Nursing Mangement on occupational and industrial disorders [Autosaved].pptx

NURSING MANAGEMENT OF PATIENT WITH
OCCUPATIONALAND INDUSTRIAL
DISORDERS.
PRESENTED BY : DR. PALLAVI.

INDEX
SI.NO. CONTENT
1. Introduction
2. Occupational health statistics [INDIA]
3. Historical view and Occupational Diseases
4. Prevention of occupational disorders
5. Identification of unrecognized occupational hazards
6. Occupational health Legislation in India
7. OSHA

INTRODUCTION
• Industries use chemicals for
making products in large quantity.
The effluents from the industrial
processes have compounds with
capacity to produce certain ill
effects among the exposed
individuals. Occupational centers
are extracting work from the
workers beyond their physical and
mental capacities. This may cause
certain diseases among the
workers.

• Occupational health is defined as the highest
level of physical, mental
and social well being of workers in all
occupations. It is the branch of health care that
deals with all aspects of workplace health and
safety. It place a strong emphasis on hazard
prevention at the primary level.
• Occupational disease and occupational
pathology, a subspecialty of clinical medicine is
the study of occupational disease that have
appeared as a result of harmful factors in the
manufacturing environment or work process.
• Nurse should know about the causes, symptoms,
diagnostic measures, management and
prevention of occupation and industry related
health disorders.

OCCUPATIONAL HEALTH STATISTICS
There are 100 million occupational injuries causing 0.1 million deaths
in the world according to WHO. It is also estimated that in India 17
million occupational non-fatal injuries (17% of the world) and 45,000
fatal injuries (45% of the total deaths due to occupational injuries in
world) occur each year. Out of 11 million cases of occupational
diseases in the world 1.9 million cases (17%) are contributed by India
and out of 0.7 million deaths in the world 0.12 (17%) is contributed by
India.
The adverse occupational factors have been estimated to cost 2-14%
of the gross national products for various countries. As the incidence
of occupational related morbidity and mortality is very high in India it
is to false to say that out of total of one million crore of rupee of GNP
in the year 1999, occupational diseases has caused a loss of around
70,000 crore. The amount paid as compensation for death and
disablement resulting from work related injuries in India has increased
from mere Rs. 8 million in 1961 to 186 million in 1997.

The enormous burden of poor working conditions
• The ILO estimates that some 2.3 million women and men around the world
succumb to work-related accidents or diseases every year; this corresponds to
over 6000 deaths every single day. Worldwide, there are around 340 million
occupational accidents and 160 million victims of work-related illnesses
annually. The ILO updates these estimates at intervals, and the updates indicate
an increase of accidents and ill health. Some of the major findings in the ILO’s
latest statistical data on occupational accidents and diseases, and work-related
deaths on a world-wide level include the following:
• Diseases related to work cause the most deaths among workers. Hazardous
substances alone are estimated to cause 651,279 deaths a year.
• The construction industry has a disproportionately high rate of recorded
accidents.
• Younger and older workers are particularly vulnerable. The ageing population
in developed countries means that an increasing number of older persons are
working and need special consideration.
• The concept of occupational health nursing is new to India. It is non-existent in
unorganised sectors. Even the public sector and private employers have not yet
realized its importance. There is a need to create awareness about this issue
amongst all stakeholders

National Institute of Occupational Safety & Health (NIOSH) has developed a
priority list of 10 leading work-related illnesses and injuries. Three criteria were
used to develop the list: a) the frequency of occurrence of the illness or injury, b)
its severity in individual cases, and c) its potential for prevention. Occupational
lung disease is first on the list. Silicosis, asbestosis and byssinosis are still
prevalent in many parts of the world. The prevalence of Occupational Asthma
varies from 10% to nearly all of the workers in certain high-risk occupations.
NISOH considers occupational cancer to be the second leading work-related
disease, followed by cardio-vascular diseases, disorder of reproduction,
neurotoxicity, noise induced hearing loss, dermatological conditions, and
psychological disorders.
Major occupational diseases can be divided in following categories for better understanding:
A. Occupational injuries
B. Occupational lung diseases
C. Occupational cancers
D. Occupational dermatoses
E. Occupational Infections
F. Occupation toxicology
G. Occupational mental disorders
H. Others

Occupational disorders can be grouped according the
etiological factors:
1. Occupational injuries: ergonomic related
2. Chemical occupational factors: dust, gases, acid,
alkali, metals etc.
3. Physical occupational factors: noise, heat, radiation
4. Biological occupational factors
5. Behavioural occupational factors
6. Social occupational factors
In India, prevalence of silicosis was 6.2 - 34 % in mica
miners, 4.1 % in manganese miners, 30.4% in lead and
zinc miners, 9.3% in deep and surface coal miners,
27.2% in iron foundry workers, and 54.6% in slate-
pencil workers. Prevalence of Asbestosis was extended
from 3% in Asbestos miners to 21% in mill workers. In
textile workers the Bysinosis was as common as 28-
47%. Nutritional status in terms of body mass indices
(BMI) of the workers is also significantly low.

PROGRAMME
Occupational health was one of the components of the National Health
Policy 1983 and now also included in National Health Policy 2002 but
very little attention has been paid to mitigate the effect of occupational
disease through proper programme. Ministry of Health & Family Welfare,
Govt. of India has launched a scheme entitled "National Programme for
Control & Treatment of Occupational Diseases" in 1998-99. The National
Institute of Occupational Health, Ahmedabad (ICMR) has been identified
as the nodal agency for the same.
Following research projects has been proposed to initiate by the
Government:
1. Prevention, control and treatment of silicosis and silico-tuberculosis in
Agate Industry.
2. Occupational health problems of tobacco harvesters and their
prevention.
3. Hazardous process and chemicals, database generation, documentation,
and information dissemination
4. Capacity building to promote research, education, training at National
Institute of Occupational Disease.
5. Health Risk Assessment and development of intervention programme in
cottage industries with high risk of silicosis.
6. Prevention and control of Occupational Health Hazards among salt
workers in the remote desert areas of Gujarat and Western Rajasthan.

GLOBAL STRATEGY FOR OCCUPATIONAL HEALTH
The global strategy for achieving occupational health for all (WHO-SEARO 1999)
includes the following ten major areas for action:
1. Strengthening of International and national policies for health at work and
development of policy tools.
2. Developing healthy work environments.
3. Developing healthy work practices and promoting health at work.
4. Strengthening occupational health services.
5. Establishing support services for occupational health.
6. Developing occupational health standards based on scientific risk assessment.
7. Developing human resources for occupational health.
8. Establishing registration and data system including development of information
services for experts, effective transmission of data, and raising pubic awareness
through strengthened public information system.
9. Strengthening research.
10. Developing collaboration in occupational health services and organisations.

Occupational injuries
Wet floors, spills, and clutter may cause slips, trips and falls.
Poor vehicle maintenance, inadequate operator training and lack of
safety restraint contribute to ambulance crashes.
Unsafe electric work practices may cause electric shock, electrocutions,
fire and explosions.

Occupational infections
Needlestick injuries contribute to 39%, 37% and 4.4% of hepatitis C,
hepatitis B and HIV infections respectively.
The prevalence of acute hepatitis B infection among health workers
globally is 5.3%.
About 54% of health workers in low- and middle-income countries
have latent TB infection.

