possible.
4) Replace sitting with other positions whenever possible. Reclining is one of the best positions for reading or talking on the phone. Also, squatting, standing, and crawling are other alternatives. Walking is often a great way to have a meeting or think through an idea.
5) Incorporate movement into your sitting. Take a break at least once an hour. Stretch, walk, stand up, jump on a mini-trampoline, hang from a bar or do some pull ups, or change positions as often as possible. Instead of sitting for long stretches, break it up with other activities.
6) Convert regular chairs by placing a zafu in the seat to offer an incline.
7) Use a slanted writing or reading surface such as a drafting table to prevent tilting of the head and neck. The desk will need to be taller than a standard desk, because the seat is taller.
CHAIR ERGONOMICS & BACK PAIN:
Seat height adjustability;
This allows the user to adjust the chair so that his/her feet are on the floor, or the worksurface or keyboard is at an appropriate height, or preferably both. Pneumatic adjustability is easier to work than mechanical adjustability.
Seat depth adjustability;
This is Achieved either by backrest in-out adjustability or a sliding seat pan, this changes the front-to-back depth of the seat. A shorter seat pan is necessary to allow small people to use the chair's backrest, while a deeper one feels more stable to taller individuals.
Backrest angle adjustability;
This refers to changing the angle of the backrest relative to the angle of the seat. Although this often is done with an adjustment mechanism, it can also be achieved through the use of flexing materials or springs in the chair shell. Backrest angle adjustability allows the chair to support different degrees of recline, which in turn transfers some upper-body weight to the chair backrest and lightens the load on the lower back's intervertebral discs. Backrest angle adjustability also increases the angle between the torso and the thighs, which causes the lower back to curve inward. This inward curve, called "lordosis," results in less pressure on the discs than a flat spinal shape.
Chair recline or tilt
This changes the angle of the entire seat relative to the floor. As with backrest angle adjustability, a reclined chair transfers some upper-body weight to the backrest of the chair.
There are two main tilt geometries. One is column tilt, in which the chair pivots at the top of the base post and lifts the knees slightly while the back descends. The other is knee tilt, in which the pivot point is forward of the post, nearer the knees. In a knee tilt chair, the knee lift is negligible, but the back (and head) descend more than in a column tilt chair.
Seat pan angle adjustability
This generally refers to changing the forward-back angle of the seat. It consists of a choice of fixed angle, rather than a free-floating recline (above). Often, this feature provides forward tilt, in which the thighs slope downward. The main purpose of forward tilt is to open the angle between the trunk and thighs, inducing lordosis and reducing disc pressure.
Armrests
These support the arms, reducing the work of the shoulders and possibly the upper arms. Armrests can, however, be used inappropriately by inhibiting free motion of the arms during activities such as typing.
Height-adjustable armrests;
These help avoid the problems of too-high armrests, which result in elevated shoulders and pressure on the undersides of the elbows and forearms, and too-low armrests, which require the worker to slump or lean to one side to use them. Height-adjustable armrests also can keep armrests out of the way during typing or other activities requiring free motion.
Width-adjustable armrests;
This kind of adjustability changes the distance between armrests. Armrests that are close to the body can help avoid splayed elbows, which in turn cause the wrists to bend to the side during activities such as keying. A maintenance-adjustable mechanism requires leaving room for the hips and therefore does not permit the close positions that at-will adjustment allows.
Padded armrests ,These potentially avoid uncomfortable pressure on the undersides of the forearms and elbows.
Lumbar support
This is intended to prevent, to the extent possible, the flattening of the lumbar spine that occurs in most people when seated. Lumbar support is usually done through gentle curves in the backrest shape.
Backrest height adjustability
This refers to a change in height of the lumbar support area of the chair backrest, although this feature is often interpreted to mean a change in height of the entire backrest. This feature accommodates preferences by different workers regarding where and how the lumbar support curve contacts the back.
Lumbar depth adjustability
This affects the size and sometimes the firmness of the lumbar support curve in a chair's backrest. Like backrest height adjustability, it accommodates different preferences and body shapes.
LOW BACK PAIN BASICS:
1. Back pain is as mystifying today as it was decades ago.
Despite excellent tests and procedures, modern back specialists admit that up to eighty percent of all cases have no clear physiological cause. In fact, many pain-free people show bulging or herniated discs in x-rays.
2. Also, despite everything we know about back pain, ninety percent of us are going to have a disabling episode at some point in our lives.
3. It is difficult to predict which individual person will develop back pain.
Strength, fitness, and back x-rays are not good predictors. One major study concluded that the only predictors were 1) whether the person has had back pain before, and 2) whether the person smokes cigarettes.
4. On the other hand, job characteristics are predictors of back pain.
Jobs with heavy or frequent lifting are high risk, as are jobs involving prolonged standing or sitting.
5. There is little agreement on how to do lifting with little risk.
Lifting with the legs is easy on the back, but hard on the legs and muscles. Lifting with the back puts strain on the disks but is less fatiguing.
6. So-called 'back belts' have not been proven to strengthen backs or prevent back problems.
On one hand, they may help remind wearers to lift carefully. On the other hand, they may give wearers a false sense of greater strength, encouraging them to lift more than they should.
7. People who sit for long periods are at risk for back disorders.
The two greatest problems seem to be 1) sitting upright or forward, and 2) not changing position.
8. An upright posture with a ninety-degree hip position is actually unhealthy, from the perspective of the intervertebral discs.
For a number of reasons, the discs experience more pressure --- and the pressure is more lopsided --- than while standing. So it's a good idea to sit with the hip joints somewhat straightened. Yes, this resembles a slouch, with your rear end scootched (a technical term!) forward in the seat. A supported slouch may be healthy in the long run.
Forward-tilt chairs support this posture, but so do chairs with level seats and reclined backrests.
9. Even if the hip joints aren't somewhat straightened, sitting in a reclined posture is more healthy than sitting upright.
This is because reclined sitting puts more of your weight onto the chair's backrest. If the chair backrest holds up more weight, the discs in the lower back hold up less weight. (Well-designed armrests also take some of the upper body weight from the discs.)
And reclined sitting lets the back muscles relax.
10. All sitters should move around.
In addition to helping the muscles relax and recover, this alternately squeezes and unsqueezes the intervertebral discs, which results in better filtration of fluids into and out of the cores of the discs. Discs stay plumper and, in the long run, healthier.
One implication: chairs should follow the sitter as he/she changes posture.
11. The most important chair adjustments are
seat height from the floor --- the feet should be able to rest flat on the floor. (However, this doesn't mean the feet should always be flat on the floor. Legs should be free to stay in different positions).
depth from the front of the seat to the backrest --- sitters should be able to use the backrest without any pressure behind the knees.
lumbar support height --- every person is shaped differently.
12. The 'proper' chair adjustments and chair posture are greatly influenced by the rest of the work area.
In particular, the eyes can affect posture, especially if the work material is too far, low, or high. Hand positions (especially working far from the body) can also affect body position, particularly the posture of the upper back and neck.
13. Upper back and neck discomfort is often related to upward viewing angles.
For example, monitors above eye height or leaning, twisting, or reaching (for example, looking down and sideways at a document on the desk, or reaching for a mouse).
14. For people with existing, chronic, difficult back pain: all the above rules are optional, because each back pain case is different.
Rules for prevention of back pain or treatment of medium- level cases may be completely inappropriate for individual cases of severe back pain. Before accepting any advice, trust the "advice" of your own body's discomfort reactions.
Visual Ergonomics in the Office
Summary: Guidelines for monitor placement and lighting
Eye-to-screen distance: at least 25", preferably more.
Vertical location: viewing area of the monitor between 15° and 50° below horizontal eye level.
Monitor tilt: top of the monitor slightly farther from the eyes than the bottom of the monitor.
Lighting: ceiling suspended, indirect lighting. Use blinds and shades to control outside light.
Screen colors: dark letters on a light background.
How do you set up a computer workstation? Do you buy monitor risers or remove the CPU from beneath the monitor. Will even lower monitor positions cause neck strain? Can you get away with tipping the monitor down to avoid glare or should you invest in indirect lighting? How about viewing distance? 16 inches? 25 inches? Or even farther? Does screen color make a difference? Is there any evidence that ergonomic workstations improve work performance?
This article suggests guidelines for monitor placement and lighting. They are based on the latest scientific research. Demonstrations illustrate the principles behind the recommendations.
EYE-TO-SCREEN DISTANCE
Locate the monitor at least 25 inches from the eyes, preferably more.
Hold your finger at arm's length. Bring it slowly towards your nose, following it with your eyes. Notice that the closer your finger comes, the more eyestrain you feel
One of the main reasons for computer-related eyestrain is the closeness of the monitor. It seems easy to understand that, if having the monitor too close contributes to the problem, one of the solutions is to place it farther away. When viewing close objects the eyes must both accommodate and converge. Accommodation is when the eyes change focus to look at something close. Convergence is when the eyes turn inward towards the nose to prevent double vision. The farther away the object of view, the less strain there is on both accommodation and convergence (Fisher 1977; Collins 1975). Reducing those stresses will reduce the likelihood of eyestrain.
How close is too close?
So how close is too close? It is difficult to set an exact limit for a minimum viewing distance. Continued viewing closer than the resting point of vergence contributes to eyestrain (Owens and Wolf Kelly 1987). The resting point of vergence (RPV) is the distance at which the eyes converge when there is nothing to look at, such as in total darkness. It varies among individuals, but averages about 45" when looking straight ahead and 35" with a 30° downward gaze angle. Viewing objects farther than the RPV has not been found to cause any problems.
What is important to understand is that farther is better (at least up to the RPV). If you can read the monitor, it is not too far away. If you can't read the characters, it's usually better to make them larger than to bring the monitor closer.
Distance to monitor and hard copy
Early recommendations said that the monitor and document had to be at the same distance. But to do that often means moving the monitor closer. Research by Jaschinski-Kruza (1990) found that eyestrain was not increased when the monitor and document distance differed. In fact, users preferred that the monitor be farther away.
For data entry tasks that require rapid shifts from screen to document, locating the screen and document at similar distances can reduce the time lag encountered when changing accommodation. In this case enlarging the document is the best solution. The larger letters will then be visible at the greater viewing distance.
Performance
Jaschinski-Kruza (1988) compared work performance with subjects working at viewing distances of 20" and 40". The task was to find mistakes in a database and he found better performance at the 40" distance. The character heights were doubled as the viewing distance doubled. In another part of the study he increased viewing distance without making the characters larger and performance suffered. To take advantage of the productivity increases with farther viewing distance, you must ensure that the user can easily read both the screen and the hard copy.
For a more complete discussion of viewing distance at computer workstations, see Ankrum (1996).
VERTICAL MONITOR LOCATION
Locate the entire viewing area of the monitor between 15° and 50° below horizontal eye level.
To see the effect of gaze angle on accommodation, hold a business card at arm's length and at eye level. Slowly bring it towards you until the letters start to blur. Without moving your head, slowly lower the card in an arc, keeping it the same distance from your eyes. You will see the letters come into focus. Your eyes have improved their ability to accommodate simply by lowering their gaze angle. Presbyopes (persons over 40 who are losing their ability to view close objects) often make use of this phenomena when they misplace their reading glasses. They hold reading material at arm's length and then tip their head back to improve their ability to accommodate.
To see the effect of gaze angle on your ability to converge, try this next demonstration. With your head erect, hold a pen at arm's length and at belt level. Gradually bring it towards your nose, following it with your eyes until you can no longer converge accurately and you see two pens. Without moving your head, try the same test at eye level. Again, notice the distance at which you can no longer converge. Now bring the pen in from an upward gaze angle. As you can see and feel, your eyes converge more easily with a downward gaze angle.
The old guidelines that recommended that the monitor be placed at eye level were based in part on the belief that the resting position of the eyes (considered to be the most comfortable gaze angle) is 15° below the horizontal (Morgan, Cook, Chapanis, and Lund 1963). New evidence (and some that has been around for a while) shows that, while the eyes might be most comfortable with a 15° gaze angle when looking at distant objects, for close objects they prefer a much more downward gaze angle (Kroemer 1997). Figure 1 shows the optimum position for the most important visual display, 20 - 50° below the horizontal line of sight, according to the International Standards Organization (ISO 1998).
A downward gaze angle improves our ability to accommodate and converge. Ripple (1952) found that subjects over age 42 increased their ability to accommodate by an average of 25.5% by directing their eyes downward in the "usual reading position." Krimsky (1948) observed, "when looking upwards, the eyes tend to diverge...and when they look down, the effort to converge is much easier." Tyrell and Leibowitz (1990) found that a low gaze angle resulted in reduced headaches and eyestrain.
Many computer users experience dry eyes. Tsubota and Nakamori (1993) found that lower monitor placement exposes less of the eyeball to the atmosphere and reduces the rate of tear evaporation. This keeps the eyes more moist and reduces the risk of Dry Eye Syndrome.
Neck posture
Lower monitor placement can increase the acceptable options that users have for neck movement (Ankrum and Nemeth 1995). Eye-level monitors allow the head and neck to assume only one posture that is both visually and posturally comfortable.
It is uncomfortable to maintain the same posture for an extended period of time. When users tire of the head-erect posture, the acceptable alternative postures with an eye-level monitor are limited. Flexing the neck is one alternative, but that results in the user looking out of the top of their eyes. While bending the neck downward may be physically comfortable (as long as you are not forced to hold it in a fixed position), looking out of the top of your eyes at close objects is extremely uncomfortable. People will just not do it for any length of time.
Neck extension and forward head posture, while acceptable for the visual system, have been associated with both discomfort and disease (Kumar 1994; McKinnon 1994). With a low monitor position you can hold your head erect and look downward. When that posture becomes tiring, as eventually it will, a low monitor will allow you to alternate among a wide range of flexed neck postures that allow good visual performance and will not increase postural discomfort (as long as you don't hold any particular posture for a long time).
Many "ergonomic" guidelines include drawings that show a computer user with arms, torso, thighs and legs at 90° angles and the head perfectly erect. And, of course, the feet are "flat on the floor." This is the "correct posture." Generally users try it for a few minutes and reject it because it's too uncomfortable. One theory has it that the reason you see drawings, and not models, depicting this "ideal" posture is that they can't pay models enough to sit that long in such an awkward posture!
Voluntary postural changes should be encouraged. Even alternative postures that look awkward may be ok if they are used for short-term relief from the discomfort caused by sustained, fixed postures. Stretching exercises require awkward postures and are often recommended by the same guidebooks that mandate the "correct" posture while working. As Paul (1997) points out, "The best posture is the next posture." Whatever posture we are in, we will be most likely be better off in the one we assume next.
Although most ergonomists agree that a low monitor is better for the visual system, the question has been "What happens to the neck and upper back?" Two recent studies have addressed that question. Turville and colleagues (1998) compared monitor locations with the center of the screen at 15° and 40° below horizontal. They compared the average (mean) muscle activity for 10 sets of neck and upper back muscles. The recommended limit for mean muscle activity is 10-14% maximum voluntary contraction (MVC) (Jonsson 1978). (MVC is the maximum muscle effort that can be voluntary exerted by the subject.) Although the 40° placement had higher readings than the 15° placement, all were much lower than the recommended limit. The highest was 6.8%. For the trapezius, the muscle most often associate with cumulative trauma disorders, the activity averaged an extremely low 2.2% MVC for the 15° and 2.0% MVC for the 40° conditions.
Unfortunately, Turville et al., mistakenly compared their findings to Jonsson's (1978) recommendation of a 2-5% MVC limit for static load. (The static load level is the lowest level of activity that occurs in the muscle during the work period, defined as the 10th percentile.) Because they reported the "mean" activity level, they should have compared it to Jonsson's recommendation for mean muscle activity, which is 10-14% MVC. They erroneously concluded that the muscle activity while working in the low monitor condition was higher than the limit, when it actually was lower.
Sommerich and colleagues (1998) compared monitor positions with the center of the monitor at eye level, and 17.5° and 35° below eye level. All of the conditions resulted in mean EMG levels of below 4% MVC, well below the recommended limit of 10-14%.
Sommerich et al., (1998) also examined work performance. They found a 10% improvement in productivity when the center of the monitor was changed from eye level to 35° below eye level. Performance was measured as the number of bibliographic references the subjects were able to format in the allowed time.
Computer work is near work. Many authors have noted that computer work differs from other near work in that most near work is done with a downward gaze angle, and computer work is done at a horizontal gaze angle. Instead of locating the monitor at a viewing angle similar to that of other near work, they often recommend special "computer" glasses. This represents the view that ergonomics means adapting the worker to the work environment. It is actually the other way around, the task of ergonomics is to adapt the work environment to the worker!
MONITOR TILT
Tilt the monitor back so that the top is slightly farther away from the eyes than the bottom.
Notice how you hold a magazine. Most likely you tilt it away from you at the top. While you are reading, rotate the magazine so that the top comes closer to you than the bottom. Keep rotating. The more you rotate the top towards you, the more uncomfortable it becomes to read.
When we look at the world, objects in the upper part of our peripheral vision are generally farther away than the point we are looking at, and objects in the lower part of our peripheral vision are usually closer. As a result, our visual system has developed to perform best when the visual plane tilts away from us at the top.
Tilting a monitor down, as is sometimes done to avoid glare, is opposite of the demonstrated capabilities of the visual system. In a comparison of monitor tilts, Ankrum and Nemeth (1996) found that tilting the monitor downward led to increased visual and postural discomfort when compared to a monitor tilted back. The most striking difference was in neck discomfort. The condition with the monitor low and tipped back led to the least increase in neck discomfort. Locating the monitor low and with the top tipped forward was the worst condition.
LIGHTING;
Ceiling suspended, indirect lighting. Control outside light with blinds and shades. Keep ambient light levels low and supplement with task lighting.
In an office of any size, the best solution for glare and reflections on the screen, as well as for overall visual performance, is ceiling suspended, indirect lighting. This is sometimes referred to as "uplighting." The underside of the lamps should be the same color as the ceiling. Wall mounted sconces may also be appropriate in certain instances. Because some tasks and workers require more light than others, it is best to keep the overall light level low and allow workers to supplement it with individually controlled task lights.
Understanding a little bit about the principles of lighting can help you improve just about any office environment. First we have to understand what we are trying to accomplish. When evaluating a monitor, high contrast is desirable. You want the letters to stand out from the background.
When evaluating what is reflected from the screen, it is the opposite: contrast is the enemy. Contrast reflected from the screen competes for the user's attention with the contrast on the screen. In some cases this can be an irritation, but in others it can make sections of the screen impossible to read.
Aside from absolute brightness, a big problem with direct ceiling lights is that they provide a high contrast with the rest of the ceiling. That contrast can reflect onto the screen. Many guidelines mistakenly specify only a luminance (brightness) value for ceilings and walls. While absolute intensity is important (a bright light reflecting off the screen will always cause problems), reducing the contrast is much more critical. Interrupting the ceiling with patches of bright light almost guarantees competing reflections on the screen.
With small office areas, it may be possible to reposition desks, or remove or reposition individual glare sources. However, this can become unwieldy for large areas. Repositioning a lamp may just transfer the problem to another workstation.
In many instances it is possible to retrofit small cube parabolic or paracube lenses to replace other types of lenses. If the cutoff angle (the angle beyond which the bulb cannot be seen) is acceptable, reflections of the light source from the screen will be eliminated. In other instances it may be possible to install shields or screens to reduce or eliminate the reflected contrast.
Reorienting the screen can help in some instances. But, as we discussed earlier, it should not be tipped down. Hoods can be effective, as can removing bulbs. Task lights can supplement lower levels of ambient lighting. Anti-glare screens have been effective in certain instances, but should be evaluated before purchase. Some anti-glare screens reduce glare by 99%, but even that may not be enough for a very bright source.
Remember, because the front of the screen is glass, something is going to be reflected from it. The goal is to reduce the contrast in those reflections. An indirect-direct combination will not work because it still creates high contrast.
Perhaps the most famous study regarding performance and lighting conditions was done at Western Electric's Hawthorne Plant in Chicago (Mayo 1933). The researchers found that when they increased light level, productivity increased. They also found that when they decreased the light level, productivity still increased. In fact, no matter how they changed the lighting, productivity continued to increase.
The term "The Hawthorne Effect" is now used to refer to the principle that making any change in a workplace can improve short-term performance. The improvement results from just "paying attention" to the workers.
Perhaps as a result of the Hawthorne experience, few field studies have measured performance under different lighting conditions. Hedge et al., (1995) found an increase in self-reported productivity of 2-3% for lensed-indirect lighting when compared with parabolic downlighting.
It's apparent that strong reflections in a screen reduce the ability to see the details on the screen. And if you can't see the details, productivity will suffer. Properly installed indirect lighting can eliminate glare as a performance-robbing factor.
Most recommendations for office lighting are full of numbers such as "Illuminance levels between 200-500 lux." Lighting designers often point to a set of measurements to show that the lighting design meets the specifications.
The primary function of light in the office is to support work. The ultimate criteria for a successful office lighting solution is how well it facilitates productivity and user satisfaction. No matter how esthetically pleasing or how well it conforms to a set of quantitative values, if a lighting design does not support the work, it has failed.
SCREEN COLORS
Screen colors: dark letters on a light background.
With the monitor off, look at your reflection in the screen. Now turn the monitor on and select a Windows-type background, (black letters on a white background). Notice that you cannot see your reflection as well.
Contrast is simply the difference in brightness between two images. With a white background, we reduce the difference in contrast between the screen and what is reflected off of it.
Negative screen contrast (black letters/white background) can reduce reflected images, as we saw with the demonstration. A white background also reduces the luminance (brightness) difference between the screen and the surrounding background of a normally lighted office. That makes it easier on your eyes.
Most early monitor screens had a black background with white, green or amber characters. Although white backgrounds were possible, the low quality of the monitors meant that the screen would flicker noticeably. Although newer technology has reduced the necessity, there are still many software programs with dark backgrounds.
Performance
Bauer and Cavonius (1980) found a lower error rate, with dark letters on a white background. Snyder and his colleagues (1990) also compared black and white backgrounds. Eight out of ten subjects increased their performance by using dark letters on a light background. The improvements ranged from a low of 2.0% to a high of 31.6%. The tasks were visual search and proofreading.
SUMMARY
Ergonomics seeks to adapt the work environment to the capabilities and limitations of the worker. The results should be increased productivity, user satisfaction, and reduced risk of injury.
These guidelines are meant as such: guidelines. There are exceptions. The final criteria for judging the effectiveness of a visual environment is not how well it conforms to a set of rules, but rather how well it facilitates the ability of the worker to perform his or her work effectively and without injury.
Health Promotion and Wellness Programs: Top Health Risks
Obesity, tobacco use and stress are the most common hazards to health in the Indian workforce. In addition to the direct harm they cause to individual wellness, they also provoke many indirect issues related to health care.
Weight loss and tobacco cessation are similar in that they both require behavioral modification and a comprehensive maintenance plan to curb the chances of a relapse. Staff qualifications should indicate training and experience adequate to deal with this type of psychology.
Furthermore, weight loss and tobacco cessation programs have varying success rates across different demographics and within small groups; therefore, health promotion and wellness programs have to be tailored to fit individual needs.
Before a diet and exercise plan can be implemented, a Health Risk Assessment is necessary to seek out pre-conditions for heart disease or stroke which could be compromised by the health promotion and wellness program.
Exercise programs and nutrition education should be scientifically-based, drug-free and physician approved. Weight loss has to be the result of a balance between caloric intake, healthy meals and exercise.
Physical Activity Programming
Encouraging people to exercise involves more than merely offering physical activity opportunities. Motivating employees includes acknowledging their present sedentary lifestyle and persuading them to make realistic and alternative lifestyle choices. The exercise program should be selected by the employee and offered during a time that is convenient for them in order to achieve a consistent participation rate.
Education will be necessary to teach employees the relationship between activity, diet and health and to demonstrate how this can be changed to encourage physical wellness. Health promotion and wellness program supervision will be necessary to ensure that injury does not develop and exercise programs are introduced safely.
Appropriate education in physiology, sports medicine or an equivalent and have a current CPR/First Aid certification should verify that health promotion and wellness programs are operated safely. The Health Risk Assessment should be checked to ensure the participant has agreed to a referral, elected exercise options and verified that there are no contravening health issues that preclude an exercise program.
Staff should monitor heart rate and blood pressure to protect health promotion and wellness program goals during all intervention procedures. Safe exercise guidelines are offered by the American College Of Sports Medicine. Free Fitness Handouts and Fitness Posters can also be found at Wellness Proposals
Tobacco Abuse
Smoking cessation is one of the most difficult health risk issues to tackle because nicotine is considered to be one of the most addictive substances. In order to succeed, participants must want to quit. Preparation to quit, support with choosing a method to quit and visible proof of results need to be demonstrated. Counseling should be available for the participant at any time.
Not all cessation programs work the same way with everyone. A qualified counselor should recognize individual differences and be able to match cessation programs with individual preferences. Diet plans, exercise programs, and activities that preclude smoking need to be presented as part of the cessation program. Relapses are common; therefore, a maintenance plan is mandatory. Nicotine substitution patches, sprays, gums or other medicinal options should be included in the counseling session to support cessation efforts.
Guidelines and resources for cessation programs are plentiful. Some of the best offerings are presented at the Surgeon General's website, The American Heart Association, The American Cancer Society, The American Lung Association, or Smoke Enders.
For the purpose of tracking tobacco cessation success rate, the participants who began the program need to be the same ones who finished it. Maintenance parts of cessation should be recorded for a minimum of one year.
Healthy Choices, Healthy Diet
The Health Risk Assessment tests where nutritional education would benefit. With almost a seventy percent rate of obesity, the American workforce is in dire need of healthy food choice counseling. Health promotion and wellness programs promote better food choices by teaching participants how to identify low carbohydrate, lower calorie, high protein, and high fiber foods.
Explaining the relationship between obesity and the escalating incidence of heart disease, Type II Diabetes and health care costs should help motivate participants to seek help to lose weight. Nutrition counseling resources should always be used in consultation with a trained.
Stress and the Workplace
Another common finding in health promotion and wellness programs is the need for stress management in the workplace. More stress-related problems are the result of the inability to cope with stressors, than they are of the issue that produces the stress.
Stress management should emphasis problem recognition and solving skills, effective communication, relaxation techniques and solution-based options. Coping mechanisms are encouraged by familiarizing employees with the organizational resources that can be used to deal with conflict as it arises. This prevents antagonistic situations from escalating and causing undue stress.
Shape up your company with a wellness program
It was more than a decade ago, but it might as well have been last year, when many other small businesses were caught in the same painful pinch.
The leaders at Highsmith, a Wisconsin-based marketer of supplies and equipment to schools and libraries, encountered the worst kind of sticker shock: a 53% rise in the company's health-insurance premiums.
Though the spike in 1990 was caused by some unusual claims by just a handful of employees, management saw it as a harbinger of future problems unless steps were taken to keep a lid on costs and claims. "We decided we would manage health care and not let it manage us," says Bill Herman, Highsmith's vice president for human resources.
So what did Herman and his colleagues do? They launched a workplace wellness program that eventually would address the physical and emotional health of about 200 employees and have a dramatic impact on the company's productivity and bottom line.
Wellness on the bottom line
Any business big or small that wants to supercharge its workplace would be well-advised to pay attention to the Highsmith experience. This is true even for small businesses where health insurance isn't an issue — because none is offered — but where absenteeism and productivity are.
"If a Fortune 500 company has 150 people a day out sick, there still are thousands of workers to cover for them," says David Hunnicutt, president of the Wellness Councils of America (WELCOA), a nonprofit organization that shows member companies how wellness programs can enhance profitability. "But if you're a small company with six employees, and two are out, you've just lost 33% of your work force."
The good news is that small businesses have an inherent advantage when it comes to instituting effective wellness programs: The smaller the employee count, the easier it is to change workplace culture. And there are plenty of cost-effective measures that are affordable for even the smallest company.
Like everything else, there's a right way and a wrong to institute a wellness program, and I'll get into that in a minute. First, though, if you're inclined to doubt the efficacy of such programs, consider the impact it has had at Highsmith.
The strategy has helped the company keep a tight lid on health-insurance costs, with its premium rising just 3.1% in 2003 and 2.9% in 2002.
Turnover also has slowed dramatically. In 2001, while the average employer in Wisconsin's Madison-Milwaukee corridor was losing 22% of its workforce, turnover at Highsmith was just 8.7%.
As for the company's workers' compensation costs, Herman says, "they haven't just slowed down, they've actually gone down. It's significantly less than what we were paying in the early '90s."
A comprehensive approach
The cornerstone of the Highsmith wellness program is a monitoring process where at-work health screening is done once a year. Blood pressure, cholesterol levels and pulmonary function are checked on the spot, and mental health also is assessed. Then follow-up exams with a physician are required based on the worker's age and gender. Participate, and Highsmith pays 75% of your health-insurance premium; refuse, and coverage drops to 60%.
This brings up a crucial point: While federal law prohibits discriminating against workers because of health status, it is entirely legal to "incentivize" participation in a health-screening program.
Highsmith also promotes physical health by offering aerobics classes at work and seeing to it that vending machines are stocked with plenty of low-fat items sold at a discount. The lower costs for healthy items are made possible by having higher-than-normal prices for the junk-food items in the machines.
