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 Fishermen
epidemic nephritis mycosis, tularemia Lyme disease
Skin infections
Waste management
Hepatitis A and C intestinal parasites
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OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS AGENTS - 2
Veterinarians
Slaugherhouse workers Fishermen
Zoonotic microbes, toxoplasma, listeria
dermatomycosis, erysipelothrix Skin infections
Health care workers
blood borne diseases, TBC, MRSA
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OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS AGENTS – 3
Security professions Laboratory workers blood borne diseases 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 entity, cellular or non-cellular and capable of replication or of transferring genetic material
microbiological
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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 causes severe human disease serious occupational hazard may present a high risk of spreading usually no effective prophylaxis or treatment
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GROUP 4:
– – – –
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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