Occupational diseases
• Occupational disease, any illness associated with a particular occupation or
industry. Such diseases result from a variety of biological, chemical, physical,
and psychological factors that are present in the work environment or are
otherwise encountered in the course of employment. Occupational medicine is
concerned with the effect of all kinds of work on health and the effect of health
on a worker’s ability and efficiency.
• Occupational diseases are essentially preventable and can be ascribed to
faulty working conditions. The control of occupational health hazards
decreases the incidence of work-related diseases and accidents and improves
the health and morale of the work force, leading to decreased absenteeism and
increased worker efficiency. In most cases the moral and economic benefits far
outweigh the costs of eliminating occupational hazards.
• Major occupational diseases can be divided in following categories for better understanding:
A. Occupational injuries
B. Occupational lung diseases
C. Occupational cancers
D. Occupational dermatoses
E. Occupational Infections
F. Occupation toxicology
G. Occupational mental disorders
H. Others

COMMON OCCUPATIONAL DISEASES IN INDIA
Respiratory diseases
• Diseases of the respiratory system are frequent in professions where workers are
exposed to hazardous substances. Daily exposure to hazardous chemicals among
industrial and construction workers causes allergies and significant respiratory
conditions. These are typical among them:
• Mesothelioma
• Pneumonitis
• Tuberculosis
• Occupational asthma
• Silicosis
• Pharyngitis
• Chronic obstructive pulmonary disease (COPD)

Hearing issues
• Those who spend their days around loud machines
and a lot of noise run the risk of losing their
hearing.
Heavy lifting
• Workers who are required to lift and carry big
goods, such as porters, labourers, and construction
workers, may become exhausted. Overexertion is
frequently linked to the following injuries:
• Hernias
• Leg wounds
• Sprained ankles
• Back and shoulder injuries
• Joint abrasions

Contemporary occupational diseases
• As a result of the difficulties in today’s workplace, mental health issues and stress-related
illnesses are on the rise. The employees are under excessive pressure due to the
employment expectations of the profit-driven economy. He doesn’t have much control
over it.
• Workplace stress is caused by a shortage of time at the worker’s disposal, a mismatch
between the skills needed and those that are accessible, isolation at the office, and a lack
of appreciation.
• All of them can result in a number of diseases. Many musculoskeletal disorders are also
brought on by prolonged computer use, a sedentary workplace culture, and a lack of
mobility. Some instances of contemporary occupational disorders include:
• High Blood Pressure
• Muscle pain, headache
• Cardiovascular diseases
• Gastrointestinal disorders
• Weakened immune system
• Increased cholesterol
• Depression
• Anxiety, anger, restlessness

Common occupational Diseases in India
• An inventory of occupational illnesses in India is provided in the
third schedule of the Indian Factories Act of 1948. They consist of:
• Chrome ulceration: Chrome ulcers, also known as chrome holes,
are generally crusted lesions that are painless and reveal a 2–5 mm
pitted ulcer covered with exudate. The hands, forearms, and feet are
the areas of the body where ulcers most frequently develop.
• Anthracosis: This illness is brought on by inhaling soot or coal dust
for an extended period of time, which turns the lungs black. When
continuous exposure to coal dust or soot particles causes anthracosis,
the majority of the time, anamnesis is used to make the diagnosis.
• Silicosis: Silicosis is a chronic lung condition brought on by
exposure to hazardous quantities of silica dust, typically over a
lengthy period of time. Those who handle specific materials run the
risk of inhaling tiny silica dust. The dust particles might leave lung
scarring after entering the lungs.
• Cancer of the skin: Skin exposed to the sun is where skin cancer, or
the abnormal proliferation of skin cells, most frequently occurs. Yet,
this prevalent type of cancer can also develop on parts of your skin
that are not often exposed to sunlight.

• Toxic anaemia: When you have anaemia, your body doesn’t produce enough healthy red
blood cells to supply your tissues with enough oxygen.
• Dermatitis due to mineral oils: When essential oils come into contact with the skin, a delayed
hypersensitivity reaction can cause dermatitis (eczema) known as allergic contact dermatitis.
• Byssinosis: Byssinosis is a lung condition that develops over time with repetitive exposure to
cotton or jute dust in working situations with poor ventilation.
• Asbestosis: A lung condition brought on by inhaling asbestos fibre, a fibrous hydrated
magnesium silicate. Asbestos fibres are utilised in the construction of insulation and roofs.
Long-term asbestos exposure results in lung fibrosis, which shortens breath.
• Contact dermatitis: Skin irritation is brought on by coming into contact with certain things
that causes rashes, dry skin, and itching.
• Noise-induced hearing loss: The hearing impairment known as noise-induced hearing loss
(NIHL) is brought on by exposure to loud noise. Individuals may lose their ability to perceive a
specific frequency range or have poor hearing, including increased sensitivity to sound or
ringing in the ears.
• Coal miners’ pneumoconiosis: The occupational pneumoconiosis known as black lung illness,
sometimes referred to as coal workers’ pneumoconiosis (CWP) or simply black lung, is
brought on by prolonged exposure to coal dust.
• Occupational cancer: Occupational cancer has been linked to exposure to chemicals, dusts,
radiation, and particular industrial processes. Cancer may develop as a result of mutations
brought on by carcinogens, which are substances that cause cells to grow out of control.
• Toxic nephritis: The inflammation of the kidneys is known as nephritis. The ability of the
kidneys to remove extra water and waste from the blood can be affected by this
inflammation.

Disorders due to chemical agents
Hazardous chemicals can act directly on the skin, resulting
in local irritation or an allergic reaction, or they may be
absorbed through the skin, ingested, or inhaled. In the
workplace ingestion of toxic chemicals is usually
accidental and most commonly results from handling
contaminated food, drink, or cigarettes.
Substances that occur as gases, vapours, aerosols, and
dusts are the most difficult to control, and most hazardous
chemicals are therefore absorbed through the respiratory
tract. If inhaled, airborne contaminants act as irritants to
the respiratory tract or as systemic poisons.
Toxicity in such cases depends on the contaminant’s
concentration, particle size, and physicochemical
properties, particularly its solubility in body fluids. An
individual’s reaction to any hazard depends primarily on
the length, pattern, and concentration of exposure but is
also affected by such factors as age, sex, ethnic group,
genetic background, nutritional status,
coexistent disease, concomitant exposure to other toxic
agents, life-style, and history of previous exposure to the
agent in question.
The wide range of both naturally occurring
and synthetic chemical compounds that can give rise to
adverse health effects can be roughly organized into four
major categories: gases, metals, organic compounds, and
dusts.

• Gases may act as local irritants to inflame mucous surfaces. Common examples include sulfur
dioxide, chlorine, and fluorine, which have pungent odours and can severely irritate the eyes
and the respiratory tract. Some gases, such as nitrogen oxides and phosgene, are much more
insidious. Victims may be unaware of the danger of exposure because the immediate effects
of these gases may be mild and overlooked. Several hours after exposure, however,
breathlessness and fatal cardiorespiratory failure due to pulmonary edema (collection of fluid
in the lungs) may develop.
• Gases that interfere with oxygen supply to the tissues are known as asphyxiants and are of
two principal types. Simple asphyxiants are physiologically inert gases that act by diluting
atmospheric oxygen. If the concentration of such gases is high enough, hypoxia (deficiency of
oxygen reaching the tissues of the body) results. Victims of mild hypoxia may appear to be
intoxicated and may even resist rescue attempts. Common examples of simple asphyxiants are
methane and carbon dioxide.
• In contrast to simple asphyxiants, chemical asphyxiants, such as carbon monoxide and
hydrogen sulfide, are highly reactive. They cause a chemical action that either prevents the
blood from transporting oxygen to the tissues or interferes with oxygenation in the tissues. For
example, carbon monoxide, a frequently encountered gas produced by incomplete
combustion, combines with hemoglobin in the blood and reduces its oxygen-carrying
capacity. In low concentration carbon monoxide poisoning can cause symptoms of fatigue,
headache, nausea, and vomiting, but heavy exposure leads to coma and death. It is especially
dangerous because it is both colourless and odourless. Hydrogen sulfide, however, can be
recognized by its characteristic smell, suggestive of rotten eggs. It is produced when sulfur
compounds decompose and acts by inhibiting the respiratory enzyme cytochrome oxidase,
thus giving rise to severe tissue hypoxia. In addition to its asphyxiant properties, hydrogen
sulfide also acts as an irritant to the eyes and mucous membranes.
• Preventing gas poisoning involves preventing exposure. Workers should never enter enclosed
spaces that have suspect atmospheres alone; workplaces should provide adequate ventilation,
and air should be regularly tested for contamination. If exposure does occur, treatment
involves the removal of the victim from the contaminated atmosphere, artificial respiration,
and administration of oxygen or recommended antidotes. Victims exposed to gases with
insidious delayed effects should be kept under medical observation for an appropriate period.