Over time, Herman says, the company has broadened the program to address issues beyond physical health that can have a profound impact on a worker's sense of well-being. Highsmith offers nearly 70 classes on subjects as diverse as resolving workplace disputes, coping with teenage children and caring for elderly parents. An innovative flextime work schedule makes it easier for workers to deal with some of these issues in a timely way.
Herman says the human impact of the wellness program is tangible: "When you walk into this company and look around, you can tell something special is going on here."
Seven steps to workplace wellness
Whatever the size of your company, and whether or not you offer health benefits, it's possible to reap bottom-line benefits from a wellness plan without putting into place a multi-tiered program like the one that has evolved at Highsmith. It's probably easier and less expensive than you think.
WELCOA's Hunnicutt urges adopting a plan that focuses on results rather than activities. Employee participation in a "smoke out" or fun run may boost short-term awareness of good health, but generally does not have a long-term impact.
If you seek real improvement, you need to set goals and devise a reasonable strategy for achieving them. With that in mind, Hunnicutt offers the following seven-step program.
1. Secure the support of top management. Any meaningful change will be driven from the top. In this vein, Herman recalls that the first wellness effort at Highsmith involved him and the chief executive officer leading the mostly female staff in lunchroom aerobics.
2. Appoint a wellness team to oversee the effort. At a small company, this might be a single individual, perhaps even the boss.
3. Collect some form of data. "You can't change what you can't measure," Hunnicutt says. Data collection can run the gamut from having employees participate in health screenings (an online version can cost as little as $8 an employee; a blood workup is about $30 per head) to weighing the workforce on a grain elevator scale to establish a weight-loss benchmark.
4. Create a simple plan and set simple goals. If excess weight is identified as a primary concern, for instance, the wellness team might say, "In 12 weeks, we're going to lose 500 pounds as a company."
5. Choose the appropriate intervention. This could be anything from providing information on healthy eating to promoting exercise as part of an employee's daily schedule.
6. Create a supportive environment. If, for example, you want your employees to exercise more, make it easier for them to do it during the workday. Consider designating or building walking trails around your company grounds, or providing shower facilities so employees can clean up after bicycling to work.
7. Carefully evaluate outcomes. If the desired result isn't being achieved, it may be necessary to change the intervention or make the environment even more supportive.
Not into structure? Be informal
If you're not into structure, then try a less formal approach.
John Harris, principal of Harris HealthTrends, a Toledo, Ohio-based wellness consultant, tells of one overweight business executive who issued his employees what became known as "Jim's Challenge." He told them he was going to lose 50 pounds and invited them to join him in the effort, with anyone who lost more in a given week than he did winning a healthy lunch. He also made certain workers received information about healthy dieting.
Or, Harris adds, employers can do something as simple and inexpensive as buying workers $5 pedometers and urging them to take 10,000 steps a day, the level at which walking provides sufficient exercise. Making it easy -- and acceptable -- for employees to walk during working hours also should be part of such an effort.
Whatever you decide to do, it pays to remember this: The health and happiness of your employees has a direct impact on your company's financial health.
Employee Health Screening Tools:
Uses and Importance
When an employee Health Screening test is administered, it covers standard measurements of vital function. Most often, employees are aware that they have health issues, but have not been tested to determine the level of severity or the risk to their health that these problems represent. The extent to which their health has deteriorated is often an ignored variable. Chronically ill employees have come to accept their present level of illness as normal. The documentation of health risks is necessary in order to be processed for treatment and accessible for admission in employee health care initiatives.
Most employee Health Screening Tests, employee Health Risk Appraisals and employee Health Risk Assessments take into account the following measurements:
Blood Glucose Level - Blood tests review for the presence of Diabetes.
Blood Pressure - Both readings are taken using the sphygmomanometer (yes, that is what it is called).
Background medical information and previous blood pressure history is noted.
Cerebrovascular/Stroke Condition - Blood is taken to determine if there are blood vessel abnormalities
Cholesterol - Healthy cholesterol and unhealthy cholesterol readings are screened using a blood sample. Diet choices and use of medication is recorded.
Coronary Disease - Routine questioning detects heart health or previous heart failure.
Demographic Information - Gender, age, weight, height, shift, department, race, marital status, and geographical location should all be part of the data collection process. This kind of information makes further study of and improvements to wellness programs more accurate.
Family History - Thorough investigation of past health issues, previous surgeries and patterns in the family tree help to detect the probability of future health issues.
Feedback - In order to promote an awareness of self-help options, the employee health screener elaborates on the significance of any discovered health risks and the solutions to reduce their impact.
Forms - All participants have the option to enroll in wellness programs and must agree in writing to submit blood work and medical information for the purpose of pursuing health promotion.
Physical Activity - The amount and duration of exercise has a direct impact on health risks
Referrals - If participants have health issues, a referral form should be filled out and signed by the employee. A requisition to ascertain the referral visit occurred accompanies this form.
Stress - Workplace stress has a huge impact on health and wellness. Determining where the stress is generated can begin a solution-based plan to deal with and reduce the incidence of work-related stress.
Surveys - Data collection and its application is the foundation of every successful workplace wellness plan. Internal promotion of surveys and recruiting employees to participate in them can be pursued during the employee health screening.
Tobacco Use - Nicotine addiction is a major focus in the wellness industry. Employees will be assisted, at their prerogative, to get help to stop tobacco use.
Weight - Body weight, height and fat ratios should be recorded for tracking purposes and demographic referencing.
The Purpose of Blood Tests
There are government standards to adhere to for extracting and testing blood samples for physical fitness and employee health screening. Extracting should only be done by a qualified professional. A blood pressure reading exposes two categories: systolic and diastolic. Systolic pressure is the higher/top number in the result. It is a measurement of the rate at which the blood circulates through the arteries. Diastolic pressure is the lower/bottom number and is a value for the rate at which the blood circulates through the arteries between heartbeats.
Normal blood pressure is approximately 120 (systolic) over 80 (diastolic). Normal blood pressure fluctuates a bit over the course of a day and should be lower during resting times. High blood pressure does not follow this sort of pattern; it remains high during resting phases. This is called hypertension.
The Purpose of Cholesterol Testing
Blood testing to determine cholesterol levels is a task for a skilled medical professional. It requires a specialized program and applied field knowledge to interpret the results. Similar to blood pressure testing, there are national guidelines to follow for testing and evaluation. Some cholesterol in the diet is considered healthy. These levels show up as HDL cholesterol readings. Other cholesterol in the diet is unhealthy and is observable as LDL cholesterol readings. A normal blood cholesterol is between 200 and 40; anything higher or lower than this is cause for a referral to a physician for follow-up testing and treatment.
Both blood pressure and cholesterol testing are key indicators of cardiovascular disease. If there is a family history of heart disease and if the employee uses tobacco, alcohol, has a high cholesterol reading and/or high blood pressure, this places the employee in a high risk category as well as indicates a need for health promotion efforts, nutrition counseling, exercise options and education.
RISK ASSESSMENT AT WORKPLACE
What is risk assessment?
A risk assessment is simply a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough
precautions or should do more to prevent harm. Workers and others have a rightto be protected from harm caused by a failure to take reasonable controlmeasures.
Accidents and ill health can ruin lives and affect your business too if output is lost, machinery is damaged, insurance costs increase or you have to go to court. You
are legally required to assess the risks in your workplace so that you put in place a plan to control the risks.
Five steps to risk assessment
How to assess the risks in your workplace
Follow the five steps in this article:
Step 1
Identify the hazards
Step 2
Decide who might be harmed and how
Step 3
Evaluate the risks and decide on precautions
Step 4
Record your findings and implement them
Step 5
Review your assessment and update if necessary
Don’t overcomplicate the process. In many organisations, the risks are well known
and the necessary control measures are easy to apply. You probably already know whether, for example, you have employees who move heavy loads and so could harm their backs, or where people are most likely to slip or trip. If so, check that you have taken reasonable precautions to avoid injury.
If you work in a organisation, you could ask a health and safety advisor to help you. If you are not confident, get help from someone who is competent. In all
cases, you should make sure that you involve your staff or their representatives in the process. They will have useful information about how the work is done that will make your assessment of the risk more thorough and effective. But remember, you
are responsible for seeing that the assessment is carried out properly.
When thinking about your risk assessment, remember:
a hazard is anything that may cause harm, such as chemicals, electricity, working from ladders, an open drawer etc;
the risk is the chance, high or low, that somebody could be harmed by these and other hazards, together with an indication of how serious the harm could be.
Step 1
Identify the hazards
First you need to work out how people could be harmed. When you work in a place every day it is easy to overlook some hazards, so here are some tips to help
you identify the ones that matter:
Walk around your workplace and look at what could reasonably be expected to cause harm.
Ask your employees or their representatives what they think. They may have noticed things that are not immediately obvious to you.
Check manufacturers’ instructions or data sheets for chemicals and equipment as they can be very helpful in spelling out the hazards and putting them in their true perspective.
Have a look back at your accident and ill-health records – these often help to identify the less obvious hazards.
Remember to think about long-term hazards to health (eg high levels of noise or exposure to harmful substances) as well as safety hazards.
Step 2
Decide who might be harmed and how
For each hazard you need to be clear about who might be harmed; it will help you identify the best way of managing the risk. That doesn’t mean listing everyone by
name, but rather identifying groups of people (eg ‘people working in the storeroom’
or ‘passers-by’).
In each case, identify how they might be harmed, ie what type of injury or ill health might occur. For example, ‘shelf stackers may suffer back injury from repeated
lifting of boxes’.
Remember:
some workers have particular requirements, eg new and young workers, new or expectant mothers and people with disabilities may be at particular risk.
Extra thought will be needed for some hazards; cleaners, visitors, contractors, maintenance workers etc, who may not be in
the workplace all the time;
members of the public, if they could be hurt by your activities;
if you share your workplace, you will need to think about how your work affects others present, as well as how their work affects your staff – talk to them; and ask your staff if they can think of anyone you may have missed.
Step 3
Evaluate the risks and decide on precautions
Having spotted the hazards, you then have to decide what to do about them. The law requires you to do everything ‘reasonably practicable’ to protect people from
harm. You can work this out for yourself, but the easiest way is to compare what you are doing with good practice.
So first, look at what you’re already doing, think about what controls you have in place and how the work is organised. Then compare this with the good practice
and see if there’s more you should be doing to bring yourself up to standard. In asking yourself this, consider:
Can I get rid of the hazard altogether?
If not, how can I control the risks so that harm is unlikely?
When controlling risks, apply the principles below, if possible in the following order:
try a less risky option (eg switch to using a less hazardous chemical);
prevent access to the hazard (eg by guarding);
organise work to reduce exposure to the hazard (eg put barriers between pedestrians and traffic);
issue personal protective equipment (eg clothing, footwear, goggles etc); and
provide welfare facilities (eg first aid and washing facilities for removal of contamination).
Improving health and safety need not cost a lot. For instance, placing a mirror on a dangerous blind corner to help prevent vehicle accidents is a low-cost precaution considering the risks. Failure to take simple precautions can cost you a lot more if an accident does happen.
Involve staff, so that you can be sure that what you propose to do will work in practice and won’t introduce any new hazards.
Step 4
Record your findings and implement them
Putting the results of your risk assessment into practice will make a difference when looking after people and your business.
Writing down the results of your risk assessment, and sharing them with your staff, encourages you to do this. If you have fewer than five employees you do not have
to write anything down, though it is useful so that you can review it at a later date if, for example, something changes.
When writing down your results, keep it simple, for example ‘Tripping over rubbish:
bins provided, staff instructed, weekly housekeeping checks’, or ‘Fume from welding: local exhaust ventilation used and regularly checked’.
We do not expect a risk assessment to be perfect, but it must be suitable and sufficient. You need to be able to show that:
a proper check was made;
you asked who might be affected;
you dealt with all the significant hazards, taking into account the number of people who could be involved;
the precautions are reasonable, and the remaining risk is low; and
you involved your staff or their representatives in the process.
A good plan of action often includes a mixture of different things such as:
a few cheap or easy improvements that can be done quickly, perhaps as a
temporary solution until more reliable controls are in place;
long-term solutions to those risks most likely to cause accidents or ill health;
long-term solutions to those risks with the worst potential consequences;
arrangements for training employees on the main risks that remain and how they are to be controlled;
regular checks to make sure that the control measures stay in place; and
clear responsibilities – who will lead on what action, and by when.
Remember, prioritise and tackle the most important things first. As you complete each action, tick it off your plan.
Step 5
Review your risk assessment and update if necessary
Few workplaces stay the same. Sooner or later, you will bring in new equipment, substances and procedures that could lead to new hazards. It makes sense, therefore, to review what you are doing on an ongoing basis. Every year or so formally review where you are, to make sure you are still improving, or at least not
sliding back.
Look at your risk assessment again. Have there been any changes? Are there improvements you still need to make? Have your workers spotted a problem?
Have you learnt anything from accidents or near misses? Make sure your risk assessment stays up to date.
When you are running a business it’s all too easy to forget about reviewing your risk assessment – until something has gone wrong and it’s too late. Why not set a review date for this risk assessment now? Write it down and note it in your diary asan annual event.
During the year, if there is a significant change, don’t wait. Check your risk assessment and, where necessary, amend it. If possible, it is best to think about
the risk assessment when you’re planning your change – that way you leave yourself more flexibility.
Some frequently asked questions
What if the work I do tends to vary a lot, or I (or my employees) move from one site to another?
Identify the hazards you can reasonably expect and assess the risks from them. This general assessment should stand you in good stead for the majority of your
work. Where you do take on work or a new site that is different, cover any new or different hazards with a specific assessment. You do not have to start from scratch
each time.
What if I share a workplace?
Tell the other employers and self-employed people there about any risks your work
could cause them, and what precautions you are taking. Also, think about the risks
to your own workforce from those who share your workplace.
Do my employees have responsibilities?
Yes. Employees have legal responsibilities to co-operate with their employer’s
efforts to improve health and safety (eg they must wear protective equipment when
it is provided), and to look out for each other.
What if one of my employee’s circumstances change?
You’ll need to look again at the risk assessment. You are required to carry out a specific risk assessment for new or expectant mothers, as some tasks (heavy lifting or work with chemicals for example) may not be appropriate. If an employee develops a disability then you are required to make reasonable adjustments.
People returning to work following major surgery may also have particular requirements. If you put your mind to it, you can almost always find a way forward
that works for you and your employees.
What if I have already assessed some of the risks?
If, for example, you use hazardous chemicals and you have already assessed the risks to health and the precautions you need to take under the Control of Substances Hazardous to Health Regulations (COSHH), you can consider them
‘checked’ and move on.
ASBESTOS UPDATE;
India opposes putting asbestos in hazardous list;
Reacting to the “anti-worker and anti-science” position of few “reckless governments” that has created a stalemate for the U.N. hazardous chemicals treaty, the Ban Asbestos Network of India (BANI) has accused Canadian, Russian and Indian governments of turning a blind eye towards the poisonous atmosphere around the asbestos factories and the dangers it poses to the health and life of citizens. This was being done just to pander to the industry’s hunger for profit at human cost, it said.
“The Indian government has betrayed the public interest by taking an unpardonable position that endangers each and every citizen of the country at the fourth meeting of the Conference of the Parties (COP-4) of the U.N.’s Rotterdam Convention on the Prior Informed Consent Procedure (PIC) for Certain Hazardous Chemicals and Pesticides in International Trade in Rome,” a statement issued by BANI said here.
As a consequence, the hazardous chemicals treaty faces deadlock in the Rome meeting. A very important proposal was placed to wriggle out of the situation where chemicals that meet the Convention’s criteria but on which the COP fails to reach consensus about listing in Annex III as has happened in the case of chrystolite asbestos aend endosulphan. Chemical and chrystolite asbestos industries and countries like India, Russia and Canada are opposed to the inclusion of these chemicals in the list although they meet the criteria to be listed as hazardous chemical. Fearing certain defeat, Canada stated that introducing voting for Annex III would create a dual system that could weaken the Convention. The Indian government took an untenable position at a U.N. meeting in Rome by opposing the inclusion of chrystolite asbestos in the U.N.’s hazardous chemical list under the “influence” of asbestos industry and Canadian and Russian governments. A number of countries, including some that continue to mine and export chrystolite asbestos, blocked its addition to the PIC list when the Parties to the Convention last met in 2006 and further opposition is expected at next week’s meeting, according to the Food and Agriculture Organisation (FAO).
India is the largest importer and consumer of Canadian and Russian asbestos to the detriment of its citizens and workers.
When the matter came up for discussion on October 28, head of the Indian delegation R.H. Khawaja, Additional Secretary, Ministry of Environment opposed the listing of chrystolite asbestos and endosulphan in the PIC list for hazardous chemicals and pesticides.
The Indian government’s delegation acted under tremendous pressure from the representatives of Indian chemical industry and chrystolite asbestos industry who dictated government’s official position, the BANI statement said.
OHSAS 18000 Occupational Health and Safety Zone
WHAT IS OHSAS 18001?
OHSAS 18000 is an international occupational health and safety management system specification. It comprises two parts, 18001 and 18002 and embraces a number of other publications.
For the record, the following other documents, amongst others, were used in the creation process:
BS8800:1996 Guide to occupational health and safety management systems
DNV Standard for Certification of Occupational Health and Safety Management Systems(OHSMS):1997
Technical Report NPR 5001: 1997 Guide to an occupational health and safety management system
Draft LRQA SMS 8800 Health & safety management systems assessment criteria
SGS & ISMOL ISA 2000:1997 Requirements for Safety and Health Management Systems
BVQI SafetyCert: Occupational Safety and Health Management Standard
Draft AS/NZ 4801 Occupational health and safety management systems Specification with guidance for use
Draft BSI PAS 088 Occupational health and safety management systems
UNE 81900 series of pre-standards on the Prevention of occupational risks
Draft NSAI SR 320 Recommendation for an Occupational Health and Safety (OH and S) Management System
OHSAS 18001 is an Occupation Health and Safety Assessment Series for health and safety management systems. It is intended to help an organizations to control occupational health and safety risks. It was devloped in response to widespread demand for a recognized standard against which to be certified and assessed.
Who Created OHSAS?
OHSAS 18001 was created via a concerted effort from a number of the worlds leading national standards bodies, certification bodies, and specialist consultancies. A main driver for this was to try to remove confusion in the workplace from the proliferation of certifiable OH&S specifications.
The participants were as follows:
* National Standards Authority of Ireland
* Standards Australia
* South African Bureau of Standards
* British Standards Institution
* Bureau Veritas Quality International
* Det Norske Veritas
* Lloyds Register Quality Assurance
* National Quality Assurance
* SFS Certification
* SGS Yarsley International Certification Services
* Asociaci?spa? de Normalizaci? Certificaci?r
* International Safety Management Organisation Ltd
* Standards and Industry Research Institute of Malaysia
* International Certification Services
Benefits - How Can OHSAS Help?
The OHSAS specification is applicable to any organisation that wishes to:
Establish an OH&S management system to eliminate or minimise risk to employees and other interested parties who may be exposed to OH&S risks associated with its activities
Assure itself of its conformance with its stated OH&S policy
Demonstrate such conformance to others
Implement, maintain and continually improve an OH&S management system
Make a self-determination and declaration of conformance with this OHSAS specification.
Seek certification/registration of its OH&S management system by an external organisation
Quality council of India (QCI)
QCI was set up in 1997 as an autonomous body by the Government of India jointly with the India industry to establish and operate the National Accreditation Structure for conformity assessment bodies. Indian industry is represented in QCI by three premier industry associations ASSOCHAM, CII and FICCI, QCI is also assigned the task of monitoring and administering the National Quality Campaign and to oversee effective function of the National Information and Enquiry Services.
To realize the objective of improving quality competitiveness of India products and services, QCI provides strategic direction to the quality movement in the country by establishing recognition of India conformity assessment system at the international level.
Vision
To be among the world’s leading national apex quality facilitation, accreditation and surveillance organizations, to continuously improve the climate, systems, processes and skills for total quality.
Mission
To help India achieve and sustain total quality and reliability, in all areas of life, work, environment, products and services, at individual, organizational, community and societal levels.
Working For "The National Well Being"
DGFASLI (Directorate General, Factory Advice Service and Labour Institutes)
The office of the Chief Adviser of factories, which is now called Directorate General, Factory Advice Service and Labour Institutes, was setup in 1945 with the objective of advising Central And State Governments on administration of the Factories Act and coordinating the factory inspection services in the States. The Directorate General, Factory Advice and Labour Institutes (DGFASLI) comprises:
Headquarters situated in Mumbai
Central Labour Institute in Mumbai
Regional Labour Institutes in Chennai, Kanpur, Kolkatta and Faridabad.
The DGFASLI is an attached office of the Ministry of Labour & Employment, Government of India and serves as a technical arm to assist the Ministry in formulating national policies on occupational safety and health in factories and docks. It also advises factories on various problems concerning safety, health, efficiency and well - being of the persons at work places.
Aim & Objectives
The activities of the institute are geared to improve work methods and working conditions so as to enhance the safety, health and productivity of the industrial workers and in general, his quality of work life. In this endeavour, CLI interacts with the state factory inspectorates, employers' associations, trade unions and professional bodies and institutes concerned with the matter. Further, the ILO/ ARPLA had designed the institute as a Centre of Excellence for training in labour administration for Asian and Pacific countries. It is the national centre of International Occupational Safety and Health Information Centre (CIS, ILO Geneva) for India. Its activities are spread all over the country with main emphasis on the factories located in the western states of the country.
Divisions/Cells of the Institute
The Divisions in CLI are organised as below :
Industrial Safety
Industrial Hygiene
Industrial Medicine
Industrial Physiology
Staff Training
Industrial Psychology
Productivity
Major Accident Hazards Control
Communication
Industrial Safety
The Industrial Safety division aims at achieving improvement in working conditions and safety standards of factories and docks through training,consultancy, field studies, surveys and other promotional activities. It has contributed to the following achievements:
Evolution of a safety movement in the country
Creation of national awareness on safety
Development of infra-structure on safety at national level through competence building
Better administration of the Factories Act through training of Inspectors of Factories and technical support.
International training in the field of safety for Labour Administrators of factories from Asian Pacific and African countries.
Studies and Surveys:
National surveys are conducted for ascertaining the status of working conditions and standards of safety in particular industries and operations.
Unit level studies are carried out with the objective of assessing the safety related problems and formulating recommendations for improvements. These studies also help the management to take necessary measures towards setting up safety systems, instituting safety programmes and achieving the goal of better safety in their organisations.
Consultancy studies are undertaken at the request of the management or government agencies like the Factory Inspectorates for studying specific problems and rendering advice for corrective measures. The findings of national surveys and unit level consultancy studies become the source of technical inputs while drafting Rules & Regulations and designing various occupational safety and health intervention modules for target groups.
Training:
In keeping with its pioneering role in the field of industrial safety, the division has been conducting training for the benefit of foreign delegates, comprising Factory Inspectors and Labour Administrators under various technical co-operation schemes such as the Colombo Plan, Special Commonwealth African Assistance Programme (SCAAP) and Commonwealth Fellowship for technical co-operation.
Specialised training courses are conducted for identified target groups such as Senior managers, Safety officers, Supervisors, Trade Union officials, and Safety Committee members from the industry. Some of these courses are :
Testing and examination of lifting machinery, lifting tackles and pressure vessels
Safety audit
Safety in chemical industry
Safety management techniques
Industrial ventilation and noise
In view of the need of inspection of specific industries and major hazards control, specialised courses are also conducted to impart necessary technical knowledge and skill to the Inspectors of Factories Act 1948.
In order to provide industries and docks sector with qualified safety officers the division division conducts one-year post diploma course in industrial safety.
Facilities:
The division has the following facilities:
Industrial Safety, Health and Welfare Centre
Mobile Safety Exhibition
Environmental Engineering Laboratory
Workshop
The Industrial Safety, Health and Welfare Centre demonstrates methods, arrangements and appliances for promoting safety and health of workers. This centre has models and exhibits regarding safety, health and welfare in the form of properly guarded machines, personal protective equipment, safe methods of material handling, light and colour schemes and other arrangements, for propagating the message of safety and other health of workplaces. This centre is open to organised groups from industry and educational institutions.
Industrial Hygiene
The Industrial Hygiene division is concerned with the improvement of industrial work environment and comprises Industrial Hygiene Laboratory (IHL), Respiratory Equipment Testing Laboratory (RETL) and Non-Respiratory Equipment Testing Laboratory (NRTEL).
The division undertakes various studies/surveys, national projects and training courses to protect the health of industrial workers through identification, evaluation and control of occupational health hazards and advises the management on ways to meet the requirements prescribed in the Second Schedule (under Section 41F) to the Factories (Amendment) Act, 1987.
The RETL tests the performance and efficiency of indigenous respiratory personal protective equipment such as dust respirators and canisters/cartridge gas respirators,etc.and advises manufacturers on improvements required to meet prescribed standards.
The NRETL carries out the testing of indigenous non-respiratory personal protective equipment such as safety shoes,safety helmets,safety goggles, eye protectors, etc. These personal protective equipment are tested as per the specifications set by the Bureau of Indian Standards(BIS). Based on the test reports, technical advice and guidance on quality improvement are suggested to the entrepreneurs and manufacturers. User industries are also advised on proper selection, use, care and maintenance of various personal protective equipment.
The division also organises training courses in the areas of industrial hygiene for the specific group of industries given in the First Schedule, Section 2(cb) of the Factories (Amendment)Act,1987. These training courses are meant to help safety officers,chemists, supervisors and middle level managers in the identification, assessment and control of occupational hazards in their factories.
Industrial Medicine
The Industrial Medicine division aims to prevent and contain health hazards at the workplace brought in by industrialisation. The hazards may arise from chemicals or from physical factors such as noise, heat, vibration and radiation.
Occupational health studies and surveys on industries manufacturing asbestos, dyestuff, cement, chemical, engineering and ports handling such products are carried out to assess the incidence of occupational diseases. The division also runs a National Referral Diagnostic Centre to diagnose occupational diseases Suitable recommendations suchas medical surveillance, use of personal protective equipment, facilities for personal hygiene and first-aid are made to prevent and control health hazards.
The division also carries out training, two major ones being the training of factory medical officers and workers on occupational health hazards and first-aid. It has also started a three-month certificate course in Industrial Health for factory medical officers from March, 1993.The laboratory attached to the division has facilities for medical investigation, including visual acuity tests, audiometric evaluation, and pulmonary function tests.
National Referral Diagnostic Centre
Occupational disease assume a significant dimension in any country and more particularly, in a developing nation like India. There is a considerable prevalence of common disorders like lead poisoning, silicosis, asbestosis, pesticides poisoning, occupational hearing loss, etc. among the industrial workers.
While the emphasis on the prevention, early diagnosis and management of occupational diseases are well accepted as the proven strategy equally important is facilitating for confirming the cases of occupational diseases as these involve legal liabilities. In recognition of this need and the fact that such referral facilities are scarce in our country, a NRDC has been established by DGFASLI in the Central Labour Institute.
Suspected cases of occupational diseases are referred to these centers by Factory Medical Officers, Medical Inspectors of Factories, Certifying Surgeons, Public hospitals, etc. for opinion. The cases are physically examined, subjected to investigations at the institute and report is given by co-relating with the occupational history before arriving at a confirmed diagnosis.
Industrial Physiology
The Industrial Physiology division undertakes research and development work as well as consultancy services in the areas of Occupational Physiology and Ergonomics with a view to improving working conditions and also suggesting work station design and workplace layout to combat mismatch in the man-machine system. Research studies carried out by the division are in the following three major areas.
Work physiology - It concentrates on physical work and its effects on man so that suitable work-rest regime for various kinds of physical activities can be determined and so also select the right man for the right job.
Environmental physiology - It helps to identify and assess the impact of factors like heat, humidity, thermal radiation and movement of air in the working environment so that limits of heat stress for day-to-day industrial work can be stipulated and suitable remedial measures prescribed.
Respiratory physiology - It determines the effects of dust, fumes, toxic gases, etc. on the pulmonary functions and work capacity of the exposed individuals and suggest remedial measures.
In the area of ergonomics the emphasis has been laid on the collection of anthropometric data from different regions of the country, which can be used in the design of work station, machinery, equipment, tools, etc.
The division conducts specialised training courses such as industrial ergonomics, occupational stress and industrial heat, etc
Asbestos Update;
NEW DELHI: Reacting to the “anti-worker and anti-science” position of few “reckless governments” that has created a stalemate for the U.N. hazardous chemicals treaty, the Ban Asbestos Network of India (BANI) has accused Canadian, Russian and Indian governments of turning a blind eye towards the poisonous atmosphere around the asbestos factories and the dangers it poses to the health and life of citizens. This was being done just to pander to the industry’s hunger for profit at human cost, it said.
“The Indian government has betrayed the public interest by taking an unpardonable position that endangers each and every citizen of the country at the fourth meeting of the Conference of the Parties (COP-4) of the U.N.’s Rotterdam Convention on the Prior Informed Consent Procedure (PIC) for Certain Hazardous Chemicals and Pesticides in International Trade in Rome,” a statement issued by BANI said here.
