Welcome to the April 2011 OH&S Newsletter
This month sees Workers Memorial Day on the 28th & we focus on targeted risk control especially for occupational health looking at better matching to risk; injuries & risk, depression & noise; masseuses, musculoskeletal disorders & biomechanical risks; occupational skin, biological and chemical risks & stress; dust diseases, fatigue and long hours. Enjoy!
Is it health promotion we need in workplaces or better assessment of occupational risk?
Much work has been published in the last few years about the need to improve health and fitness levels in the workforce. There is no doubt that if we have a fitter and healthier working population that we may have improved capacities to meet what our job demands. The problem is that most health and wellbeing programs are highly generalised, voluntary and if goal achievement is not linked to employee benefits such medical insurance provision they have minimal benefit in altering the sustainable health outcomes for the individual. In other words the people who get involved in health and well-being programs in workplaces are the ones who would get involved in such activities even if they weren’t provided by the employer.
There is no doubt that a proportion of injuries such as strain and sprain injuries could be minmised if we were fitter and stronger but rarely do employers actually identify the capacities required to complete jobs until after a compensable injury/illness occurs. Pre-existing injuries may be given careful consideration to assess an individual’s injury risk but rarely is that well linked to the actual task requirements or the injury risk of tasks. In some industries where such an assessment is conducted they are often not repeated due to cost so a fire officer may need to demonstrate their specific physical and cognitive capacities for the job at 18 when joining their occupation but may not be required to do that again until they have been injured or made ill by work.
It has become apparent that perhaps we have been looking at this the wrong way. Perhaps we should be assessing lifestyle risks which may affect our ability to complete a role or our work risks that impact on our lifestyle risks & then in turn our work risks. This vicious circle has been focused on in this newsletter with articles which look at the multifactorial nature of our injury and illness risks ranging from the link between hearing loss and depression to disturbed sleep cycles and lack of awareness of sleep apnea symptoms in commercial drivers.
In other cases it may be our work that is creating the disease risk with long work hours affecting our ability to exercise and eat well which can in turn increase our cardiovascular risk and we have a heart attack or we end up getting fatter. This is something that is seen with mobile plant operators in the mining industry as we move to longer shifts for those who may sit on vibrating machinery for greater periods of time then drive home with little time left to eat and sleep let alone exercise. We have lost all the incidental exercise that may be achieved at work by increasing exposure to sitting/driving activities and there is minimal exposure to healthy food. So our operator gets fatter, eats less well, becomes at increased risk of fatigue, sleep apnea, diabetes and CV disease. While this happens he becomes depressed due to his inability to lose weight even though he may feel unhealthy.
So is it the work or the lifestyle that is making us ill or injuring our back? Perhaps our focus needs to be what are the capacities required for specific jobs and what are the factors that the employer has control over. Do we need to determine pre-existing lifestyle risks and how these can be managed? It is interesting that the way many organisations deal with this is to offer morning exercises, or fruit at morning tea but we do a poor job at matching the specific control with the actual risk of the job. An example of this are the workers in highly manual industries in Asia performing morning aerobic exercises and then going onto work in a physically demanding aerobic jobs where we should be giving them work breaks to allow their bodies to recover from the aerobic demand. Another would be Australian office workers doing little but sitting all day, having access to biscuits and sugar filled vending machines and no access to stairways to move between floors. Where the work is affecting our lifestyle risk this perhaps need to be better analysed and managed.
It isn’t rocket science but we still have difficulty matching control approaches to the actua l risk. Particularly with occupational health, noise control being a great example of our continued focus on PPE to control noise. Another example in this newsletter is exposure to isocyanates by a driver in an open cabin vehicle when the product could have more safely been applied using a different method. It seems that most employers have lost the art of identifying the specific hazards associated with specific roles and then ensuring conditions will allow the best possible match between the controls and the risk. Can we look more closely at how we organise our work tasks to minimise injury/illness risk exposure- how long is someone performing that higher risk job for? Can we minimise that exposure risk?
Big players finally recognising that low injury rates don’t equal low risk!
An increased focus on risk management and compliance has helped miner Rio Tinto reduce its all injury frequency rate (AIFR) by 18% in a year, according to its 2010 annual report. It also reduced the rate of new cases of occupational illness/10,000 employees by 56% compared with 2008. However, it failed to achieve a reduction in the rate of employees exposed to an eight hour noise dose of more than 85 decibels.