• Metals and their compounds are among the poisons most commonly encountered in the
home and workplace. Even metals essential for life can be toxic if they are present in
excessive amounts. Iron, for example, is an essential element and is sometimes given
therapeutically; if taken in overdose, however, it can be lethal.
• Mercury poisoning, one of the classic occupational diseases, is a representative example of
metal poisoning. Exposure to mercury can occur in many situations, including the
manufacture of thermometers, explosives, fungicides, drugs, paints, batteries, and various
electrical products. The disorders it can cause vary depending on the type of
mercury compound and the method of exposure.
• Ingestion of mercury salts such as mercuric chloride (corrosive sublimate) leads to nausea,
vomiting, and bloody diarrhea. Kidney damage resulting in death may follow in extreme
cases. Inhalation or absorption through the skin of mercury vapour causes salivation,
loosening of the teeth, and tremor; it also affects the higher centres of the brain, resulting in
irritability, loss of memory, depression, anxiety, and other personality changes. This mental
deterioration, known as erethism, led to the well-known saying “mad as a hatter,” because,
in the past, hatters commonly became ill when they used mercury salts to make felt out of
rabbit fur. Poisoning with organic mercury compounds (used in fungicides and pesticides)
results in permanent neurological damage and can be fatal.
• Other hazardous metals commonly encountered in industry include arsenic, beryllium,
cadmium, chromium, lead, manganese, nickel, and thallium. Some have been shown to be
carcinogenic, including certain compounds of nickel (linked to lung and nasal cancer),
chromium (lung cancer), and arsenic (lung and skin cancer).

• Organic compounds
• The organic compounds that pose the greatest occupational hazards are various aromatic, aliphatic,
and halogenated hydrocarbons and the organophosphates, carbamates, organochlorine compounds,
and bipyridylium compounds used as pesticides.
• Pesticides are used the world over; and, even though precautionary measures (such as using
protective clothing and respirators, monitoring contamination of equipment and clothing, keeping
workers out of recently sprayed areas, and requiring workers to wash thoroughly after exposure) can
be instituted, poisoning not infrequently occurs in agricultural communities. The organophosphates
and the generally less toxic carbamates exert their effects by inhibiting cholinesterase, an enzyme
that prevents stimulation from becoming too intense or prolonged by destroying the acetylcholine
involved in the transmission of impulses in the autonomic nervous system. Cholinesterase inhibitors
allow the accumulation of acetylcholine, causing symptoms related to parasympathetic overactivity,
such as chest tightness, wheezing, blurring of vision, vomiting, diarrhea, abdominal pain, and in
severe cases respiratory paralysis. Atropine and certain oximes counteract their effects.
• Paraquat and diquat, the bipyridylium compounds, are deadly if ingested. Skin contact or inhalation
of a concentrate of paraquat can cause fatal lung damage. Because no specific antidote is known,
treatment consists of minimizing the body’s absorption of the poison.
• The organochlorine compounds, such as DDT, are being progressively phased out of use. Because
they are fat-soluble and very stable, they accumulate and remain in the fatty tissues of the body for
prolonged periods. Symptoms of poisoning include nausea, irritability, weakness, muscle tremors,
and convulsions. There is no specific antidote.
• Hydrocarbons are used industrially in the derivation of other compounds and in solvents, degreasing
agents, refrigerants, fire extinguishers, dry cleaning agents, paint removers, and other products. Many
are volatile and can be absorbed by inhalation; some are fat-soluble and can be readily absorbed
following spills on the skin.
• Gasoline, fuel oils, and other petroleum products are common examples of aliphatic hydrocarbons. If
they are ingested or inhaled, dizziness, weakness, nausea, or irritation of the lungs may follow. In
very severe cases victims may become unconscious or experience convulsions. Direct contact causes
skin irritation and dryness. Prolonged exposure to certain petroleum oils may result in skin cancer.

• The aromatic hydrocarbon benzene provides the basis for the synthesis of many other
organic compounds. It is rapidly absorbed following inhalation or skin contact.
Symptoms from mild exposure include dizziness, headache, euphoria, confusion, and
nausea. Long-term exposure may be followed by bone marrow depression, anemia,
spontaneous bleeding, and leukemia. Several aromatic hydrocarbons are known to be
carcinogens. Particularly hazardous are naphthylamine, benzidine, and 4-amino
diphenyl, which cause bladder cancer. Previously used in the synthetic dye, synthetic
rubber, cable-making, and chemical industries, they have been banned in a number of
countries.
• When aliphatic and aromatic hydrocarbons have hydrogen atoms in their structure
replaced by halogens (often chlorine), they are known as halogenated hydrocarbons. In
general, increasing the chlorination of aliphatic hydrocarbons increases their toxicity,
while the reverse is true of the aromatic series. Many chlorinated hydrocarbons,
including chloroform and trichloroethylene, act as depressants on the central nervous
system, producing anesthetic or narcotic effects that may be abused. Occupational
exposure to many solvents may act synergistically with alcohol, resulting in more
damage than either agent could produce on its own.
• Some halogenated hydrocarbons cause extensive disorders in addition to their common
narcotic effect. Inhaling or ingesting the solvent carbon tetrachloride, for example, leads
to liver damage; and exposure to vinyl chloride causes Raynaud’s phenomenon (spasms
in the small arteries that cause the extremities to become pale and cold, as well as
painful), necrosis of the small bones of the hand, liver damage, and a rare, highly
malignant tumour of the liver.
• Workers exposed to hydrocarbons should wear protective clothing or masks when
appropriate, moderate alcohol consumption, and verify that work areas are well
ventilated and that recommended exposure levels are not exceeded.

The inhalation of a variety of dusts is responsible for a number of lung and respiratory disorders, whose
symptoms and severity depend on the composition and size of the dust particle, the amount of dust inhaled,
and the length of exposure. The lung diseases known as the pneumoconioses result when certain inhaled
mineral dusts are deposited in the lungs, where they cause a chronic fibrotic reaction that leads to
decreasing capacity for exercise and increasing breathlessness, cough, and respiratory difficulty. No specific
treatment is known, but as with all respiratory disorders patients are urged to quit smoking, which
aggravates the condition. Suggested measures for limiting exposure include using water and exhaust
ventilation to lower dust levels and requiring workers to wear respirators or protective clothing, but such
procedures are not always feasible. Coal worker’s pneumoconiosis, silicosis, and asbestosis are the most
common pneumoconioses.
As its name suggests, coal worker’s pneumoconiosis (also known as black lung) occurs most frequently
among coal miners and workers involved in the transporting or processing of coal. It is generally benign in
its early stages, but after a variable number of years of exposure to coal dust, progressive massive fibrosis
may develop, ending in cardiorespiratory failure. Miners and quarry workers are the people most likely to
suffer from silicosis. Because silica is found in many rocks and is used in a variety of industries, workers
involved in stonecutting, grinding, drilling, foundry work, sandblasting, pottery making, and the
manufacture of abrasives are also at risk. Silicosis is an aggressive form of pulmonary fibrosis that speeds
the progress of tuberculosis. Routine chest X rays can aid early diagnosis by revealing abnormal
shadowing. Asbestosis is more difficult to detect in the early stages because chest X rays usually reveal
little until the disease is advanced. From onset asbestosis progresses more rapidly than the other
pneumoconioses and can result from relatively low exposure. Asbestos is the general term for a number of
fibrous silicates that are used primarily in various fireproofing, insulation, and cement products. In addition
to pulmonary fibrosis, inhaling asbestos fibres has also been shown to cause lung and other cancers.
Prolonged exposure to certain plant and animal dusts can cause asthma, even in people without a
predisposition for allergies. Specific hazards include dusts from flour, grains, and wood and wood products.
Cotton workers and others handling hemp or flax may develop a condition known as byssinosis, similar to
asthma. The group of diseases known as farmer’s lung, malt worker’s lung, bird fancier’s lung, and so forth
are caused by an allergic inflammatory reaction to the fungal spores present in moldy hay or barley, bird
droppings, feathers, and a variety of other organic materials. Symptoms initially resemble those
of influenza or pneumonia, but repeated episodes eventually lead to pulmonary fibrosis with chronic
respiratory impairment. The only treatment for these disorders is avoiding exposure to the dusts.