As a consequence, the hazardous chemicals treaty faces deadlock in the Rome meeting. A very important proposal was placed to wriggle out of the situation where chemicals that meet the Convention’s criteria but on which the COP fails to reach consensus about listing in Annex III as has happened in the case of chrystolite asbestos aend endosulphan. Chemical and chrystolite asbestos industries and countries like India, Russia and Canada are opposed to the inclusion of these chemicals in the list although they meet the criteria to be listed as hazardous chemical. Fearing certain defeat, Canada stated that introducing voting for Annex III would create a dual system that could weaken the Convention. The Indian government took an untenable position at a U.N. meeting in Rome by opposing the inclusion of chrystolite asbestos in the U.N.’s hazardous chemical list under the “influence” of asbestos industry and Canadian and Russian governments. A number of countries, including some that continue to mine and export chrystolite asbestos, blocked its addition to the PIC list when the Parties to the Convention last met in 2006 and further opposition is expected at next week’s meeting, according to the Food and Agriculture Organisation (FAO).
India is the largest importer and consumer of Canadian and Russian asbestos to the detriment of its citizens and workers.
When the matter came up for discussion on October 28, head of the Indian delegation R.H. Khawaja, Additional Secretary, Ministry of Environment opposed the listing of chrystolite asbestos and endosulphan in the PIC list for hazardous chemicals and pesticides.
The Indian government’s delegation acted under tremendous pressure from the representatives of Indian chemical industry and chrystolite asbestos industry who dictated government’s official position, the BANI statement said.
A very good article by Dr Kulkarni Ref Kulkarni GK. Implementation of occupational health legislation at work place, issues and concerns. Indian J Occup Environ Med 2008;12:51-2
Implementation of occupational health legislation at work place, issues and concerns
In the last fifty years Indian industry has grown rapidly and more so in the last two decades. This has resulted in increased manufacturing activities, technological advancements and change in work practices. This change in business environment has profound effect on the health of working population. Thus the onus is on Occupational Health Physician to protect and promote health of working population. This can only be achieved by comprehensively implementing Occupational Health Legislations pertaining to work place.
The Occupational Health Legislation has been amended only twice in the last fifty years, one central act related to Building and other Construction workers of 1996 and The Biomedical waste (management and handling) rules of 2003 under Environment protection act of 1986 have seen the daylight, whereas in the field of Public health more than 36 different Health Legislations have come with changing time. It is only after the Bhopal disaster that legislations in the area of safety. Health and environment were forced to be reframed and notified. The concern is whether only change in legislation would result in improved Occupational health care at work place or benefits of legislation remain only on the paper is the issue. The expectation from Occupational Health Legislation would be:
Occupational health legislation
Prohibit conduct injurious to workers Health
Aims at protecting from disease and promoting positive health
Defines resourses for occupational Health care
Carry out medical screening, surveillance and rehabilitation
Concerning ethical issues in occupational health care
Current occupational health care service is because of
Governmental legislation for Industry, Mines, Docksand Ports and others Demand from the Trade Union Management concerns for compliance of legislation and Employee health care
Action groups NGO like Indian Association of Occupational Health, NSC and others.
Current factories acts - Occupational health care (Factories Act and Maharashtra factories rules as illustrative reference)
FA - 45- First aid appliances: Under this act and MFR- 76,77 and 78 describe First- aid facilities at work place, ambulance room. Trained First-Aiders and contents of the first-aid Box.
MFR - 43: Drinking water certification by Health Officer for Human consumption.
FA - 87 - MFR - 114: Medical examinations for persons employed in "25 Dangerous Operations".
FA - 89: Notification of Occupational diseases(29 as per Third schedule)
MFR - 73L: Declaration of Health and safety Policy.
MFR - 73 V: Deals with fitness for employment in form No. 6, pre-placement and Periodic Medical examinations. Maintaining Health Register in form No. 7.
MFR - 73 W: Describes size, equipment, manpower, qualifications and facilities at Occupational health Centre
MFR - 73X: Deals with ambulance van, emergency medicines and equipments.
MFR - 73Z: Making available Health records to Workers.
MFR - 116: Notice of poisoning or disease (Form no.25)
A survey was conducted amongst randomly selected 26 Industries in and around Mumbai to assess the problems faced by Occupational health Physicians in implementing legislations pertaining to Occupational health. Findings of the survey are being shared here.
Reporting of Notifiable Diseases
In the survey more than 90% of the respondent expressed that they are in conflict with themselves in reporting such cases. There is dilemma whether to report directly or through the company manager. There is also confusion and lack of clarity with respect to ESIS and Non ESIS work force. There is need for regulatory authorities to proactively guide the Occupational Health Physician which would result into effective compliance.
Injury and Disease Compensatation;
Occupational Health Physicians expressed difficulties in assessing disabilities of non-amputation injuries. Hearing loss and Pneumoconiosis are areas where experts can pool in knowledge to create uniform and acceptable process protocols to deal with above issues.
Periodic Medical Examination
Logistic problems faced by the Occupational Health Physicians in complying with Contract Labor Medical Examination working in hazardous areas. Some times, risk communication and notifying results of medical examination to employees' ends up with controversy, loss of trust on both sides i.e. management and trade union. Nearly 10 to 20 % of employees do not attend medical examination and hardly any action can be taken on them. The surveillance program is difficult to sustain in mining and construction sectors. The demand for change of job after risk communication increases which many times leads to friction and strained relations, and loss of trust in medical examinations. Some times business managers do not spare employees for medical examinations because of production pressures. Many felt that statutory forms need to be modified and made user friendly.
Training in Occupational Health and Lack of Technology Support;
In the survey 69% Occupational Health Physicians felt that adequate training opportunities in Occupational Health are not provided and at work place there is lack of support in the form of Industrial Hygiene technology. Since 70% of the work currently is focused on curative mode, Occupational Health Physicians felt that they must reorient themselves to practice of Occupational Health care technology. Many felt that even the certifying surgeons were short of competency required to deliver Occupational Health Service. It is my view that there must be accreditation system in certifying the competency levels of Certifying Surgeons and IAOH can play techno-participatory role in helping the Government to bridge this gap.
Diversity of Lack of Interest by Occupational Health Physicians
The language and presentation of Occupational Health laws did not generate interest of reading amongst Occupational health Physicians. Many part-timers and retainers felt that lack of interest in law medicine and paucity of time are factors responsible for poor understanding of legislations. Most of the state rules are uniform but they do differ in some aspects and there is urgent need to follow common code in all states.
Job Not Protected by Law
Twelve percent of the respondents pointed out that the position of Medical Officer is not protected by law as it is for the Safety Officer. They felt that some times Occupational Health Physicians could be victimized.
Conclusions
It is not enough that there are Occupational Health legislations but Occupational Health Physicians must put efforts to understand and will to implement Occupational Health laws pertaining to respective work places. Employer must create supportive environment for practice of Occupational Health and provide opportunities for continuous learning and training in Occupational Health. A regular dialogue must take place between Occupational Health Physicians, Safety professionals and local factory inspectorate authorities to clear doubts seek advice and bring in role clarity. Review of legislation is required once in five years and Law makers must seek feed back from Occupational Health Physicians and other sources. Governments can involve NGO's like Indian Association of Occupational Health as Member of the review committee on Occupational Health legislations. I am sure this is only a tip of the iceberg as far as issues are concerned and many more need to be addressed about which readers can write to us that can be highlighted in the future articles.
India HIV & AIDS Statistics
India has a population of one billion, around half of whom are adults in the sexually active age group. The first AIDS case in India was detected in 1986; since then HIV infection has been reported in all states and union territories.
The spread of HIV in India has been diverse, with much of India having a low rate of infection and the epidemic being most extreme in the southern half of the country and in the far north-east. The highest HIV prevalence rates are found in Maharashtra, Andhra Pradesh and Karnataka in the south; and Manipur, Mizoram and Nagaland in the north-east.
Four southern states (Andhra Pradesh, Maharashtra, Tamil Nadu and Karnataka) account for around 63% of all people living with HIV in India.
In the southern states, HIV is primarily spread through heterosexual contact, whereas infections are mainly found amongst injecting drug users and sex workers in the north-east.
Estimated number of people living with HIV/AIDS, 2007
People living with HIV/AIDS 2.4 million
Adult (15 years or above) HIV prevalence 0.3%
Previously it was thought that around 5 million people were living with HIV in India - more than in any other country. Better data, including the results of a national household survey, led to a major revision of the prevalence estimate in July 2007. It is now thought that around 2.4 million people in India are living with HIV.
Back-calculation suggests that HIV prevalence in India may have declined slightly in recent years, though the epidemic is still growing in some regions and population groups.
HIV statistics, 2005-2006
The National Family Health Survey conducted between 2005 and 2006 measured HIV prevalence among the general adult population of India, as presented in the table below.4 The survey found the rate among men to be considerably higher than that among women.
Age group HIV prevalence (%)
Male Female Total
15-19 0.01 0.07 0.04
20-24 0.19 0.17 0.18
25-29 0.43 0.28 0.35
30-34 0.64 0.45 0.54
35-39 0.53 0.23 0.37
40-44 0.41 0.19 0.30
45-49 0.48 0.17 0.33
Total age 15-49 0.36 0.22 0.28
The National Family Health Survey, which tested more than 100,000 people for HIV, also found prevalence to be higher in urban areas (0.35%) than in rural areas (0.25%).
The table below presents HIV prevalence among women attending antenatal clinics. It also shows results from the National Family Health Survey for the six states in which most testing took place.
State/Union Territory Antenatal clinic HIV prevalence in 2006 (%)5 General population HIV prevalence in 2005-2006 (%)6
A & N Islands 0.17 -
Andhra Pardesh 1.26 0.97
Arunachal Pradesh 0.00 -
Assam 0.00 -
Bihar 0.50 -
Chandigarh 0.25 -
Chattisgarh 0.00 -
D & N Haveli 0.00 -
Daman & Diu 0.00 -
Delhi 0.00 -
Goa 0.50 -
Gujarat 0.50 -
Haryana 0.13 -
Himachal Pradesh 0.00 -
Jammu & Kashmir 0.00 -
Jharkhand 0.00 -
Karnataka 1.00 0.69
Kerala 0.13 -
Lakshdweep 0.00 -
Madhya Pardesh 0.00 -
Maharashtra 0.75 0.62
Manipur 1.25 1.13
Meghalaya 0.00 -
Mizoram 1.00 -
Nagaland 0.93 -
Orissa 0.50 -
Pondicherry 0.25 -
Punjab 0.00 -
Rajasthan 0.00 -
Sikkim 0.10 -
Tamil Nadu 0.25 0.34
Tripura 0.42 -
Uttar Pradesh 0.00 0.07
Uttranchal 0.00 -
West Bengal 0.00 -
Some areas report an HIV prevalence rate of zero in antenatal clinics. This does not necessarily mean that there is no HIV in the area, as some of them report the presence of the virus at STD clinics and amongst injecting drug users. In some states and territories the average antenatal HIV prevalence is based on reports from only a small number of clinics.
HIV prevalence among different population groups
The average HIV prevalence among women attending antenatal clinics in India is 0.60%. Much higher rates are found among people attending sexually transmitted disease clinics (3.74%), female sex workers (4.90%), injecting drug users (6.92%) and men who have sex with men (6.41%).
Rates vary widely between regions, and in 2006 were found to exceed 15% among female sex workers in Maharashtra and Nagaland; injecting drug users in Chandigarh, Maharashtra, Manipur and Tamil Nadu; and men who have sex with men in Maharashtra and Nagaland.
AIDS data, end of August 20068
Gender Cumulative AIDS cases
Male 88,245
Female 36,750
Total 124,995
The statistics presented in these tables refer to reported AIDS cases. These are a poor guide to the severity of the epidemic as in many situations a patient will die without HIV having been diagnosed, and with the death attributed to an opportunistic infection, such as tuberculosis.
Transmission Categories Number of cases %
Sexual 106,669 85%
Mother-to-child 4,755 4%
Blood and blood products 2,563 2%
Injecting drug users 2,930 2%
Others (not specified) 8,078 6%
Total 124,995 100%
Age group Male Female Total
0-14 3,313 2,283 5,596
15-29 23,905 15,876 39,781
30-49 54,204 16,701 70,905
≥50 6,823 1,890 8,713
Total 88,245 36,750 124,995
State/Union Territory AIDS cases
A & N Islands 37
Andhra Pradesh 15,099
Arunachal Pradesh 13
Assam 372
Bihar 155
Chandigarh (UT) 1,934
Chattisgarh 0
Daman & Diu 1
Dadra & Nagar Haveli 0
Delhi 2,759
Goa 657
Gujarat 6,873
Haryana 655
Himachal Pradesh 302
Jammu & Kahmir 2
Jharkhand 258
Karnataka 4,385
Kerala 1,769
Lakshadweep 0
Madhya Pradesh 1,729
Maharashtra 14,325
Manipur 2,866
Meghalaya 8
Mizoram 106
Nagaland 736
Orissa 641
Pondicherry 302
Punjab 454
Rajasthan 1,153
Sikkim 8
Tamil Nadu 52,036
Tripura 5
Uttar Pradesh 1,751
Uttranchal 79
West Bengal 2,397
Ahemdabad MC 726
Chennai MC 0
Mumbai MC 10,362
Total 124,995
BLOODBORNE PATHOGENS;
Bloodborne Diseases
Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. There are many different bloodborne pathogens including malaria, syphilis, and brucellosis, but Hepatitis B (HBV) and the Human Immunodeficiency Virus (HIV) are the two diseases specifically addressed here.
While this module will focus primarily on HBV and HIV, it is important to know which bloodborne pathogens (from humans or animals) you may be exposed to at work, especially in laboratories. For example, personnel in the College of Veterinary Medicine might have the potential for exposure to rabies, and it would therefore be important to know specific information about rabies.
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Hepatitis B (HBV)
"Hepatitis" means "inflammation of the liver," and, as its name implies, Hepatitis B is a virus that infects the liver. While there are several different types of Hepatitis, Hepatitis B is transmitted primarily through "blood to blood" contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer.
There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies, which help them get over the infection and protect them from getting it again. It is important to note, however, that there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type.
The Hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. For this reason, this virus is the primary concern for employees such as housekeepers, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first-aid or medical care situation.
Symptoms:
The symptoms of HBV are very much like a mild "flu". Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and a darkened urine will often occur. However, people who are infected with HBV will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection.
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Human Immunodeficiency Virus (HIV)
AIDS, or acquired immune deficiency syndrome, is caused by a virus called the human immunodeficiency virus, or HIV. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system, weakening it so that it cannot fight other deadly diseases. AIDS is a fatal disease, and while treatment for it is improving, there is no known cure.
Estimates on the number of people infected with HIV vary, but some estimates suggest that an average of 35,000 people are infected every year in the US (in 2000, 45,000 new infections were reported). It is believed that as of 2000, 920,000 persons were living with HIV/AIDS in the United States. These numbers could be higher, as many people who are infected with HIV may be completely unaware of it.
The HIV virus is very fragile and will not survive very long outside of the human body. It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. However, because it is such a devastating disease, all precautions must be taken to avoid exposure.
AIDS infection essentially occurs in three broad stages. The first stage happens when a person is actually infected with HIV. After the initial infection, a person may show few or no signs of illness for many years. Eventually, in the second stage, an individual may begin to suffer swollen lymph glands or other lesser diseases, which begin to take advantage of the body's weakened immune system. The second stage is believed to eventually lead to AIDS, the third and final stage, in all cases. In this stage, the body becomes completely unable to fight off life-threatening diseases and infections.
Symptoms:
Symptoms of HIV infection can vary, but often include weakness, fever, sore throat, nausea, headaches, diarrhea, a white coating on the tongue, weight loss, and swollen lymph glands.
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If you believe you have been exposed to HBV or HIV, especially if you have experienced any of the signs or symptoms of these diseases, you should consult your physician or doctor as soon as possible.
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Modes of Transmission
Bloodborne pathogens such as HBV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids such as:
•Semen
•Vaginal secretions
•Cerebrospinal fluid
•Synovial fluid
•Pleural fluid
•Peritoneal fluid
•Amniotic fluid
•Saliva (in dental procedures), and
•Any body fluid that is visibly contaminated with blood.
It is important to know the ways exposure and transmission are most likely to occur in your particular situation, be it providing first aid to a student in the classroom, handling blood samples in the laboratory, or cleaning up blood from a hallway.
HBV and HIV are most commonly transmitted through:
•Sexual Contact
•Sharing of hypodermic needles
•From mothers to their babies at/before birth
•Accidental puncture from contaminated needles, broken glass, or other sharps
•Contact between broken or damaged skin and infected body fluids
•Contact between mucous membranes and infected body fluids
Accidental puncture from contaminated needles and other sharps can result in transmission of bloodborne pathogens.
In most work or laboratory situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. For example, if someone infected with HBV cut his or her finger on a piece of glass, and then you cut yourself on the now infected piece of glass, it is possible that you could contract the disease. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission.
Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through:
•Open sores
•Cuts
•Abrasions
•Acne
•Any sort of damaged or broken skin such as sunburn or blisters
Bloodborne pathogens may also be transmitted through the mucous membranes of the
•Eyes
•Nose
•Mouth
For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.
PPE, Work Practices & Engineering Controls
It is extremely important to use personal protective equipment and work practice controls to protect yourself from bloodborne pathogens.
"Universal Precautions" is the name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are, in fact, infectious, regardless of the perceived status of the source individual. In other words, whether or not you think the blood/body fluid is infected with bloodborne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. This also means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur.
Personal Protective Equipment
Probably the first thing to do in any situation where you may be exposed to bloodborne pathogens is to ensure you are wearing the appropriate personal protective equipment (PPE). For example, you may have noticed that emergency medical personnel, doctors, nurses, dentists, dental assistants, and other health care professionals always wear latex or protective gloves. This is a simple precaution they take in order to prevent blood or potentially infectious body fluids from coming in contact with their skin.
To protect yourself, it is essential to have a barrier between you and the potentially infectious material.
Rules to follow:
•Always wear personal protective equipment in exposure situations.
•Remove PPE that is torn or punctured, or has lost its ability to function as a barrier to bloodborne pathogens.
•Replace PPE that is torn or punctured.
•Remove PPE before leaving the work area.
If you work in an area with routine exposure to blood or potentially infectious materials, the necessary PPE should be readily accessible. Contaminated gloves, clothing, PPE, or other materials should be placed in appropriately labeled bags or containers until it is disposed of, decontaminated, or laundered. It is important to find out where these bags or containers are located in your area before beginning your work.
Gloves
Gloves should be made of latex, nitril, rubber, or other water impervious materials. If glove material is thin or flimsy, double gloving can provide an additional layer of protection. Also, if you know you have cuts or sores on your hands, you should cover these with a bandage or similar protection as an additional precaution before donning your gloves.
You should always inspect your gloves for tears or punctures before putting them on. If a glove is damaged, don't use it! When taking contaminated gloves off, do so carefully. Make sure you don't touch the outside of the gloves with any bare skin, and be sure to dispose of them in a proper container so that no one else will come in contact with them, either.
Always check your gloves for damage before using them
Goggles
Anytime there is a risk of splashing or vaporization of contaminated fluids, goggles and/or other eye protection should be used to protect your eyes. Again, bloodborne pathogens can be transmitted through the thin membranes of the eyes so it is important to protect them. Splashing could occur while cleaning up a spill, during laboratory procedures, or while providing first aid or medical assistance.
Face Shields
Face shields may be worn in addition to goggles to provide additional face protection. A face shield will protect against splashes to the nose and mouth.
Aprons
Aprons may be worn to protect your clothing and to keep blood or other contaminated fluids from soaking through to your skin.
Normal clothing that becomes contaminated with blood should be removed as soon as possible because fluids can seep through the cloth to come into contact with skin. Contaminated laundry should be handled as little as possible, and it should be placed in an appropriately labeled bag or container until it is decontaminated, disposed of, or laundered.
Remember to use universal precautions and treat all blood or potentially infectious body fluids as if they are contaminated. Avoid contact whenever possible, and whenever it's not, wear personal protective equipment. If you find yourself in a situation where you have to come in contact with blood or other body fluids and you don't have any standard personal protective equipment handy, you can improvise. Use a towel, plastic bag, or some other barrier to help avoid direct contact.
Hygiene Practices
Handwashing is one of the most important (and easiest) practices used to prevent transmission of bloodborne pathogens. Hands or other exposed skin should be thoroughly washed as soon as possible following an exposure incident. Use soft, antibacterial soap, if possible. Avoid harsh, abrasive soaps, as these may open fragile scabs or other sores.
Hands should also be washed immediately (or as soon as feasible) after removal of gloves or other personal protective equipment.
Because handwashing is so important, you should familiarize yourself with the location of the handwashing facilities nearest to you. Laboratory sinks, public restrooms, janitor closets, and so forth may be used for handwashing if they are normally supplied with soap. If you are working in an area without access to such facilities, you may use an antiseptic cleanser in conjunction with clean cloth/paper towels or antiseptic towelettes. If these alternative methods are used, hands should be washed with soap and running water as soon as possible.
If you are working in an area where there is reasonable likelihood of exposure, you should never:
•Eat
•Drink
•Smoke
•Apply cosmetics or lip balm
•Handle contact lenses
No food or drink should be kept in refrigerators, freezers, shelves, cabinets, or on counter tops where blood or potentially infectious materials are present.
You should also try to minimize the amount of splashing, spraying, splattering, and generation of droplets when performing any procedures involving blood or potentially infectious materials, and you should NEVER pipette or suction these materials by mouth.
Decontamination and Sterilization
All surfaces, tools, equipment and other objects that come in contact with blood or potentially infectious materials must be decontaminated and sterilized as soon as possible. Equipment and tools must be cleaned and decontaminated before servicing or being put back to use.
Decontamination should be accomplished by using
•A solution of 5.25% sodium hypochlorite (household bleach / Clorox) diluted between 1:10 and 1:100 with water. The standard recommendation is to use at least a quarter cup of bleach per one gallon of water.
•Lysol or some other EPA-registered tuberculocidal disinfectant. Check the label of all disinfectants to make sure they meet this requirement.
If you are cleaning up a spill of blood, you can carefully cover the spill with paper towels or rags, then gently pour the 10% solution of bleach over the towels or rags, and leave it for at least 10 minutes. This will help ensure that any bloodborne pathogens are killed before you actually begin cleaning or wiping the material up. By covering the spill with paper towels or rags, you decrease the chances of causing a splash when you pour the bleach on it.
If you are decontaminating equipment or other objects (be it scalpels, microscope slides, broken glass, saw blades, tweezers, mechanical equipment upon which someone has been cut, first aid boxes, or whatever) you should leave the disinfectant in place for at least 10 minutes before continuing the cleaning process.
Of course, any materials you use to clean up a spill of blood or potentially infectious materials must be decontaminated immediately, as well. This would include mops, sponges, re-usable gloves, buckets, pails, etc.
Sharps
Far too frequently, housekeepers, custodians and others are punctured or cut by improperly disposed needles and broken glass. This, of course, exposes them to whatever infectious material may have been on the glass or needle. For this reason, it is especially important to handle and dispose of all sharps carefully in order to protect yourself as well as others.
Needles must be disposed of in sharps containers.
Improperly disposed needles can injure housekeepers, custodians, and other people.
Needles
Needles should never be recapped.
Needles should be moved only by using a mechanical device or tool such as forceps, pliers, or broom and dustpan.
Never break or shear needles.
Needles shall be disposed of in labeled sharps containers only.
•Sharps containers shall be closable, puncture-resistant, leak-proof on sides and bottom, and must be labeled or color-coded.
•When sharps containers are being moved from the area of use, the containers should be closed immediately before removal or replacement to prevent spillage or protrusion of contents during handling or transport.
Broken Glassware
Broken glassware that has been visibly contaminated with blood must be sterilized with an approved disinfectant solution before it is disturbed or cleaned up.
•Glassware that has been decontaminated may be disposed of in an appropriate sharps container: i.e., closable, puncture-resistant, leak-proof on sides and bottom, with appropriate labels. (Labels may be obtained from OSU EHS.)
Broken glassware will not be picked up directly with the hands. Sweep or brush the material into a dustpan.
•Uncontaminated broken glassware may be disposed of in a closable, puncture resistant container such as a cardboard box or coffee can.
By using Universal Precautions and following these simple engineering and work practice controls, you can protect yourself and prevent transmission of bloodborne pathogens.
Signs, Labels & Color Coding
Warning labels need to be affixed to containers of regulated waste, refrigerators and freezers containing blood or other potentially infectious material; and other containers used to store, transport, or ship blood or other potentially infectious materials. These labels are fluorescent orange, red, or orange-red, and they are available from EHS. Bags used to dispose of regulated waste must be red or orange red, and they, too, must have the biohazard symbol readily visible upon them. Regulated waste should be double-bagged to guard against the possibility of leakage if the first bag is punctured.
Labels should display this universal biohazard symbol.
Regulated waste refers to
•Any liquid or semi-liquid blood or other potentially infectious materials
•Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed
•Items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling
•Contaminated sharps
•Pathological and microbiological wastes containing blood or other potentially infectious materials
All regulated waste must be disposed in properly labeled containers or red biohazard bags. These must be disposed at an approved facility. Most departments or facilities that generate regulated waste will have some sort of contract with an outside disposal company that will come pick up their waste and take it to an approved incineration/disposal facility.
Non-regulated waste (i.e., does not fit the definition of regulated waste provided above) that is not generated by a medical facility such as the Student Health Center, Wellness Center, or human health-related research laboratory may be disposed in regular plastic trash bags if it has been decontaminated or autoclaved prior to disposal.
However, all bags containing such materials must be labeled, signed, and dated, verifying that the materials inside have been decontaminated according to acceptable procedures and pose no health threat. Pre-printed labels designed for this purpose are available from EHS, and they must be placed on the bag so that they are readily visible.
Custodians and housekeepers will not remove bags containing any form of blood (human or animal), vials containing blood, bloody towels, rags, biohazardous waste, etc. from laboratories unless the bag has one of these labels on it. They have been given very strict instructions not to handle any non-regulated waste unless it has been properly marked and labeled (including signature).
Custodians will not handle regulated waste.
Emergency Procedures
In an emergency situation involving blood or potentially infectious materials, you should always use Universal Precautions and try to minimize your exposure by wearing gloves, splash goggles, pocket mouth-to-mouth resuscitation masks, and other barrier devices.
If you are exposed, however, you should:
1.Wash the exposed area thoroughly with soap and running water. Use non-abrasive, antibacterial soap if possible.
If blood is splashed in the eye or mucous membrane, flush the affected area with running water for at least 15 minutes.
2.Report the exposure to your supervisor as soon as possible.
3.Fill out an exposure report form, if you desire. This form will be kept in your personnel file for 40 years so that you can document workplace exposure to hazardous substances. This report is available from your supervisor or from OSU EHS.
4.You may also go to the Student Health Center to request blood testing or the Hepatitis B vaccination if you have not already received it.
The specific set of procedures they will follow for all post-exposure cases.
•Document the route(s) of exposure and the circumstances under which the exposure incident occurred.
•Identify and document the source individual unless such documentation is impossible or prohibited by law.
•Test the source individual's blood for HBV and HIV as soon as possible after consent is obtained. If the source individual is known to be seropositive for HBV or HIV, testing for that virus need not be done.
•Collect your blood as soon feasible, and test it after your consent is obtained.
•(If you consent to baseline blood collection, but do not give consent at that time for HIV serological testing, your blood sample will be kept for at least 90 days. If, within 90 days of the incident, you decide to consent to have the baseline sample tested, such testing shall be done as soon as possible, and at no cost to you.)
•Administer post exposure prophylaxes, when medically indicated, as recommended by the US Public Health Service.
•Provide counseling.
•Evaluate reported illnesses.
Apart from the circumstances surrounding the exposure itself, all other findings or diagnosis by the SHC or health care professional(s) will remain entirely confidential.
Hepatitis B Vaccinations
Employees who have routine exposure to bloodborne pathogens (such as doctors, nurses, first aid responders, etc) shall be offered the Hepatitis B vaccine series at no cost to themselves unless:
•They have previously received the vaccine series
•Antibody testing has revealed they are immune
•The vaccine is contraindicated for medical reasons
In these cases they need not be offered the series.
Although your employer must offer the vaccine to you, you do not have to accept that offer. You may opt to decline the vaccination series, in which case you will be asked to sign a declination form. Even if you decline the initial offer, you may choose to receive the series at anytime during your employment thereafter, for example, if you are exposed on the job at a later date.
As stated in the Emergency Procedures section, if you are exposed to blood or potentially infectious materials on the job, you may request a Hepatitis B vaccination at that time. If the vaccine is administered immediately after exposure it is extremely effective at preventing the disease.
The Hepatitis B vaccination is given in a series of three shots. The second shot is given one month after the first, and the third shot follows five months after the second. This series gradually builds up the body's immunity to the Hepatitis B virus.
The vaccine itself is made from yeast cultures; there is no danger of contracting the disease from getting the shots, and, once vaccinated, a person does not need to receive the series again. There are booster shots available, however, and in some instances these may be recommended (for example, if there is an outbreak of Hepatitis B at a particular location).
ASBESTOS BASICS;
What is asbestos - why is it problem?
Asbestos was extensively used as a building material in the UK from the 1950s through to the mid-1980s. It was used for a variety of purposes and was ideal for fireproofing and insulation. Any building built before 2000 (houses, factories, offices, schools, hospitals etc) can contain asbestos. Asbestos materials in good condition are safe unless asbestos fibres become airborne, which happens when materials are damaged.
Why is asbestos dangerous?
