This file has been cleaned of potential threats.

If you confirm that the file is coming from a trusted source, you can send the following SHA-256

hash value to your admin for the original file.

bf73f2817cf692195041b2fb4569dbf99c94b34004ef65d4f5fd5afdd4a60b7e

To view the reconstructed contents, please SCROLL DOWN to next page.

Ded icat i ng f i ve decades to the nat i on i n OHS

Dr. Sunil Kumar, Dr. HG Sadhu

National Institute of Occupational Health (ICMR, DHR) Ahmedabad

Issues Related to Occupational Health and Safety of Workers

(33rd DAE Safety and Occupational Health Professionals Meet Institute of Plasma Research, Gandhinagar, 23-25 Nov 2016)

Mandate

Devoted to the cause of working class of people to provide “Occupational Health” to workers of all occupations and minimize deterioration of environ due to industrial activities through Research Education and Service

WHO CC –Since 1981 Pesticide Laboratory - NABL accredited

Golden jubilee celebration (2015-16)

Occupational Hazards and Occupational Health

• An occupational hazard is something unpleasant that workers may suffer/experience during job

• Occupational Health deals with all aspects of Health and safety at workplace and has a strong focus on prevention of hazards

• Promotion and maintenance of the highest degree of physical, mental and social well being of the workers in all Occupations (WHO/ILO )

• The Health of workers has several determinants, including risk factors at workplace leading to diseases and disorders

• Employment and working conditions in formal or informal sectors hold other determinants including working hours, salary, workplace policies for maternity leave, Health Promotion and Protection provisions, etc.

Background • India - Vast and highly populated - 1,210 billion(Census, 2011)

• Emerging Occupational Health problems are to be tackled along with existing Health problems like communicable diseases, malnutrition, poor environmental sanitation, etc.

• Agriculture is the main Occupation giving employment to about 58% of people : 2-8 % industrialized (USA & W. Europe)

• Proportion of employment in manufacturing and service sector is much lower : other devel nations

• Working female population lead to certain concerns. Such as women of reproductive age are vulnerable to adverse effects on reproduction from exposure to toxicants.

• India's workforce nearly 92% in unorganized sector, entire farm sector falling under informal category, while one-fifth of non-farm workers- in organized sector

•Gases

•Vapours

•Dusts

•Chemicals

•Fumes

•Electromagnetic &

Ionizing radiation

•Noise

•Vibrations

•Extremes of

Temperature

•Extremes of

Pressures

•Insects

•Moulds

•Viruses

•Fungi

•Bacteria

Occupational Hazards

•Work Place

Stress

•Shift work

A Research Institute..

• Identifies the priority areas • Generates baseline data • Provides systemic scientific information • Develops and promote intervention measures • Plans and conducts awareness and education

programmes • Helps generating trained personnel • Assists in making of policy decisions

Human Resource Development • NIOH dedicated to create a pool of manpower in

OHS

– Faculty support to MGLI and IIPH - AFIH course; Manipal Uni - MPH course and VV Nagar - MIHS course

– Conducts short term training courses for students and faculty/Directorate of Industrial Safety Health officials, etc.

– Initiating AFIH course (25 seats) at ROHC, Bengaluru in Dec 2016

– Planning to initiate AFIH course at ROHC, Kolkata by 2017

Fulfillment of Judiciary directives • Quantitative detection of heavy Metals & Phthalates in toys - (PIL No.79/2007)

– Multi-institutional (AIIMS-NIOH-NIN) Coordinated from ICMR-National study in estimating the harmful phthalates & heavy metals in the toys sold in the country (Report submitted)

• Safety, Health & Environmental issues in Coal-fired thermal power plants CFTTP (PIL Writ Petition (Civil) No.79/2005) – As a nodal institute of the expert committee, prepared guideline “Environment,

Health & Safety issues on coal fired thermal power plants” submitted to the Hon’ble Supreme Court. Hon’ble court directed all the CFTPP to implement the recommendations

• Coal Fired Thermal Power Plant – Jharkhand High Court (W.P. PIL No.1073 of 2014)

- Also received queries from Orissa, Punjab, Rajasthan, Gujarat, etc

• Hon’ble High Court of Gujarat at Ahmedabad – WP (PIL) 91 of 2005 - A1 & A2 Milk – Filed an affidavit on behalf of Department of Hlth Research, MoH&FW to Hon’ble

High Court & case disposed off.

