Occupational Health Clinics for Ontario Workers Inc

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Exploring Work-related Health Concerns Where do
you begin?Municipal Health Safety Association
ConferenceOctober 28, 2008

• John Oudyk Michelle Tew Steve Macdonald
• Occupational Hygienist Occupational Health Nurse
  Ergonomist

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Outline for session

• Introduction to OHCOW
• Identify samples of work-related health concerns
  amongst municipal employees
• Case examples of multi-disciplinary approach and
  experiences
• Prevention activities
• Questions regarding services

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Occupational Health Clinics for Ontario Workers
(OHCOW)

• an inter-disciplinary occupational health team
• occupational physicians
• occupational health nurses
• ergonomists
• occupational hygienists
• occupational health coordinators
• administrative personnel
• funded by WSIB Prevention Services

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Occupational Health Clinics for Ontario Workers
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Mission

• Prevent occupational illnesses and injury,
• and to
• Promote the highest degree of physical, mental
  and social well-being for all workers

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OHCOW Clinic Services

• Individual Clients (clinical)
• Groups
• Inquiries (answering questions regarding
  work-related issues)
• Education / Outreach
• Research

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What OHCOW does

• Exposure
• to what
• how much
• how long
• toxicology

• Medical
• symptoms
• tests results
• physical exam
• diagnosis

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Service Niche

• Generally, consultants do not combine medical
  with hygiene/ergonomics in the services they
  provide.
• OHCOW clinics have followed a policy of not
  duplicating the services of other organisations
• consultants
• WSIB ergonomics or modified work specialists
• Ministry of Labour (MOL)
• Canadian Centre for Occupational Health and
  Safety (CCOHS)
• Health and Safety Workplace Associations (HSAs)

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Clinic Services

• Group work
• workplace visits
• requested by co-chairs of JHSC
• exposure/health investigations/research
• medical/hygiene/ergonomic combined
• intervention recommendations focused on
  prevention

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How issues involving groups of workers arise?

• Through JHSC
• May recognize a health hazard and need assistance
  to reduce the hazard
• May need information about a health hazard
• May need assistance to assess whether there is a
  health issue among their workers

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How issues involving groups of workers arise?
contd

• Through the union/ worker
• May be concerned about a health hazard
• Want to understand it in further detail
• May be looking for options or information to
  offer employer
• May not have confidence in employer approach
• Through external sources
• E.g. MOL, Public, WSIB

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Some Examples of OHCOW work with municipalities

• Workers in LTC setting find out they have been
  exposed to asbestos and have concerns about their
  health
• JHSC waste management plant have questions about
  health effects of exposures to waste water
• High number of cancers in a specific area
  workers concerned it is work related
• JHSC recognizes risk factors e.g. musculoskeletal
  injuries but dont know how to deal with it
• Union identified problem with laundry area in LTC
  JHSC asked OHCOW requested to assess and offer
  solutions

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Some Examples of OHCOW work with municipalities

• Office ergonomics assessment and education
• Assessing musculo-skeletal problems R/T
  medication cart usage in LTC
• IAQ health complaints

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Case 1Line painters and exposure to toluene
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How the issue arose?

• CUPE group concerned about toluene exposures
  (particularly historical exposures) among line
  painters
• they were particularly worried about possible
  neuropsychological effects cancer
• many were also angry that no one had warned them
  of the dangers of toluene and were worried about
  possible future disease

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How did we proceed?

• OHCOW met with the union
• Encouraged discussion with the employer
• Steering committee was set up consisting of
  employer union
• HR, HS, managers, JHS reps, union reps (local
  and provincial), OHCOW
• Developed a detailed plan
• Key feature of the plan was open communication
  which involved ongoing meetings of the steering
  committee and information sessions to the
  workforce

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Framework Purpose

• Investigate exposures
• Anticipate occupational diseases associated with
  such exposures
• Screen for occupational diseases (survey)
• Present results, explain toxicology
• Document exposures
• Assess patients based on screening
• Specific assessment for expected health problems
  e.g. neuropsychological testing
• Apply for WSIB compensation if indicated
• Relate findings back to current workplace
  exposure issues

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Summary of Exposures (past present)

• SOLVENTS toluene, VMP naphtha, latex paint
  solvents (glycol ethers)
• LEAD, CHROMIUM
• ISOCYANATE methylene bis-phenyl di-isocyante
  (MDI)
• PHTHALATES di(2-ethylhexyl)phthalate
• GLASS DUST amorphous silica
• NOISE, VIBRATION, HEAT, AWKWARD POSITIONS, HEAVY
  LIFTING, HEAT STRESS

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Anticipated health effects (based on
exposures/toxicology)

• neuro-psychological symptoms (solvents)
• dermatitis (solvents, resins in paints)
• hearing loss (noise, toluene)
• shoulder/back issues (awkward positions, lifting)
• asthma (isocyanates, irritants)
• chronic bronchitis (irritants, isocyanates,
  smoking)
• vibration white finger (vibration)
• kidney? cancer? other?