Asbestos fibres are present in the environment in Great Britain so people are exposed to very low levels of fibres. However, a key factor in the risk of developing an asbestos-related disease is the total number of fibres breathed in. Working on or near damaged asbestos-containing materials or breathing in high levels of asbestos fibres, which may be many hundreds of times that of environmental levels could increase your chances of getting an asbestos-related disease.
When these fibres are inhaled they can cause serious diseases which are responsible for around 4000 deaths a year. There are three main diseases caused by asbestos: mesothelioma (which is always fatal), lung cancer (almost always fatal) and asbestosis (not always fatal, but it can be very debilitating).
Remember, these diseases will not affect you immediately but later on in life, so there is a need for you to protect yourself now to prevent you contracting an asbestos-related disease in the future. It is also important to remember that people who smoke and are also exposed to asbestos fibres are at a much greater risk of developing lung cancer.
Where can you find asbestos?
Some of the places where you may find asbestos are
Asbestos cement products
Textured coatings
Floor tiles, textiles andcomposites
Sprayed coatings on ceilings,walls and beams/columns
Asbestos insulating board Lagging
Loose asbestos
When am I at risk?
You are mostly at risk when:
You are working on an unfamiliar site
The building you are working on was built before the year 2000
Asbestos-containing materials were not identified before the job was started
Asbestos-containing materials were identified but this information was not passed on by the people in charge to the people doing the work
You don’t know how to recognise and work safely with asbestos
You know how to work safely with asbestos but you choose to put yourself at risk by not following proper precautions, perhaps to save time or because no one else is following proper procedures
Remember, as long as the asbestos is not damaged or located somewhere where it can be easily damaged it won’t be a risk to you.
You can’t see or smell asbestos fibres in the air.
The effects of asbestos take many years to show up - avoid breathing it in now.
Smoking increases the risk many times.
Asbestos is only a danger when fibres are made airborne
Are you sure that you don’t come in to contact with asbestos?
If you work in any of the following occupations, and are working on a building built or refurbished before 2000, you may come in to contact with asbestos:
Heating and ventilation engineers
Demolition workers
Carpenters and joiners
Plumbers
Roofing contractors
Painters and decorators
Plasterers
Construction workers
Fire and burglar alarm installers
Shop fitters
Gas fitters
Computer installers
General maintenance staff eg caretakers
Telecommunications engineers
Building surveyors
Cable layers
Electricians
This list does not include all occupations where you may come in to contact with asbestos.
It’s not easy to tell asbestos from how it looks, and it needs to be properly identified in a specialist laboratory.
Asbestos used as packing between floors and in partition walls
Sprayed (‘'impet') asbestos on structural beams and girders
Lagging on pipework, boilers, calorifiers, heat exchangers etc
Asbestos insulating board - ceiling tiles, partition walls, service duct covers, fire breaks, heater cupboards, door panels, lift shaft lining, fire surrounds, soffits etc.
Asbestos cement products such as roof and wall cladding, bath panels, boiler and incinerator flues, fire surrounds, gutters, rainwater pipes, water tanks etc.
Other products such as floor tiles, mastics, sealants, rope seals and gaskets (in pipework etc.), millboard, paper products, cloth (fire blankets, etc.) and bituminous products (roofing felt, etc)
How do I deal with asbestos waste?
Make sure you double-bag it and label as asbestos waste. You can then get in contact with the Local Authority or Environment Agency to find out if they will assist you in disposing of it, they may charge for this service.
What can you do to protect yourself?
Do:
Stop and ask if you are suspicious something may be asbestos or if you think the work might need to be carried out by a licensed contractor
Follow the plan of work and the task guidance sheets;
make sure you use the right sheet for the job
Make sure you take account of other risks such as work at height
Use your protective equipment, including a suitable face mask, worn properly
Clean up as you go - stop waste building up
Make sure waste is double-bagged and is disposed of properly at a licensed tip
Wash before breaks and going home
Don't:
Use methods that create a lot of dust, like using power tools
Sweep up dust and debris - use a Type H vacuum cleaner or wet rags
Take home overalls used for asbestos work
Reuse disposable clothing or masks
Smoke
Eat or drink in the work area
What should those in charge of the job do?
They must:
Find out if asbestos-containing materials are present and plan the work to avoid disturbing these materials if possible
Ensure that anyone who is going to work on asbestos material is trained properly and is supervised
Know what work can be carried out on asbestos-containing materials, ie does this work need to be carried out by a contractor licensed.
Take account of other risks as well as asbestos, eg work at height, and take the precautions necessary to do the job safely
Use the equipment and method sheetsand the right task sheet to make sure that the job is carried out properly and that exposure to asbestos is kept as low as possible
Prepare a plan of work, explaining what the job involves, the work procedures, and what controls to use
Provide you with the right equipment, which is clean, in good working order, and protects you against asbestos
Train you in using this equipment
Make sure the work area is inspected visually at the end of the job, to check it’s fit for reoccupation
Make arrangements for the safe disposal of any asbestos waste
Consult the health and safety representative (if there is one)
Basics of CORPORATE RISK ASSESSMENT;
What is a hazard?
A hazard is anything with the potential to cause harm e.g. working at height on scaffolding.
What is risk?
A risk is the likelihood that a hazard will cause a specified harm to someone or something e.g. if there are no guard rails on the scaffolding it is likely that a construction worker will fall and break a bone.
What is risk management?
Risk Management is a process that involves assessing the risks that arise in your workplace, putting sensible health and safety measures in place to control them and then making sure they work in practice.
What is risk assessment?
A risk assessment is nothing more than a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm.
What do "ALARP" and “SFAIRP” mean?
You may come across these abrieviations. ALARP stands for “as low as reasonably practicable” and SFAIRP stands for “so far as is reasonably practicable”. In essence, these are the same; however, SFAIRP is the term most often used in the Health and Safety at Work etc Act and in Regulations, and; ALARP is the term used by risk practitioners.
What does “reasonably practicable” mean?
This means that you have to take action to control the health and safety risks in your workplace except where the cost (in terms of time and effort as well as money) of doing so is “grossly disproportionate” to the reduction in the risk. You can work this out for yourself, or you can simply apply accepted good practice.
Risk assessment
Why is risk assessment important?
Managing health and safety risks puts you in control since it leaves your business less open to chance. A risk assessment helps to prevent accidents and ill health to you, your workers and members of the public. Accidents and ill health can ruin lives and harm your business too if output is lost, equipment is damaged, insurance costs increase or you have to go to court. You are legally required to assess the risks in your workplace so that you can put in place a plan to control the risks.
How do I do a risk assessment?
This tells you how to do a risk assessment for occupational health and safety. This is not the only way to do a risk assessment, there are other methods that work well, particularly for more complex risks and circumstances. However we believe this method is the most straightforward for most organisations.
Is HSE’s 5 steps to risk assessment the only acceptable method?
No. We believe “5 steps to risk assessment” provides a straightforward method, but it’s certainly not the only acceptable way.
A number of alternatives exist.
Identify the hazards
Decide who might be harmed and how
Evaluate the risks and decide on precautions
Record your findings and implement them
Review your risk assessment.
Where other methods tend to differ is at the “evaluate the risks” stage. Here, we suggest comparing your control measures with good practice to assess whether more needs to be done. But, another common and very effective method involves working out a risk level by categorising the likelihood of the harm and the potential severity of harm and then plotting these two risk determining factors against each other in a risk matrix (see below). The risk level determines which risks should be tackled first. As with any other method of risk assessment you should not overcomplicate the process e.g. by having too many categories.
Using a matrix can be very helpful for prioritising actions. It is suitable for very many assessments but particularly lends itself to more complex situations. However, it does require a fair degree of expertise and experience to judge the likelihood of harm accurately. Getting this wrong could result in applying unnecessary controls or failing to take important ones. People working full-time in health and safety often use a version of this method.
Who do I involve in a risk assessment?
Make sure that you involve employees and safety representatives in carrying out the assessment.Remember to speak to workers who may have particular requirements e.g. new and young workers[5], new or expectant mothers[6] and people with disabilities.
What things do I have to include in a risk assessment record?
In your risk assessment you need to be able to show that:
A proper check of the hazards was made;
You asked who might be affected;
You dealt with all the obvious significant hazards, taking into account the number of people who could be involved;
The precautions are reasonable, and the remaining risk is low; and
You involved your staff or their representatives in the process.
When do I need to do a risk assessment?
You should carry out an assessment before you do the work that gives rise to the risk, and review it as necessary.
When should I review my risk assessments?
Few workplaces stay the same. Sooner or later, you will bring in new equipment, substances and procedures, and that could lead to new hazards. Therefore, you will need to review where you are every year or so, to make sure you are still improving, or at least not sliding back.
During the year, if there is a significant change, don't wait: check your risk assessment and where necessary, amend it. If possible, it is best to think about the risk assessment when you're planning your change - that way you leave yourself more flexibility.
What do you mean by "good practice" and how do I find it?
Good practice refers to practices that have been acknowledged by HSE or local authorities as representing standards of compliance with the law. It doesn’t mean “custom and practice” necessarily – that can be poor practice. There are many sources of good practice and HSE works with industries to produce good practice guidance.
Sensible risk management
Do I need to get consultants in to do my risk assessment?
In most cases, this is not necessary. Risk assessment is a straightforward process that most people can do, given a little time and effort. You will probably need help if you have particularly hazardous or complex processes, but for the majority of organisations, you or a competent member of staff should be able to complete a satisfactory assessment.
Just use your common sense: you don’t need an electrician to re-wire a plug, but most people would need one to re-wire their house. It’s the same with risk assessment.
Do I have to record the findings of the risk assessment? If so, why? Isn’t that just bureaucracy?
Health and safety law requires that you keep a record of the significant findings of your assessment if you employ five or more people. It makes sense to keep a record of the assessment so that when you come to review it, you can check back to see if anything has changed. It is also useful to keep a record so that you can share the findings with your staff. Finally, it proves that you have carried out the process if a health and safety inspector asks about it.
Is there a specific form/format that I have to use to record a risk assessment?
You can record the assessment in any convenient way with the help of a COnsultant.
Isn’t risk assessment nonsense? Everybody is grown-up in my firm and can look after themselves.
All workers are entitled to work in environments where risks to their health and safety are properly controlled. Under health and safety law, the primary responsibility for this is down to employers. Doing a risk assessment is the key to preventing accidents and ill-health in your workplace to you, your workers and members of the public. Accidents and ill health can ruin lives and harm your business too if output is lost, equipment is damaged, insurance costs increase or you have to go to court.
However, workers also have a duty to take care of their own health and safety and that of others who may be affected by their actions. Health and safety legislation, therefore, requires employers and workers to cooperate. Involving workers and their representatives in your risk assessment is one of the best ways of doing this.
Doesn’t risk assessment just lead to more and more safety measures - most of which aren’t necessary?
No. When done properly, it should identify the measures that are needed to reduce the risk as low as “reasonably practicable” and not further. It is important to remember that risk assessment can show that a process is safe enough with the measures you already have in place, and no more need be done.
Is HSE too risk averse?
We don’t think so. Our approach is to seek a balance between the unachieveable aim of absolute safety and the kind of poor management of risks that damages lives and the economy. In a nutshell: risk management, not risk elimination. For more information about this please read our Principles of Sensible Risk Management.We consult widely on our proposals and we listen carefully to those who have views different from our own.
Precautionary principle
What is the precautionary principle?
The precautionary principle should be applied only in very particular circumstances. It is highly unlikely to be relevant to your work.
The precautionary principle says that where you have good reason to believe that something might cause harm but there isn’t enough scientific knowledge to carry out a full risk assessment, this should not be used as an excuse to do nothing to prevent harm. The precautionary principle is therefore applied to a few new hazards until enough is learned about the risks they present. It should not be applied to well-known hazards where the broad level of risk has been established.
Principles of sensible risk management;
Sensible risk management is about:
Ensuring that workers and the public are properly protected.
Providing overall benefit to society by balancing benefits and risks, with a focus on reducing real risks – both those which arise more often and those with serious consequences
Enabling innovation and learning not stifling them.
Ensuring that those who create risks manage them responsibly and understand that failure to manage real risks responsibly is likely to lead to robust action.
Enabling individuals to understand that as well as the right to protection, they also have to exercise responsibility.
Sensible risk management is not about:
Creating a totally risk free society.
Generating useless paperwork mountains.
Scaring people by exaggerating or publicising trivial risks.
Stopping important recreational and learning activities for individuals where the risks are managed.
Reducing protection of people from risks that cause real harm and suffering
HIV UPDATES:
This year the National AIDS Control Organisation announced that there was good news, the HIV prevalence had come down in India. They also reported an estimated 2.5 million persons infected with HIV in India. The first message that HIV infection in India was either stable or even coming down in some significant groups was by and large acceptable.
However, the announcement was over-shadowed by a release of the HIV estimates for 2006. People learnt with some surprise that the estimates for the year 2006 was now just over 2.5 million when the data for the year for the ending December 2005 had been processed to conclude that there had been 5.2 million infected persons living with the virus in India. The reduction in HIV prevalence to half the earlier value did not appear to be believable.
The general impression created was that that the new figure was a result of some mathematical jugglery that produced a figure half of the value that NACO had been vociferously defending over the past many months, and was not due to an actual reduction in prevalence. In fact both occurred – there was probably a fall in the estimated number of HIV infected persons and at the same time a new method of estimating the total infected was used. The new method based on a household survey gave a much lower value than the method based on ante-natal clinic surveillance which was the basis of the estimates made earlier. This lowering of the estimated total has occurred in every country where the basis for the HIV estimate has been changed to use household survey data rather than clinic based surveillance data.
It is worth noting that we have known for many years that using data from ante-natal clinics gives higher values during HIV estimates. (By definition pregnant women are sexually active and not using condoms – both factors that are not true of the general population). An alternate source of data to give us an estimate of HIV prevalence in the general population was not available because of the need for eliminating the possibility of leakage of the identity of those that tested positive by using unlinked anonymous surveillance. In unlinked anonymous surveillance, the blood is tested and not the individual. In other words the blood sample is identified only with a code number that cannot be traced back to the identity of the person giving the blood. As the person is not tested and only blood is, it is also not necessary to take the permission of the person whose blood is tested. Therefore an essential part of the unlinked anonymous testing protocol is the use of a small portion of the blood drawn for some diagnostic procedure. Such groups are hard to find.
The only valid way to compare the estimates for two separate years is to use the exactly same estimation process over the two years being compared and then compare the value for the total infected in the population under consideration. As in this instance in we must remember that both the methods only give estimates and not true values and the consensus amongst experts is that the new method used this year is likely to be closer to the truth India, it is fruitless to compare the 5.2 million of December 2005 with 2.5 million of December 2006. The figures do not show that the number of HIV infected in 2006 was half that of 2005.
When the method used in 2005 was also applied to the 2006 data we arrived at an estimate of roughly 4.84 million. The good news is that the actual prevalence if HIV in India has fallen and the epidemic is at least stabilising even if not actually falling. Next year we will be in a better position to comment and to see if we succeed in consolidating the advantage we have gained in this war against HIV. As to the question of how much HIV infection there is in India,.
Safety belts: Why you should use them
While wearing of seat belts for the front seat passengers in motor vehicles has been made compulsory by the Supreme Court, the Government will make it mandatory for even rear seat passengers to wear safety belts from October 2002. Any person contravening this law will be punishable under Section 177 of the Motor Vehicles Act 1988. Car crashes are responsible for killing the maximum number of people till the age of 35 years. Many of these deaths and injuries can be prevented with safety belts.
What happens in a crash?
In a car crash, there are two collisions. The first is when the car hits something, or is hit, and comes to a sudden stop. The second crash happens a split second later when anyone not buckled in can fly forward, slamming into the steering wheel, windshield, dashboard or front seat.
In most cars, safety belt is one unit made up of the lap and shoulder belt. In a crash or sudden stop, safety seats and belts hold everyone in their place. This helps keep them from smashing into the inside of the car or into each other. It also keeps them from being thrown through the windshield.
It takes only a second or two for an adult to buckle up. It takes only a couple of minutes to get a baby into the safety seat. Take the time to be safe - even when you are only going a short distance.
Safety belts improve your chances of travelling safely in many ways.
They stop collision:
Many injuries or deaths occur when a person inside the car collides with the steering wheel, the dashboard, windshield, the roof or other passengers. A safety belt stops this human collision by holding you in place.
They keep you inside the car:
You are 25 times more likely to be killed or injured if you are thrown from the car. If you are thrown "free" you may be thrown into the path of your own car if it rolls over, oncoming traffic or a tree, telephone pole or other object.
They spread out the force of a collision:
A safety belt stops you from moving after the car has stopped, so the force of the collision is lessened. Also they spread the force of the collision over the strongest parts of your body-your hips and shoulders.
They keep you conscious:
Since safety belts prevent the "human collision," there is a better chance that you will remain conscious. If you remain conscious, you can release your belt in an instant and take action to help yourself and others.
They help keep you in control and prevent minor injuries
In an emergency, safety belts keep you behind the wheel and ready to react if necessary. Being in control can help you keep injuries minor or avoid them altogether.
What is your reason for not wearing one?
"I am only going to the shopping centre." Actually, this is the best time to wear a safety belt, since 80% of traffic fatalities occur within a small distance from home.
"I won't be in an accident: I am a good driver." Your good driving record will certainly help you avoid accidents. But even if you are a good driver, a bad driver may still hit you.
"I will just brace myself." Even if you had the split-second timing to do this, the force of the impact would shatter the arm or leg you used to brace yourself.
"I am afraid the belt will trap me in the car." Statistically, the best place to be during an accident is in your car. If you're thrown out of the car, you are 25 times more likely to die. And if you need to get out of the car in a hurry-as in the extremely tiny percent of accidents involving fire, you can get out a lot faster if you haven't been knocked unconscious inside your car.
"They are uncomfortable." Actually, modern safety belts can be made so comfortable that you may wonder if they really work. You can put a little bit of slack in most belts simply by pulling on the shoulder strap. Others come with comfort clips, which hold the belt in a slightly slackened position. If the belt does not fit around you, you can get a belt extender at most car dealerships.
"I do not need a belt – I have got an airbag." An air bag increases the effectiveness of a safety belt by 40 percent. But air bags were never meant to be used in place of safety belts, since they do not protect against side impacts at all.
With an "effective" safety belt, your body will stop in a crash before you hit or go through the windshield. Seat belts are especially important in small cars, because your chances of being killed or badly hurt in a collision with a big car is eight times greater. Wearing your belt will greatly improve your chances of survival
Travel tips for diabetics
Diabetes is a chronic illness and needs to be continuously managed. However, it does not mean that diabetics cannot travel or will have any problems while on a trip. There are only some tips that the patient needs to keep in mind to have a tension-free and safe holiday.
Get the location and duration of the trip approved by the treating physician.
If possible, get the doctor to prescribe medication that may be required during the travel period. The medications may include not only those used to treat diabetes, but also ones for preventing nausea, vomiting, diarrhoea etc.
Make preparations for getting your blood sugar checked at the destination. You should also try to identify medical services in the vicinity of your area for any emergency.
Travel tips:
Apart from the medical services available at the place of your stay, it is also necessary to be alert and make preparations thereof, during the duration of your journey. Some tips for the journey are:
Keep the insulin or the oral anti-diabetic drugs handy; carry it in hand baggage in the plane or train.
Protect the insulin from extreme heat or cold.
Maintain your food habits even when your routine is different. Eat at regular intervals and do not overeat.
Keep candies or toffees handy in case of a sudden drop in blood sugar.
Mental Health series 1
Anxiety
What is anxiety?
Anxiety is the feeling of uneasiness, fear and insecurity when in reality there is nothing to be afraid of. Fear normally disappears after the danger is gone, but anxiety persists without any apparent danger.
Fear, or mild anticipatory anxiety is normal emotion, leading to adaptive behaviour. But when the fear-provoking situation becomes long-standing, it causes harm to the body. Long lasting anxiety becomes stressful for the body, leading to medical problems when it is persistent and interferes with normal daily activities or harms physical health.
How does it occur?
Anxiety can vary from a mild, nagging feeling to extreme panic. It may start with a difficult or painful experience. Older people may have anxiety associated with loss of status after retirement, bereavement, ill health, or financial worries. It can also be brought on by the use of alcohol or drugs, too much coffee, or certain medicines. It could also be a symptom of depression or other mental illnesses.
What are the symptoms?
The symptoms include flushing, sweating, shortness of breath, rapid breathing or a feeling of choking. There could be trembling, frequent urination, dry mouth, nausea, vomiting, diarrhoea or constipation. Tension, inability to relax, irritability, difficulty in concentrating, sleeplessness or sexual difficulties may also occur.
How is it diagnosed?
Mild cases of anxiety could be discovered during a medical check- up or while investigating other medical problems. Severe anxiety-panic attacks generally cause people to seek medical help, as the symptoms are similar to those of a heart attack. The doctor will discuss the problems and circumstances that act as a trigger for the anxiety attack.
What is the treatment?
The doctor will treat any underlying disease. Alcohol, coffee and cola drinks should be avoided. The doctor may prescribe medicines to reduce anxiety. Psychotherapy may help to cope with the situation. Relaxation techniques, meditation and yoga help to reduce the anxiety. Getting enough rest during the day, as well as a good night’s sleep can help.
What is a panic attack?
Sometimes anxiety is experienced as the sudden onset of intense fear, usually accompanied by physical symptoms, such as shortness of breath, palpitations, trembling, a fear of dying or going insane, or a sense of impending disaster. Such an attack may last for 10-15 minutes or longer, and often cause the person to seek medical help.
Mental health Series 2
Depression
What is depression?
Clinical depression is a medical condition where a person feels very low or sad over a long period of time. It is more severe than the general feeling of hopelessness that a person may feel after a particularly stressful event in her life and often results in a change in the person's functioning. During bouts of depression, a person feels extremely dejected and has feelings of inadequacy or low self esteem. They take a gloomy outlook upon life.
How is it caused?
It is now believed that depression is caused by a combination of genetic factors and exposure to a stressful life event. In other words, the chance of a person having the condition increases considerably if one or more family members has it. It is also fairly well established that a change in the activity of certain chemicals in the brain is associated with depression. Clinical depression is seen more in women than in men. Women in their child bearing years are more vulnerable to it. There are many causes for clinical depression:
It can be inherited i.e., the chance of a person having the condition increases considerably if one or more family members have it.
Environmental factors like the death of a parent can cause a depressive episode.
Physical illnesses like cancer and heart disease may be followed by depression. There may also be conditions like Parkinson’s disease, whose symptoms include depression.
Depression can also be a side effect of certain drugs used to treat hypertension.
Some people have personality traits that make them more susceptible to depression. These people view themselves as losers and have a negative attitude towards themselves.
What are the symptoms?
A patient with depression may have physical symptoms in addition to psychological ones. The most commonly seen symptoms are:
Sleep disturbance, either excessive sleep or insomnia (lack of sleep)
Continuous fatigue and tiredness
Headache
Feeling of irritability and excessive crying
Loss of appetite
Loss of interest in any activity
Vague pains in the body
Fluctuation in weight
Constipation
Decrease in sexual urge
Poor concentration
Poor co-ordination of limbs
Feelings of worthlessness, helplessness and guilt
Suicidal thoughts sometimes culminating in suicide attempts.
How is it diagnosed?
The first thing that any doctor will do is take a detailed and thorough history and rule out the possibility of a physical illness giving rise to these complaints. This may include blood tests to detect anaemia or thyroid problems. Once physical illness is ruled out a psychiatrist can make the diagnosis based on the cluster of symptoms commonly associated with the depressive condition. The doctor confirms over a two week period that the episode is not due to a temporary stressful event. Once all other causes are eliminated, the diagnosis is confirmed.
Initially a person seeks medical help when she is depressed for most of the time during the day. The psychiatrist then diagnoses the condition based on the symptoms associated with the depressive condition. In case the doctor sees the main symptoms of the condition like sleeplessness, apathy, lack of interest and loss of appetite and a constant feeling of fatigue, depression is short listed as a possible cause.
What is the treatment?
Drug treatment is the most common method of treatment. Antidepressants are prescribed in adequate doses. These generally include oral medication from a group of drugs known as tricyclic antidepressants. These have a calming effect on the patient and also help in reducing sleep problems.
Therapy to improve the patient’s outlook towards events is begun in conjunction with the drug treatment. The person is encouraged to think positively and to shun thoughts of worthlessness, guilt and suicide.
In severe cases, shock treatment (Electro Convulsive therapy) is given. It is mostly resorted to when the patient cannot wait for the drugs to become effective or when she goes into deeper depression and stops reacting completely to situations, a condition known as depressive stupor. A combination of treatment measures is usually helpful in bringing depressive episodes under control.
Mental Health series-3
Smoking ( yes it is a mental disease)
Introduction;
Cigarette smoking kills nearly about 420,000 people a year, making it more lethal than AIDS, accidents, homicides, suicides, drug overdoses, and fire. Smokers are also inhaling other chemicals including cyanide, benzene, formaldehyde, methanol (wood alcohol), acetylene (the fuel used in torches), and ammonia. Smoke also contains nitrogen oxide and carbon monoxide, which are harmful gases.
What are the risks?
1. Heart disease
Smokers in their thirties and forties have a heart attack rate that is five times higher than their nonsmoking peers. Cigarette smoking may be directly responsible for at least 20% of all deaths from heart disease, or about 120,000 deaths annually. Smoking cigars may also increase the risk of early death from heart disease, although evidence is much stronger for cigarette smoking.
Its damaging effects on the heart are multifold:
Smoking lowers HDL levels (the so-called good cholesterol) even in adolescents.
It causes deterioration of elastic properties in the aorta, the largest blood vessel in the body, and increases the risk for blood clots. It increases the activity of the sympathetic nervous system (which regulates the heart and blood vessels).
Tobacco smoke may increase cardiovascular disease in women through an effect on hormones that causes oestrogen deficiency.
2. Cancer
Smoking is the cause of 85% of all cases of lung cancer in 2000, account for 28% of all cancer deaths. Quitting reduces the risk for lung cancer, even well into middle age.
Smoking and smokeless tobacco also cause between 60% and 93% of cancers of the throat, mouth, and oesophagus. Smokers also have higher rates of leukaemia and cancers of the kidney, stomach, bladder, and pancreas. About 30% of cervical cancers have been attributed to both active and passive smoking. Lung cancer patients who survive and continue to smoke face a serious risk of developing a second tobacco-related tumour within ten years.
3. Dementia and neurologic diseases;
People who smoke a pack a day have almost two and a half times the risk of stroke as non-smokers. The best current research suggesting that smoking makes little difference in the risk for Alzheimer's, and if it does, the risk for dementia is slightly higher in smokers. Certainly, smoking can affect blood vessels in the brain as it does in the heart, increasing the risk for dementia from small or major strokes.
4. Lung disease
Smoking is associated with a higher risk for nearly all major lung diseases, including pneumonia, flu, bronchitis, and emphysema. There is also a link between smoking and increased asthma symptoms. Heavy smokers with asthma are also more likely to seek emergency treatment for their condition during times of heavy ozone pollution.
5. Female infertility and pregnancy
Studies have now linked cigarette smoking to many reproductive problems. Women who smoke pose a greater danger not only to their own reproductive health but, if they smoke during pregnancy, to their unborn child. Some of these risks include the following:
Greater risk for infertility in women.
Greater risk for ectopic pregnancy and miscarriage.
Greater risk for stillbirth, prematurity, and low-birth weight.
Smoking reduces folate levels, a B vitamin that is important for preventing birth defects.
Women who smoke may pass genetic mutations that increase cancer risks to their unborn babies.
6. Male sexuality and reproduction
Men's sexual and reproductive health is not immune from the effects of smoking.
Heavy smoking is frequently cited as a contributory factor in impotence because it decreases the amount of blood flowing into the penis.
Smoking also reduces sperm density and their motility, increasing the risk for infertility.
7. Behavioural and Social Problems
Children of smoking mothers are more likely to have more motor control problems, perception impairments, attention disabilities, and social problems than children of non-smoking mothers. Some reasons for these associations have been suggested:
Women who breast feed and smoke pass nicotine by-products to their babies, which may contribute to these problems.
Women smokers tend to be less educated than women non-smokers, which may cause increased stress at home.
Smoking mothers and their children may share certain inherited psychologic factors, such as depression, which cause addictive and behavioural problems that are unrelated to smoking itself.
8. Effects on bones and joints
Smoking has many negative effects on bones and joints:
Smoking impairs formation of new bone and women who smoke are at high risk for osteoporosis.
Postmenopausal women who smoke have 17% greater risk for hip fracture at age 60, a 41% greater risk at 70, and a 108% greater risk at age 90.
Smokers are more apt to develop degenerative disorders and injuries in the spine.
Smokers have more trouble recovering from spinal surgery.
Smokers whose jobs involve lifting heavy objects are more likely to develop low back pain than non-smokers.
In women, smoking may also pose a small increased risk for developing rheumatoid arthritis.
What are the specific effects of parental smoking on children?
An estimated four million children a year fall ill from exposure to second-hand smoke. Parental smoking has been shown to affect the lungs of infants as early as the first two to 10 weeks of life. A number of studies have reported associations between smoking parents and childhood illnesses.
Parental smoking is believed to increase the risk for lower respiratory infections (asthma, bronchitis, and pneumonia) by 50%. Environmental smoking is thought to be responsible for a large number of cases of lower respiratory tract infections every year. It also worsens the condition of children who have existing asthma.