DISORDERS DUE TO PHYSICALAGENTS
• Temperature
• When working in a hot environment, humans maintain normal body temperature by perspiring and by increasing
the blood flow to the surface of the body. The large amounts of water and salt lost in perspiration then need to be
replaced. In the past, miners who perspired profusely and drank water to relieve their thirst experienced intense
muscular pain—a condition known as miner’s cramps—as a result of restoring their water but not their salt
balance. When salt in the requisite amount was added to their drinks, workers no longer developed miner’s
cramps. Heat exhaustion is characterized by thirst, fatigue, giddiness, and often muscle cramps; fainting can also
occur. Heatstroke, a more serious and sometimes lethal condition, results when prolonged exposure to heat and
high humidity prevents efficient perspiration (by preventing evaporation of sweat), causing the body temperature
to rise above 106° F (41° C) and the skin to feel hot and dry. If victims are not quickly cooled down, coma,
convulsions, and death can follow. To prevent heat exhaustion or heatstroke, workers unaccustomed to high
temperatures should allow adequate time (ranging from days to weeks) for their bodies to become acclimatized
before performing strenuous physical tasks.
• Work in cold environments may also have serious adverse effects. Tissue damage that does not involve freezing
can cause inflammatory swelling known as chilblains. Frostbite, or the freezing of tissue, can lead to gangrene and
the loss of fingers or toes. If exposure is prolonged and conditions (such as wet or tight clothing) encourage heat
loss, hypothermia, a critical fall in body temperature, may result. When body temperature falls below 95° F (35°
C), physiological processes are slowed, consciousness is impaired, and coma, cardiorespiratory failure, and death
may ensue. Workers exposed to extreme cold require carefully designed protective clothing to minimize heat loss,
even though a degree of acclimatization occurs with time.

Atmospheric pressure
Decompression sickness (caisson disease) can result from
exposure to high or low atmospheric pressure. Under
increased atmospheric pressure (such as that experienced by
deep-sea divers or tunnel workers), fat-soluble nitrogen gas
dissolves in the body fluids and tissues. During
decompression the gas comes out of solution and, if
decompression is rapid, forms bubbles in the tissues. These
bubbles cause pains in the limbs (known as the bends),
breathlessness, angina, headache, dizziness, collapse, coma,
and in some cases death.
Similarly, the gases in solution in the body tissues under
normal atmospheric pressure form bubbles when pressure
rapidly decreases, as when aviators in unpressurized aircraft
ascend to high altitudes too quickly.
Emergency treatment of decompression sickness consists of
rapid recompression in a compression chamber with gradual
subsequent decompression. The condition can be prevented
by allowing sufficient decompression time for the excess
nitrogen gas to be expelled naturally.

Noise
Exposure to excessive noise can be unpleasant and can impair working efficiency. Temporary or
permanent hearing loss may also occur, depending on the loudness or intensity of the noise, its pitch or
frequency, the length and pattern of exposure, and the vulnerability of the individual.
Prolonged exposure to sound energy of intensity above 80 to 90 decibels is likely to result in noise-
induced hearing loss, developing first for high frequencies and progressing downward.
The condition can be prevented by enclosing noisy machinery and by providing effective ear protection.
Routine audiometry gives an indication of the effectiveness of preventive measures.

• Vibration
• Whole-body vibration is experienced in surface and air transport, with motion sickness its most familiar effect. A
more serious disorder, known as Raynaud’s syndrome or vibration white finger (VWF), can result from the
extensive use of vibratory hand tools, especially in cold weather. The condition is seen most frequently among
workers who handle chain saws, grinders, pneumatic drills, hammers, and chisels. Forestry workers in cold
climates are particularly at risk. Initial signs of VWF are tingling and numbness of the fingers, followed
by intermittent blanching; redness and pain occur in the recovery stage. In a minority of cases the tissues, bones,
and joints affected by the vibration may develop abnormalities; even gangrene may develop. VWF can be
prevented by using properly designed tools, avoiding prolonged use of vibrating tools, and keeping the hands
warm in cold weather.
• Other mechanical stresses
• Muscle cramps often afflict workers engaged in heavy manual labour as well as typists, pianists, and others who
frequently use rapid, repetitive movements of the hand or forearm. Tenosynovitis, a condition in which the sheath
enclosing a tendon to the wrist or to one of the fingers becomes inflamed, causing pain and temporary disability,
can also result from prolonged repetitive movement. When the movement involves the rotation of the forearm,
the extensor tendon attached to the point of the elbow becomes inflamed, a condition commonly known as tennis
elbow.

Ionizing radiation
Ionizing radiation damages or destroys body tissues by breaking down the molecules in the tissues into
positively or negatively charged particles called ions. Radiation that is capable of causing ionization may be
electromagnetic (X rays and gamma rays) or particulate (radiation of electrons, protons, neutrons, alpha
particles, and other subatomic particles) and has many uses in industry, medicine, and scientific research.
Ionizing radiation injury is in general dose-dependent. Whole-body exposure to doses in excess of 1,000 rads
results in acute radiation syndrome and is usually fatal. Doses in excess of 3,000 rads produce cerebral
edema (brain swelling) within a matter of minutes, and death within days. Lesser doses cause acute
gastrointestinal symptoms, such as severe vomiting and diarrhea, followed by a week or so of apparent well-
being before the development of the third toxic phase, which is characterized by fever, further gastrointestinal
symptoms, ulceration of the mouth and throat, hemorrhages, and hair loss. There is an immediate drop in the
white-cell elements of the blood, affecting the lymphocytes first and then the granulocytes and platelets, with a
slower decline in the red cells. If death does not occur, these symptoms may last for many months before slow
recovery begins.
Delayed effects of exposure to radiation include the development of leukemia and other cancers. Examples
include the skin cancers that killed many of the pioneering scientists who worked with X rays and radioactive
elements; the lung cancer common among miners of radioactive ores; and the bone cancer and aplastic
anemia that women who painted clock dials with a luminous mixture containing radium and mesothorium
developed as a result of ingesting small amounts of paint when they licked their paintbrushes to form a point.

Nonionizing radiation
Nonionizing forms of radiation include electromagnetic radiation in the radio frequency, infrared, visible light, and
ultraviolet ranges. Exposure to radiation in the radio frequency range occurs in the telecommunications industry and in
the use of microwaves.
Microwaves produce localized heating of tissues that may be intense and dangerous. Various other disorders, mainly of
a subjective nature, have been reported in workers exposed to this frequency range. Infrared radiation can be felt as heat
and is commonly used in industry in drying or baking processes.
Prolonged exposure to the radiation can result in severe damage to the skin and especially to the lens of the eye, where
cataracts may be produced. Working under poor lighting conditions can adversely affect worker efficiency and well-
being and may even cause temporary physical disorders, such as headache or dizziness.
Proper lighting should provide adequate, uniform illumination and appropriate contrast and colour, without any
flickering or glare. Exposure to ultraviolet radiation from the Sun or such industrial operations as welding or
glassblowing causes erythema of the skin (a condition familiarly known as sunburn), skin cancer, and inflammation of
the conjunctiva and cornea.
Pigmentation offers natural protection against sunburn, and clothing and glass can also be used as effective shields
against ultraviolet radiation. Lasers emit intense infrared, visible, or ultraviolet radiation of a single frequency that is
used in surgery, for scientific research, and for cutting, welding, and drilling in industry. Exposure to these beams can
burn the skin and cause severe damage to the eye.

DISORDERS DUE TO INFECTIOUS AGENTS
• A large number of infectious diseases are transmitted to humans by
animals. Many such diseases have been largely eliminated, but
some still pose hazards. Anthrax, for example, can be acquired by
workers handling the unsterilized hair, hide, and bone of infected
animals; and slaughterhouse workers, farmers, veterinarians, and
others in contact with infected animals, milk, and milk products
still frequently contract brucellosis.
• Contact with contaminated water is another common method of
acquiring infectious diseases. Many workers are infected by
organisms that thrive in the puddles or stagnant water found in
sewers, canals, paddies, slaughterhouses, irrigation projects, and
mines.
• Laboratory workers, nurses, surgeons, and other health care
workers may contract infectious diseases such as tuberculosis in
the course of their work. To help prevent infection, these workers
should wear appropriate protective clothing and exercise care
when handling contaminated needles or other equipment.
Contaminated material should be appropriately bagged, labeled,
and disposed.

