OCCUPATIONAL INFECTIONS DISEASES AND OTHER DISEASES OF BIOLOGICAL

OCCUPATIONAL INFECTIONS DISEASES AND OTHER DISEASES OF BIOLOGICAL ORIGIN Tartu 10.-11.3 OCCUPATIONAL HAZARDS  physical  chemical  biological  psycho-social Markku Seuri, FIOH, 2004 1 BIOLOGICAL OCCUPATIONAL HAZARDS = occup. biohazards infectious allergic toxic carcinogenic Markku Seuri, FIOH, 2004 2 – – – – BIOLOGICAL AGENTS        viruses bacteria fungi plant substances invertebrate animals substances derived from vertebrate animals (hazards of accidental) Markku Seuri, FIOH, 2004 3 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 Markku Seuri, FIOH, 2004 4 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  Markku Seuri, FIOH, 2004 5 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  Markku Seuri, FIOH, 2004 6 GENERAL MEASURES OF PREVENTION -2 inform the workers  written guidelines  guidance and instructions  use signs   (health check-ups have a limited role) Markku Seuri, FIOH, 2004 7 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)  Markku Seuri, FIOH, 2004 8 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 Markku Seuri, FIOH, 2004 9 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 10 Markku Seuri, FIOH, 2004 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 11 Markku Seuri, FIOH, 2004 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) Markku Seuri, FIOH, 2004 12 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. Markku Seuri, FIOH, 2004 13 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" Markku Seuri, FIOH, 2004 14 DEFINITION OF BIOLOGICAL AGENTS  micro-organisms, which may be able to provoke any –infection –allergy –toxicity Markku Seuri, FIOH, 2004 15 DEFINITION OF MICRO-ORGANISM entity, cellular or non-cellular and  capable of replication or of transferring genetic material  microbiological Markku Seuri, FIOH, 2004 16 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"  Markku Seuri, FIOH, 2004 17 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 Markku Seuri, FIOH, 2004 18 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 Markku Seuri, FIOH, 2004 19  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) Markku Seuri, FIOH, 2004 20 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  Markku Seuri, FIOH, 2004 21 DETERMINATION AND ASSESSMENT OF RISKS - 3 for all agents  renewed regularly  on request authorities must by supplied by information on the assessment process  Markku Seuri, FIOH, 2004 22 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 Markku Seuri, FIOH, 2004 23 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  Markku Seuri, FIOH, 2004 24 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  Markku Seuri, FIOH, 2004 25 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)  Markku Seuri, FIOH, 2004 26 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  Markku Seuri, FIOH, 2004 27 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  Markku Seuri, FIOH, 2004 28 TRAINING OF WORKERS at the begining of work involving contact with biological agents  new or changed risks  repeated periodically if necessary  Markku Seuri, FIOH, 2004 29 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  Markku Seuri, FIOH, 2004 30 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  Markku Seuri, FIOH, 2004 31 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) Markku Seuri, FIOH, 2004 32 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  Markku Seuri, FIOH, 2004 33 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  Markku Seuri, FIOH, 2004 34 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  Markku Seuri, FIOH, 2004 35 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  Markku Seuri, FIOH, 2004 36 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)  Markku Seuri, FIOH, 2004 37 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  Markku Seuri, FIOH, 2004 38 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 Markku Seuri, FIOH, 2004 39 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 Markku Seuri, FIOH, 2004 40 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 Markku Seuri, FIOH, 2004 41 GROUP 4 only viruses  11 viruses  rare like  – Ebola – Marburg – Lassa – Junin Markku Seuri, FIOH, 2004 42 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 Markku Seuri, FIOH, 2004 43 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 Markku Seuri, FIOH, 2004 44