• Hon’ble High court of Gujarat- effect of hazardous waste at secured land fill site (SLF-Vinzol) ‒ NIOH associated with GPCB for the study

• Hon’ble High court of Gujarat-directed for health check up of workers of poly acrylate manufacturing unit. ‒ Report submitted to hon’ble Court and matter was disposed off.

Hon’ble Court/National/societal requirement • Hon’ble Gujarat High Court nominated NIOH for a committee to suggests

measures to prevent death among staffs due to malaria & Dengue, BJ Med college, A’bad (Dozen meeting), 2013-15. Report submitted & Hon’ble court ask to implement certain measures suggested by the committee.

• Drugs controller of India, DGHS meeting to examine issues on “Harmful effects of packaging of pharmaceuticals products in plastics bottles, 12 July 2013, AIIMS, New Delhi and also prepare a status document on use of Plastic/Pet bottles for medicine

• NHRC Silicosis-Recently NHRC directed to carry out a follow up study of Workers who are alive from the 57 workers studied during 2005 by NIOH.

• Re-examination of former asbestos worker-Based on NIOH study, & intervention of the NHRC, state Govt. allocated monitory relief to the extent of Rs. 3.00 lakhs each to the victims & set up Pneumoconiosis Board in Rajasthan.

• Central Insecticide Board & Registration Committee (CIB&RC) meeting on Mencozeb issue. Presented ICMR-NIOH view. Assisting the local medical college for the project & possible assistance in this regards

• Status documents on Arsenic problems-Future Research direction

• Natl Profile of Occupational Health & Safety (OHS)- A document is prepared as a part of NIOH-WHO CC activity. Natl Profile-India document, based upon the printed information available or on websites of various stakeholders. The draft document is ready.

Promotion of Natl/Regional language • एन. आई. ओ. अच. पोम्पप्ऱेट हहिंदी, और गुजराती में बनाया है। इसे

बिंगऱI और कन्नड में भी प्र िंट करेंगे। • दो पुस्तके हहन्दी मे लऱखी - पयाावरनीय एवम ्व्यावसाययक पददाषण

और स्वास््य , 2012- सुनीऱ कुमार - वातावरनीय पददाषण, जीवनशेऱी एवम ्

रजनन स्वास््य 2016-सुनीऱ कुमार • राष्ट्रीय सिंगोंप्ि की रोलसडड िंग “वतामान

परररेऺेय में पयाावरण एवम ्व्यावसाययक स्वास््य”

• एक पुस्स्तका हहन्दी में लऱखी “व्यावसाययक रोग एवम ्रोकथाम ” 2016 - सुनीऱकुमार

• श्रलमक स्वास््य- एस्न्वस न्यदज़ ऱेटर-2014- Onwards

Translational research

• Hand gloves for tobacco harvesters

– Green Tobacco Sickness occurs in tobacco harvesters due to absorption of nicotine.

– NIOH carried out efficacy testing & found nylon gloves most efficient, durable & acceptable to harvesters.

– This technology has received an IS no.-16390-2015

– Distributed among workers also approaching NGOs for its awareness

Translational research

Redesigned Cycle Rickshaw – Structural & functional changes

• Driving mechanism, brake system, hoods including driver’s hood, passenger seat unit, luggage space, footboard, boarding height

– Based on study, cycle rickshaw redesigned, fabricated & tested

– Significant reduction in energy expenditure observed

– Model demonstrated & tested by rickshaw puller, passenger & assemblers

– Awareness program & efficacy test held in Patna & Cuttack

– The model appreciated by all groups.

– Transfer of technology to local manufacturers/ assemblers is being explored

Translational research Personal Cooling Garment (PCG)

• Workers in hot environ are prone to

fatigue & heat strain, resulting

development of Heat Related Injuries &

illnesses

• This can be utilized by workers of Iron &

Steel Foundries, Construction,

Agricultural, Military personnel, Mining

sites, Chemical Plants, Brick-Firing &

Ceramic Plants, Textile industry, power

plants, Glass product Industry, Boiler

rooms, Bakeries etc.

