Transcript hometalo ja astma

OCCUPATIONAL
INFECTIONS DISEASES
AND OTHER DISEASES OF
BIOLOGICAL ORIGIN
Tartu
10.-11.3
OCCUPATIONAL HAZARDS
 physical
 chemical
 biological
 psycho-social
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BIOLOGICAL
OCCUPATIONAL HAZARDS
=
–
–
–
–
occup. biohazards
infectious
allergic
toxic
carcinogenic
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BIOLOGICAL AGENTS







viruses
bacteria
fungi
plant substances
invertebrate animals
substances derived from vertebrate animals
(hazards of accidental)
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BIOHAZARDS VS. CHEMICAL
AND PHYSICAL AGENTS






less well known
problems in definition
less important in industrialized countries
changing nature of the exposure
seldom an essential part of the work task
difference in prevention: as few exposed as
possible
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SPREADING
by inhalation
 by ingestion (from hand to mouth)
 by sharps injuries
 by blood or other body fluid contact
 by bites or stings of vectors

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GENERAL MEASURES
OF PREVENTION -1
avoid hazardous agents whenever
possible
 minimize the exposure by proper
working practice, technical solutions
and personal hygiene
 minimize the number of exposed

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GENERAL MEASURES
OF PREVENTION -2
inform the workers
 written guidelines
 guidance and instructions
 use signs


(health check-ups have a limited role)
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THE INCIDENCE OF WORK-RELATED
DISEASES OF BIOLOGICAL ORIGIN
IN FINLAND IN 2002 - 1
bacterial and fungal spores 264
 TBC 16
 bacteria, virus, fungi and protozoa 134
 all biological agents (not including
allegens of biological origin) 414
(8,5 % of the total number)

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THE INCIDENCE OF WORK-RELATED
DISEASES OF BIOLOGICAL ORIGIN
IN FINLAND IN 2002 - 2

bacterial and fungal spores 264
– in farming 43
– public administration 49
– education 42
– health care 71

damp and mouldy work-places are
often found in the public sector
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OCCUPATIONAL GROUPS
THREATEND BY
INFECTIOUS AGENTS - 1
Agriculture
Forestry
epidemic nephritis
mycosis, tularemia
Lyme disease
Fishermen
Skin infections
Waste management
Hepatitis A and C
intestinal parasites
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OCCUPATIONAL GROUPS
THREATEND BY
INFECTIOUS AGENTS - 2
Veterinarians
Zoonotic microbes,
toxoplasma, listeria
Slaugherhouse
workers
dermatomycosis,
erysipelothrix
Fishermen
Skin infections
Health care workers
blood borne diseases,
TBC, MRSA
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OCCUPATIONAL GROUPS
THREATEND BY
INFECTIOUS AGENTS – 3
Security professions
blood borne diseases
Laboratory workers
what ever handled in
the laboratory
Teachers, day care
workers
viruses causing
epidemics among
children
Personal care workers dermatophytic fungi
(cosmeticians, hairdressers)
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EU DIRECTIVE
2000/54/EC
18th of Sept. 2000
On the protection of
workers from risks
related to exposure to
biological agents at
work
Tartu
10.3.-11.3.
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OBJECTIVE
 "protection
of workers against
risks to their health and safety,
including the prevention of
such risks, arising or likely to
arise from exposure to
biological agents at work"
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DEFINITION OF
BIOLOGICAL AGENTS
 micro-organisms,
which may
be able to provoke any
–infection
–allergy
–toxicity
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DEFINITION OF
MICRO-ORGANISM
 microbiological
entity, cellular
or non-cellular and
 capable of replication or of
transferring genetic material
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DEFINITION OF
EXCLUDES
microbial toxins if the replicating cell is
not present
 plant substances (allergens)
 substances derived from vertebrate
animals (allergens)
 => definition is very close to the
concept of "occupational infections"

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CLASSIFICATION OF
BIOLOGICAL AGENTS - 1

GROUP 1:
– unlikely to cause human disease

GROUP 2:
– can cause human disease
– may be an occupational hazard
– unlikely to spread to the community
– usually an effective prophylaxis or
treatment
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CLASSIFICATION OF
BIOLOGICAL AGENTS - 2

GROUP 3:
–
–
–
–

can cause human a severe disease
serious occupational hazard
may spread to the community
usually an effective prophylaxis or treatment
GROUP 4:
–
–
–
–
causes severe human disease
serious occupational hazard
may present a high risk of spreading
usually no effective prophylaxis or treatment
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DETERMINATION AND
ASSESSMENT OF RISKS - 1

where workers are or are potentially
exposed to biological agents
– biological agents are present deliberately
in the occupational activity (e.g.
laboratories) or
– workers may be exposed to the agent not
essential to the occupational activity
(work in forests and Lyme disease)
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DETERMINATION AND
ASSESSMENT OF RISKS - 2

if a risk of exposure to biological agent
– nature,
– degree and
– duration of the exposure must be
determined
for the assessment of the risk and
 to lay down measures

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DETERMINATION AND
ASSESSMENT OF RISKS - 3
for all agents
 renewed regularly
 on request authorities must by
supplied by information on the
assessment process