Smoking in pregnant women and new mothers is strongly linked to sudden infant death syndrome (SIDS).
Maternal smoking is believed to be related to 37% of the cases of childhood meningococcal disease, an uncommon but potentially fatal infection.
Parental smoking has also been linked to ear infections and eczema.
Maternal smoking has been linked to abnormal lung function in children; the defects persist throughout life.
What are the methods to quit smoking?
At this time the most effective methods for quitting is a combination of nicotine replacement products and the antidepressant drug bupropion bolstered by counselling. After a year only about 4% of smokers who quit without any outside help succeed. The primary obstacle in trying to quit alone is making the behavioural changes necessary to eliminate the habits associated with smoking. Excellent books, tapes, and manuals are available and are strongly recommended to help people who want to quit without other assistance.
1. Nicotine replacement
Nicotine replacement products provide low doses of nicotine that do not contain the contaminants found in smoke. They are proving to be twice as helpful as other standard quitting methods. Replacement products include nicotine patches, gums, nasal sprays, and inhalers. Side effects of any nicotine replacement product may include headaches, nausea, and other gastrointestinal problems. People often experience sleeplessness in the first few days, particularly with the patch, but the insomnia usually passes. Patients using very high doses are more likely to experience symptoms, and reducing the dose can prevent them. Certain individuals like people with heart disease, pregnant women, small children may need to avoid nicotine replacement products.
Nicotine patches: Nicotine patches, or transdermal nicotine, can be an effective way to quit smoking. The quit rate for patch users is around 20% after six months. Nicotine patches are available over the counter, but it is best to consult a doctor before using them, particularly people with any medical problems.
Nicotine gum: Nicotine gum (Nicorette), available over the counter, has also been effective for a number of people. Some prefer it to the patch because they can control the nicotine dosage and chewing satisfies the oral urge. Long-term dependence may be a problem with this method.
Nicotine inhaler: The nicotine inhaler resembles a plastic cigarette holder. It comes with a number of nicotine cartridges which are inserted into the inhaler. It has some specific advantages over other slower nicotine replacement products:
Nicotine nasal spray: The nasal spray satisfies immediate cravings by providing doses of nicotine rapidly, and thus may play a useful role in conjunction with slower acting nicotine replacement therapies.
Nicotine tablet: A nicotine tablet that is held under the tongue is also very useful.
2. Alternative and ther Methods for Quitting
Scheduled reduction: One study showed that people who used a systematic withdrawal schedule were twice as likely to quit as those who went cold turkey. The procedure involves the following steps:
Divide the number of minutes per day awake by the number of daily cigarettes; the result is the minute-long wait between smokes.
Set up a schedule with time intervals based on this result and using a timer, smoke only at those intervals; if the "cigarette appointment" is missed by more than five minutes, the smoker must skip that cigarette.
The following week, one-third fewer cigarettes are used and the smoking time is recalculated based on the lower number.
During the third week the count is again reduced by a third, and the smoker quits in the fourth week.
Change daily habits:
Change the daily schedule as much as possible. Eat at different times or eat many small meals instead of three large ones, sit in a different chair, rearrange the furniture.
Find other ways to close a meal. Play a tape or CD, eat a piece of fruit, get up and make a phone call, or take a walk (a good distraction that burns calories as well).
Substitute oral habits (eat celery, chew sugarless gum, suck on a cinnamon stick.) Go to public places and restaurants where smoking is prohibited or restricted.
Set short-term quitting goals and reward yourself when they are met, or every day put the money normally spent on cigarettes in a jar and buy something pleasurable at the end of a predetermined period of time.
Find activities that focus the hands and mind but are not taxing or fattening: computer games, solitaire, knitting, sewing, whittling, crossword puzzles.
Avoid heavy drinking of alcohol, caffeine, or other stimulants or mood altering substances.
What is the physical benefits after quitting ?
Time after last cigarette Physical & Response
20 minutes; Blood pressure and pulse rate return to normal.
8 hours; Levels of carbon monoxide and oxygen in the blood return to normal.
24 hours;Chance of heart attack decreases.
48 hours; Nerve endings start to regrow; ability to taste and smell increases.
72 hours; Bronchial tubes relax; lung capacity increases.
2 weeks to 3 months; Improved circulation; lung function increases up to 30%.
1 to 9 months; Decreased incidence of coughing, sinus infection, fatigue, and shortness of breath; regrowth of cilia in lungs, increasing the ability to handle mucus, clean the lungs, and reduce chance of infection; overall energy level increases.
What are the withdrawal effects of smoking?
Withdrawal symptoms begin as soon as four hours after the last cigarette, generally peak in intensity at three to five days, and disappear after two weeks. They include both physical and mental symptoms. During the quitting process people should consider the physical symptoms like tingling in the hands and feet, sweating, intestinal disorders (cramps, nausea), and headache.
Tension and craving build up during periods of withdrawal, sometimes to a nearly intolerable point. Nearly every moderate to heavy smoker experiences strong emotional and mental responses like feelings of being an infant, temper tantrums, intense needs, feelings of dependency, a state of near paralysis, insomnia, mental confusion, vagueness, irritability, anxiety to withdrawal.
Mental Health Series-4
Fussy eaters
Every parent knows it is difficult to get children to eat nutritious food, whether it is a toddler who wants nothing but instant noodles or a teenager who lives on junk food and soft drinks. Children need to eat frequently to sustain their high energy levels and keep their bodies growing.
Many young children go through periods of being fussy eaters and this is a normal part of growing up. Children often want to eat certain foods at a certain time and in a certain way. Many children, especially those from 1.5-5 years of age are sometimes picky eaters. They eat what appears to an adult as a small amount of food, and yet they are well, active and growing normally. The term “Fussy eaters” is not used for children who are breast feeding, only toddlers and children.
Some babies are very fussy while feeding, while others tend to doze off after a few minutes of feeding. The mother is not sure whether or not he has had his fill. But no sooner does she put him in the cot that he is up again and crying for feed.
What is the cause?
It may be that while feeding he is not in a comfortable position, or his nose is blocked due to secretions or being pushed against the breast. In a bottle-fed baby, the hole in the nipple may be so small that the child tires easily.
Fussy eating habits are more acquired. An anxious mother is more likely to have an anxious fussy eater. Making meal times a battleground can worsen the situation. Often there may be no obvious reason. The child’s nervous system may not have matured enough to realize when his stomach is full. Whatever the reason, it makes the mother tense, which, in turn makes feeding even more difficult. The mother gets frustrated having to feed every half an hour, and the child remains unsatisfied and irritable.
What should parents do if their child does not appear healthy and growing normally?
In such a situation, it is important for the mother to remain calm and comforting to the child. Shift him from one breast to the other. If he still goes to sleep, put him back in the cot very gently. If he cries soon after, try to comfort him. May be you can give him a few spoons of water to pacify him. Sometimes nothing works and you have just be patient until the child quietens down.
If a child is a fussy eater and does not appear to be healthy or growing normally, parents should take the child to a physician for assessment. A child should never be forced to eat a specific food. However, if a child is hungry and is given a choice of foods, he is more likely eat something. It is the role of parents to ensure that the foods from which a child can choose are all nutritious and appealing.
How should parents encourage their child to eat?
We all know that a healthy, varied diet is important for our child's growing needs. But what should you do if your child turns up his nose at just about everything.
Offer your child a wide variety of foods, he will get a balanced diet. It is better for him to eat something that he likes even if you disapprove of it than to eat nothing at all.
If your child refuses to eat fruits and vegetables, try to make them more tempting or more fun, but do not camouflage a detested food by mixing it with something else. The child should eat because he wants to and for no other reason. Encourage your child to feed himself.
Serve food that is fresh and presented in an attractive way.
Create a mealtime that is pleasant and relaxed.
Talk about food; this may encourage a child to eat. Whenever possible, allow children to choose from one or two items on the menu (for example, a choice of peas or carrots for vegetables).
Give your child the same food you eat.
You should be careful that the child is not overweight. Overweight kids are more likely to remain heavy as adults. This can lead to any number of health problems.
Your child should eat a more balanced diet. Start by setting a good example. If other members of your family commonly eats lots of fruits, vegetables, whole grains and low-fat dairy products, your kids will learn to eat a good diet. Kids tend to copy their parents, so if you eat well, they are more likely to eat well too. Do not get angry and do not panic if the child refuses to eat. If you are concerned about your child's dietary intake, talk to your doctor or a dietician. Put less on your child's plate and praise your child for eating even a little. Try to make meals enjoyable and not just about eating. Limit snacks and drinks between meals. Drinking too much liquid can lessen your child's appetite. This will help ensure that your child is hungry enough to eat solid foods. Do not overfeed. Obesity in children is rarely recognised by parents and is a major health problem.
Children's tastes change. One day they will hate something and a month later they'll love it. Fussy eaters are often slow eaters who dawdle over their plate. It is pointless trying to hurry them. Do not lose your cool at dinner. Simply remove the uneaten food.
If you find that these techniques are not working, there are people who can help. A registered dietician who specialises in children's nutritional needs can assess your situation and provide strategies for dealing with a picky eater.
Tips for coping with fussy eaters
Here is a list of things you can do to make it easier to cope with fussy eaters:
Try to find meals that the rest of the family enjoys. Include one or two items that the fussy eater avoids, they may eat the items not knowing they are there.
Try to serve smaller portions of food to your child
Invite a friend of the child who has a large appetite. This sometimes works well.
Invite an adult that the child likes for dinner like an uncle or friend. Sometimes a child will eat for someone else without any fuss.
Do not force the child to eat.
If your child is playing with his food, quietly remove the plate with no fuss.
Make meal times enjoyable and talk about what the child is doing.
Limit snacks and drinks between meals so the child feels hungrier when it comes to meal times.
Offer drinks after a meal so that they don't ruin the appetite.
Offer new foods when you know your child is hungry and more receptive to new tastes.
Do not substitute milk for meals.
Mental Health series-5
Obsessive compulsive disorder;
What is Obsessive Compulsive Disorder?
Obsessive-compulsive disorder, also called OCD, is a disorder characterised by recurrent and unstoppable anxious thoughts associated with repetitive actions that help to ease these thoughts. These thoughts are called ‘obsessions’ and arise in a person’s mind, over which he apparently has no control. The person tries to banish them, often unsuccessfully. Attempting to do so can often lead to greater anxiety. Instead, he ends up repeating the actions, called compulsions, to erase the thoughts.
This behavioural problem causes a lot of disturbance in a person’s daily life - to a point that he may stop doing routine activities like going out of the house or eating at the table. Most people with OCD realise that they have a problem, but they are unable to control their urges. In such cases, the problem may be hidden from family and friends for a long time and treatment is delayed.
What are the causes?
The exact cause of the disorder is unknown. OCD is attributed to a neurological condition and is believed to be the result of a defect in the transfer of neurotransmitters in the brain. Some psychologists believe that it is caused when a person learns to associate a negative emotion with an otherwise neutral stimulus.
What are the symptoms?
The common symptoms are:
Unwanted but unstoppable thoughts creating anxiety in an individual.
The most common are often thoughts of contamination, repeated doubts (wondering whether one has performed a certain act), and often aggressive thoughts like thinking of shouting out obscenities in a temple or place of worship.
People often have a need to have things arranged in a certain order (e.g. symmetrical arrangements of articles on a table)
Repetitive Behaviours that are irrational but unstoppable for example
repeatedly checking that things are in order, e.g. checks that the door is locked many times
Collection of unnecessary items
Performance of the ritualistic behaviours over and over again and great anxiety if they are not performed.
The person is usually conscious of the disorder but fails to do anything about it.
How is it diagnosed?
The doctor takes a complete history of the patient and the condition is diagnosed based on the description of the symptoms by the patient. Usually no tests are performed, but a psychological profile of the patient is sometimes done to assist with the diagnosis.
What is the treatment?
Medications are now considered the first line of treatment. A group of drugs called serotonin reuptake inhibitors is often the most helpful. Sometimes a trial of two or three medications is necessary before the optimal choice is found. Many of the medications used are the same as those used to treat depression.
Besides drug treatment, behavioural therapy is used to treat the patient. Cognitive Behavioural Therapy is a form of psychotherapy where simple skills are taught to diminish the repetitive patterns of behaviour. The patient is gradually eased into becoming less anxious from the disturbing thoughts. As a consequence, the patient learns to reduce the behaviours associated with the recurrent thoughts. Relaxation techniques are also taught which help to reduce the subjective distress.
Treatment is often unable to completely rid a person of the symptoms, but can make them decrease enough to allow a return to normal life.
Health Insurance in India;
The escalating cost of medical treatment today is beyond the reach of a common man. In case of a medical emergency, cost of hospital room rent, the doctor's fees, medicines and related health services can work out to be a huge sum. In such times, health insurance provides the much needed financial relief.
An investment in health insurance scheme would be a judicious decision. The health insurance scheme could either be a personal scheme or a group scheme sponsored by an employer. Some of the existing health insurance schemes currently available are individual, family, group insurance schemes, senior citizens insurance schemes, long-term health care and insurance cover for specific diseases. There are two major insurance companies in India namely:
- The Life Insurance Company of India (LIC)
- The General Insurance Company of India (GIC)
The Life Insurance Corporation (LIC) offers:
- The Asha Deep Plan: It provides cover for cancer, paralytic stroke resulting in permanent disability, renal failure and coronary artery disease where by-pass surgery has been done. It caters to people between 18 - 65 years.
- Jeevan Asha: The Jeevan Asha policy is the other healthcare product offered by LIC. It is an open-ended scheme covering many surgical procedures.
While LIC deals with insurance for life coverage only, the GIC deals with the other aspects of insurance, including health. Following are the main health policies offered by the Indian Insurance Companies. These policies are regulated by the General Insurance Corporation and are marketed by the four big insurance companies: United India Insurance Co Ltd., New India Assurance Co Ltd., Oriental Insurance Co Ltd. and National Insurance Co Ltd.
The insurance policies offered by GIC are:
1. Mediclaim
Insures against any hospitalisation expenses that may arise in future. This policy is designed to prevent the insured from paying for any hospitalisation expenses owing to illness or injury suffered by the insured, whether the hospitalisation is domiciliary or otherwise.
It covers the expenses incurred on the following:
Room boarding expenses by the hospital nursing home
Nursing expenses
Operation theatre expenses
Surgeon, anaesthetist, medical practitioner, consultants, specialist’s fees
Also for any cost of equipment like pacemaker, artificial limbs and charges paid for anaesthesia, blood, oxygen, operation charge, surgical appliances, medicines and drugs, diagnostic material and x-rays, dialysis and chemotherapy, radiotherapy, and cost of organs etc.
2. Jan Arogya Bima Policy
It insures hospitalisation or domiciliary hospitalisation expenses incurred on medical or surgical treatment for any illness or disease (contracted after 30 days from the commencement of the policy) or injury. Any person in the age group of three months to 70 years can be insured under this. The risk insured include sudden illnesses like heart attack, jaundice, pneumonia, appendicitis, paralytic attack, food poisoning or accidents that require hospitalisation. This insurance policy was designed for the lower income group of society and the common masses. The entire idea was to protect them from high costs of hospitalisation.
3. Overseas Mediclaim Policy
Any person going abroad on holiday, business, study or employment can avail this policy. Coverage under the medical expense section of this insurance is intended for use by the Insured person in the event of a sudden and unexpected sickness or accident arising when the Insured is outside the Republic of India.
4. Personal Accident Policy
The policy compensates an individual against death, loss of limbs, loss of eyesight, permanent total disablement, permanent partial disablement and temporary total disablement, solely and directly resulting from accidental injuries.
5. Critical Illness Policy
Critical Illness Policy is an exclusive benefit policy for individuals in the age group 20-65 years covering coronary artery surgery, cancer, renal failure, stroke, multiple sclerosis and major organ transplants like kidney, lung, pancreas or bone marrow.
6. New India Assurance Bhavishya Arogya
This caters to persons between 3 to 50 years. This policy is essentially to take care of medical expenses needs of persons in their old age. The policy provides for expenses in respect of hospitalisation and domiciliary hospitalisation during the period commencing from the Policy Retirement Age selected till survival. This is selected by the insured for the purpose of commencement of benefits in the policy.
Health insurance products from some private insurance companies:
Bajaj Allianz Health Guard
Covers individuals between 5 to 55 years. Children below 5 years can be insured if the parents are concurrently insured with the company. It provides cashless facility across various hospitals across India. Herein pre-existing illness and injuries are covered in the year of cover, if the insured renews his policy consecutively for 5 years.
Royal Sundaram Health Shield Gold
Covers individuals between 5 to 55 years. from 91 Days to 75 years and also persons above the age of 55 years are covered as a part of family and not on individual basis. All in hospitalisation expenses are covered (period of stay in hospital should be more than 24hours). Pre hospitalisation expenses are covered for a period of 30 days & post hospitalisation for 60 days. Under this policy pre-existing illness and injuries are covered in the 6th year of cover, if the insured renews his policy consecutively for 5 years. Maternity treatment charges are covered upto the extent of Rs. 20,000. These include expenses incurred in hospital/ nursing homes as in -patient in India.
Birla Sun Life
Birla Sun Life Insurance is the coming together of the Aditya Birla group and Sun Life Financial of Canada to enter the Indian insurance sector. The Aditya Birla Group, a multinational conglomerate has over 75 business units in India and overseas with operations in Canada, USA, UK, Thailand, Indonesia, Philippines, Malaysia and Egypt to name a few.
HDFC Standard Life
HDFC Standard Life Insurance Co. Ltd. is a joint venture between HDFC Ltd., India’s largest housing finance institution and Standard Life Assurance Company, Europe’s largest mutual life company.
ICICI Pru
ICICI Prudential Life Insurance is a joint venture between the ICICI Group and Prudential plc., of the UK. ICICI started off its operations in 1955 with providing finance for industrial development, and since then it has diversified into housing finance, consumer finance, mutual funds to being a Virtual Universal Bank and its latest venture Life Insurance.
Om Kotak Mahindra
Established in 1985 as Kotak Capital Management Finance promoted by Uday Kotak the company has come a long way since its entry into corporate finance. It has dabbled in leasing, auto finance, hire purchase, investment banking, consumer finance, broking etc.
Tata AIG General Insurance Company
The Tata AIG joint venture is a tie up between the established Tata Group and American International Group Inc. The Tata Group is one of the largest and most respected industrial houses in the country, while AIG is a leading US based insurance and financial services company with a presence in over 130 countries and jurisdictions around the world.
Max India
Max India Limited is a multi-business corporation that has business interests in telecom services, bulk pharmaceuticals, electronic components and specialty products. It is also the service-oriented businesses of healthcare, life insurance and information technology.
World No Tobacco Day 2008;
Globally, most people start smoking before the age of 18, with almost a quarter of those beginning before the age of 10 years. The younger children are when they first try smoking, the more likely they are to become regular tobacco users and the less likely they are to quit.
A strong link between advertising and smoking in young people has been proven. A heightened awareness and appreciation of tobacco advertising by youngsters’ results in an increased likelihood of their smoking. As a result, the tobacco industry spends billions of dollars worldwide each year spreading its marketing net as widely as possible to attract young customers. Tobacco companies market their products wherever youth can be easily accessed - in the movies, on the Internet, in fashion magazines, and at music concerts and other events using increasingly creative tactics to boost the sale of its products. Adverts on billboards, in magazines and on the Internet, comprise only one strand of the complex tobacco marketing net. Tobacco companies sponsor sports and entertainment events, hand out branded items and organize numerous popular promotional activities in an attempt to win and keep their customers.
Only total bans can break the tobacco marketing net. The industry has numerous ways of targeting youth and partial bans merely allow companies to shift their vast resources from one promotional tactic to another.
This year World No Tobacco Day campaigns for a - Total ban on all forms of tobacco advertising, promotion and sponsorship by the tobacco industry.
There is need to campaign for such a total ban because-
about half the children of the world live in countries that do not ban free distribution of tobacco products to them.
only total and comprehensive bans can be effective in reducing tobacco consumption.
national-level studies before and after advertising bans found a decline in tobacco consumption of up to 16%.
partial bans have little or no impact on demand since advertising can be switched to alternative media.
The tobacco industry falsely associates use of its products with desirable qualities such as glamour, energy and sex appeal as well as with exciting activities and adventure. Widespread tobacco advertising “normalises” tobacco use, portraying it as being no different from any other consumer product, and making it difficult for young people to understand the hazards of its use. Young people underestimate the risk of becoming addicted to nicotine and the tragic health consequences that can follow.
Tobacco facts
Tobacco use is one of the biggest public health threats the world has ever faced. 50% of all deaths from lung disease are linked to tobacco.
There are more than one billion smokers in the world.
Globally, use of tobacco products is increasing, although it is decreasing in high-income countries.
Almost half of the world's children breathe air polluted by tobacco smoke.
The epidemic is shifting to the developing world.
More than 80% of the world's smokers live in low- and middle-income countries.
Tobacco use kills 5.4 million people a year - an average of one person every six seconds - and accounts for one in 10 adult deaths worldwide.
Tobacco kills up to half of all users.
520 million people will die from tobacco use in the next 50 years
It is a risk factor for six of the eight leading causes of deaths in the world.
Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of disease and death has just begun.
100 million deaths were caused by tobacco in the 20th century. If current trends continue, there will be up to one billion deaths in the 21st century.
Unchecked, tobacco-related deaths will increase to more than eight million a year by 2030, and 80% of those deaths will occur in the developing world.
(Source: World Health Organization)
Controlling tuberculosis in India
Introduction
India has far more cases of tuberculosis than any other country in the world. There are about 2 million new cases each year and India accounts for nearly one third of prevalent cases globally.
Tuberculosis is an infectious disease that commonly affects the lungs, but can affect any part of the body. It develops slowly and can lead to prolonged ill health. Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. This bacterium usually attacks the lungs but may also lodge in the lymph glands. From here the disease may spread to any part of the body including brain, intestines, kidneys or bones. As reported by researchers in the October 31st issue of the New England Journal of Medicine, by September 2001, about 3.4 million patients had been evaluated for tuberculosis, and nearly 8,00,000 had received treatment, with a success rate greater than 80 percent. More than half of all those treated in the past 8 years were treated in the past 12 months. According to the study, tuberculosis kills nearly 500,000 people in India each year. Until recently, less than half of patients with tuberculosis received an accurate diagnosis, and less than half of those received effective treatment.
TB in India:
India has one third of all TB patients in the world
40% of the Indian population is infected with TB bacillus
Each day, 20,000 get infected and 5,000 develop the disease
Each year 18 lakh people develop TB, of whom 8 Lakh are infectious
More women die of TB than all causes of maternal mortality put together
National Tuberculosis Control Programme
The Indian tuberculosis control programme is now one of the largest public health programs in the world. The programme has been remarkably successful, although it still faces many challenges. Direct health benefits to date include the treatment of 1.4 million patients, and prevention of more than 2,00,000 deaths. The programme has prevented more than 2 million tuberculosis infections and, therefore, more than 200,000 secondary cases. In rural areas, India has an established health infrastructure, with a large health centre for each 1,00,000 people, a smaller clinic for each 30,000 people, and a health post staffed by paramedical staff for every 5000 people.
The Revised National Tuberculosis Control Programme began in October 2, 1993. Diagnosis is primarily by sputum microscopy, treatment is directly observed, and standardised regimens and methods of recording and reporting are used. For diagnosis, physicians are trained to ask all patients attending health care facilities if they have had a cough for three weeks or more. Those with a cough undergo three sputum-smear examinations over a two-day period. If two or three of the smears are positive for acid-fast bacilli, anti-tuberculosis treatment is initiated. If all three smears are negative, one to two weeks of broad-spectrum antibiotics (e.g., trimethoprim–sulfamethoxazole) are prescribed. If only one of the three smears is positive or if symptoms persist after the administration of broad-spectrum antibiotics, a chest X-ray is obtained, usually at a larger health centre, and the patient is evaluated.
Policy direction and supervision, drugs, and microscopes are provided by the Central Government. State governments hire the general health staff as well as the specialised staff of the district tuberculosis centres, clinics, and hospitals. On the basis of their clinical features, patients are given one of three categories of treatment. All treatment is given three times weekly.
The Outcome
Eight years later, delivery of service had begun in 211 districts of 19 states covering 436 million people (43 percent of the entire population). Nearly 2,00,000 health staff had been trained. More than 3000 laboratories had been provided with electricity and water connections, new binocular microscopes, and reagents.
There had been more than 250,000 supervisory visits, half to patients homes and half to health care facilities. Patient outcomes were reported one year after the start of treatment. Eighty-three percent of 6,66,037 patients due for evaluation were successfully treated. Approximately 20 percent of districts had treatment success rates of less than 80 percent, but only 5 percent had treatment success rates of less than 70 percent. For previously treated patients, the rate of treatment success was 71 percent. For patients in whom treatment had previously failed, the risk of failure of the re-treatment regimen was higher than for patients who had previously had a relapse, those who had discontinued treatment prematurely, or other patients undergoing re-treatment.
The Challenges
India has faced several challenges in implementing this programme:
The general health service often does not function optimally. This suggests that patients with tuberculosis can be identified and treated even in a relatively dysfunctional health care system.
A large and mostly unregulated private sector provides a substantial proportion of outpatient care, and this care is of inconsistent quality.
The level of socio-economic development can have a major effect on programme performance.
The role and effectiveness of the government system also pose a challenge.
Ensuring the quality of drugs is difficult.
Establishing patient-friendly services so that no patient should have to pay for transportation or lose wages to participate.
Conclusion
Sustaining this programme in India will require continued financial support, particularly for drugs and contractual supervisors, as well as continued and intensified supervision and monitoring. The creation and equipping of small laboratories and the initial training of large numbers of health workers should have long term benefits. The rate of decline in the incidence of tuberculosis will be affected by the proportion of cases resulting from recent transmission, as well as by other factors. It will be at least several years before the Indian programme can be expected to have a discernible effect on disease incidence.
Further expansion to cover the entire country is under way, with plans to cover 80 percent of the country by 2004. Coverage of the entire country will require training of 20,000 more doctors and more than 1,00,000 allied health staff, improvements in more than 6000 laboratories, and the medications to treat more than 1 million patients per year. Given the success of the programme to date, expansion on this scale appears to be possible, but it is far from assured. Continued high-level commitment and technical rigour from the central and state governments of India and assistance from international organisations will be essential.
Exercise prevents heart disease
Physical inactivity, is a major risk factor for developing coronary artery disease. It also contributes to other risk factors, including:
Obesity
High blood pressure
A low level of HDL i.e good cholesterol
Diabetes
Even moderately intense physical activity such as brisk walking is beneficial when done regularly for a total of 30 minutes or longer 3-6 days a week. There are 3 kinds of exercises that can be done. They are:
Stretching (stay loose)
Aerobic (for blood flow and oxygen)
Strengthening (toning or building muscles)
The most important exercise for the heart is aerobic exercises. Walking, jogging, running, swimming, dancing and cycling are aerobic. The decision to carry out a physical fitness programme cannot be taken lightly. It requires a life long commitment of time and effort. Exercise must become one of those things that you do without question, like bathing, brushing your teeth. Unless you are convinced of the benefits of fitness and the risks of unfitness, you will not succeed. How often, how long and how hard and what kinds of exercises you do should be determined by what you are trying to accomplish. For example, an athlete training for high level competition would follow a different programme than a person whose goals are good health and the ability to meet work and recreational needs.
Should you exercise?
The hour just before the evening meal is a popular time for exercise. Another popular time to work out is early morning, before the work day begins.
What are the benefits of exercise?
The heart can pump more blood and oxygen to the body.
Most people will have more energy
You sleep better and feel less stress
Blood pressure and blood sugar go down
You can tone muscles and lose body fat
Your HDL i.e., good cholesterol goes up
How should you exercise?
Step 1. Get loose, spend 5-10 minutes warming the muscles before you work out harder. Take a walk, jog slowly or cycle with no tension. Then stretch the muscles to loosen them.
Step 2. Hard work for 20 to 30 minutes. Wear comfortable clothes and shoes that match the sport.
Step 3. Cool down like you warmed up. Spend 5-10 minutes walking slowly or cycling with no tension. Then stretch the muscles to keep them loose. Pick up more than one kind of exercise so that you don’t get bored, while on exercise machines. You can often watch television or listen to music. This is a good way to keep from getting bored. You may join an exercise group or get a friend to work out with you. Add more daily exercise in these ways:
Climb stairs rather than taking an elevator
Park at the far end of parking lot so that you have to walk more
Do more housework
Recommendation
For most healthy people
For health benefits to the heart, lung and circulation perform any vigorous activity for at least 30-60 minutes, 3-4 days each week at 50-75 per cent at your maximum heart rate. Physical activity need not be strenuous to bring health benefits. Moderate-intensity physical activities for 30 minutes or longer on most days provide some benefits. What is important is to include activity as part or a regular routine. Activities that are especially beneficial when performed regularly include:
Brisk walking, hiking, stair-climbing, aerobic exercise
Jogging, running, cycling, rowing and swimming
Activities such as soccer, basketball that involve continuous running
For people who are sedentary
Walking for pleasure, gardening and yard work
Housework, dancing and prescribed house exercise
Recreational activities
Dealing with Sports Injuries
The best way to deal with sports injuries is to prevent them. Prevention includes knowing the rules of the game one is playing, using the proper equipment, and playing safe. Sports injuries typically occur while participating in organised sports, competitions, training sessions, or organised fitness activities. These injuries may occur for a variety of reasons, including improper training, lack of appropriate footwear or safety equipment.