Rio, which employs 77,000 people in more than 40 countries, says in the report the AIFR includes medical treatment cases, restricted work day and lost day injuries for employees and contractors. In 2008, its AIFR/200,000 hours worked was 0.95. It dropped to 0.81 in 2009 and fell further to 0.66 in 2010, the report says. It is interesting however that RIO chooses to record this amount in 200000 hrs. worked rather than the million hours other use- it does make comparison a little interesting and as you can see by reporting in this figure the ratio does seem slightly lower than the 3.3 most other organisations would report this as.
There were also 3 deaths in Rio managed facilities. One of the fatalities involved a fall from height, another was the result of an electric shock, and the third involved a worker who was struck by a falling object. In 2010 Rio's annual chief executive safety award went to the ISAL aluminium smelter in Iceland for 4.7 million hours worked without a lost time injury. However, the report stresses that lowinjury rates "do not mean that serious incidents will not occur". How well does you organisation recognise this issue in terms of remuneration rewards? Perhaps effective risk reduction strategies rather than AIFR would be a better measure of performance? What are you KPI’s for health and safety performance and do they really reflect the effectiveness of your risk management for both high and low consequence outcomes?
Perhaps RIO should pay more attention to their noise dose hearing reduction strategies
Australian researchers have found an association between low frequency hearing loss, poor balance & anxiety & depression among workers exposed to noise.
The study, led by University of Newcastle researcher Maya Guest, assessed more than 3000 Royal Australian Air Force workers including F-111 aircraft maintenance workers, who had an increased risk of hearing loss due to increased noise and solvent exposure. Clinical examinations and surveys found workers with low-frequency hearing loss also had lower functional reach (signifying poorer balance). The association did not, however, apply to workers with high-frequency hearing loss. The connection between hearing loss and balance is consistent with statistics that show noise-induced hearing loss is the most common occupational disease in Australia, while slips, trips and falls are the most commonly reported accidents, the researchers say.
The results also showed a significant correlation between poor hearing and balance, and depression and anxiety. The researchers say this finding was unexpected. What type of hearing loss occurs in your workplace and is it also affecting the balance or mood of your personnel?
Guest M et al: An Observed Relationship Between Vestibular Function & Auditory Thresholds in Aircraft-Maintenance Workers. J Occ Env Med, 53 (2) 2011.
Noise also an issue for WA employers
A WA WorkSafe inspection program on noise management has revealed that noise remains a widespread hazard in WA workplaces. Noise-induced hearing loss is responsible for a significant number of workers’ compensation claims in WA, a total of 81 in 2007/08. Inspectors visited workplaces in the metropolitan area and the Bunbury and Karratha regions last year, identifying potential noise hazards in almost a third of the 94 workplaces visited. Of the workplaces in which noise hazards were found, 30% were in the construction sector and 27% in manufacturing, with the remainder spread over 8 industry sectors: services, local government, mining services, transport, agriculture, education, retail and wholesale.
Ten improvement notices were issued to workplaces where inadequate controls or poor management procedures were in place. The most common problem inspectors found was that many employers had not had the risk adequately assessed by a competent person, and so had no basis for formulating an effective noise control and management program. In other workplaces, although the noise hazards had been identified, the only action taken was the provision of personal hearing protectors. Other areas of concern were the lack of noise-related information and training to workers and their managers, and the failure to provide annual hearing tests.
Depression and sexual harassment
A Tasmanian apprentice who suffered depression after being sexually harassed by his male manager, in a workplace where "banter and horseplay" were common, has been awarded $8000 in damages. The teenage apprentice chef, who weighed just 45kg, told the Tasmanian Anti-Discrimination Tribunal that in his 8 months at Lucks Restaurant in Launceston the manager regularly lifted him up, touched him on the bottom, showed him his genitals & made sexually explicit comments, including threats to anally penetrate him and his mother. It eventually "became too much" for the apprentice and he resigned, before seeking counselling for depression, self-harming, binge drinking and suicidal ideation. The apprentice had been targeted more often than others because of his size. If this type of harassment is to be stamped out in workplaces a greater cultural change in our ommunity is required on acceptable and non-acceptable behaviour.
Masseuses providing our travel relaxation need to watch out for RSI !
