السلامة والصحة المهنية
شعبة المعاونين الصحيين
Occupational safety and health:
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or workplace health and safety (WHS), is a multidisciplinary field concerned with the safety, health, and welfare of people at work.
The goals of occupational safety and health programs include to foster a safe and healthy work environment. OSH may also protect co-workers, family members, employers, customers, and many others who might be affected by the workplace environment.
As defined by the World Health Organization (WHO) "occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards.
" Health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
Objectives of occupational health:
"The main focus in occupational health is on three different objectives:
(i) the maintenance and promotion of workers’ health and working capacity;
(ii) the improvement of working environment and work to become conducive to safety and health and
(iii) development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity of the undertakings.
"Occupational health should aim at:
1) the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations;
2) the prevention amongst workers of departures from health caused by their working conditions;
3) the protection of workers in their employment from risks resulting from factors adverse to health;
4) the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities; and,
5) to summarize, the adaptation of work to man and of each man to his job.
The research and regulation of occupational safety and health are a relatively recent phenomenon. As labor movements arose in response to worker concerns in the wake of the industrial revolution, worker's health entered consideration as a labor-related issue.
In the United Kingdom, the Factory Acts of the early nineteenth century (from 1802 onwards) arose out of concerns about the poor health of children working in cotton mills: the Act of 1833 created a dedicated professional Factory Inspectorate. The initial remit of the Inspectorate was to police restrictions on the working hours in the textile industry of children and young persons (introduced to prevent chronic overwork, identified as leading directly to ill-health and deformation, and indirectly to a high accident rate). However, on the urging of the Factory Inspectorate, a further Act in 1844 giving similar restrictions on working hours for women in the textile industry introduced a requirement for machinery guarding (but only in the textile industry, and only in areas that might be accessed by women or children).
In 1840 a Royal Commission published its findings on the state of conditions for the workers of the mining industry that documented the appallingly dangerous environment that they had to work in and the high frequency of accidents. The commission sparked public outrage which resulted in the Mines Act of 1842. The act set up an inspectorate for mines and collieries which resulted in many prosecutions and safety improvements, and by 1850, inspectors were able to enter and inspect premises at their discretion.
Otto von Bismarck inaugurated the first social insurance legislation in 1883 and the first worker's compensation law in 1884 – the first of their kind in the Western world. Similar acts followed in other countries, partly in response to labor unrest.
Although work provides many economic and other benefits, a wide array of workplace hazards also present risks to the health and safety of people at work. These include but are not limited to, "chemicals, biological agents, physical factors, adverse ergonomic conditions, allergens, a complex network of safety risks," and a broad range of psychosocial risk factors. Personal protective equipment can help protect against many of these hazards.
Physical hazards affect many people in the workplace. Occupational hearing loss is the most common work-related injury in the United States, with 22 million workers exposed to hazardous noise levels at work and an estimated $242 million spent annually on worker's compensation for hearing loss disability.
Falls are also a common cause of occupational injuries and fatalities, especially in construction, extraction, transportation, healthcare, and building cleaning and maintenance.
Biological hazards (biohazards) include infectious microorganisms such as viruses and toxins produced by those organisms such as anthrax. Biohazards affect workers in many industries; influenza, for example, affects a broad population of workers. Outdoor workers, including farmers, landscapers, and construction workers, risk exposure to numerous biohazards, including animal bites and stings, urushiol from poisonous plants, and diseases transmitted through animals such as the West Nile virus and Lyme disease. Health care workers, including veterinary health workers, risk exposure to blood-borne pathogens and various infectious diseases, especially those that are emerging.
Dangerous chemicals can pose a chemical hazard in the workplace. There are many classifications of hazardous chemicals, including neurotoxins, immune agents, dermatologic agents, carcinogens, reproductive toxins, systemic toxins, asthmagens, pneumoconiotic agents, and sensitizers. Authorities such as regulatory agencies set occupational exposure limits to mitigate the risk of chemical hazards. An international effort is investigating the health effects of mixtures of chemicals. There is some evidence that certain chemicals are harmful at lower levels when mixed with one or more other chemicals. This may be particularly important in causing cancer.
Psychosocial hazards include risks to the mental and emotional well-being of workers, such as feelings of job insecurity, long work hours, and poor work-life balance. A recent Cochrane review - using moderate quality evidence - related that the addition of work-directed interventions for depressed workers receiving clinical interventions reduces the number of lost work days as compared to clinical interventions alone. This review also demonstrated that the addition of cognitive behavioral therapy to primary or occupational care and the addition of a "structured telephone outreach and care management program" to usual care are both effective at reducing sick leave days.
Identifying safety and health hazards:
Hazards, risks, outcomes:
The terminology used in OSH varies between countries, 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 could be a musculoskeletal disorder (MSD) or an acute back or joint injury. The risk can be expressed numerically (e.g. a 0.5 or 50/50 chance of the outcome occurring during a year), in relative terms (e.g. "high/medium/low"), or with a multi-dimensional classification scheme (e.g. situation-specific risks).