Specification

Battery operated water cooled garment

Ice & water easily available, & low cost

Lightweight - < 3.0 Kg with ice reservoir

Provides ~15oC cooler temp. & comfort

Affordable, Easy to use

Silicone tubing system can be fitted to any garment (Casual Half Shirt, jacket)

High heat absorption due to close contact with skin

2 hrs cooling duration, can be extended by replacing ice & battery

Transfer of Technology/Commercialization: “Soothe Healthcare Pvt. Ltd Noida

Patent Number: Indian Patent Office,

Application No.2746/DEL/2012 dated 5/9/2012

Cost Benefit: Approximately Rs.3000/-

Strategy for Prevention and Control of Occupational Diseases

Components: 1. Development of database and information system in Occupational health Need to collect data and information on research already conducted

a) Compilation of information and making a Directory of Institutions and Universities working on Occupation related matters and linkages between them. Information can also be collected on capabilities of these organizations.

b) Compilation of available information regarding epidemiological surveys and related studies to prepare a National Occupational Health profile.

2. Evaluation of effectiveness of the control strategy (Periodic medical and environmental monitoring)

This has following purposes:

1) Early detection of occupational morbidity

2) Evaluation of the success of control strategy and

3) Compliance of law.

•Under the amended Factories and Mines Act, the pre-employment and periodical medical exam and environ monitoring is mandatory in factories and mines having hazardous processes.

•Training of factory inspectors, medical inspectors of factories, mine inspectors, staff of industrial hygiene laboratories of State Govt, provision of equipment/supplies, are necessary for the periodic medical and environmental monitoring.

3. Management of cases of occupational diseases

Special skill is required in diagnosis, treatment and

post illness management of the cases of occupational

diseases.

Before allowing worker to resume work after sickness,

it is essential to review the work environment and also

physical demand of the work.

Training of physicians working in ESIS, District

Hospitals and PHCs.

4. Creation of awareness in workers, trade unions and management:

In India, a large numbers of workers--employed in unorganised sectors, largely illiterate and unaware of the hazards associated.

Sometimes, owners are also unaware about the hazards in the workplace.

Poor implementation of control measures and enforcement of legislative measures.

Awareness and health education program should be carried out for workers, supervisors and management.

Health education programmes should include advice on avoidance of drinking, eating and smoking at workplace.

5. Recognition, evaluation and control of hazards-Intervention

•Appropriate technology should be developed for the elimination of hazard. Joint effort by the entrepreneurs, machinery manufacturers, Factory Inspectorate, CLI, NIOH, DGMS and NGOs, etc. will help in identifying appropriate technology for elimination/control of hazard.

•The success of control technology: 1) Initial cost

2) Cost of maintenance and running

3) Acceptability by the workers

ENVIS NIOH Environ Information System Centre, NIOH, sponsored by Min. of Env, Forests & Climate Change, working since 1984. The mandate is to establish linkages with all information sources, & creation of data bank on selected parameters on Environ & Occup Hlth & disseminate to community. It also aims to identify the information gaps & serve as interface for the users on environ & Occup hlth.

1. Miners Health (2012) 2. Byssinosis (2012) 3. Professional Drivers (2012) 4. Cadmium Toxicity (2012) 5. Biomedical Waste Hazard (2013) 6. Chromium: Occupational & Env.

Hazards (2013) 7. Indian OSH Legislations (2013) 8. Electromagnetic Radiation Hazards

(2013) 9. E-Waste Health Hazards (2014) 10. Agriculture and Health (2014) 11. Environmental Health Legislations

in India (2014) 12. Major Industrial Disasters in India

(2014) 13. Social Security Schemes for

workers in India (2015) 14. Occupational health Issues of

Sewage & Sanitary Workers (2015) 15. Health Hazards of Mobile Phones

& Towers (2015) 16. Manganese: Occupational & Env.

Health (2015) 17. Children in Hazardous Occupation

(2016)

Bibliographies

1. कीटनाशक एविं स्वास््य दषु्प्रभाव (2014)

2. शोर एविं स्वास््य दषु्प्रभाव (2014)

3. रेस्टोरेंट तथा ढाबा कलमायों की व्यावसाययक स्वास््य समस्याऐ: एक लसहवऱोकन (2015)

4. स्वच्छता की उपयोगगता (2015)

Exhibitions , Seminar & Awareness

1. Occupational Cancer (2016) 2. Carbon monoxide Toxicity (2015) 3. Chromium toxicity (2015) 4. Occupational Skin Hazards (2014) 5. Industrial Effluent (2014) 6. Health Care workers (2013) 7. Temperature hazards (2013) 8. Byssinosis (2012) 9. Silicosis (2012)

Centre has ranked Second place among 69 thematic centres, India, during Natl Evaluation by MoEF, Delhi.