Two former beauty therapists who developed repetitive strain injuries (RSI) through giving massages to air travellers have won a total of £300,430 damages from Virgin Atlantic. Jayne Evans and Michelle Hindmarch worked in the Clubhouse Lounge at Heathrow, giving frequent prolonged treatments, until they developed pain in their wrists, shoulders and backs. The court was told the problem was caused by working over-long shifts, and by using Shiatsu pressure-point techniques with heavy pressure and at fast pace. There were insufficient breaks between therapy sessions and that the main determinant of work pressure was flight scheduling. Both women had to give up their careers, for which they had trained since they left school, and find other work. They also now need help with daily tasks around their homes. Virgin Atlantic Airways Ltd accepted liability but disputed the amount of compensation due.
Mrs Evans, 40, was awarded £230,972 by Judge McKenna at London's High Court. He said she was entitled to consider she had achieved professional success in her chosen field but now had less congenial & well-paid clerical work in the airline's cargo division. Mrs Hindmarch, 32, who quickly found better-paid work in a different field, was awarded £69,458. The judge said she was 'a woman of determination and fortitude who was making the best of her situation' and dismissed a suggestion that she was exaggerating her symptoms. How often do you think personnel suffer injuries for our relaxation? Do you ever ask about their health and safety practices?
Musculoskeletal pain (MCP) & hand held mobile devices
In work funded by the Office Ergonomics Research Committee (OERC), Canadian researchers performed an epidemiological study to investigate the prevalence f upper body MCP in mobile device users. In their introduction, they note that there are case reports and laboratory studies that suggest a link between musculoskeletal disorders (MSDs) & hand-held mobile devices, but this is the first epidemiological study, and the first to provide empirical evidence of relationships between mobile device use & symptoms of the upper extremity and neck.
Specifically, case reports have suggested a link between device use and both De Quervain's tenosynovitis and osteoarthritis at the base of the thumb (carpometacarpal joint), and laboratory studies have shown that smaller keyboards (as compared to desktop or laptop computers) may increase "static strain" on the hand and arm muscles. Lab studies have also demonstrated that user thumb postures approach their maximum range of motion while the thumb moves over the keyboard interface while, for example, texting, increasing static loading on the thumb muscles.
The results showed a consistent relationship between mobile device use and pain in the shoulders and neck; total time spent using a mobile device on a typical day was significantly associated with any pain reported in the left shoulder, the right shoulder, and the neck. Participants used such devices for a mean time of 4.65 hrs/day (though the standard deviation (SD) was 5.67 hrs/day, indicating substantial variations in time using such devices). How long are your employees using these devices for and what is their level of pain?
Berolo, S., et al Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: A preliminary study in a Canadian university population, Applied Ergonomics, 42(2):371-378 2011.
Almost our whole workforce is exposed to some biomechanical risks that could result in injury/illness
Injuries/illness caused by biomechanical demands (BD), such as repetitive hand movements or heavy lifting, cost Australian business $361 million a year in compensation payments & 99% of employees are at risk, according to new Safe Work Australia research. The National Hazard Exposure Worker Surveillance (NHEWS), surveyed 4500 workers across all industries, and says the reporting of pain & fatigue symptoms is "highly related" to the BD of a worker's job.
BD contribute to the development or aggravation of inflammatory or degenerative musculoskeletal disorders, which are some of the leading causes of morbidity & disability worldwide. About 80% of surveyed workers said they experienced fatigue and more than half reported pain as a result of work-related BD. More than 99% of workers reported exposure to at least one of the nine identified BD, and 22% were deemed to have high overall exposure. One in five workers had jobs that involved all nine demands, which are: lifting or carrying heavy loads; repetitive hand or arm movements; working with the body bent forward; working in twisted or awkward posture; working with the hands raised above the head; working while sitting down; squatting or kneeling while working; pushing or pulling using some force; and working while standing in one place.
Workplaces that were large, and where employees faced high overall exposure, were most likely to implement controls, such as lifting equipment and trolleys; changing the layout of the job; changing the size and shape of loads; and manual handling training, the report says. How well do you manage these risks at your workplace, are your controls working to reduce risk or are you just waiting for incidents to tell you that your strategies may not be effective?