DISORDERS DUE TO PSYCHOLOGICAL FACTORS
• Psychological factors are important determinants of worker health, well-
being, and productivity. Studies have shown the benefits to workers who
feel satisfied and stimulated by their jobs, who maintain good relationships
with their employers or supervisors and with other employees, and who do
not feel overworked. Such workers have lower rates of absenteeism and job
turnover and higher rates of output than average.
• The two psychological hazards commonly encountered at work
are boredom and mental stress. Workers who perform simple, repetitious
tasks for prolonged periods are subject to boredom, as are people who work
in bland, colourless environments. Boredom can cause frustration,
unhappiness, inattentiveness, and other detriments to mental well-being.
More practically, boredom decreases worker output and increases the
chances of error and accident. Providing refreshment and relaxation breaks
or other outside stimulus can help relieve boredom.
• Mental stress often results from overwork, although nonoccupational
factors, such as personal relationships, life-style, and state of physical
health, can play a major role. Job dissatisfaction, increased responsibility,
disinterest, competition, feelings of inadequacy, and bad working
relationships can also contribute to mental stress. Stress affects both mental
and physical health, causing anger, irritation, fatigue, aches, nausea, ulcers,
migraine, asthma, colitis, or even breakdown and coronary heart disease.
Moderate exercise, meditation, relaxation, and therapy can help workers to
cope with stress.

• Pneumoconiosis is one of a group of interstitial lung disease caused by breathing in certain kinds of
dust particles that damage your lungs.
• Because you are likely to encounter these dusts only in the workplace, pneumoconiosis is called an
occupational lung disease.
• Pneumoconiosis usually take years to develop. Because lungs can't get rid of all these dust
particles, they cause inflammation in lungs that can eventually lead to scar tissue.

Types of pneumoconiosis
The disease appears in different forms, depending on the type of
dust you inhale. One of the most common forms is black
lung disease, also known as miner's lung. It’s caused by breathing in
coal dust. Another is brown lung, which comes from working
around dust from cotton or other fibers. Other types of dusts that
can cause pneumoconiosis include silica and asbestos. Diacetyl, the
compound used to give movie popcorn its buttery flavor, also can
lead to the disease. This is known as popcorn lung.
Pneumoconiosis can be simple or complicated. Simple
pneumoconiosis causes a small amount of scar tissue. The tissue
may appear on an X-ray as round, thickened areas called nodules.
This type of the disease is sometimes called coal worker
pneumoconiosis, or CWP. Complicated pneumoconiosis is known
as progressive massive fibrosis, or PMF. Fibrosis means that a lot of
scarring is present in the lungs.
For either simple or complicated pneumoconiosis, the damage
causes the loss of blood vessels and air sacs in your lungs. The
tissues that surround your air sacs and air passages become thick
and stiff from scarring. Breathing becomes increasingly difficult.
This condition is called interstitial lung disease.

Who's at risk
• Being exposed to dust that can cause pneumoconiosis,
in an everyday setting, is not enough to cause the
disease. But you could be at risk if you've worked
around or directly with these dusts. Studies show that
about 16 percent of American coal miners may
eventually develop interstitial fibrosis from coal dust.
Other dust exposures that may put you at risk include
working with asbestos fibers or silica dust. Risk may
also be increased by:
• Smoking
• Being exposed to a high level of dust
• Being exposed for a long time

Symptoms
• Symptoms of pneumoconiosis often depend on how severe the disease is. Simple CWP may have no or few symptoms and
show up only on an X-ray. PMF may cause mild to severe difficulty breathing. Symptoms may include: Cough, Lots of
phlegm, Shortness of breath
Diagnosis
• You may be diagnosed with pneumoconiosis if you have lung symptoms, X-ray abnormalities, and a history of working
around coal, asbestos, or silica. You may also be diagnosed by having a routine X-ray during the time you are employed.
The Federal Mine Safety and Health Acts require that all underground coal miners be offered a chest X-ray after three years
and then at five-year intervals to look for the disease. Your doctor may use any of these to help make a diagnosis:
• Personal history of work exposure, Physical examination
• Chest X-ray or CT scan to look for lung nodules, masses and interstitial disease, CT scan of the chest
• Pulmonary function studies, including blood gasses, Biopsy

Treatment
• Pneumoconiosis can’t be cured. Once the disease has been diagnosed, treatment is aimed at
keeping it from getting worse and controlling symptoms. A treatment plan may include:
• Not smoking
• Avoiding all dust exposure
• Using oxygen
• Taking medications called bronchodilators that open lung passages
Prevention
Wearing a mask
Washing areas of skin that come in contact with dust
Safe removal of dust from clothing
Washing your face and hands thoroughly before eating, drinking, or taking any
medications
Not smoking
Letting your doctor and your employer know about any symptoms of pneumoconiosis
Getting regular chest X-rays and physical exams

ANTHRACOSIS
Carbon dust (coal mine dust): Coal miner’s pneumoconiosis
Two phases in coal miners pneumoconiosis
1. Simple pneumoconiosis: little ventilatory impairment
– Around 12 yr. of exposure needed for this phase to appear
2. Progressive massive fibrosis (PMF): severe respiratory disability and frequently results in
premature death
The risk of death among coal miners has been appx twice that of the general population.
Coal-miners’ pneumoconiosis is a notifiable disease under Indian Mines Act of 1952
It is also compensatable in Workmen's Compensation (Amendment) Act, 1959

• Anthracosis of the lungs is black discoloration of bronchial mucosa that can
occlude bronchial lumen and is associated with bronchial anthracofibrosis (BAF).
• This disease usually presents with a chronic course of dyspnea and or cough in
an elderly non-smoker woman or man. In addition, concomitant exposure to dust
and wood smoke is the most postulated etiology for anthracosis.
• Pulmonary function tests usually show an obstructive pattern with no response to
bronchodilators and normal DLCO, but some cases with restrictive pattern have
also been seen. Computed tomography (CT) may show more specific findings
such as lymph node or bronchial calcification and mass lesions. Final diagnosis
can be made by bronchoscopy when obtaining samples for tuberculosis (TB),
which is the most common disease associated with BAF. Endobronchial
ultrasound shows a hypoechoic scattered nodular pattern in adjacent lymph
nodes, which is unique to anthracosis.
• Treatment is very similar to that of chronic obstructive pulmonary disease
(COPD) with a chronic course and low mortality. This review discusses this
disease as a separate entity; hence, anthracosis should be added to the list of
obstructive lung diseases and benign mass lesions and differentiated from
biomass induced COPD.

Byssinosis
• Byssinosis is a disease of the lungs. It is caused by breathing in
cotton dust or dusts from other vegetable fibers such as flax, hemp,
or sisal while at work
Causes
• Breathing in (inhaling) the dust produced by raw cotton can cause
byssinosis. It is most common in people who work in the textile
industry.
• Those who are sensitive to the dust can have an asthma-like
condition after being exposed.
• Methods of prevention in the United States have reduced the
number of cases. Byssinosis is still common in developing
countries. Smoking increases risk of developing this disease. Being
exposed to the dust many times can lead to long-term (chronic)
lung disease.

• Symptoms
• May include any of the following:, Chest tightness, Cough, Wheezing, Shortness of breath
• Symptoms are worse at the beginning of the work week and improve later in the week. Symptoms are also less severe
when the person is away from the workplace.
Exams and Tests
• Health care provider will take a detailed medical history. You'll be asked whether your symptoms
relate to certain exposures or times of exposure. The provider will also do a physical exam, paying
special attention to the lungs.
• Tests that may be ordered include: Chest x-ray, Chest CT scan, Lung function tests

Treatment
• The most important treatment is to stop being exposed to the dust.
Reducing dust levels in the factory (by improving machinery or
ventilation) will help prevent byssinosis. Some people may have to
change jobs to avoid further exposure.
• Medicines used for asthma, such as bronchodilators, usually improve
symptoms. Corticosteroid drugs may be prescribed in more severe cases.
• Stopping smoking is very important for people with this condition.
Breathing treatments, including nebulizers, may be prescribed if the
condition becomes long-term. Home oxygen therapy may be needed if
blood oxygen level is low.
• Physical exercise programs, breathing exercises, and patient education
programs are often helpful for people with a long-term (chronic) lung
disease.
Prevention
• Controlling dust, using face masks, and other measures can reduce the
risk. Stop smoking, especially if you work in textile manufacturing.