Construction

Ceramic

Cotton ginning

Bus drivers

Lead acid battery

Agriculture Veterinarians

Solid waste disposal

Coal field

Handicrafts

New Initiatives

• Multi-centric study to assess exposure & health effects of pesticide – Complying Hon’ble Supreme Court directives of generating data on potential toxicity & health hazards associated with pesticides (ICMR & ICAR)

• Urban air quality using remote sensing & GIS – detection and quantifying rural-urban transformation assessment of human health impacts over Ahmedabad (ISRO, NIOH & NEERI)

• Lead exposure on neuro-imaging correlates and cardiac autonomic functions – investigation of BLL with serum micro-nutrients & correlates of clinical cognitive cardio autonomic data, delineating the relationships between alterations in cognitive & autonomic functions

• Total metal dust & gaseous pollutants among rail coach rehabilitation workshop – To identify body burden of heavy metals in workplace air & effect on thyroid & reproductive systems

New Initiatives • Work stress & cardiovascular diseases among nursing personnel –

Assessment of physiological, postural & work stress; and development of cardiovascular diseases & their risk factors along with determination of an early biomarker

• Occupational health assessment among asphalt workers – to identify body burden of toxic chemical exposure and to suggest suitable PPEs. Asphalt workers are not covered under any Factories Act & this study will be useful for the policy makers to enact the Act

• Occupational safety, hazards & health effects in Indian automotive industries - Occupational health injuries, work area pollutants; evaluating early biomarkers for identifying occupational diseases & ergonomic risk factors will be identified. Exploring associations between major pollutants; morbidity & mortality. (collaborative study with DGFASLI- able to suggest suitable control measures.

No Investigation Samples

Poison Information Centre (PIC-NIOH)

Hospitals of Abad & nearby towns

utilize services of the PIC.

1887 cases (2360 referrals) of

poisoning referred to the centre

during 2012-2016

Highest number of poisonings

contributed by pesticides ~60 of

which OPs pesticides most

common (phorate, dimethoate, monocrotophos & chlorpyrifos).

26.42

32.94

6.09

2.1 2.563.36

1

24.04

1.49

0

5

10

15

20

25

30

35

OP P

est

Oth

er p

est

Hous

pro

d

Indu

st/E

nv C

hem

Nat

tox

ins

Dru

gs

Misce

ll. com

ps

Unkn

own

Mixed

Compound

No

. o

f C

ases (

%)

Compounds involved in poisoning

among the cases referred to PIC-

NIOH (10 yrs)

Lab support for public health

Lab support for public health

• NIOH-Contributing Central Sector Scheme – Monitoring of pesticide residues at national level

• Less than 1% samples above MRL

Pesticides Analysis (4182 food samples)

Lab support for public health

– Patients’ serum/urine/blood referred to this Institute for heavy metals analysis

– The analysis report provided to the Doctors for management for heavy metal poisoning

Heavy metal analysis

Year Cu Pb As, Mn, Zn, Hg & Cd

2012 77 06 02

2013 109 08 07

2014 154 09 01

2015 109 11 05

2016 145 10 02

Total 594 44 17

Lab support for public health

• NIOH entrusted to conduct Clinical, Anthropometrical and Biochemical component in 26 districts of Gujarat & 3 districts of Uts

• Total 80368 dried blood samples (DBS) collected from 1047 villages and analysed for Hb.

• The final report & data submitted

District Level Health Survey in Gujarat – DLHS IV MoHFW

Lab support for public health

• Muzaffarpur – As per ICMR directives, NIOH participated in this investigation with NCDC, NIV – NIOH analyzed acetyl cholinesterase & butyryl cholinesterase levels & pesticide

residues in food items and water & ruled out pesticide cause. – CDC USA also analyzed for presence of metabolites of herbicides (atrazine) &

OPs (dialkyl phosphate), & metals which also yielded negative results. – The clinical findings revealed severe hypoglycemia in the majority of patients,

suggesting that this was an outbreak of acute hypoglycemic encephalopathy. – Similar outbreaks of hypoglycemic encephalopathy documented from W Africa,

& illness found to be associated with Ackee fruit ingestion, due to presence of a naturally occurring compound called hypoglycin.

– US CDC evaluated & confirmed both alpha-methyl-4-carboxyphenylglycine (MCPG) & hypoglycin metabolites. These findings not observed in control children. They also detected both hypoglycin & MCPG in aril (fruit) & seeds of Litchi.