Occupational skin & biological hazard disorders
Reports on occupational skin diseases and exposure to biological hazards, also based on the National Hazard Exposure Worker Surveillance (NHEWS), have also been released by Safe Work Australia
One of the main risk factors for occupational skin diseases is work that exposes an employee's hands to liquids, either through frequent hand washing or immersion of the hands in liquid, the wet work exposure report says. Nearly one in 10 surveyed workers said they washed their hands more than 20 times a day, and nearly 5% said their hands were immersed in liquid for more than two hours a day. Workers in health and community services or hospitality were most likely to encounter wet work, and exposure often involved chemicals, such as disinfectants. Time restriction, the most effective wet work exposure control, was reported as a control measure by only 32% of exposed workers, but provision of gloves was reported by 75% of workers.
According to the biological hazards report, communicable diseases caused by work-related exposure to biological hazards cause an estimated 320,000 deaths worldwide each year. Nearly 20% of workers reported biological materials in their workplace. Most exposed employees worked in health and community services or the agriculture, forestry and fishing sector. Provision of controls such as PPE, labelling and warning signs, safety cabinets, safe handling training and ventilation systems was relatively low for workers in contact with animals and animal products. How well do you protect against occupational skin and biological hazards or are you waiting for an incident to indicate inadequacy?
Wrong equipment choice ensures hazardous chemical exposure
An international utilities company has been fined after an agency worker suffered skin problems caused by prolonged exposure to a hazardous chemical. Laing O'Rourke Utilities Ltd was prosecuted by the Health and Safety Executive (HSE) after Peter Johnson, suffered sore skin around his face after several weeks of exposure to isocyanate between July and August 2007.
The chemical is the second largest cause of occupational asthma, and can also cause conjunctivitis, dermatitis, bronchitis and rhinitis. Mr Johnson was exposed while repainting joints along a raised gas pipeline. He was driving an open-cabbed vehicle with an attached sprayer which was spraying paint containing isocyanate. The Magistrates' Court heard how Laing O'Rourke Utilities had failed to protect Mr Johnson by ensuring exposure to isocyanate was prevented or adequately controlled. The open cab meant Mr Johnson was periodically exposed to the paint aerosol as it was being sprayed. The company failed to provide him with proper protective equipment, and so he was likely to have been exposed to up to 10 times the workplace exposure limit for isocyanate.
When his skin started to feel sore, Mr Johnson filed a complaint with HSE, which then launched its investigation. He has since been referred to a dermatologist and continues to receive treatment. Although the type of work meant there was no alternative to the type of paint being used, it could have been applied with a brush, instead of by spray gun, thereby removing the risk of exposing Mr Johnson to an air contaminant containing isocyanate. Laing O'Rourke Utilities Ltd pleaded guilty to a criminal breach of the Control of Substances Hazardous to Health Regulations 2002 and was ordered to pay a £4,000 (A$6 K) fine and £15,062 (A$23 K) in costs.
Stress damaging to career prospects
The large population based study published in the Journal of Epidemiology and Community Health reports it is well known that mental health problems are associated with long term disability, but adds the impact of milder forms of psychological stress is likely to have been under-estimated. Even relatively mild stress can lead to long term disability and an inability to work. The research team from the University of Bristol tracked between 2002 and 2007 the health of more than 17,000 working adults up to the age of 64, who had been randomly selected from the population in the Stockholm area. During the monitoring period, 649 people started receiving disability benefit, 203 for a mental health problem and the remainder for physical ill health.
Higher levels of stress at the start of the study were associated with a significantly greater likelihood of subsequently being awarded long term disability benefits. Even those with mild stress were up to 70% more likely to receive isability benefits, after taking account of other factors likely to influence the results, such as lifestyle and alcohol intake. One in four of these benefits awarded for a physical illness, such as high blood pressure, angina, and stroke, and almost two thirds awarded for a mental illness, were attributable to stress.
The authors say that it is important to consider their findings in the context of modern working life, which places greater demands on employees, and social factors, such as fewer close personal relationships and supportive networks. These factors lead them to ask if the strains and demands of modern society commonly exceeding human ability? What are the level of stress of your employees like- do they have adequately supportive social networks available to them?