Bagassosis
Occupational lung disease caused by inhalation of bagasse or
sugarcane dust.
• First reported in India in a cardboard manufacturing firm near
Kolkata. India has a large sugarcane industry. Sugarcane fiber
is utilized in manufacturing of paper, cardboard and rayon
• Bagassosis occurs due to a thermophilic actinomycete k/a
Thermoactinomyces sacchari. Symptoms:Breathlessness,
Cough, Hemoptysis and Slight fever.
• Acute diffuse bronchiolitis, Skiagram: Mottling in lungs or
shadow
• Impairment of pulmonary function tests
• Treatment:
– If treated early: acute inflammatory condition may resolve
– If left untreated, there is diffuse fibrosis, emphysema and
bronchiectasis

• Bagassosis – Prevention
1. Dust control
– Suppression of dust, e.g. wet process, enclosed apparatus, exhaust
ventilation etc.
– Personal protection
– Masks or respirators with mechanical filter or with oxygen or air supply
– Medical control
– Initial medical examination and
– periodical check ups of the worker
• Bagasse control
– Keeping the moisture content above 20%
– Spraying the bagasse with 2% propionic acid (fungicide)

Silicosis
Cause of permanent disability and mortality.
• It is Caused by inhalation of dust containing free silica or
silicon dioxide (SiO2). First reported in India in 1947 from
Kolar Gold Mines (Mysore). Mostly Silica exposure occurs
in industries like:
– Mining of: Coal, Mica, Gold and Silver, Lead, Zinc,
Manganese etc, Pottery and ceramic, Sand blasting, Metal
grinding, Building and construction, Rock mining, Iron and
steel etc.
• Higher the concentration of free silica in the dust, greater
the hazard
• Longer the duration of exposure, the greater the risk of
developing silicosis
• Incubation period may vary from months up to 6 yr. of
exposure depending upon previously discussed factors

• Particles ae ingested by phagocytes, these phagocytes block the lymph channels
• Pathology:
– Dense ‘nodular’ fibrosis
– Nodules range from 3 – 4 mm in diameter
• Clinically:
– Insidious onset
– Early manifestations include
• Irritant cough
• Dyspnea on exertion and
• Pain in the chest
– Impairment of TLC common in advanced stage
• Lab investigations:
– Xray: ‘snow – storm’ appearance
• Silicosis increases the proneness to tuberculosis
• No effective treatment as Fibrotic changes irreversible
• Prevention and control of silicosis:
– Rigorous dust control measures
– Regular physical examination of workers
– Silicosis is a notifiable disease under Factories Act 1948 and Mines Act 1952

Asbestosis (as-bes-TOE-sis) is a chronic lung disease caused by inhaling asbestos fibers. Prolonged
exposure to these fibers can cause lung tissue scarring and shortness of breath. Asbestosis symptoms
can range from mild to severe, and usually don't appear until many years after initial exposure.
Asbestosis
• Asbestos consists of certain types of fibrous material made up of silicates
• Silica may be combined with: Magnesium, Iron, Calcium, Aluminum
Asbestos is of two types:
1. Serpentine or Chrysolite –
– Hydrated magnesium
– 90% of world’s asbestos production
2. Amphibole
– Contains little magnesium
– Fibers are straight and longer than chrysotile fibers
Asbestos is used in the manufacture of: Asbestos cement, Fire proof textiles, Roof tiling, Brake lining, Gaskets etc.
Asbestos enters the body by inhalation and fine dust may be deposited in the alveoli
• The fibers are insoluble
• The dust deposited in the lungs causes pulmonary fibrosis leading to:
– Respiratory insufficiency and death
– Carcinoma of bronchus
– Mesothelioma of the pleura or peritoneum (otherwise a rare form of cancer) and
– Cancer of the gastro intestinal tract

• Asbestosis is a type of persistent lung condition which happens when one inhales asbestos fibres.
Long-term contact with these fibres can result in lung tissue scarring and breathing difficulties.
Initially, some mild to severe symptoms of asbestosis can be seen. Asbestos is a naturally occurring
mineral substance that is heat- and corrosion-resistant. In the past, it was widely utilized in items
like insulation, cement, and some floor tiles.
• Asbestosis can be contracted by individuals exposed to construction areas and cement production
sites. If you abide by the safety regulations your workplace sets, developing asbestosis is very rare.
The management of asbestos materials should only be done by certified and educated personnel.

Causes: Asbestosis occurs when some airborne fibres from prolonged exposure to high quantities of asbestos
dust lodge in your alveoli, the tiny sacs in your lungs where oxygen is exchanged for carbon dioxide in your
blood. The irritation caused by the asbestos fibres makes the lung tissue inflexible. This makes breathing
challenging. Scarring of lung tissue increases as asbestosis worsens. Your lung tissue eventually stiffens to the
point that it cannot contract and expand correctly. Smoking frequently causes the disease to advance more
quickly and enhances the retention of asbestos fibres in the lungs.
Risk factors
• The greatest risk of developing asbestosis is among individuals exposed to asbestos due to the nature of their
job. Few such jobs are listed below.
• Miners of asbestos
• Aircraft and automobile repair workers
• Operator of boilers
• Employees in the building industry
• Electricians
• Railroad personnel
• Workers in mills and refineries
• Shipyard personnel
• Workers are removing older buildings' steam pipes' asbestos insulation.
• The quantity and length of asbestos exposure are typically connected to the risk of asbestosis. The risk of lung
injury increases with exposure levels.
• Household members of exposed workers may be exposed to secondhand infection of asbestos fibres is easily
possible through garments. Asbestos fibres dispersed into the air may also be exposed to people who live
close to mines

Symptoms: In most cases, it takes 10–40 years after the initial exposure to asbestos before
the symptoms of long-term exposure become apparent. The degree of symptoms can vary.
Some symptoms and indicators of asbestosis include:
• Breathing difficulty
• A continuous, Drycough
• Chest discomfort or stiffness
• When you breathe in, your lungs make dry and crackling noises.
• Wider and rounder-than-normal finger and toe tips (clubbing)
When to see a doctor?
• Speak to your doctor about the likelihood of asbestosis if you have a history of asbestos
exposure and are seeing that your shortness of breath is worsening.
• Get the best treatment for Asbestosis from the top Pulmonologist at Medicover Hospitals.

Treatment
• The effects of asbestos on the alveoli cannot be reversed with medication. Treatment targets symptom relief, reducing the disease's course and
avoiding consequences.
• Depending on the severity of your condition, you may require routine follow-up care at regular intervals, including lung function tests and chest X-
rays or CT scans. Respiratory infections should be treated as soon as possible to avoid consequences.
• Therapy
• Your doctor might advise taking supplementary oxygen to help with breathing difficulties brought on by advanced asbestosis. Tiny plastic tubes
with prongs that fit into your nostrils or thin tubes attached to a mask that covers your mouth and nose are used for distribution.
• Some persons may benefit from taking part in a pulmonary rehabilitation program. The program provides information on enhancing physical
activity habits, learning breathing and relaxation techniques, and improving general health.
Surgery
• Thoracentesis,
• A lung transplant may be an option if your symptoms are severe.
Lifestyle changes and self-care
• In addition to receiving medical care:
• Avoid smoking
• Lung cancer risk rises in the presence of asbestosis. This risk can be decreased by quitting smoking. Try to stay away from secondhand smoking.
Smoking may also weaken your lung reserves by doing extra harm to your lungs and airways.
• Take vaccine
• Prevent additional exposure to asbestos

Farmer’s Lung
• Due to inhalation of moldy hay or grain dust
(hypersensitivity pneumonitis)
• Grain dust or hay with a moisture content of >30%,
bacteria and fungi grow rapidly in the dust and
causing rise of temperature of 40 – 50⁰C
• This heat promotes growth of Thermophilic
actinomycetes esp. Micropolyspora faeni which
causes Farmer’s lung.
• Acute Illness
– General and respiratory symptoms and physical
signs
• Repeated attacks of acute illness cause
– pulmonary fibrosis and inevitable pulmonary
damage and
– Finally Corpulmonale
• India has the bulk of the population engaged in
agricultural work – the condition might be
widespread in the country

• Farmer’s lung is an allergy to the dust from moldy crops. It’s often caused by
moldy hay, but any kind of moldy crop can cause this condition.
• Untreated farmer’s lung can lead to serious complications including lung
damage and even death.
• Farmer’s lung is caused by the dust that’s found on moldy crops. This dust
contains bacteria spores that are heat resistant and cause irritation.
• When crops are harvested in rainy or wet weather, they can start to compost and
create heat while in storage. This can result in rapid mold growth and large
amounts of mold dust. Workers who handle these spoiled crops then breathe in the
accumulated dust.
• Farmer’s lung is not an infection. The bacteria causes an allergic reaction, much
like seasonal or environmental allergies. It happens as the body’s immune system
responds to the presence of mold dust. This creates inflammation and the
symptoms of farmer’s lung.