Hazard identification or assessment is an important step in the overall risk assessment and risk management process. It is where individual work hazards are identified, assessed and controlled/eliminated as close to source (location of the hazard) as reasonably as possible. As technology, resources, social expectation or regulatory requirements change, hazard analysis focuses controls more closely toward the source of the hazard. Thus hazard control is a dynamic program of prevention. Hazard-based programs also have the advantage of not assigning or implying there are "acceptable risks" in the workplace. A hazard-based program may not be able to eliminate all risks, but neither does it accept "satisfactory" – but still risky – outcomes. And as those who calculate and manage the risk are usually managers while those exposed to the risks are a different group, workers, a hazard-based approach can by-pass conflict inherent in a risk-based approach.
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 prioritize appropriate control measures.
The calculation of risk is based on the likelihood or probability of the harm being realized 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 if 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.
Global strategy on occupational health for all: The way to health at work:
The 10 priority objectives proposed by the strategy on occupational health for all are as follows:
- Strengthening of international and national policies for health at work and developing the necessary policy tools.
- Development of healthy work environment.
- Development of healthy work practices and promotion of health at work.
- Strengthening of occupational health services (OHS).
- Establishment of support services for occupational health.
- Development of occupational health standards based on scientific risk assessment.
- Development of human resources for occupational health.
- Establishment of registration and data systems, development of information services for experts, effective transmission of data and raising of public awareness through public information.
- Strengthening of research.
- Development of collaboration in occupational health and with other activities and services.
A national programme for developing occupational health should include:
- Updating of legislation and standards.
- Definition and, if needed, strengthening of the role of the competent authority.
- Emphasis on the primary responsibility of the employer for health and safety at work.
- Establishment of mechanisms for tripartite collaboration between government, employers and trade unions for implementation of national occupational health programmes.
- Education, training and information of experts, employers and workers.
- Development of occupational health services.
- Analytical and advisory services.
- Development and, if needed, establishment of registration systems of occupational accidents, diseases and, if possible, exposures.
- Action to ensure collaboration between employers and workers at workplace and enterprise level.
Principles of occupational health and safety:
- Protection and promotion of the health of workers by preventing and controlling occupational diseases and accidents and by eliminating occupational factors and conditions hazardous to health and safety at work.
- Development and promotion of healthy and safe work, work environments and work organizations.
- Enhancement of physical, mental and social well-being of workers and support for the development and maintenance of their working capacity, as well as professional and social development at work.
- Enablement of workers to conduct socially and economically productive lives and to contribute positively to sustainable development.
The key strategy principles of international and national occupational health and safety policies are:
- Avoidance of hazards (primary prevention).
- Safe technology.
- Optimization of working conditions.
- Integration of production and health and safety activities.
- Government’s responsibility, authority and competence in the development and control of working conditions.
- Primary responsibility of the employer and entrepreneur for health and safety at the workplace.
- Recognition of employees’ own interest in occupational health and safety.
- Cooperation and collaboration on an equal basis by employers and workers.
- Right to participate in decisions concerning one’s own work.
- Right to know and principle of transparency.
- Continuous follow-up and development of occupational health and safety.
Occupational and work-related diseases:
An “occupational disease” is any disease contracted primarily as a result of an exposure to risk factors arising from work activity. “Work-related diseases” have multiple causes, where factors in the work environment may play a role, together with other risk factors, in the development of such diseases.
An occupational disease is any chronic ailment that occurs as a result of work or occupational activity. It is an aspect of occupational safety and health. An occupational disease is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations. The first such disease to be recognised, squamous-cell carcinoma of the scrotum, was identified in chimney sweep boys by Sir Percival Pott in 1775. Occupational hazards that are of a traumatic nature (such as falls by roofers) are not considered to be occupational diseases.
Occupational lung diseases include asbestosis among asbestos miners and those who work with friable asbestos insulation, as well as black lung (coalworker's pneumoconiosis) among coal miners, silicosis among miners and quarrying and tunnel operators and byssinosis among workers in parts of the cotton textile industry.
Bad indoor air quality may predispose for diseases in the lungs as well as in other parts of the body.
Occupational skin diseases are ranked among the top five occupational diseases in many countries.
Occupational skin diseases and conditions are generally caused by chemicals and having wet hands for long periods while at work. Eczema is by far the most common, but urticaria, sunburn and skin cancer are also of concern.
Contact dermatitis due to irritation is inflammation of the skin which results from a contact with an irritant. It has been observed that this type of dermatitis does not require prior sensitization of the immune system. There have been studies to support that past or present atopic dermatitis is a risk factor for this type of dermatitis. Common irritants include detergents, acids, alkalies, oils, organic solvents and reducing agents.
Another occupational skin disease is Glove related hand urticaria. It has been reported as an occupational problem among the health care workers.
High-risk occupations include:
- Hair dressing.
- Metal machining.
- Motor vehicle repair.