Raj D et al Psychological distress and risk of long-term disability: populationbased longitudinal study, Journal of Epidemiology and Community Health, March 2011
Finally justice for dust exposed South African miners
South African miners have won a landmark dust disease case in the nation's highest court. The legal precedent is expected to allow thousands of miners stricken with life-threatening respiratory and other diseases to sue companies under common law in South Africa. The Constitutional Court, the highest court in the land, overturned a Supreme Court of Appeal judgment and granted a former AngloGold Ashanti worker the right to sue the company for damages for silicosis, a debilitating and often fatal occupational lung disease.
The miner, father-of-ten Thembekile Mankayi, died 6 days before the ruling, and now it is up to his family whether or not to continue the case. The Supreme Court and a lower court had ruled against Mankayi because he had already received state compensation under South Africa's Compensation for Occupational Injuries and Diseases Act (COIDA). Under the scheme he received just R16,320 (A$2260) after it was determined he was ill with tuberculosis and silicosis caused by exposures to crystalline silica dust while working inside the AngloGold's Vaal Reefs mine from 1979 to 1995. But in this month's ruling, Constitutional Court Judge Khampepe said the Supreme Court 'had erred in concluding' the two pieces of legislation had the same compensatory structure. 'If COIDA removes Mr Mankayi's common law right to claim compensation for negligence, employees in his position... would be left without an effective remedy to rectify the harm caused by the negligence of employers.' A very interesting stance not necessarily followed by other Western insurers and governments.
Are we aware of our own fatigue or state of health?
In a study that shows employers must do more to determine the health of their workforce, researchers have found commercial drivers at risk of sleep disorders are inadvertently underreporting their symptoms. The US researchers said fatigue is a leading cause of motor vehicle accidents, and untreated sleep disorders can dramatically increase the risk of a crash.
Their study focused on the medical records of 1890 commercial motor vehicle drivers who presented for medical examinations at a Tennessee occupational health clinic in 2007 and 2008. Some 57 drivers had a previous diagnosis of obstructive sleep apnea (OSA), & 192 suspected cases were referred to a sleep clinic, where OSA was confirmed in 51 cases. Overall, the researchers confirmed OSA in 6.1% of follow-up participants, even though only 2.6% of all drivers had reported a sleep history suggestive of OSA when questioned about symptoms.
The study suggests that asking a driver whether he or she suffers from: sleep disorder, pauses in breathing while asleep, day-time sleepiness, or loud snoring, may have limited value. Commercial drivers with undiagnosed OSA may not understand the sleep disorder questions & drivers with OSA may underreport sleep disorder symptoms. The researchers also found drivers with confirmed OSA had a higher prevalence of hypertension and diabetes. Most were over the age of 40 and nearly half were morbidly obese.
Subsequent analysis suggested those with a BMI greater than 30 were more than 25 times more likely to suffer from OSA, and those with a history of hypertension were 2.5 times more at risk compared with those whose blood pressure was normal. A history of diabetes was also a risk factor.
Given the "limited value" of asking workers to selfreport symptoms, the researchers concluded that "objectively measurable risk factors" could be more effective in diagnosing OSA. Untreated, OSA can cause cognitive impairment, reduced work productivity and a sevenfold increase in the risk of a vehicle accident, they warned. Are your drivers at increased risk of an accident?
Wen Xie, et al: Factors Associated With Obstructive Sleep Apnea Among Commercial Motor Vehicle Drivers., US, J Occ Env Med, 53 (2) 2011.
CV risk and long work hours
Extra hours at work can increase markedly the risk of heart disease according to a research team from University College London who warned people who work an 11 hour day compared with those who work a standard seven or eight hours increase their risk of heart disease by 67%.
The findings, reported in April in the Annals of Internal Medicine, are based on the ongoing 'Whitehall' study of 7,095 civil service employees whose health they have been tracking since 1985. They suggest GPs should now be asking their patients about working hours as this new information should help improve decisions regarding medication for heart disease. It could also be a wake-up call for people who overwork themselves, especially if they already have other risk factors.
Over the course of the 11-year study, 192 of the participants suffered a heart attack. People who worked 11 hours or more a day were more than half as likely again to have a heart attack than those who worked shorter hours. This study might make us think twice about the old adage that hard work won't kill us. Tackling lifestyles that are detrimental to health is a key area reminding us that it's not just diet and exercise we need to think about. What is the heart attack relationship at your workplace? What hours were those people regularly working?
Written by Julie Armour