Sports activities can result in injuries - some minor, some serious, and still others resulting in lifelong medical problems. There are two general types.
Acute traumatic injury: Acute traumatic injuries usually involve a single blow from a single application of force. These injuries include the following:
a fracture - a crack, break, or shattering of a bone
a bruise - caused by a direct blow, which may cause swelling and bleeding in muscles and other body tissues
a strain - a stretch or tear of a muscle or tendon, the tough and narrow end of a muscle that connects it to a bone
a sprain - a stretch or tear of a ligament, the tissue that supports and strengthens joints by connecting bones and cartilage
Overuse or chronic injury: Chronic injuries are those that happen over a period of time. Chronic injuries are usually the result of repetitive training, such as running, overhand throwing, or serving a ball in tennis. These include:
stress fractures - tiny cracks in the bone's surface often caused by repetitive overloading (such as in the feet of a basketball player who is continuously jumping on the court)
tendinitis - inflammation of the tendon caused by repetitive stretching
bursitis - an inflammation of the bursa, which is a small sac, in the shoulder, elbow, or knee.
Head injuries include concussions, contusions, fractures, and haematomas. A concussion is a violent jarring or shock to the head that causes a temporary jolt to the brain. If severe enough, or recurrent, concussions can cause brain damage. A haematoma is a bleeding or pooling of blood between the tissue layers covering the brain or inside the brain. All of these injuries can be caused by impact to the head from a fall, forceful shaking of the head, a blow to the head, or whiplash. Whiplash is an injury to the neck caused by an abrupt jerking motion of the head. It is necessary to always wear helmets for contact sports and when doing activities like biking to prevent head injuries.
Neck injuries are among the most dangerous. One can hurt the neck through a sudden traumatic injury in sports like mountain climbing, skydiving, horseback riding, gymnastics, diving, or boxing. Neck injuries include strains, fractures, contusions, and sprains. Most neck injuries are caused by impact to the head or neck sustained during a fall or a blow. The neck can also be injured a little at a time. Too much strain on the neck can cause increasing pain, sometimes only on one side of the neck. If the injury is severe and there is a chance that the neck might be injured, it is very important to keep the injured person still with their head held straight while someone calls for emergency medical help.
Foot injuries can include ligament strains, stress fractures, heel bruises, and bursitis. Because one’s feet support all of the weight and must absorb a lot of force over and over again, they can be particularly susceptible to injury.
Sex Organs: When it comes to injuries to the sex organs, boys and men usually suffer more trauma than girls because the penis and testicles are outside the body and lack natural protection during contact sports. They should always wear athletic supporters, or in some sports a cup, to protect the genitals from serious injury. Injuries to the uterus or ovaries are rare, but breast injuries are common complaints among girls. As the breasts develop, they can often be sore, and a blow from a softball or a jab from an elbow, can be painful. Girls should wear supportive sports bras while playing sports or exercising.
Back injuries include sprains, fractures, contusions, and strains and are caused by twists or overexertion of back muscles during bending or lifting movements. These injuries can occur in contact sports like football, weight lifting, skating, gymnastics, dancing, and basketball.
Hand injuries include fractures, dislocations, and sprains and often occur in contact sports such as football, hockey etc. Hand injuries can result from a fall that forces the hand or fingers backward, a forceful impact to the hands, or a direct blow.
If the pain progressively increases with activity and causes any limping or loss of range of motion, one needs to see a doctor as soon as possible. The most important thing to do when one suspects injury is to stop doing whatever sport has caused the injury right away and see a doctor. For more severe or complicated injuries, it may be best to see a doctor who specialises in sports medicine. Once the doctor knows the full extent of the injury, he will start with conservative treatment techniques such as rest and ice to help decrease swelling. Pain relief and anti-inflammatory medicines such as ibuprofen may be prescribed. Splints, casts, and surgery also may be needed, depending on the injury. The doctor may recommend that one not play while the injury heals and to use protective devices.
Preventing Cricket Injuries:
Overall, cricket injuries are mostly sprains, fractures and bruising. Adult cricketers most often sustain injuries to the upper limbs, followed by the lower limbs and the head. A direct blow from the ball during delivery or fielding, mostly to the face, fingers and hand, is the most common cause of injury and results in fractures and bruising. Overuse injuries are also common and are most often associated with back injuries to fast bowlers, particularly at the elite level and in young cricketers.
Safety Tips:
Good preparation is important
Warm up and stretch before the day's cricket. Bowlers, particularly fast bowlers, should warm up before their bowling session
Good technique and practices will help prevent injury
Coaches should undergo regular reaccreditation and education updates to ensure they have the latest information about playing techniques
Wear appropriate safety equipment, wear body padding when batting including gloves, leg pads, boxes and forearm guards
When batting, wicket keeping or fielding in close wear a cricket helmet with a faceguard
Wear protective gear during informal play as well as competition
Seek professional advice on appropriate cricket shoes
Modify rules for children
Drink adequate water during the day's play.
Wear a broad spectrum sunscreen, hat and sunglasses when appropriate
If an injury occurs ensure all injured cricketers receive adequate treatment and full rehabilitation before they resume participation
Asset Integrity;
These questions may be used to test how effectively asset integrity hazards are understood and are being managed. Supplementary questions or comments also indicate what good practice looks like.
Facility Major Incidents & Barriers
A1 What process do we have to identify major ‘loss of asset integrity’ scenarios.
• Is there a list? Is it realistic?
• Who is responsible for identifying, assessing and managing these major incident risks. Do they have suitable skills,and resources.
• How would a new person learn about all this.
A2 In the context of current operations, what is one major incident scenario for this facility, and how could it escalate from an initial minor event.
• How often can the initial event happen? How likely is it to escalate?
• How far would the effects extend, initially and after escalation? (Heat radiation, explosion damage, smoke, etc. -
this checks use of a suitable consequence model)
• Could effects extend beyond the asset? Have neighbours been informed.
A3 For this scenario, what barriers ensure the risk is acceptably low.
Which are your most important barriers and why.
(this checks knowledge of specific major incident scenarios at the facility, understanding
of associated barriers and their value in preventing such incidents)
• How are key barriers and related Performance Standards defined and recorded.
• Are structural failure, extreme weather and collision/impact barriers considered, as appropriate.
A4 What do we do when a barrier is by-passed or degraded (not fully operational).
• Does everyone involved understand and actively manage all the barriers needed to avoid major incidents. How do we know when barriers are degraded.
• How do we respond when barriers are known to be degraded, etc. (including during maintenance. What compensating
systems are put in place?
• Do you have written guidance about when to shut down if one or more barriers are degraded.
A5 How many safety device overrides do you currently have in your area.
How were they authorised. Where are they recorded.
• Are they all temporary? If some are long-term, for how long have these been authorised?
• What additional measures do you have in place to compensate?
A6 What metrics/KPIs do you use for asset integrity performance?
• Do they cover all the main headings in this guide? If using CCPS Standard, how does performance compare with
others.
A7 Do we follow up on loss-of-integrity incidents with suitable actions.
• How are you sure that possible management failings are considered, as well as those of workers?
• Is action closeout always timely? How many open items on the current list.
A8 What are the current focus areas for further reducing the probability of a major
incident occurring? What have we done in the past 2-5 years?
• Is there a ‘continual improvement’ approach to managing major incident risk?
• Is there a documented management review within the past 2 years?
Critical Equipment (Hardware Barriers)
B1 How do we identify safety-critical equipment and devices? Which are linked to reducing the risk of major incidents.
• Is there a standard definition and practice for critical equipment categorisation?
• Who determines criticality? Do operations and technical authorities work well together?
• Is some non-critical equipment included, because of a role in ensuring personal safety.
B2 Are there clear Performance Standards for equipment critical to asset integrity.
• Do these cover reliability, availability, survivability, as well as what the equipment is designed to do.
• Which Performance Standards are met by the basic design specification, which have to be site tested or verified?
• How is barrier reliability and availability checked against the Performance Standards.
B3 How do we test each barrier (or equipment item), to make sure it works as intended. Do we ever test the whole barrier.
• Where are the records for the last test on each barrier or component. Do they include details of the test results or
measurements and who did them?
• What would you do if a test was either missed or failed? When would you consider ceasing operations. Are relevant
decision criteria documented and available.
• If the whole barrier is never tested, why not.
• How is actual barrier performance communicated and to whom? (Workers affected if it failed in a real incident,
Asset Manager, Technical Authorities.
B4 Do we deviate from supplier recommended inspection or maintenance frequencies. If so, how are deviations justified.
• Are there sufficient records to justify increasing/decreasing intervals.
• Do changes have to be approved by a competent technical authority.
B5 What is the current backlog of maintenance/inspection for critical equipment? Who monitors this.
• Who is authorised to approve a delay/deferment? For how long?
• Do records show an improving or deteriorating trend?
• Have you ever shut down because critical equipment performance verification was overdue? Who took that decision?
(Should not require high-level authorisation).
B6 Is there an up-to-date Management of Change (MoC) procedure.
How does it apply for critical equipment (hardware barriers).
• How many changes to critical equipment have been registered in the last month/year.
• How many are still being progressed?
• How soon are all relevant drawings, documents, etc. updated after a change is made.
B7 How does the MoC process apply for minor changes to critical equipment, e.g.
change of material spec, chemical dosing or alarm/trip settings?
Permanent changes should be assessed by MoC process, with technical authority involvement
and approval. Temporary changes should also be assessed, then recorded and time-bound.
B8 Are operating limits for all process equipment clear? Who is allowed to deviate from or change them.
• Do all operating limits that are not self-limiting have alarms and trips.
• Does the local MoC procedure cover permanent changes to alarm and trip settings.
• Are all trip defeats recorded and made only by authorised persons.
B9 In typical operations, how often do alarms activate? Do all alarms require a response
action (in addition to acknowledging the alarm to silence it).
• What is the proportion of ‘nuisance alarms’? If this is high, has any rationalisation taken place.
People and Processes
C1 Are there always sufficient competent people to operate, inspect and maintain the facility?
• How do we know our people are technically competent, including supervisors?
• What about long-term and short-term contractors?
• What about vacations and in emergencies? How do we maintain ?group competence? when some members are
absent or are new workers?
• Are critical tasks ever carried out alone by persons not yet assessed as competent? (This may be part of their training,
but they should not be alone)
• Who determines competence? (Self-assessed? Supervisor? Independent assessor? Are assessments recorded.
C2 How do we ensure supervisors and managers are competent as leaders
and in their understanding of this facility?
• Do competences include understanding of asset integrity barriers and their contributions to preventing, controlling
and mitigating major incidents?
• Are all critical task competences assessed pre-appointment?
• Are there any challenges in ensuring this standard? (e.g. shortage of good people, need to rotate them, etc.)
C3 Are responsibilities for the performance of critical equipment/asset integrity barriers clear.
• Are both operations and technical authorities involved?
• Are timely decisions about required changes made and implemented as needed?
• Do operations personnel contribute suitably to technical studies and reviews (risk assessments, Hazops, etc.)?
• Do technicians have all the tools and equipment needed to efficiently operate, inspect and maintain the facility? Are
these calibrated as appropriate.
C4 Is there a robust permit system in place to manage tasks that may affect asset integrity? Are
all persons trained in its use and assessed before being authorised to sign any section?
• What are the hardest areas to implement consistently?
• Are Permits ever issued for tasks that involve no risks to or controls implemented by anyone other than those doing
the work, if so why? (Detracts from higher risks)
• How do we decide what isolation standard is required for ‘live working’? How do we integrity test before re-introducing
process fluids? (Operations standards for both should be defined, in agreement with technical authorities).
C5 How are workers using task risk assessments to identify situations that could affect asset integrity? Are there agreed standards for performing tasks that could directly affect the integrity of the asset.
• Are workers using JSA and personal task risk evaluation to consider ‘worst case’ asset integrity hazards or consequences
(in addition to personal injury exposures)?
• Are there written standards/guidance for activities such as: start-up/shutdown/recovery; working on ‘live’ systems;
opening process equipment, etc? Have technical authorities and operations both contributed to the standards.
C6 Do the emergency response procedures include major incidents. How do we know the scenarios are realistic Is everyone confident that barriers will work as intended.
• How are training and exercise scenarios linked to realistic failures of the key barriers?
• How do we simulate major incidents (fire, explosion, etc.) to provide realistic experience?
• Are all response authorities and deputies trained in major emergency scenarios?
• Are complex systems ever tested overall (e.g. ESD, full-scale flaring, HVAC shutdown, lifeboat launch and recovery).
C7 How quickly do we usually detect and respond to a minor process fluid release to prevent it from escalating?
• Does this apply everywhere? (e.g. open areas, where detection is harder)
• Are there always enough people to patrol critical areas? (e.g. nights, weekends)
• In areas with no automatic detection, will personnel reliably detect a release, as it is a rare event.
Projects
D1 Are roles, responsibilities and accountability for asset integrity management and major
incident risk reduction clearly and adequately defined for this project.
• What has been done to minimise lifecycle risk, not just capital cost.
• How are barrier Performance Standards optimised during detail design?
• How can you be sure the overall major incident risk is acceptably low.
D2 In selecting a development concept or design how do you optimise asset integrity management/
major incident risk reduction and assure it is achievable throughout the facility life?
• Which options were considered? What factors led to the selected option?
• What major hazard studies were/will be used to aid selection as the design develops?
• What examples are there of considering total lifecycle cost, not just initial cost.
D3 How are asset integrity expectations and barrier optimisation communicated to designers.
• Are there examples of going beyond required minimum standards?
• How is operations concurrence with selected design options obtained.
D4 How are major incident barrier Performance Standards communicated to operations?
• Do any novel Performance Standards need to be verified by type tests during the design phase?
• How are Performance Standards verified before or during commissioning?
• How do reliability/availability expectations compare with what we achieve in existing facilities.
D5 Is there a readily available catalogue of the codes and standards utilised to design barriers?
• How were specific standards selected and what assurance process was followed to demonstrate their application?
• How do Technical Authorities and others use the catalogue?
• Has the catalogue been maintained? What changes have been made to the facility in response to revisions to codes
and standards.
Culture
E1 What do you see as the important differences between personal and process safety?
There should be many similarities, e.g. both high priority, tracked with leading and lagging indicators
and with clear management leadership actions. However, process safety risk assessments will more often be complex, and require specialist people and tools to select and optimise barriers. Operators and technicians are likely to have less detailed experience/understanding of the consequences when barriers fail, and thus may not fully understand the basis for some operating limits.
E2 How often does management discuss facility-specific major incident scenarios and the effectiveness
of barriers with supervisors and operators on your facility?
• What are the greatest concerns of operations and of technical authorities? What is being done about these?
• Have supervisors and operators made improvement suggestions? How are these being actioned.
E3 What are we doing to improve the ability of workers at this facility to identify and
raise concerns about situations that may contribute to a process incident?
Workers must be competent to recognise a deficiency or concern and
must also feel empowered to take action to resolve it.
E4 Is there a plan to audit and review our barriers for managing major incident risks? Are we meeting that plan?
• Are there systematic reviews that specifically consider asset integrity and major incident risks?
• What data sources, including audits, are fed into the review?
• Is auditing done by truly independent and competent people?
• What strengths have been reported in recent audits, and what weaknesses?
• What actions have followed the review.
E5 Do people here feel management would support them if they stopped a job, or
stopped production because major incident barriers were degraded?
• Do you have recent examples? Does everyone agree?
• For those unsure about management support, what would you do to change that
Smoking is really injurious to health!
The World Health Organisation (WHO) has launched this year's campaign for World No Tobacco Day with the slogan: Tobacco and Poverty. The slogan explains the link that exists between tobacco and poverty, and how the use of tobacco, especially by poor people who consume this product the most, can have harmful consequences.
WHO notes that the tobacco epidemic is still expanding, especially in developing countries where, currently, 84% of the smokers live. Tobacco use kills 4.9 million people each year, and this toll is expected to double in the next 20 years. At current rates, the total number of tobacco users is expected to rise to 1.7 billion by 2025 from 1.3 billion now. Every 6.5 seconds one person dies and many others fall ill or suffer disease and disability due to tobacco use. Tobacco is the fourth most common risk factor for disease worldwide.
Smoking causes a range of diseases never before suspected, including cataracts, acute myeloid leukemia and cervical, kidney, pancreatic and stomach cancers. In fact, smoking affects virtually every organ of the body. It has been known since decades that smoking is bad for health, but the current report shows that it's even worse.
According to the American Cancer Society smoking kills people in different ways in different countries, but what is common is the high toll from smoking, wherever it becomes prevalent. A study last month found that in India, smoking mainly kills through tuberculosis rather than lung cancer, as in the West. According to researchers from the Epidemiological Research Center in Chennai, India, smoking causes half the male tuberculosis deaths in India. Almost 200,000 people a year in India die from tuberculosis because they smoked, and half the smokers killed by TB are still only in their thirties, forties or early fifties when they die.
A legislation was introduced, earlier this month, under India's new Anti-Smoking Act, which was passed by the country's parliament last year. The law forbids public smoking and any direct or indirect advertising of tobacco products and the sale of cigarettes to children. Anyone caught breaking the law will be fined 200 rupees. It is important that the government gets much tougher on the tobacco industry. States should raise tobacco taxes and ban all smoking in public places, according to the American Heart Association.
New report records environmental
performance in 2007;
OGP’s Environment Committee has
compiled its annual report on
environmental performance. Covering
data from the year 2007, the newly published document incorporates
material supplied by 27 companies
operating in 61 countries.
In total, the companies participating produced 2,096 million tonnes of hydrocarbon during the year, which is about 32% of global production cited in the BP Energy Review for 2007. However, regional coverage proved to be uneven, ranging from almost complete coverage of production in Europe to 8% in the Former Soviet Union.
The aim of collecting and publishing the data is to allow OGP member companies to compare their performance with others in the sector.
That knowledge can lead to improved
and more efficient environmental
performance. The programme also
contributes to the upstream industry goal of transparency in its operations.
As in previous years, the report focuses on five indicators: gaseous emissions, aqueous discharges, non-aqueous drilling fluids (NADFs) on cuttings,mhydrocarbon spills and energymconsumption.
• Gaseous emissions: In 2007 reporting companies emitted 295 million tonnes of carbon dioxide (CO2), the equivalent of 141 tonnes of CO2 per thousand tonnes of production.
Methane emissions totalled 2.1 million tonnes, equivalent to 1.0 tonnes of methane per thousand tonnes of oil equivalent production. The report also recorded lesser amounts of non-methane volatile organic compounds, sulphur dioxide and
nitrogen oxides and noted a direct
link between the level of infrastructure required to collect, market and use the gas associated oil production and the level of CO2 and CH4 emissions. There was no significant change between figures for 2006 and 2007.
• Aqueous discharges: For every
tonne of hydrocarbon produced,
0.6 tonnes of produced water
was discharged and 1.0 tonnes of
produced water was reinjected. The
quality of produced water discharges is measured in terms of oil content. In 2007, the average concentration of oil in produced water was 18mg per litre for onshore discharges and 15mg per litre for offshore discharges. There was a 3% decrease in the concentration of oil in produced water between 2006 and 2007.
• NADFs on cuttings: NADFs used by
the industry now consist of either low toxicity mineral oil or a combination of enhanced mineral oils and synthetics. In 2007, an exceptionally active year for drilling, reporting companies discharged 38,876 tonnes of NADF on drill cuttings. These discharges took place in all regions except Europe. There were no reports from anywhere of discharges of NADFs containing diesel or conventional mineral oils.
Spills: Participating companies
reported 3,036 spills greater than
one barrel in size. These released a total of 13,416 tonnes of oil during 2007. This was a slight reduction from the previous year and the equivalent of 7.0 tonnes of oil spilled per million tonnes of hydrocarbon produced. The reported spillage rate offshore was a third the onshore average.
• Energy consumption: Reporting
companies consumed an average of
1.5 GigaJoules of energy for every
tonne of hydrocarbon produced. This
was minimally higher (0.7%) than the 2006 average.
Onshore productionwas more energy intensive in 2007 than offshore production.
The complete report, Environmental
performance in the E&P industry 2007 data, is freely available from the publications section of www.ogp.org.uk.
How do I deal with mood instability?
Q. I am a 39 years male, an engineer by profession, also doing my masters part time. I have a 4 years old daughter and my wife is expecting our second child. I have been going through a roller coaster ride in my moods through out for the last two-three years. Many a times, I feel lack of enthusiasm and at others, I work with all zeal and vigour. How do I get a stable enthusiastic mood?
A. There are many causes of up-and-down moods, which can be referred to as mood instability. The commonest cause is the ups and downs of life, as circumstances change, people come and go from our lives, we have a problem at work or get a promotion. Parenting young children can lead to new stresses, sleep deprivation, etc.
However, mood instability may also be due to a psychiatric disorder, or a personality disorder. To help you learn the cause of your problem you would do best to consult a psychiatrist who is skilled in diagnosing and treating mood problems, as there are mood stabilizing medications available if the cause is not simply the ups and downs of life.
A good psychiatrist will spend an hour taking a careful history of your life, relationships, family history, and the duration and severity of your up moods and depressions. From this information he can make a helpful diagnosis and plan treatment to relieve your problem.
Health Performance Indicators–Tier 1:
Implementation of a Health Management System
Purpose Virtually all companies within the oil and gas industry employ management systems as a principal means of achieving continuous improvement of business performance. This typically includes a system to address the health status of employees.Where applicable, the system may extend to surrounding communities. Note: individual country legislation may preclude adoption of some indicators. Local legislative arrangements must always take precedence over the specific requirements of the individual management system element.
Type of indicator
Qualitative—ranking and rating is based on a subjective assessment of the integrity of the programme. High level quantitative assessments may be made based on a ‘traffic light’ system.
Scope
Reporters should describe the company’s status in terms of implementing an occupational health management system and whether it broadly meets the eight categories set out below. A Health Management System is a process that applies a disciplined and systematic approach to managing health incompany activities. This approach uses a cyclical process that takes experiences and learning from one cycle and uses them toimprove and adjust expectations during the next cycle. Management systems should convey a company’s structure, responsibilities, practices, procedures and resources for implementing health management, including processes to identify root causes of poor performance, prevent recurrences, and drive continuous improvement.A Health Management System may be integrated into an Environmental, Health and Safety—and possibly also
Quality and Security—Management System or it may stand alone.
Note that nothing in this document is in conflict with OSHAS 18001/18002, which specifies the requirements for an Occupational Health and Safety Management System
(OHSMS). Such a system would typically include requirements on establishment and support for a policy, the communication of the policy, and other overarching requirements.
The elements given below concentrate solely on the implementable aspects of a Health Management System, and which
would be evidenced by characteristic activity
in the following key areas:
● health risk assessment and planning;
● industrial hygiene and control of workplace exposures;
● medical emergency management;
● management of ill-health in the workplace;
● fitness for task assessment and health surveillance;
● health impact assessment (HIA);
● health reporting and record management;
and
● public health interface and promotion of good health.
These characteristics are expanded below.
Health risk assessment and planning
Health risk assessment is generally understood to relate to ‘within the fence’ activities.
Workplace, product and environmental health hazards are identified, their risks assessed and a health plan produced for all current activities,operations and products. This takes place during the development stage of all new projects and products, prior to modifications to plant or process, and before the acquisition or divestiture of sites, leases, plant or other processes or materials, to address changing public and environmental health conditions.
The health plan addresses any risks identified,is reviewed regularly and is progressed against internally set targets.
Industrial hygiene and control of
workplace exposures.The workplace environment meets legal requirements and does not harm health.Industrial hygiene and occupational health expertise is used to assess all chemical, physical,biological, ergonomic and psychological health hazards and advise on the implementation of appropriate controls and work practices toeliminate or minimize exposures.Workplace
exposure monitoring is used to confirm ongoing effectiveness of control measures.Material storage, labelling, and safety data sheets are kept current. Employees are trained to understand the health risks, preventive measures and emergency procedures associated with their work. The workplace maintains adequate records for auditing and demonstrating compliance.
Medical emergency management. Provision is made for the management of medical emergencies associated with company operations and activities. There is a medical emergency plan based on competent medical advice and level of risk, and it is in alignment with existing local provisions. The plan is integrated into other emergency procedures,communicated effectively, and practised regularly with drills and reviews as appropriate. A process is in place to ensurethat lessons learned are acted upon as a result of drills or incidents. Appropriate response times are established for first aid, emergency medical care and evacuation, and adequate resources have been made available to meet these times. All staff are provided with emergency contact numbers for medical assistance on each work site and during travel.
Management of ill-health in the
workplace Employees have access to occupational health practitioners who can help mitigate the effects of ill-health on their ability to work effectively, including facilitating employee rehabilitation and return to work post-illness or post-injury. A system is in place to provide access to primary, secondary and emergency medical facilities as well as counselling and employee assistance where appropriate.
Fitness for task assessment and health surveillance Employees’ health status is compatible with the work that they do, and this is confirmed by assessments when necessary. There is a task check-list for different job categories, and health assessments/surveillance are performed by a competent health practitioner who has knowledge of the work to be performed. Pre-employment, pre-placement and periodic health assessments are conducted as dictated by legal requirements and by the health risksassociated with specific tasks. Wherever possible, work is adapted so that individuals are included rather than needlessly excluded from work. Health surveillance is performed where required by legislation or where the work is known to be associated with the development of a recognized health problem for which there is a valid method for testing.
Health impact assessment
Health impact assessment is generally understood to relate to ‘outside the fence’activities. HIAs are initiated during the development stage of all new projects and expansions. Baseline data are established on the
demography, community health status, air, soil and water quality prior to the start of a new project. Health impact assessors are assigned to work with social and environmental impact assessors in order to outline the range and types of hazard and potential beneficial impacts from the new project/expansion.External stakeholders are defined, and the product/project staff communicate and consult with them on a regular basis. Partnerships are developed with joint ventures, contractors and local government to create a common, costeffective approach to health management.
Health reporting and record
management
Health information on all operations and products meets legal requirements and is accurate, secure and readily available. Records are maintained on raw materials, processes, products, work locations and work duties, as well as monitoring and assessment activities such as health risk assessments, workplace and personal exposure monitoring. Significant health incidents or trends are investigated. Personal health records are retained confidentially in line with any legislation on access and data protection. Health records are retained for a minimum of 40 years after an individual leaves employment. Categories and cases of occupational ill-health are tracked and analysed on a regular basis, and form part of the routine presentation of operating, business and financial metrics to facility management. In turn, these data are aggregated to form part of the annual business planning process. Public health interface and promotion of good health
An effective interface between public health and occupational health is maintained to mitigate major business risks and identify key sources of epidemiological information.Communications are maintained with local governments and health authorities to plan timely response to major outbreaks of infectious diseases. A programme is in place to identify key employee health issues and develop programmes to educate around prevention/ harm reduction. Where appropriate these programmes extend beyond the workforce and into the community; examples might include HIV, tuberculosis, smoking, obesity, heart disease, malaria and vaccination programmesTier 2 indicators provide data to support Tier 1 indicators.
Health risk assessment and planning
● The percentage of health risk
assessments (HRAs) completed from
the total population being studied
Definition: A percentage that measures the proportion of ‘in-date’ HRAs completed against an identified need within an agreed time frame or frequency as required by written procedures and standards.
Scope: The identification of, at a given location, the number of HRAs that should be completed to assess all the relevant health risks in the workplace. Out-of-date assessments are not counted towards the total. Completed assessments are expressed as a percentage of the total required.The assessor must make a judgment on the quality of the HRA and not count any towards the total that do not adequately assess risk.
Purpose: A semi-objective measure which, over time, will allow a business to track how comprehensive the assessment of health risk in the workplace is. Quality assurance and continuous improvement can be included in the assessment process through auditing. Industrial hygiene and control of workplace exposures.
● The percentage of ‘at-risk’ people that have completed appropriate job-related health awareness, education and training programmes.
Definition: The proportion of eligible people (those identified by a HRA as being exposed to a hazard for which specific training/education is considered appropriate) who have completed the training required by company standards and procedures.
Scope: The indicator is calculated by defining the cohort (the number of people at a given location who are exposed to a hazard) and calculating the percentage that have received appropriate training.
Purpose: This indicator links an objective measure of compliance with a required control for a hazard or risk. The cohort must be specifically defined and targeted to the specific location or job hazard or risk:‘generic’ training will not usually qualify.
Medical emergency management
● Regular medical emergency drills are conducted at all locations to a defined standard.
Definition: Medical emergency drills are conducted on a defined schedule/frequency
and the performance of those drills is assessed for compliance with a pre-defined standards.
Scope: The percentage of drills that are conducted compared to the number/ frequency required by written procedures and standards.
● Percentage compliance with defined response times.
Definition: as above.
Scope: Of the drills conducted, the indicator is the percentage compliance with defined response times for a given category of medical emergency.
Management of ill-health in the
workplace
(No indicators).
Fitness for task assessment and health surveillance
● The identification of jobs/tasks with specific physical, mental and social requirements, and the process for assessing worker ability to meet requirements
with or without restriction or limitation
Definition: The proportion of individuals identified by the jobs/tasks that they do as needing a fitness-for-task assessment who have actually undergone that assessment.
Scope: The presence or absence of a system for identifying such groups, the definition of the impacted groups and the required intervention,
a process for reviewing and monitoring entry, exit and return to employment in these groups to assure fitness for task.