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EMPLOYERS´
OBLIGATIONS








whenever possible replace the agent
if not possible reduce the risks
information for the authority
hygiene and individual protection
information and training of workers
list of exposed workers
consultation and participation of workers
notification of the authority
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MEASURES TO REDUCE THE
RISK OF EXPOSURE -1
minimize the number of workers
exposed
 design of work processes and
engeneering control measures
 collective protection measures and/or
individual protection measures
 hygiene measures to prevent
accidental transfer from the workplace

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MEASURES TO REDUCE THE
RISK OF EXPOSURE -2
use warning signs
 plans to deal with accidents
 testing the presence of the agent outside
the primary physical confinement
 safe waste handling
 safe handling and transport within the
workplace

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INFORMATION FOR THE
COMPETENT AUTHORITY
results of the assessment
 activities where exposed (or potentially)
 number of exposed
 name and capabilities of the person
responsible for safety and health at work
 protective and preventive measures taken
 emergency plan for the loss of physical
containment (group 3 and 4)

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HYGIENE AND
INDIVIDUAL PROTECTION
no eating or drinkin in working areas
where there is a risk of contamination
 protective clothing (for free)
 adequate washing and toilet facilities
 any necessary protective equipment
 procedures for taking, handling and
processing samples of human or
animal origin

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INFORMATION OF
WORKERS
potential risks to health
 precautions to be taken to prevent
exposure
 hygiene requirements
 use of protective equipment and clothing
 steps to be taken by workers in the case
of incidents and to prevent incidents

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TRAINING OF WORKERS
at the begining of work involving
contact with biological agents
 new or changed risks
 repeated periodically if necessary

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LIST OF EXPOSED
WORKERS
for group 3 and 4 agents
 the list shal be kept for 10 years (for
some agents 40 years)
 the doctor and/or authority for health
and safety shall have access to the
list

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NOTIFICATION OF THE
COMPETENT AUTHORITY
prior (30 days) notification for group 2,
3 and 4 agents
 subsequent notification of new group 4
agents (excluding diagnostic
laboratories)
 renotification if substantial changes
 information content of the notification
is defined

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HEALTH
SURVEILLANCE
"The Member State shall establish, in
accordance with national laws and
practice, arrangements for carrying out
relevant health surveillance of workers
for whom the results of the
assessment referred to in Article 3
reveal a risk to health or safety."
(underlined by MS)
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RELEVANT HEALTH
SURVEILLANCE - 1
principles and practices of
occupational medicine
 in the light of the most recent
knowledge available to occupational
medicine
 evidence based medicine

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RELEVANT HEALTH
SURVEILLANCE - 2
depends on risk assessment not only
on the biological agent
 if a worker is suffering of infection or
an illness suspected to be the result of
exposure, surveillance should be
offered to other workers similarly
exposed

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RELEVANT HEALTH
SURVEILLANCE - 3
can be done prior to exposure and at
regular intervals thereafter
 doctor shall propose protective and
preventive measures
 all cases of diseases and death shall
be notified to the comptent authority

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VACCINATION
if risk and effective vaccination exist,
employers should offer vaccination
 workers should be informed of the
benfits and drawbacks of both
vaccination and non-vaccination
 vaccination must be offered free of
charge to workers

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HEALTH AND VETERINARY
FACILITIES OTHER THAN
DIAGNOSTIC LABORATORIES

in risk assessment consider:
– uncertanties about the presence of
biological agents
– suspected biological agents
in particular decontamination and
disinfection procedures
 special containment measures for
group 3 or 4 agents (Annex V)

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SPECIAL MEASURES FOR INDUSTRIAL
PROCESSES, LABORATORIES AND
ANIMAL ROOMS
for group 2, 3 and 4 agents
 containment measures according to
the agent (levels 2,3 and 4)
 separate containment measures for
laboratories and industrial processes

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CLASSIFICATION OF
BIOLOGICAL AGENTS 1

in four groups on the basis of four
features:
– ability to cause diseases
– ability to cause occupational diseases
– risk of spreading to the community
– treatment or prophylaxis
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CLASSIFICATION OF
BIOLOGICAL AGENTS 2
based on healthy adults
 not considering:

– pre-existing disease
– medication
– compromised immunity
– pregnancy or breast feeding

those agents not listed in groups 2, 3
or 4, are not implicitly group 1 agents
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CLASSIFICATION OF
BIOLOGICAL AGENTS 3

indications:
– A possible allergic effect
– D keep the list of exposed workers more
than 10 years
– T toxin production
– V effective vaccine available
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GROUP 4
only viruses
 11 viruses
 rare like

– Ebola
– Marburg
– Lassa
– Junin
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GROUP 3

27 bacteria, like
– Brucella, Bacillus anthracis, Coxiella, several
Mycobacteria

52 viruses, like
– hepatitis viruses, HIV, Creutzfeldt-Jacob, Rabies,
Kumlinge

16 parasites, like
– Echinococcus, Plasmodium falciparum

6 fungi, like
– Histoplasma capsulatum
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Group 2




120 bacteria
66 viruses
60 parasites
20 fungi
NB!
Direktiiv on tõlgitud eesti keelde:
http://europa.eu.int/eurlex/et/dd/docs/2000/32000L0054-ET.doc
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