• Adults who handle moldy hay and other crops are at the highest risk of
farmer’s lung. Farmers and farm workers who work with hay and straw
indoors are at higher risk than people who harvest these crops. Some reports
show that it affects between 2-10% of farm workers.
• Other people at an above-average risk of farmer’s lung include:
• straw and grain handlers
• poultry workers
• zoo and circus workers who care for animals
• pet store workers
• stable employees or people who visit stables recreationally

• The exact symptoms of farmer’s lung depend on whether you’re experiencing a mild, acute, or
chronic case. Chronic farmer’s lung is the result of multiple episodes of acute farmer’s lung.
• Symptoms of mild farmer’s lung include are similar to a cold or allergies. They can be easy to
ignore. Symptoms can get worse with repeated exposure to crop mold.
• Symptoms of acute farmer’s lung include:
• fever
• chills
• rapid heart rate
• rapid breathing
• difficulty breathing
• dry cough
• Symptoms of chronic farmer’s lung include:
• fatigue
• unintentional weight loss
• chronic cough
• weakness
• shortness of breath
• permanent lung damage

Treatment
• Farmer’s lung is usually a lifelong condition. Treatment can help you get
symptom relief, but avoiding continued exposure to moldy dust is key.
• However, if the exposure to the allergen hasn’t been going on for very long
and no permanent damage has been done to the lungs, it may be possible to
cure your allergy. This requires working with an allergist as well as
avoiding all exposure to the dust that caused your allergic reaction for a
long time.
• Having farmer’s lung means you have an increased sensitivity to moldy
dust. Your doctor may write prescriptions for antihistamines,
bronchodilator inhalers, and other treatments to ease symptoms.
• If you have acute farmer’s lung, you might need a few weeks of rest and
recovery in order to prevent lung damage.

IDENTIFICATION OF UNRECOGNIZED OCCUPATIONAL HAZARDS.
Hazard recognition is one of the most critical aspects of
occupational safety. “One of the ‘root causes’ of workplace injuries,
illnesses, and incidents is the failure to identify or recognize hazards
that are present, or that could have been anticipated.”
The recognition of hazards involves the study of work processes, to
identify possible factors which may pose health and safety hazards.
This is a fundamental step in the practice of occupational hygiene.
Hazards which are not recognized will be neither evaluated nor
controlled.
Recognition requires the basic background information. But to apply
it in the workplace requires a systematic approach, consisting of
gathering of information and a workplace survey, not necessarily
involving measurement. However, a quantitative evaluation of
the risks and of the necessary control measures may then be needed.

IDENTIFICATION OF UNRECOGNIZED OCCUPATIONAL HAZARDS.
• 1. Medical Treatment
• 2. General Health Education
• 3. Supervision Of Working Environment
• 4. Legal Protection To Employee
• 5. Proper Engineering Measures
• Design of Building
• Good Housekeeping
• Good ventilation.
• Proper dust control
• Protective device for the employees
• Environmental monitoring
• Harmful material : dust Avoided

Preventions of occupational disorders
• The primary concerns of occupational health services remain those specified by the
ILO/WHO in 1950, although work-related diseases are now considered as well as purely
occupational diseases. The actual services offered are essentially preventive in nature.
• Job placement
• People with certain preexisting medical conditions may be at a disadvantage in some jobs.
A preemployment health questionnaire or medical examination can be of great value in
such cases by determining job unsuitability before training time and expense have been
incurred. Job suitability may also need to be regularly monitored in order to assure
employee health and ability. Airline pilots, for example, undergo regular medical
checkups because a pilot with failing vision or one who suffers from an undetected heart
condition that can lead to a heart attack could endanger many lives. The health service can
also give valuable advice with regard to alternative employment when a worker is found
to be unfit for a particular job.

• Safety training
• An occupational health service has a responsibility to keep all employees
informed about hazards in the workplace. The measures taken to protect
employee health should be thoroughly explained so that workers understand
the necessity of complying with such irksome or unpleasant restrictions as
the wearing of protective clothing and face masks. First aid facilities should
be organized and employees instructed about first aid procedures in case of
accidental injuries or other emergencies.
• Supervision of high-risk groups
• Exposure levels considered safe for a young male worker may be hazardous
for a pregnant woman (the fetus, especially during the first three months of
development, is particularly sensitive to environmental toxic agents).
Pregnant women, as well as such other vulnerable groups as the very young,
the elderly, and the disabled, therefore require appropriate medical
surveillance and advice about specific precautionary measures they can
take.

• Control of recognized hazards
• A complex system of environmental and biological monitoring has been
developed for the control of known hazards at work. Occupational health
practice is concerned with monitoring the concentration of toxic substances
in the environment, determining safe exposure levels, suggesting procedures
to limit worker exposure, and monitoring workers for signs of
overexposure. Occupational health specialists can also contribute to the
prevention of health risks by assisting in the planning and design of new
equipment and factories.
• Identification of unrecognized hazards
• Occupational health services can play a major role in the detection of new
health hazards of all types. Clinical observation and study may reveal a
causal relationship between patterns of sickness or mortality in groups of
workers and their occupational exposure. Examples of hazards identified in
this manner include lung and nasal cancer among nickel workers, lung
cancer in asbestos workers, and coronary heart disease among workers
exposed to carbon disulfide (used in the manufacture of rayon).

• Treatment
• Quick, on-site treatment of work injuries and poisonings can prevent
complications and aid recovery. Such treatment can also be
economically beneficial by saving traveling and waiting time. Furthermore,
physicians and nurses who are unfamiliar with their patients’ working conditions
may keep workers with minor injuries away from work longer than necessary. An
occupational treatment service offers opportunities for specialized counseling and
health education.
• General health education and surveillance
• Occupational health services may have to provide general medical care for
workers and their families in developing countries with
inadequate community health services. Even when general health care is provided
elsewhere, an occupational health service can offer an effective and often
economically advantageous program of health education and counseling. By
advising employees on such topics as smoking, alcohol or drug abuse, exercise,
and diet, the occupational health service can improve worker health
and efficiency and reduce illness and absenteeism. The health service is also in a
position to organize employee health surveillance programs for the
early diagnosis of disease.

STRATEGIES FOR CONTROLLING OCCUPATIONAL HAZARDS

1. Eliminate the hazard Elimination of the hazard is not always achievable
though it does totally remove the hazard and thereby
eliminates the risk of exposure. An example of this
would be that petrol station attendants in Ireland are
no longer exposed to the risk of chronic lead
poisoning following the removal of lead from petrol
products sold at forecourts.
2. Substitute the hazard with a lesser risk Substituting the hazard may not remove all of the
hazards associated with the process or activity and
may introduce different hazards but the overall harm
or health effects will be lessened. In laboratory
research, toluene is now often used as a substitute for
benzene. The solvent-properties of the two are similar
but toluene is less toxic and is not categorised as a
carcinogen although toluene can cause severe
neurological harm.

3. Isolate the hazard Isolating the hazard is achieved by restricting
access to plant and equipment or in the case of
substances locking them away under strict
controls. When using certain chemicals then a
fume cupboard can isolate the hazard from the
person, similarly placing noisy equipment in a
non-accessible enclosure or room isolates the
hazard from the person(s).
4. Use engineering controls Engineering Controls involve redesigning a
process to place a barrier between the person and
the hazard or remove the hazard from the person,
such as machinery guarding, proximity guarding,
extraction systems or removing the operator to a
remote location away from the hazard.