Purpose: An objective measure of compliance with a required control for a hazard.
● The percentage of a defined cohort of at-risk employees who have undergone health surveillance appropriate to thehazardous exposure.
Definition: The proportion of individuals identified as being potentially exposed to a health hazard who have undergone healthsurveillance.
Scope: Health surveillance is a generic term which covers procedures and investigations to assess workers’ health in order to detect and identify any abnormality. Health surveillance is appropriate where potential exposure to a workplace hazard has a known health effect and there is a validated, reproducible and measurable biological impact. Hazards include a wide spectrum of chemical, physical and biological agents which can be divided into general industry-related hazards such as noise, radiation, benzene and also locationspecific exposures such as process-related chemicals. Surveillance should be conducted when an exposure is identified or can be reasonably expected, or as required under legislation. Health assessment procedures may include, but are not limited to, medical examinations, biological monitoring, radiological
examinations, questionnaires or a
review of health records.
Purpose: This indicator requires preliminary identification of employees at risk from potentially damaging exposures in the workplace and then measures compliance with a requirement that all these employees need health surveillance on a regular basis.
Surveillance serves as a feedback loop to identify potential problem areas and the effectiveness of existing workplace preventative strategies. The results of surveillance should be used to protect and promote the health of the individual, collective health at the workplace, and the health of the exposed working population.
Health impact assessment (HIA)
● A description of health impact
assessments completed for new projects
Definition: The establishment of a system to assess the potential impact of a policy, project or company operations on the health of local communities.
Scope: The reviewer should describe the systems or programmes the company has to accomplish HIAs either as part of comprehensive impact
Purpose: This indicator requires preliminary identification of employees at risk from potentially damaging exposures in the workplace and then measures compliance with a requirement that all these employees need health surveillance on a regular basis.Surveillance serves as a feedback loop to identify potential problem areas and the effectiveness of existing workplace preventative strategies. The results of surveillance should be used to protect and promote the health of the individual, collective health at the workplace, and the health of theexposed working population.
Health impact assessment (HIA)
● A description of health impact
assessments completed for new projects
Definition: The establishment of a system to assess the potential impact of a policy, project or company operations on thehealth of local communities.
Scope: The reviewer should describe the systems or programmes the company has to accomplish HIAs either as part of comprehensive impact assessments or as freestanding assessments. The assessments should be consistent across company operations and be scalable by project size, potential risk and location. For projects, the health function should be involved during planning, engineering and construction through to start-up.
Purpose: Understanding the potential health impacts of a policy, project of change in operations upon the local community is important so that impacts can be either prevented or appropriately managed. This cannot be accomplished effectively without the early and continued dialogue with the affected community.
Health reporting and record
management
(No indicators) Public health interface and health promotion
● A description of how the company
manages the interface between employees in different locations and the public health situation in those locations
Definition: The existence of programmes and practices to understand the general health risks and experiences affecting the local workforce.
Scope: The reviewer should describe any processes and programmes the company has for identifying the general workforce health problems that are most significant in each location and approaches used to address these health problems.This indicator pertains to health problems in the workforce that are both work-related and non work-related. It may include health issues that are prevalent in the communities where businesses are located. Sources of information can include local public health officials, medical absenteeism data, health benefits data, information from company-sponsored medical clinics, health impact assessment information, knowledge of work-related incidents and summary data from employee personal health risk and wellness data.The programme to understand workforce health issues will vary widely bylocation.
Purpose: Understanding the health profile of the local workforce (e.g. frequent diagnoses, health concerns and lifestyle risks) can help to identify opportunities to improve employee and family health, employee productivity and the company’s business performance.
Communicable diseases pose a serious threat to employee health in many areas of the world in which the oil and gas industry operates. HIV/AIDS is a good example of a workforce health issue that requires special focus in some areas of the world. In other locations the primary employee health concerns may be very different, e.g. substance abuse, cardiovascular disease, obesity or automobile related injuries. Although there is no uniform approach,evaluations of potential diseases, workforce health issues and causes of lost work days can help determine the most important issues and appropriate preventative measures in each location.
● The percentage of sites at which the health concerns of employees are represented at an appropriate group, e.g. health circle, health and safety committee.
Definition: The extent to which individual and collective employee health concerns are able to be heard, discussed and acted upon by the employer.
Scope: The presence or absence of a
system to have a voice on health matters.
Purpose: Dialogue with employees is an effective method of obtaining a good understanding of opportunities for performance improvement.
This section provides data to support Tier 1 indicators.There is only one lagging indicator, in part because the emphasis should be on leading indicators, but also because the established occupational illness definitions are the only ones that meet the required criteria. Industrial hygiene and control of
workplace exposures.
● The efficient reporting of workrelated illlness Definition: Occupational illness frequency rate (OIFR), expressed per million manhours exposure.
Scope and purpose: Not defined.
Workplace manners pay: Survey
Manners maketh the businessman, with a global survey finding Americans and Britons to be the most easily insulted by lack of workplace etiquette, while Australians are among the most offensive.
The survey, by Australian-based international office space provider Servcorp, listed the top five most offensive workplace behaviors as not saying hello or good morning, not offering office guests a beverage, speaking loudly across the room, using swear words and taking calls on mobile phones. The use of stationery without permission and asking colleagues about their personal lives were also deemed insulting.
The poll revealed that the US and UK to be the most sensitive nations in the world, despite 60% of respondents believing Japan has the strictest work etiquette. English and American businessmen were also more easily offended than their colleagues in the Middle East, Japan and China, countries whose cultural traditions span centuries.
Almost 25% of Australians, however, thought it was perfectly acceptable to swear - something the majority of Japanese and Middle Easterners found offensive. Nearly all Australians polled said they would not think twice about addressing their boss by their first name, something Chinese business people found very rude.
Australians also regularly talk loudly at work, take personal calls and ask too many personal questions. "Australians are very natural in their business style, perhaps more so than any other country in the world," Taine Moufarrige, Servcorp's executive director, said, adding that the survey was commissioned to help Australians.
Human factors in HSEMS,Part-1
Human factors is the term used to describe the interaction of individuals with each other, with facilities and equipment, and with management systems. This interaction is influenced by both the working environment and the culture of the people involved. What may be a good system of work in one part of an organisation, may be found to be less than ideal in a region where culturally driven attitudes to risk taking may be significantly different.
Human factors analysis focuses on how these interactions contribute towards the creation of a safe workplace.
Traditionally, the development of Health, Safety and Environmental Management Systems (HSEMS) has concentrated on the facilities and equipment to be used and the management systems themselves. Although human error has been recognised as part of the risk contribution, the root causes associated with particular types of human error have been difficult to address.
This website is aimed at assisting line management and HSE professionals to understand how the HSEMS can incorporate human factor issues. It is an extension to the brochure Human Factors:a means of improving HSE performance which can be downloaded here. It has been produced by the OGP Human Factors working group.
Human factors
Over the past two decades, the upstream oil and gas industry has been successful in reducing incident frequency by adopting improved engineering solutions and sophisticated safety management systems.
However, safety performance has reached a plateau in many companies: despite all the money and effort being spent, there is little improvement between one year’s performance and the next.
How can we achieve further improvements in HSE performance?
Progress will come by taking better and more explicit account of the way people interact with every aspect of the workplace; in other words, incorporation of Human Factors.
We need to consider how individuals interact with each other, facilities, equipment, and management systems. All of this, in turn, has to be understood within the context of the local culture and environment.
What are the benefits of taking human factors into account?
Fewer accidents
Fewer near misses
Reduced potential for human error and its consequences
Although the focus of this brochure is on improving HSE performance, incorporating human factors into an HSE plan can also yield operational benefits, including:
Improved efficiency (increased reliability/reduced downtime)
Lower lifetime costs associated with the maintenance and re-engineering of systems
A more productive workforce
This website aims to raise the awareness of the significance of human factors in achieving improved HSE performance. It provides the basic information to determine when and how this fundamental component should be factored into HSE activities.
E&P experience with engineering, systems and behaviour
Even with the implementation of engineering controls and HSE management systems, E&P companies are still searching for ways to improve performance. Some E&P companies are implementing tools and technologies from other industries to improve efficiency, productivity, and minimize errors in the workplace. A survey of OGP members revealed that the top ten human factor issues involve systems, people, and culture. Facilities and equipment issues, whilst important, were considered less critical. This reflects the industry interest to balance systems and engineering controls with people interface issues .
Culture/Working environment
Social and Community values
Communication flow within an organisation
Acceptance and willingness for change
Language, geography, climate
Management support of safety values
Management Systems
Compatible organisational goals
Job safety analysis
Quality of operating procedures/work practices
Clear interfaces/responsibilities/accountability
Risk management
Safe working practices
Work/task design issues
Leadership
People
Fatigue and stress
Training systems
Workload and shift schedule
Behavioural safety
Physical and mental fitness
Facilities/Equipment
Ergonomics
Design
Maintenance
Reliability
Physical layout of facilities and site
Noise, lighting, toxics, radiation
What should your organisation be doing?
Would HSE performance improve if your organisation gave explicit consideration to human factors?
One way to determine whether human factor issues should be addressed directly is by assessing the HSE culture of your organisation.
Alternatively, benchmarking the performance of your organisation against others can indicate where there is room for improvement.
Incident investigations also provide another good source of data. Properly performed, they can give clear insight into potential problem areas related to human factors. Similarly, diagnosing known problem areas provides valuable information for directing future improvements.
Leadership and commitment
HSE culture is largely determined by the management’s leadership and commitment. Change for the better will not happen without these factors (see case study Developing a leader accountabilities agreement).
Assessing HSE culture
Culture has a major impact on personal HSE behaviours.
The simplest way to evaluate your organisation’s HSE culture is to discuss it with both management and workforce. Gauge their perceptions by using a recognised tool such as the five step HSE Culture Ladder.
The HSE Culture Ladder allows an organisation (or a part of an organisation) to determine where it sits on a scale of improving HSE culture.
One extreme (pathological) displays a failure and lack of willingness to recognise and/or address those issues which may result in poor safety performance.
At the other extreme (generative) safe working practices are viewed as a necessary and desirable part of any operation.
Descriptions of 20 critical HSE elements and the definitions of actions and behaviours at each level can be found.
The challenge for each organisation is to recognise its own safety culture and identify how it may be improved.
Surveying the workforce is an effective way to gather the data needed for assessment. Consider using one of the many organisations accustomed to undertaking this complex research to assist in conducting the effort.
Identifying problem areas
Several techniques can indicate potential human factors related problems. These vary from specific surveys–such as procedure violations, ergonomic problems, stress reviews–to more general surveys covering a number of issues. Some surveys will lead to improvement actions. Others confine themselves to diagnosis.
Survey tools provide a good way to identify potential areas for improvement, particularly for organisations in which there is little feedback from incidents. However, they are not in themselves immediate solutions for addressing change.
Benchmarking
Benchmarking HSE performance can provide valuable insights. This type of benchmarking can be done at the local level by comparing one installation with another. At a higher level, an organisation may compare its overall HSE performance with that of others.
There are many different types of benchmarking exercises. Safety performance data presented in the OGP report Safety Performance of the Global E&P Industry is an example of an industry-wide benchmarking excercise. At a more detailed level, you can compare the performance of individual organisations on specific tasks.
Incident investigation
Analysing the root causes of incidents (and near misses) provides a unique opportunity to gain an important insight into safety culture and identify possible problem areas.
Incident analyses generally establish the sequence of events and the primary causes. For example, the outcome of an incident investigation may be “…the incident resulted from a worker failing to secure the drill pipe in accordance with company policy”.
Your ‘solution’ may be to improve the quality of supervision for this particular type of operation. However, taking human factors into account, you may learn more by determining why the worker failed to recognise, or chose to ignore, the risk at hand. For example, is there a local company culture which promotes task completion ahead of operational safety?
A range of tools can help in structuring incident investigations to ensure that root causes are uncovered. Examples of incident investigations include TapRooT®, Tripod Beta®, Why Tree Analysis, SCAT, etc.
Well run organisations can operate for many years without a major incident. That is why it is essential to share the learnings from each incident analysis as widely as possible.
How are improvements made?
Improvements in HSE performance occur when people, culture, working environment, management systems and facilities/equipment are managed effectively together. The steps to improvement are no different from those employed within any change management system.
It is important that account is taken of the human factor issues associated with implementing any change. Two issues of particular importance are management leadership and readiness for change.
Those individuals with key responsibilities for implementing any change should receive training in human factor fundamentals and tools.
The implications of implementing a new system of work must be recognised and accepted by both the management and the workforce. There is no use telling a worker to spend more time assessing the risks associated with a particular task if the management does not make more time available, and the worker does not recognise the benefits that should result.
Planning for change
Before implementing a human factors change initiative, it is important to determine the organisation’s readiness for change.
In general, there are five stages: pre-contemplative, contemplative, preparation, action & maintenance.
Associated with each stage are certain actions that are essential to secure the proposed change. For example, if an organisation falls into the pre-contemplative category, then the strategy for change must include raising awareness of the need and benefits which will result from the change.
Initiative overload, the perception that too much is happening too soon, should be avoided. A key to success is “integrating” human factors into existing systems and processes, not trying to work it as a stand-alone independent effort.
Provide appropriate communication and training to the parties who will be implementing the change, and to those who will be affected by it.
Readiness for change Actions to secure change;
Pre-contemplative;
We don't see a problem
Raise awareness of the problem areas
Create a need in individuals
Make the outcome believable and achievable
Contemplative;
We are aware of the problem but don't know how to solve it
Provide information about success
Develop personal vision
Preparation;
We have a plan to improve Construct a feasable plan
Define measurements of success
Make everyone publicly commit to their plans
Action;
We are working to improve
Carry out the plan
Review progress
Maintenance;
We have achieved improvement and are holding on to it. Perform management review,Secure outcome
Food adulteration;
Contaminated foods and drinks are common sources of infection. Among the more common infections that one can get from contaminated foods and drinks are typhoid feverEscherichia coli infections, shigellosis or bacillary dysentery, giardiasis, cryptosporidiosis, other salmonelloses, cholera, rotavirus infections, also a variety of worm infestations. Many of the infectious diseases transmitted in food and water can also be acquired directly through the faecal-oral route.
In February this year, The Centre for Science and Environment (CSE) had challenged the bottled water industry’s claims of being ‘pure’ when its laboratory had found pesticide residues in bottled water sold in Delhi and Mumbai. Recently CSE announced that 12 soft drink brands collected for testing from in and around Delhi contained residues of four toxic pesticides and insecticides - lindane, DDT, malathion and chlorpyrifos just as it had in bottled water six months ago. The test results were as shocking as those of bottled water.
The multinational companies immediately challenged the report and indicated that they might consider legal action. In all the samples, the levels of pesticide residues far exceeded the maximum limit as set by the European Economic Commission (EEC). Each sample had enough poison to cause long-term cancer, damage to the nervous and reproductive systems, birth defects and severe disruption of the immune system. However CSE found no pesticides in tests of Coke and Pepsi soft drink brands sold in the United States. According to the centre, soft drinks in India had high pesticide residues because the soft drink and bottled water industry used an enormous amount of ground water as the basic raw material.
Food adulteration
Food adulteration is the act of intentionally debasing the quality of food offered for sale either by the admixture or substitution of inferior substances or by the removal of some valuable ingredient. Food is declared adulterated if:
a substance is added which depreciates or injuriously affects it
cheaper or inferior substances are substituted wholly or in part
any valuable or necessary constituent has been wholly or in part abstracted
it is an imitation
it is coloured or otherwise treated, to improve its appearance or if it contains any added substance injurious to health
Food-preservatives have a very extensive use, which often constitutes adulteration. Salt is the classic preservative, but is seldom classified as an adulterant. Salicylic, benzoic, and boric acids, and their sodium salts, formaldehyde, ammonium fluoride, sulphurous acid and its salts are among the principal preservatives. Many of these appear to be innocuous, but there is danger that the continued use of food preserved by these agents may be injurious. Some preservatives have been conclusively shown to be injurious when used for long periods.
Coal-tar colours are employed a great deal, pickles and canned vegetables are sometimes coloured green with copper salts; butter is made more yellow by anatta; turmeric is used in mustard and some cereal preparations. Apples are the basis for many jellies, which are coloured so as to simulate finer ones. In confectionery, dangerous colours, such as chrome yellow, prussian blue, copper and arsenic compounds are employed. Yellow and orange-coloured sweets is to be suspected. Artificial flavouring compounds are employed in the concoction of fruit syrups, especially those used for soda water. Milk is adulterated with water, and indirectly by removing the cream. The addition of water may introduce disease germs. Cream is adulterated with gelatin, and formaldehyde is employed as a preservative for it. Butter is adulterated to an enormous extent with oleomargarine, a product of beef fat. Brick dust in chilli powder, coloured chalk powder in turmeric, injectable dyes in watermelon, peas, capsicum, brinjal, papaya seeds in black pepper etc.
To avoid illness, one is advised to select foods with care. All raw food should be considered to be contaminated, particularly in areas where hygiene and sanitation are inadequate. One is advised to avoid salads, uncooked vegetables, and unpasteurised milk and milk products such as cheese, and to eat only food that has been cooked and is still hot. Undercooked and raw meat, fish, and shellfish can carry various intestinal pathogens. Cooked food that has been allowed to stand for several hours at ambient temperature can provide a fertile medium for bacterial growth and should be thoroughly reheated before serving. Consumption of food and beverages obtained from street food vendors has been associated with an increased risk of illness.
Water
Water that has been adequately chlorinated, by using the minimum recommended water treatment standard provide protection against viral and bacterial waterborne diseases. However, chlorine treatment alone, as used in the routine disinfection of water, might not kill some enteric viruses and the parasitic organisms that cause giardiasis, amoebiasis, and cryptosporidiosis. In areas where chlorinated tap water is not available or where hygiene and sanitation are poor, one is advised that only the following might be safe to drink:
Beverages, such as tea and coffee, made with boiled water
Beer and wine
The safety of canned or bottled carbonated beverages, including carbonated bottled water and soft drinks is questionable nowadays.
Where water might be contaminated, one is advised that ice should also be considered contaminated and should not be used in beverages. If ice has been in contact with containers used for drinking, one should thoroughly clean the containers, preferably with soap and hot water, after the ice has been discarded.
It is safer to drink a beverage directly from the can or bottle than from a questionable container. However, water on the outside of beverage cans or bottles might also be contaminated. Therefore, one should be advised to dry wet cans or bottles before they are opened and to wipe clean surfaces with which the mouth will have direct contact. Where water might be contaminated, one is advised to avoid brushing their teeth with tap water.
The following methods may be used for treating water to make it safe for drinking and other purposes.
Boiling
Chemical disinfection (for eg. chlorine tablets)
Water filters
Proper selection, operation, care, and maintenance of water filters are essential to producing safe water. If no source of safe drinking water is available or can be obtained, tap water that is uncomfortably hot to touch might be safer than cold tap water; however, proper disinfection, filtering, or boiling is still advised.
Human factors in HSEMS,Part-2
Management commitment drives HSE performance
An Offshore Production Operation Management Team addressed the question “How can we improve and raise our HSE performance to the next level?”
They determined that management commitment and leadership was the primary driver, generating employee involvement with shared responsibility based on open and honest communication. The result: HSE as an integral part of day-to-day business.
To accomplish this there were a number of programme and organisational changes. These included:
Highlighting HSE performance reports at quarterly employee meetings
Management attendance at all field safety meetings
Incident investigation reviews
Communicating and supporting HSE initiatives and accomplishments
Featuring HSE objectives in performance reviews for managers and supervisors
Expectation that employees would ‘shut the job down’ if conditions became unsafe.
Benefits
From 1998 to 2000, combined employee and contractor incident rates were reduced by:
71% for Total Recordable Incidents
100% for Lost Time Incidents
Enhanced savings/profits due to less property damage; reduced medical expenses, compensation/insurance costs, and legal fees; fewer replacement workers; less equipment downtime.
Improved company image and reputation.
Lessons learned
Not a quick fix/overnight exercise; progress takes years.
An integrated programme is necessary.
Senior management support for cultural change is essential for credibility and effectiveness.
Application of human factors to a new project The owners of a large-scale onshore and offshore development agreed to incorporate human factors engineering (HFE) into the base design and philosophy of a new operation.
Action
With senior management endorsement, HFE professionals helped to produce a human factors programme based on seven key principles.
Involve HFE early in the project
Assign an HFE champion Locate capability in engineering departments Base programme on accepted HFE design standards
Involve an HSE professional in appropriate tasks
Design facilities either to eliminate or minimise human error and to mitigate errors that may occur Extend influence of HFE beyond facility design
Implementation
With the approval of an “HFE champion”, work instructions outlining HFE expectations were issued to project staff. Technical staff training started immediately. HFE professionals were included as part of the engineering team.
Impact
Component rearrangements (relocation of heat exchangers, orientation and elevation of large valve components, deluge pipe simplification) comprised the majority of HFE changes. Because these rearrangements were incorporated early in the design process, their cost was minimal.
Human factors also influenced procedures development, training, labeling and signage to enable efficient and effective training.
The HFE programme introduced a number of standardised designs for the project, including a ladder design specifically covered by one of the HFE guides.
Results
Project HFE costs reflect personnel charges only. HFE driven design changes were considered design development. The original estimated cost for the HFE programme was 0.07 percent of the facilities budget. The actual HFE cost for this project was approximately half of the estimate.
Plan for improvement
A drilling organisation developed a plan to promote leadership visibility, individual accountability, and highly visible actions to improve HSE performance. This was in conjunction with roll out of a HSE Management System and specially focused contractor safety initiative.
Leadership visibility
The drilling vice president clearly communicated the emphasis on safety and that managing safety is no different from managing any other performance variable. He consistently asked about HSE within the normal course of business discussions with his team leaders. A team leader was designated as the safety champion to ensure proper data collection and analysis, to discuss HSE issues during team leader meetings, and to supervise a group of HSE professionals.
Individual accountability
The drilling vice president established safety goals to halve incidents in the first year and to achieve/maintain top quartile performance. The HSE management system spelled out roles and responsibilities for team leaders and rig supervisors, and performance reviews based on these expectations. Safety metrics were included in incentive programmes throughout the organisation.
Highly visible actions examples
Team leaders were required to report all lost time incidents to the drilling vice president. Rig supervisors, translators or specialised training were allocated to ensure work was performed safely. Common management actions included returning bids because of unacceptable safety performance on prior job, hosting an interactive safety forum for contractors with involvement by management, and suspending drilling operations when a rig experienced a high level of recordable incidents.
Benefits
Since 1998, combined incident rates for employees and contractors were reduced by 70% for lost time incidents and by 60% for total recordable incidents
Embedded HSE considerations in the business process
In 1999, moved from 4th quartile to 1st quartile in safety performance
Lessons Learned
Implement focused safety management systems with special emphasis on leadership visibility, line management accountability, and the achievement of tangible goals.
Developing a leader accountabilities agreement
To define leadership accountabilities better within an E&P technology department, a 4-member team developed an ‘Accountabilities Agreement’. The multi-functional team reviewed existing company policies/procedures and regulatory requirements and compiled all leadership accountabilities on one page. The document was then reviewed and approved by the safety and health committee.
The team then developed an implementation programme for team leaders. A manual was developed with excerpts from company policies, procedures, HSE manuals and communications to support or provide additional information on the leadership accountabilities. Team leaders attended a training session sponsored by the company leader and each team leader signed an agreement. The accountabilities are incorporated into each leader’s performance review with a specific objective related to their operations
Benefits
All team leaders, as well as employees, were able to articulate an HSE related objective for their performance review
Team leaders became visibly more active in HSE issues such as reporting, investigating and follow up on incidents
Active/timely follow up on reported HSE hazards
Increased visible support of HSE issues from leadership
Increased awareness of HSE issues specifically related to job function
Ownership of HSE issues and processes
Increased leadership in areas outside those defined on the accountabilities agreement.
Lessons learned
Use a cross-organisational team, including representatives from leadership, which promotes employee ownership
Rely on existing policies, procedures, etc. for information when compiling the accountabilities and training material
Use all members of the team to present the material to the leadership ranks (not only the HSE professional)
Keep it simple–the document is a one page agreement and the guidance manual consists of copies of excerpts from existing HSE sources.
Alcohol dependence
What is alcoholism?
Alcohol abuse is a condition in which a person drinks to the point that this habit interferes with his or her life. Alcohol dependence describes a more severe condition marked by physical symptoms and loss of control to the point, that maintaining the addiction to alcohol becomes the main focus of a person’s life. The physical dependence on alcohol is continued despite the knowledge of its harmful consequences.
Physical dependence on alcohol is continued despite the harmful consequences. There is an inability to limit the drinking despite continued efforts. The person drinks more and more alcohol to achieve a particular state of mind (colloq. 'high’). He may also drink more to lessen depressive feelings, which are worse when the person is not under the influence of alcohol. Signs of physical dependence include bodily changes, such as shakes, ‘delirium tremens’ (withdrawal symptoms), or sweats on cessation of drinking.
Alcoholism is a common illness. It is especially serious in older people, since other medical problems are made worse by alcohol.
How does it occur?
Many factors may lead to alcohol dependence. These can include genetic factors, family environment, ongoing stress and self-medication for emotional problems such as depression or anxiety and the nature of alcohol. Grief, loneliness, depression, or boredom could lead to drinking late in life.
What are the symptoms?
Alcohol dependence can manifest itself in different patterns. Drinking may range from daily excessive drinking to binge drinking. Tolerance refers to the fact that many alcoholics drink ever-larger amounts of alcohol before feeling or getting drunk. By the time one has progressed from alcohol abuse to alcohol dependence, it is necessary to consume the same to avoid withdrawal symptoms.
People who are dependent on alcohol may try to hide evidence of drinking and promise to give up the habit. They may drink stronger alcoholic beverages and have long periods of drunkenness. Alcohol dependents may have frequent episodes of blackouts – times when they do not remember what happened during the drinking episode.
Additionally, there may be problems at work (like disinterest, missing work). Interest in food is decreased. There may be mood changes (angry, irritable, violent) and personality changes (jealous, distrustful). People with alcohol dependence may scarcely care for personal or social rules. They repeatedly drive while drunk, and may hurt themselves or others. They are careless about their appearance, confused and have memory problems, losing the ability to think quickly or concentrate, and often have money problems.
Typical physical symptoms include nausea or tremors in the morning, stomach pain or ulcers, cramps or diarrhoea. They can have numbness, tingling or weakness in the hands and legs, red eyes, face, or palms. The walk may be unsteady and the person may fall frequently. Alcohol is toxic to the brain, the heart, liver, kidneys, stomach and intestines, muscles, eyes and the sexual organs. This toxicity leads to many medical problems.
How is it diagnosed?
The doctor will take a careful medical history of the symptoms including the pattern of use of alcohol. The doctor will ask about the history of using other drugs as well. Other important questions relate to the ability to function socially, work history, family history, prior and current emotional or mental problems and thoughts of suicide.
The doctor will examine to look for medical problems caused by alcohol use. Lab tests of urine and blood may be done. The most frequent and severe effects of alcoholism are problems with emotions, relationships, accidents and work, and medical problems such as cirrhosis of liver.
How is it treated?
The aim of treatment is to stop the person from drinking alcohol completely, referred to as abstinence. People who are mild alcohol abusers can stop or reduce alcohol drinking on their own. But people who have gone as far as becoming alcohol dependent must be assisted to become, and more importantly, remain abstinent. Relapse to drinking is common in the early period of recovery. The patient must be helped to limit these slips and get back to abstinence as soon as possible. Patients who are alcohol dependent may also go through a unique phase of denial – where they feel that they will be able to stop drinking whenever they want to. This prevents them from seeking professional help to sort out their problem.
Psychotherapy and social rehabilitation help in recovery. Family members should be included in the treatment program. After immediate withdrawal from alcohol (detoxification), long-term rehabilitative treatment is needed. Initially hospital based treatment followed by outpatient treatment at de-addiction clinics is required. A support program for rehabilitation plays a very important role in treatment.
Support groups like “The Alcoholics Anonymous” in India and abroad, form a key part of rehabilitation of patients with alcohol dependence. One of the most important aspects of alcohol counselling and treatment is to learn the behaviour patterns that lead to drinking. It is important to recognize these patterns and change them. Health related problems can often be controlled or prevented by stopping drinking. However, severe damage to the liver or pancreas can be long-lasting and ultimately fatal.
Driving for work
Road traffic legislation imposes specific requirements on employers in respect of vehicle use and maintenance.
But employers also have responsibility under Health and Safety legislation to ensure so far as reasonably practicable the health and safety of their employees and others who may be affected by their work activities. This includes the activity of driving on public roads.
There is a strong business case for managing work-related road safety. Fewer road incidents mean:
less days lost to injury
fewer repairs to vehicles
fewer missed orders
reduced running cost
HSE wants to achieve:
Effective management by employers of the risks from driving for work, working together with their employees.
Good partnership working between HSE and other organisations that are well placed to raise awareness of work related road risk.
A sensible and proportionate approach to the issues.
BENEFITS OF MANAGING WORK-RELATED ROAD SAFETY
The true costs of accidents to organisations are nearly always higher than just the costs of
repairs and insurance claims. The consequences of an accident on the self-employed and small businesses are likely to be proportionately greater than on a larger business with greater resources. The benefits to you from managing work-related road safety can be considerable, no matter the size of your business.