• Malda – An outbreak of acute encephalitis also reported from Kaliachak, Malda , W

Bengal affecting 72 children (9 months to 10 yrs) with 34 (47%) death – NIOH also involved in this study to understand its etiology. In addition, NIOH conducting a study in Rajanand Gaon (Chhattisgarh) to

assess health risk & environmental monitoring of Arsenic in the area

Acute Encephalitis Syndrome among children

Mobile App

- NIOH-ENVIS developed mobile App to get the information on chemicals hazards & Safety based upon the information available on the referred chemical. We are in the process to translate it in Hindi also.

Awareness

Tobacco Harvesters poster & use of gloves

Fish Processing use of Gloves & Break for short interval

Salt Workers Gum Boot and Globes

Ear muff for noise polluting industries

Silicosis Poster

Textile Mill Workers Ear muff and Dust protection

Safe use of chemicals Posters

Ongoing Research Activities – Outreach Programme

– Collection & dissemination on occupational & environmental health through newsletters, Bibliographies, awareness programmes, mobile application

– Sensitization programme for medical graduates in the country

– Training programmes for safety officers, industrial hygienists, medical inspectors, industrial physicians, researchers etc.

– Organize awareness programmes for NGOs and workers

– Enriching occupational health among students

Justification for Occupational Health Services

• Statutory Requirement

• International Trade Requirement

• Economic Benefits

• Social Benefits

Own regulation

• Self regulation-Proactive-before problem occurs

• Self regulation- Reduce exposure or risk

Provide education to workers regarding risk associated with work

Provide PPDs

Follow safety rules and regulation

Work together for the safety and Health of workers.

Summary: • Occupational & environ health is an expanding domain. In order to address

newer issues as well as existing problems, the generation of data is necessary not only to prioritise the planning but also to formulate policy matters.

• Need for further strengthening Res facilities & trained man power.

• Compilation of available information on Occup & Environ Health.

• Intervention/ translational aspect through imparting knowledge & develop of protective/Cont devices.

• Liberalizations, privatization & globalization affected working life & present new OSH challenges. The country needs strengthening OSH guidelines;

1) legislation to extend OSH coverage to all working sectors including unorganized sector

2) Spreading awareness about OSH among stakeholders

3) Development of OSH infrastructure & OSH professionals

Integration of Occupational Health with primary health care (BOSH)

Workers’ health & better safety at workplace

Investigation on Acute Encephalitis Syndrome (AES) among children - environmental & toxicological correlates • During 2013 -14, Natl Centre for Disease Control in collaboration with

NVBDCP, ICMR (NIOH, NIV) & support of US CDC conducted systematic investigations of AES outbreak.

• Clinical investigations suggested that an infectious etiology was unlikely. Pathogen-based testing of biologic specimens at NCDC were negative for bacteriological & virological pathogens.

• Thus non-infectious etiologies of pesticide toxicity & heavy metals explored. NIOH analyzed acetyl cholinesterase & butyryl cholinesterase levels in biologic specimens of cases (affected children) & controls (well children) & found no evidence to OPs pesticide toxicity.

• CDC USA additionally analyzed for the presence of other metabolites of herbicides (atrazine) & OPs (dialkyl phosphate), which also yielded negative results.

• NIOH also tested pesticide residues in food grains, water, vegetation & fruits (litchi), which again tested negative. Additionally, the US CDC also tested over 25 heavy metals & found no evidence to heavy metal toxicity.

• The clinical findings also revealed severe hypoglycemia in the majority of case patients, suggesting that this was an outbreak of acute hypoglycemic encephalopathy.

Contd • Similar outbreaks of hypoglycemic encephalopathy documented in W

Africa & West Indies, where the illness found to be associated with Ackee fruit ingestion, due to presence of a naturally occurring compound called hypoglycin. Thus, decided to proceed to assess outbreak of illness with naturally occurring toxins (MCPG & hypoglycin).

• The US CDC evaluated & confirmed the presence of both MCPG & hypoglycin metabolites in urine specimens of cases & also disruption of fatty acid metabolic function by identifying biomarkers of the same (organic acids, including dicarboxylic acid, in urine and medium & long chain acylcarnitines in blood) in human specimens. These abnormal findings (MCPG, hypoglycin, or abnormal elevations in fatty acids) were not observed in any specimens of control children. They also detected both hypoglycin & MCPG in the aril (fruit) & seeds of Litchi fruits collected from Muzaffarpur.