. Use administrative controls Administrative controls include adopting standard operating
procedures or safe work practices or providing appropriate
training, instruction or information to reduce the potential for
harm and/or adverse health effects to person(s). Isolation and
permit to work procedures are examples of administrative
controls.
6. Use personal protective equipment Personal protective equipment (PPE) include gloves, glasses,
earmuffs, aprons, safety footwear, dust masks which are
designed to reduce exposure to the hazard. PPE is usually seen
as the last line of defence and is usually used in conjunction
with one or more of the other control measures. An example of
the weakness of this control measure is that it is widely
recognised that single-use dust masks cannot consistently
achieve and maintain an effective facepiece-to-face seal, and
cannot be adequately fit-tested and do not offer much, if any real
protection against small particulates and may lead to a false
sense of security and increase risk. In such instances an
extraction system with fitted respirators may be preferable
where the hazard may have significant health effects from low
levels of exposure such as using isocyante containing chemicals.

OCCUPATIONAL HEALTH LEGISLATION IN INDIA
• There are presently 16 laws related to working hours, conditions at work and
employment. There are two acts containing the main provisions for legal measures for the
protection of health and safety of workers; they are the Factories Act (1948) and the
Mines Act (1952).
• The Factories Act was amended in 1987 and stipulates pre-employment examination as a
pre-placement procedure, statutory periodic medical examination for job in hazardous
areas. In India, occupational health is under two ministries: 1) Labour and 2) Health and
Family Welfare.
• The Ministry of Labour and the labour departments of the states and union territories are
mainly responsible for health and safety of workers. The Ministry of Health and Family
Welfare is responsible for providing health and medical care to workers through its
facilities.
• The DGMS (Directorate General of Mines Safety) and the DGFASLI (Directorate
General – Factory Advisory Services and Labour Institutes) assist the Ministry in
technical aspects of occupational health and safety in mines, ports and factories
respectively.

NATIONAL PROGRAMME FOR CONTROL AND TREATMENT
OF OCCUPATIONAL DISEASES
• Occupational health was one of the components of the National Health Policy in 1983 and 2002.
The Ministry of Health and Family Welfare, Government of India, launched a programme entitled
“National Programme for Control and Treatment of Occupational Diseases” in 1998–99.
• The National Institute of Occupational Health, Ahmedabad, is the nodal agency for the same. The
categories of major occupational diseases in India are: occupational injuries, occupational lung
diseases, occupational cancers, occupational dermatoses, occupational Infections, occupational
toxicology and occupational mental disorders.
• A grouping of major occupational disorders in India according to the etiological factors includes –
occupational injuries: ergonomics related; chemical occupational factors: dust, gases, acid, alkali,
metals etc.; physical occupational factors: noise, heat, radiation etc.; biological occupational
factors; behavioural occupational factors; and social occupational factors.
• In India in 1998–99, the prevalence of silicosis was 6.2–34% in mica miners, 4.1% in manganese
miners, 30.4% in lead and zinc miners, 9.3% in deep and surface coal miners, 27.2% in iron
foundry workers, and 54.6% in slate-pencil workers. Prevalence of asbestosis was extended from
3% in asbestos miners to 21% in mill workers. In textile workers, byssinosis was as common as
28–47%. Nutritional status in terms of body mass indices (BMI) of the workers was also
significantly low.

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)
• The Occupational Safety and Health Administration (OSHA) assures safe and healthful working conditions
by setting and enforcing standards, and by providing training, outreach, education and assistance.
• The Occupational Safety and Health Administration (OSHA) is a federal agency in the United States
committed to safeguarding worker health and safety.
• Congress established OSHA in 1971, following its enactment of the Occupational Safety and Health Act of
1970. This groundbreaking legislation came in response to the growing concerns over workplace accidents
that resulted in an alarming 14,000 worker deaths and 2.5 million disabled workers annually in the two years
previous to the bill's passing.
• Since its inception, OSHA has been a key player in transforming the landscape of worker safety across the
nation. The agency's firm enforcement of workplace laws and standards, coupled with its commitment to
providing training, outreach, education and assistance, have significantly contributed to making workplaces
safer.
• OSHA has been successful in slashing the work fatality rate by more than half and has achieved considerable
reductions in overall injury and illness rates in industries where it has focused its attention, such as textiles
and excavation.

ADMINISTRATION AND SCOPE OF OSHA
• OSHA's direction falls under the assistant secretary for occupational safety and health,
who answers to the secretary of labor, a member of the Cabinet of the United States.
• OSHA's authority extends across the country and its jurisdictions, covering all 50 states
and U.S. territories, including the District of Columbia, Puerto Rico, American Samoa,
Guam, the U.S. Virgin Islands and the Northern Mariana Islands.
• OSHA's jurisdiction extends to most private sector employers and their workers, and it
encompasses a broad range of industry workplaces from construction to maritime to
agriculture. Through state OSHA agencies, the agency also covers some public
sector employers and their workers.
• However, it's important to note that OSHA does not cover self-employed workers or
immediate members of farm families who do not employ nonfamily workers.
• States can have their own federally approved occupational safety and health regulatory
programs, which are referred to as state plans. These state plans must have regulations
that are at least as stringent as federal OSHA regulations, but they also have the discretion
to implement stricter regulations if they choose.

OSHA standards and enforcement
• OSHA sets and enforces standards and requirements that employers must adhere
to. These standards are developed based on rigorous workplace research and
feedback from a diverse array of stakeholders, including technical experts,
employers, unions and other relevant parties.
• To comply with OSHA requirements, employers must take a number of specific
actions. Those include inspecting the workplace for potential hazards, eliminating
or minimizing hazards, keeping records of workplace injuries and illness, training
employees to recognize safety and health hazards, and educating employees on
precautions to prevent accidents.
• OSHA also requires employees to follow rules, such as complying with all
applicable OSHA standards, following OSHA safety regulations, wearing required
protective equipment, reporting hazardous conditions, and reporting job-related
injuries and illnesses.
• To aid employers in meeting these standards, OSHA provides a wide range of
resources, including training programs and educational tools.

EMPLOYEE RIGHTS AND OSHA PROGRAMS
• OSHA also serves as a strong advocate for employee rights. Under OSHA
regulations, employees have the right to access copies of OSHA regulations
and request information about workplace hazards, precautions and
procedures.
• They can request OSHA inspections if they believe hazardous conditions or
violations exist in their workplace. Moreover, federal laws and OSHA
protect workers who complain or whistleblowers who report possible
violations to their employers, OSHA or other agencies from retaliation.
• To support its mission, OSHA runs various programs like the Alliance
Program, which enables employers, labor unions, trade or professional
groups, government agencies and educational institutions to collaborate
with OSHA to prevent workplace injuries and illnesses.
• Its Safety and Health Achievement Recognition Program provides
incentives and support to employers for the development and
implementation of workplace safety and health programs.

Special recommendation
• The following are the main present and future needs in occupational health in India:
• Existing occupational health related legislation and facilities need to be expanded and extended to
workers in the unorganised sector with immediate implementation and periodic review for
improvement.
• Further development of institutions and infrastructure of occupational health, with simultaneous
training of professionals in the field.
• Spreading awareness of occupational health related issues among all stakeholders such as
employers, employees, lawmakers, workers’ organisations (e.g. trade unions), non-governmental
organisations (NGOs) and the general public.
• Integration of occupational health into primary health care and general health services through the
concept of BOHS (basic occupational health services).

• There is an urgent requirement of modern occupational health and safety
legislation, adequate enforcement machinery and establishment of centres of
excellence in occupational medicine in all states of the country controlled by a
central institute, to catch up with the global pace.
• There is a need to increase awareness about the concept of occupational health
nursing among all stakeholders along with recruitment of adequately trained
occupational health nurses for implementing basic occupational health services.
• Basic issues which are barriers to economic development as well as
implementation of occupational health policy like dense population,
unemployment, poverty, illiteracy, ignorance and unskilled manpower need to be
addressed urgently.
• The national policy on safety, health and environment at workplaces (2009) needs
to be implemented urgently in full swing with a detailed five-year review.

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