It allows you to exercise better control over costs, such as wear and tear and fuel,insurance premiums and legal fees and claims from employees and third parties.
It also allows you to make informed decisions about matters such as driver training and vehicle purchase, and helps you identify where health and safety improvements can be made.
Case studies and research have shown that benefits from managing work-related road
safety and reducing crashes include:
- fewer days lost due to injury;
- reduced risk of work-related ill health;
- reduced stress and improved morale;
- less need for investigation and paperwork;
- less lost time due to work rescheduling;
- fewer vehicles off the road for repair;
- reduced running costs through better driving standards;
- fewer missed orders and business opportunities so reduced risk of losing the goodwill of customers.
- less chance of key employees being banned from driving, eg as a result of points on their licences.
Promoting sound health and safety driving practices and a good safety culture at work may well spill over into private driving, which could reduce the chances of staff being injured in a crash outside work.
HOW TO MANAGE WORK-RELATED ROAD SAFETY
Work-related road safety can only be effectively managed if it is integrated into your arrangements for managing health and safety at work. You should look at your health and safety systems and consider whether they adequately cover this area of work. The main areas you need to address are, policy, responsibility, organisation, systems and monitoring.
Policy
Does your health and safety policy statement cover work-related road safety? Your policy should be written down if you employ five or more people.
Example: A small firm with four cars and two vans set down its policy and addressed issues
which it considered significant to their particular circumstances. These included management duties, journey organisation, driver training and vehicle maintenance.
Responsibility
Is there top-level commitment to work-related road safety in your organisation and is responsibility clearly defined? Does the person who is responsible for it have sufficient authority to exert influence and does everyone understand what is expected of them?
Organisation and structure
In larger organisations, your aim is to ensure that you have an integrated organisational structure that allows cooperation across departments with different responsibilities for work.
related road safety. In smaller businesses, your aim is to ensure you consider the links between driving activities.
Example: A council brought together expertise from its training, occupational health and safety and fleet management sections to develop and implement a work-related road safety policy.
Systems
Do you have adequate systems to allow you to manage work-related road safety effectively?
For example, are you confident that your vehicles are regularly inspected and serviced in
accordance with manufacturers’ recommendations?
Monitoring
Do you monitor performance to ensure that your work-related road safety policy is effective? Are
your employees encouraged to report all work-related road incidents without fear that punitive action will be taken against them? Do you collect sufficient information to allow you to make informed decisions about the effectiveness of existing policy and the need for changes?
Example: A company, with 330 people driving on business, quantified employee driving in terms of distance and time. The results revealed that there were 70 people significantly exposed to risk and they were targeted first.
ASSESSING RISKS ON THE ROAD
Risk assessments for any work-related driving activity should follow the same principles as
risk assessments for any other work activity. You should bear in mind that failure to properly
manage work-related road safety is more likely to endanger other people than a failure to properly manage risks in the workplace.
A risk assessment is nothing more than a careful examination of what at work activities can cause harm to people. It helps you to weigh up whether you have done enough to ensure safe working practices or should do more to prevent harm. Your risk assessment should be appropriate to the circumstances of your organisation and does not have to be over complex
or technical. It should be carried out by a competent person with a practical knowledge of the work activities being assessed. For most small businesses, and the self-employed, the hazards will be easy to identify. Employers who employ less than five people do not have to record their findings, but they may find it helpful to make some notes.
The aim is to make the risk of someone being injured or killed, as low as possible. See Five
steps to risk assessment4 for more information.
Hazard means anything that can cause harm.
Risk is the chance, high or low, that someone will be harmed by the hazard.
Steps to risk assessment
Step 1 - Look for hazards that may result in harm when driving on public roads. Remember
to ask your employees, or their representatives, what they think as they will have first hand
experience of what happens in practice. You need the views of those who drive extensively,
but also get the views of those who only use the roads occasionally. The range of hazards
will be wide and the main areas to think about are the driver, the vehicle and the journey.
See ‘Evaluating the risks’ for some suggestions.
Step 2 - Decide who might be harmed. In almost all cases this will be the driver, but it
might also include passengers, other road users and/or pedestrians. You should also consider whether there are any groups who may be particularly at risk, such as young or newly qualified drivers and those driving long distances.
Step 3 - Evaluate the risk and decide whether existing precautions are adequate or
more should be done. You need to consider how likely it is that each hazard will cause
harm. This will determine whether or not you need to do more to reduce the risk. It is likely
that some risks will remain even after all precautions are taken. What you have to decide for
each significant hazard is whether the remaining risk is acceptable. More detailed advice on evaluating the risks in each of the topic areas mentioned under.
Step 1 is given in the next
section of this guidance.
Ask yourself whether you can eliminate the hazard, eg hold a telephone or videoconference
instead of making people travel to a meeting. If not, you should think about how to control
the risk, to reduce the possibility of harm, applying the principles set out below. These should be considered in the following order, if possible:
Consider whether your policy on the allocation of company cars actively encourages employees to drive rather than consider alternative means of transport.
Consider an alternative to driving, eg going at least part of the way by train.
Try to avoid situations where employees feel under pressure, eg avoid making unrealistic claims about delivery schedules and attendance which may encourage drivers to drive too fast for the conditions, or exceed speed limits.
Organise maintenance work to reduce the risk of vehicle failure, eg ensure that maintenance schedules are in place and that vehicles are regularly checked by a competent person to ensure they are safe.
Ensure that drivers and passengers are adequately protected in the event of an incident,eg ensure that seatbelts, and where installed airbags, are correctly fitted, work properly
and are used. For those who ride motorcycles and other two-wheeled vehicles, crash helmets and protective clothing should be of the appropriate standard.
Ensure that company policy covers the important aspects of the Highway Code,1 such as not exceeding speed limits.
Step 4 - Record your findings. Employers with five or more employees are required to
record the significant findings of their risk assessment. If you have fewer than five employees.
you do not have to write anything down, though it is useful to keep a written record. You must also tell your employees about what you have done. Your risk assessment must be
suitable and sufficient. You need to be able to show that:
a proper check was made;
you consulted those who might be affected;
you dealt with all the obvious hazards.
Step 5 - Review your assessment and revise it if necessary. You will need to monitor and
review your assessment to ensure that the risks to those who drive, and others, are suitably controlled. For this to be effective you need to have a system for gathering, recording and
analysing information about road incidents. You should also record details of driver andvehicle history.
You may also need to review your assessment to take account of changing circumstances,
eg the introduction of new routes, new equipment or a change in vehicle specification. Such a review should seek the views of employees and safety representatives where appointed.
It is good practice to review your assessment from time to time to ensure that precautions
are still controlling the risks effectively.
Air bags, seats belts best protection against spine fractures
A new study has unearthed compelling evidence that combination of air bags and seat belts affords the best protection against spine Fractures sustained in motor vehicle crashes.
This research project examined the records of more than 20,000 crash victims aged 16 and older admitted to Wisconsin hospitals after car or truck crashes from 1994 to 2002
In 2007, there were over six million motor vehicle accidents in the US. Nearly 2.5 million of those accident victims were injured and more than 41,000 lost their lives.
"Motor vehicle accidents are the leading cause of spinal cord injury (SCI) in the United States for people aged 65 and younger and spine fractures are a significant cause of morbidity and mortality," said Marjorie C. Wang, of
Medical College of Wisconsin and co-author of the study.
A spine fracture is a break in one or more of the bones of the spine (vertebrae in the back or neck). Spine fractures can lead to a complete SCI, which may result in some degree of paralysis or even death. Of the 2,530 patients with spine factures analyzed in this study, 64 died in hospital.
Wang and her team analyzed the data and correlated the incidence of spine fractures with air bag and seat belt usage. Of the 29,860 motor vehicle crash hospital admissions, a data group of 20,276 drivers and front seat passengers was analyzed.
This group met the following criteria: drivers or front seat passengers age 16 or older with complete air bag/seat belt data who were not ejected from the vehicle. Key research findings include:
--Use of a seat belt and an air bag together was associated with a decreased risk of a spine fracture, including more severe fractures.
-- Only 14 percent of the drivers and front seat occupants involved in Wisconsin motor vehicle crashes between 1994 and 2002 were protected by the combination of air bags and seat belts, although this number increased from 1994 to 2002.
-- An alarming 38 percent of these crash victims were not wearing seat belts.
-- There were 2,530 spine fractures (12.5 percent) identified among the 20,276 hospital admissions: 1,067 cervical fractures, 565 thoracic fractures, and 1,034 lumbosacral fractures.
-- Use of an air bag alone was associated with an increased risk of a severe thoracic spine fracture, said a Wisconsin release.
"I commend Dr. Wang and her group for performing this extensive, labour-intensive study of motor vehicle crash victims. This research offers an invaluable assessment of air bags and seat belts to safety measures that when used together show evidence of decreasing the risk of these traumatic and often devastating injuries," said Charles H. Tator, a neurosurgeon at the University of Toronto.
These findings will appear in the February issue of Journal of Neurosurgery
Chickpeas can cure skin disease: BHU scientists
VARANASI: Chickpeas hold the cure for leucoderma, a chronic skin disease that causes loss of pigment, resulting in white spots or patches on the skin, claim scientists of the Banaras Hindu University (BHU).
In a research project undertaken jointly by the varsity's medicinal chemistry and skin departments, scientists have found that application of a poly-herbal ointment with chickpeas as its base can efficiently treat leucoderma or vitiligo, controlling the spread of the skin disease that is widely feared for the unsightly white patches it produces.
"The results were encouraging," said an elated Yamini Tripathi, a professor with BHU's medicinal chemistry department and a member of the research team, said.
The chickpea therapy has been tried on 50 patients, who got "considerable relief from the skin disorder", added Tripathi, who has now approached the Indian Council of Medical Research (ICMR) for a major research project on vitiligo treatment.
According to the researchers, patients who applied the chickpea-based cream on affected parts of the skin for 20-90 days found their normal skin pigmentation had returned.
In the fastest cure, a young scooter mechanic here saw the white patches disappear within 28 days.
"Such a speedy result surprised even us. When we asked for his feedback, he said during his treatment he included a good amount of chickpeas in his regular diet," said Tripathi.
Vitiligo is an autoimmune disease in which the body starts producing antibodies that destroy cells known as melanocytes that give the skin its normal colour. Gradually, the affected areas of the skin turn white, which is one of the most common symptoms of vitiligo.
BHU researchers say that the anti-vitiligo ointment derives its potency from amino acids found in chickpeas.
"Amino acids found in chickpeas promote synthesis of melanin (skin pigment) formation cells, regenerates the pigment cells and help in treating the chronic skin disorder," said Tripathi.
In vitiligo patients, white patches are more obvious in sun-exposed areas, including arms, legs, face and lips. Other common areas for white patches to appear are the armpits and groin, around mouth and eyes.
S.N. Ojha, a doctor who is also the member of the research team, said that at present there is no definite method to prevent vitiligo. "It is heartening that our chickpea therapy can offer a promising and cost-effective treatment," he .
Audiometry
What is audiometry?
Audiometry is a method of testing the hearing capacity of an individual. It is used to diagnose the extent of hearing loss in a person suffering from suspected hearing loss, or other disorders of the ear. Earlier, audiometry should only be used with the active cooperation and participation of the patient. However, with newer and more technology-based audiometry tests, it is now possible to test the patient objectively, i.e., without having to depend on the patients’ assessment.
What are the various types of hearing tests?
First of all is the clinical assessment of hearing: this is by the tuning fork tests: Rinne and weber test. A tuning fork (a two pronged resonating instrument which produces a sound when struck) is used next to the ear (AIR Conduction). Then is applied on the bone behind the ear. Comparing the two, and how long the sound can be heard, gives an assessment of the extent, and type of hearing loss- conductive hearing loss, due to a problem in the middle ear, or sensory neural hearing loss, due to a problem in the inner ear or the nerves. It can also pick up malingering. (Acting). Basic speech audiometry is also a clinical assessment, where the examiner says words standing six feet behind the patient, or whispers words 2 feet away and gets a subjective assessment of the hearing loss.
There are three main types of audiometrical procedures:
Pure tone audiometry
Speech audiometry
Immittance audiometry
Evoked response Audiometry
Pure tone audiometry: This procedure uses an audiometer (an instrument for recording the intensity of sound heard by the patient) to determine the extent of hearing loss. The patient is made to hear pure tones (musical or non-musical) of varying frequencies and intensities. There may be high-pitched sounds played at frequent intervals and the patients response to these are noted. The site of hearing loss can also be determined by the readings on the audiogram. They are given by air conduction by an earmuff, and by a probe put on the bone behind the ear. The patient is seated in a quiet testing chamber and made to wear earphones. Each ear is tested separately. The sounds begin with the lowest frequency that is increased till the person is able to hear the sound. The patient indicates as such by raising a hand, and the audiometer reading is noted.
Speech audiometry: The procedure being essentially the same, speech audiometry utilises human speech instead of pure tones for testing. The test measures patient’s ability to hear a sentence (sensitivity) and to distinguish intelligible speech sounds. The examiner asks the patient to repeat whatever is said to him and then determines the extent and area of hearing loss. Unlike the clinical speech- hearing assessment, a definite number of words, for a set protocol are used, and the percentage of words understood is noted, and the lowest intensity to understand a set percentage is noted. This helps in differentiating between hearing loss caused due to damage in the hearing organ, and the hearing nerve.
Immittance audiometry: Contrary to the other two procedures, this procedure measures the resistance the structures of the ear offer to incoming sound. Then sound waves enter the normal human ear, they strike the eardrum and are carried by the auditory nerves in the form of electrical impulses to the brain. The movement of the eardrum in response to pressure changes is measured but the reflection of the sound waves from the drum. In a patient with hearing loss due to malformation of the eardrum or the ossicles, (the three small bones which work as a lever mechanism), or fluid in the middle ear, these sound waves are reflected back abnormally, and are measured by the special audiometer called the electro-acoustic immittance bridge (Impedance audiometer).
Brain stem evoked audiometry (BERA):- This is a more frequently used in younger or mentally challenged children, where an assessment of hearing cannot be made otherwise. It is painless and non-invasive procedure wherein two electrodes are pasted on the skin behind the ears and any change in the nerve activity with sound stimuli is recorded. It gives some assessment of the basic level of hearing, and about defects in the nerves.
Electric Response Audiometer (ERA): Is an instrument to measure the hearing power of a child soon after birth. It measures the normal electrical signals given out by a normal inner ear and is the most painless and non- invasive method to assess that a newborn child has normal or near-normal hearing.
Air Pollution
What is air pollution?
Air pollution is a large number of gases, droplets and particles that reduce the quality of the air. Air can be polluted in both the city and the country. In the city, air pollution may be caused by cars, buses and airplanes, as well as industry and construction. Air pollution in the country may be caused by dust from tractors plowing fields, trucks and cars driving on dirt or gravel roads, rock quarries and smoke from wood and crop fires.
Ground-level ozone is the major part of air pollution in most cities. Ground-level ozone is created when engine and fuel gases already released into the air interact in the presence of sunlight. Ozone levels increase in cities when the air is still and the sun is bright and the temperature is warm. Ground-level ozone should not be confused with the "good" ozone that is miles up in the atmosphere and that protects us from radiation.
What symptoms does air pollution cause?
Air pollution can irritate the eyes, throat and lungs. Burning eyes, cough and chest tightness are common with exposure to high levels of air pollutants. However, responses to air pollution vary greatly in people. Some people may notice chest tightness or cough, while others may not notice any effects. Because exercise requires faster, deeper breathing, it may increase the symptoms. People with heart disease, such as angina, or with lung disease, such as asthma or emphysema, may be very sensitive to exposure to air pollution and may notice symptoms when others do not.
Is air pollution bad for health?
Fortunately for most healthy people, the symptoms of air pollution exposure go away as soon as the air quality improves. However, certain groups of people are more sensitive to the effects of air pollution than others. Children probably feel the effects of pollution at lower levels than adults. They also experience more illness, such as bronchitis and earaches, in areas of high pollution than in areas with cleaner air.
People with heart or lung disease also react more severely to polluted air. During times of heavy pollution, their condition may worsen to the point that they must limit their activities or even seek additional medical care. In the past, a number of deaths have been associated with severely polluted conditions.
Some of these gases can seriously and adversely affect the health of the population and should be given due attention by the concerned authority. The gases mentioned below are mainly outdoor air pollutants but some of them can and do occur indoor depending on the source and the circumstances.
Tobacco smoke: Tobacco smoke generates a wide range of harmful chemicals and is a major cause of ill health, as it is known to cause cancer, not only to the smoker but affecting passive smokers too. It is well-known that smoking affects the passive smoker (the person who is in the vicinity of a smoker and is not himself/herself a smoker) ranging from burning sensation in the eyes or nose, and throat irritation, to cancer, bronchitis, severe asthma, and a decrease in lung function.
Biological pollutants: These are mostly allergens that can cause asthma, hay fever, and other allergic diseases.
Volatile organic compounds: Volatile compounds can cause irritation of the eye, nose and throat. In severe cases there may be headaches, nausea, and loss of coordination. In the longer run, some of them are suspected to cause damage to the liver and other parts of the body.
Formaldehyde: Exposure causes irritation to the eyes, nose and may cause allergies in some people.
Lead: Prolonged exposure can cause damage to the nervous system, digestive problems, and in some cases cause cancer. It is especially hazardous to small children.
Radon: A radioactive gas that can accumulate inside the house, it originates from the rocks and soil under the house and its level is dominated by the outdoor air and also to some extent the other gases being emitted indoors. Exposure to this gas increases the risk of lung cancer.
Ozone: Exposure to this gas makes our eyes itch, burn, and water and it has also been associated with increase in respiratory disorders such as asthma. It lowers our resistance to colds and pneumonia.
Oxides of nitrogen: This gas can make children susceptible to respiratory diseases in the winters.
CO (carbon monoxide): It combines with hemoglobin to lessen the amount of oxygen that enters our blood through our lungs. The binding with other harem proteins causes changes in the function of the affected organs such as the brain and the cardiovascular system, and also the developing foots. It can impair our concentration, slow our reflexes, and make us confused and sleepy.
SO2 (sulfur dioxide): SO2 in the air is caused due to the rise in combustion of fossil fuels. It can oxidize and form sulfuric acid mist. SO2 in the air leads to diseases of the lung and other lung disorders such as wheezing and shortness of breath. Long-term effects are more difficult to ascertain as SO2 exposure is often combined with that of SPM.
SPM (suspended particulate matter): Suspended matter consists of dust, fumes, mist and smoke. The main chemical component of SPM that is of major concern is lead, others being nickel, arsenic, and those present in diesel exhaust. These particles when breathed in, lodge in our lung tissues and cause lung damage and respiratory problems. The importance of SPM as a major pollutant needs special emphasis as a) it affects more people globally than any other pollutant on a continuing basis; b) there is more monitoring data available on this than any other pollutant; and c) more epidemiological evidence has been collected on the exposure to this than to any other pollutant.
How to protect from air pollution?
people can protect themselves from the effects of air pollution by doing the following:
It is recommended to stay indoors as much during the day. Many pollutants have lower levels indoors than outdoors. One should limit outside activity to the early morning hours or wait until after sunset. This is important in high ozone conditions (as in many large cities) because sunshine drives up ozone levels. More pollution taken into the lungs in case of faster breath.
These steps will generally prevent symptoms in healthy adults and children. However, if people who live or work close to a known pollution source, or if you have a chronic heart or lung problem, talk with your doctor about other ways to deal with air pollution.
Resist industry pressure to dilute green reform: UN
NEW DELHI: Industries are pressing governments worldwide to dilute policies on climate change, but the world must not slacken the fight for a "structural shift" to a green economy, the U.N. climate panel chief said on Friday.
Calling the global economic downturn "a major distraction," R.K. Pachauri said even countries such as Germany, which was among those leading the climate change war, were under pressure.
"There is a lot of pressure from business and industry now on the leadership to see that they cut back on some of the professed commitment that they have articulated in the past," said Pachauri, the head of the Nobel Prize-winning U.N climate panel.
Many industrialized nations are shelving ambitions for the deepest cuts in greenhouse gas emissions by 2020 as economic slowdown overshadows the fight against climate change.
But, the election of Barack Obama as the new U.S. president, has tempered the gloom, Pachauri said.
For many nations, Obama's election is reason for optimism -- many U.S. allies accuse his predecessor George W. Bush of doing too little to diversify away from fossil fuels. China and the United States are the top greenhouse gas emitters.
"They are very proactive on this issue," Pachauri told a news conference.
"But it will take them a little time to sort of get all the nuts and bolts together, though I think the speed at which the new administration is moving gives you some reassurance that things will happen in the right direction."
Obama has spoken of a "planet in peril" and says he will cut U.S. emissions back to 1990 levels by 2020 -- they have risen about 14 percent since then -- followed by far deeper cuts to 80 percent of 1990 levels by 2050.
He is also pushing for massive stimulus packages that should help a shift from fossil fuels by creating "green" jobs.
Pachauri rejected suggestions that cheaper oil could undermine the move to cleaner fuel, saying record high prices in the last year have created a lasting interest in energy conservation and green fuel.
"This time around people have learnt a lesson," he said.
"Anyone who understands the oil market, the energy market would know that we shouldn't be fooled by the current lull in prices.
"Look, we can not afford to wait much longer...otherwise we are going to create problems that would become intractable and almost impossible to solve in the future
'Policy intervention needed to prevent climate change'
GANGTOK: Prime Minister's envoy on climate change Shyam Sharan underlined the "urgent" need for a policy intervention aimed at safeguarding the ecology and climate in the country.
"There is an urgent need for policy intervention to prevent degradation of ecology in the country in general and the Himalayan states in particular," he said, following an interactive meeting with top officials of various state departments here.
"Such a policy intervention should put into place a comprehensive approach to prevent the climate change," Sharan, who recently visited Himalayan states like Jammu and Kashmir, Himachal Pradesh and Uttarakhand to get feedback on the ground reality of ecological conditions said.
Sharan, who was briefed about the impact of global warming on the glaciers and snow-capped mountains in Sikkim, said the states falling under the Himalayan mountain range have witnessed adverse impact of global warming and should adopt common approach for carrying out development works in an environmentally sustainable manner.
World Leprosy Day 2009
World Leprosy Day is celebrated on the last Sunday of January every year. This year it falls on 25 January 2009. The main objective of celebrating the day is to increase public awareness about the disease and bring out a feeling of solidarity towards the people suffering from this discriminating disease. The central theme of the day is to seek the cure for the disease in leprosy endemic regions. It also enables the lepers to live a life with dignity in the society. A holistic approach that ensures a smooth integration of the leprosy victims with the society forms the tenet of every World Leprosy Day.
Leprosy is widely regarded as a curse because it deforms the face and body of the sufferer. It affects the skin and nerves mainly and if the disease is left untreated, there can be a progressive and permanent damage to the nerves, skin, limbs and eyes.
It is a highly infectious disease and can be transmitted through droplets from nose and mouth during the frequent contact with untreated cases. Due to this, people suffering with leprosy have to face criticism and are subjected to stringent treatment even in recent times. They are required to wear a special kind of dress and carry a prop to warn the other people that are on the move; they are also not allowed to visit public places like markets, temples or other crowded places.
With the development of multi-drug therapy (MDT), recommended by WHO, the treatment of leprosy has become easy. Widespread use of these drugs results in the resistance of the disease. It has become a curable disease now provided the treatment is provided in the early stages. It can protect the leper from disability.
Globally, the prevalence rate of new cases have come down by 4% compared to the previous year and many countries have registered themselves in the list of complete eradicated region of leprosy. In India, 1,37,685 new cases of leprosy were reported in 2007, including 47, 537 women, 12,976 children, 3, 477 with grade 2 disability and 64, 980 multibacillary leprosy. However, these figures are quite less than the previous years’ figure, which was 1,39,252 in 2006. The figures have shown some improvement in eradication of the disease but the numbers are still high. The effective implementation of MDT therapy in the uncovered areas, early recognition of nerve damage and management of relapse following short-term MDT represents some of the challenges that have to be overcome to ensure the complete eradication of the leprosy. People need to be informed and more aware about the disease and its cure.
Various NGOs and the government have launched many preventive and curative programmes to help the people in controlling the disease. The need for information campaigns about leprosy in the high-risk areas has become crucial so that the patients and their families and their communities can come up and receive the treatment.
People need to be encouraged to take the treatment as it can protect the coming generation from the threat of this highly infectious disease. The most effective way of preventing disabilities in leprosy, as well as preventing further transmission of the disease, lies in the early diagnosis and treatment.
Steps to eradicate leprosy
Political support needs to be sustained in the remote areas where leprosy remains a public health problem.
Full integration to reach out to every patient of leprosy, the treatment should be made fully integrated into the general health services. This is a key to successful elimination of the disease.
Support groups and NGOs need to continue to ensure that human and financial resources are made available for the elimination of leprosy.
The age-old stigma associated with the disease remains an obstacle to self-reporting and early treatment. The opinion about leprosy has to be changed at the global, national and local levels. There is a need for new environment where the patient can feel free to come forward for the diagnosis and treatment.
The government should ensure the uninterrupted availability of multi-drug therapy services to all patients through flexible and friendly drug delivery system.
US becomes top wind producer, solar next
The United States overtook Germany as the biggest producer of wind power last year, new figures showed, and will likely take the lead in solar power this year, analysts said on Monday.
Even before an expected "Obama bounce" from a new President who has vowed to boost clean energy, US wind power capacity surged 50% last year to 25 gigwatts (GW) -- enough to power more than five million homes.
Political and business leaders worldwide have urged "green growth" spending on clean energy to fight both recession and climate change. German wind power capacity reached nearly 24 GW, placing it second ahead of Spain and fourth-placed China, which doubled its installed wind power for the forth year running, said the Brussels-based Global Wind Energy Council.
"Governments must send a strong and unequivocal signal that the age of fossil fuels is over," said Steve Sawyer, secretary general of GWEC. Global wind power production reached 121 GW at the end of 2008, growing by about 29 percent.
New US wind projects accounted for about 42 percent of the country's total new power-producing capacity added last year, GWEC said, underlining its challenge to more traditional forms of power generation, including coal and natural gas.
The wind sector is now suffering from a financial crisis which has dried up project finance and a sharp fall in oil prices which has weakened its competitiveness compared to gas, but it is aided by subsidies such as a guaranteed price premium in Germany and Spain. Spanish wind power business group AEE said on Monday that it expected similar growth in 2009 as last year.
The US Senate Finance Committee last week approved some $31 billion in tax breaks and other incentives to boost alternative energy supplies and efficiency as part of the Obama administration's much bigger US economic stimulus plan.
Obama wants to double US alternative energy output over three years. The United States is also expected to overtake Germany this year as the world's biggest producer of solar power, aided by its far sunnier climate, Jefferies analyst Michael McNamara told Reuters on Monday. European Union leaders agreed at the end of last year that the bloc should get a fifth of all its energy from renewable sources by 2020 compared with about 10 percent now.
Managing skin exposure risks at work Part-1
Many materials used at work can affect the skin or can pass through the skin and cause diseases elsewhere in the body. If you are an employer, health and safety adviser, trainer or safety representative, this book provides practical advice to help you prevent these disabling diseases.
It covers:
the protective role of the skin,
ill health arising from skin exposure, recognising potential skin exposure in your workplace,
and managing skin exposure to prevent disease.
Many employers don't realise they have legal duties to assess the health risks from skin exposure to hazardous substances at work. This book can help you comply with those duties by preventing or controlling exposure to the hazards by using and maintaining suitable controls.
There is advice on assessing and managing risks, reducing contact with harmful materials, choosing the right protective equipment and skin care products, and checking for early signs of skin disease.
Causes of skin disease Part2
There are many reasons why skin diseases can occur and several different types of disorder can affect people at work. This part of the site is aimed at health service and health and safety professionals. It provides a detailed explanation of the structure and functions of the skin.It should also give people a better chance of understanding the causes of skin disease.
Most work-related skin diseases are contact dermatitis[3] and have been caused by contact with an external agent.
However, external agents are also involved in an important minority of other work-related skin diseases.
These include:
contact urticaria
acnes
cancers
leucoderma (vitilgo)
skin infections
Google helps consumers reduce energy usage
LOGoogle Inc said it would use its software skills to help consumers trac;k their home energy usage and thereby lower demand and the
global warming emissions that come from producing electricity.
The move is part of Google's effort to pump hundreds of millions of dollars into renewable energy, electricity-grid upgrades and other measures that will reduce greenhouse gas emissions.
The company has already invested in several fledgling solar, wind and geothermal companies, as well as two "smart grid" companies. Smart grid describes a more efficient, less costly method of moving electricity along long-distance transmission lines to local power lines and end-users in homes and businesses.
On its official company blog, Google said it is developing a smart grid tool called Google PowerMeter that will show home energy consumption almost in real time on a user's computer. The company cited studies showing that access to home energy information typically saves between 5 percent and 15 percent on monthly electricity bills.
"It may not sound like much, but if half of America's households cut their energy demand by 10 percent, it would be the equivalent of taking eight million cars off the road," Google said. Google PowerMeter is currently being tested by employees and is not yet available to the public.
The company hopes to develop partnerships with utilities so it can roll PowerMeter out to consumers in the next few months, spokeswoman Niki Fenwick said. Google's investments in smart grid companies include Germantown, Maryland-based Current Group and Redwood City, California-based Silver Spring Networks.
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