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Medical follow up

• Met with union, region, and WSIB (occupational
  disease claims manager) to work out a process to
  address concerns
• Individual consultations were offered to all
  those who completed questionnaires plus anyone
  else who requested to be seen
• 34 workers were seen for individual consultations
  by an OHN and Occupational Health Physician over
  3 months
• Approx ½ of these were seen by psychologist for a
  3 hour neuropsychological screening assessment
• less than 15 were recommended for full assessment

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Outcomes of project

• Recognition of possible Work-related conditions
  (N15)
• Approximately 15 cases of work-related
  conditions Vibration white finger, Carpal tunnel
  syndrome, Musculoskeletal conditions,
  encephalopathy
• No identification of work-related respiratory
  conditions
• Cancer
• The number of cancers amongst those assessed was
  not more than would be expected

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Recognition of ongoing risk

• Health and Safety Initiatives
• Several risk factors for health issues and/or
  injuries within the workplace were identified
• Awkward postures and forceful work when line
  painting
• Use of vibrating equipment
• Continuing exposure to solvents during the
  painting process
• Noise

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Comments on project

• Focused clinical screening is more efficient and
  gives patients realistic expectations
• neuropsychological screening avoided unnecessary
  WSIB claims
• Provides direction for health and safety
  initiatives in the workplace
• The services provided were as comprehensive and
  as high a caliber as could be
• Few employers could have afforded to pay for this
  service
• Could not have been done without the co-operation
  of the region and support of union and their team
• Workplace parties assessment
• Region was pleased with outcome and process of
  the work
• Union recognized that work needed to be done in
  controlling exposures
• Some workers were satisfied others were not

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Case 2 Indoor Environment Problem Investigation
John Oudyk Occupational Hygienist
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Problem

• A number of occupants of the municipal office
  experienced episodes of passing out
• A hygiene consulting firm was retained to
  determine if there were any exposures in the
  building which might explain these episodes
• they measured temp, RH, CO2, CO dust
• they could not associate any of their
  measurements with the symptoms reported
• The occupants and the HS staff were frustrated
  so they called OHCOW (staff had used OHCOW
  services in previous workplace)

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Process

• Met with JHSC, HS staff and worker reps of
  areas of concern
• Invited symptomatic workers to be seen medically
  at clinic (confidential)
• Collect simultaneous symptom and exposure data
  (questionnaires, logs and datalogging equipment)
• Inspect ventilation system and conduct
  cross-sectional measurements in offices

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Measurements

• A datalogging air monitoring machine was placed
  in selected locations for 24 hour periods
• The machines log the following parameters over
  this time (5 minute averaging)
• temperature (C) (temp)
• relative humidity () (RH)
• carbon dioxide (in ppm) (CO2)
• carbon monoxide (in ppm) (CO)
• Occupants located near monitor are asked to fill
  out an workplace conditions/symptom log each hour
  while the monitor is in their work area (1 day)

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Measurement Findings

• comparison of measurements with ASHRAE guidelines
  for thermal comfort and outdoor air supply, and
  CO guidelines
• temperature too low (lt20.5?C) 0 of 15 days
• temperature too high (gt25.5?C) 0 of 15 days
• temperature fluctuations were detected 0 of 15
  days
• relative humidity too high (gt60) 0 of 15 days
• relative humidity too low (lt30) 10 of 15 days
• carbon dioxide exceeded levels expected (900 ppm)
  if the minimum outdoor air supply rate was 17
  cfm/person was achieved (i.e. not enough outdoor
  air) 0 of 15 days
• carbon monoxide above 2 ppm was detected 0 of 15
  days
• (except for Friday night when it reached 18
  ppm)

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Context IAQ standards

• ASHRAE 62.1-2007 Ventilation for Acceptable
  Indoor Air Quality states
• 3. acceptable indoor air quality air in which
  there are no known contaminants at harmful
  concentrations as determined by cognizant
  authorities and with which a substantial majority
  (80 or more) of the people exposed do not
  express dissatisfaction.
• ANSI/ASHRAE Standard 55-2004, Thermal
  Environmental Conditions for Human Occupancy,
  specifies the combinations of indoor space
  environment and personal factors that will
  produce thermal environmental conditions
  acceptable to 80 percent or more of the
  occupants. http//www.ashrae.org/pressroom/page/
  934

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r2(adj) 70.5
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Cross-sectional measurements

• Measurements were taken cross-sectionally for the
  following parameters
• lighting
• noise
• ultrafine particulate (low)
• volatile organic compounds (low)

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Lighting

• Generally, the eye sub-consciously tends to go to
  the brightest area in the field of vision, thus
  if something other than the computer screen is
  about 400-500 lux, the eye will be pulled into
  that direction (the screen being about 200-250
  lux).  This can cause tension which contributes
  to eye and neck strain and headaches. 
• Lighting levels were lowered on average about 100
  lux by removing various lights (from 400-500 lux
  down to 300-400 lux). 
• Anecdotally, the people consulted while taking
  the measurements after lowering the lighting
  levels, all stated that there was a significant
  improvement.

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Low Frequency Noise (LFN)Criteria (UK)

• Proposed criteria for the assessment of low
  frequency noise disturbance
• by Dr. A. Moorhouse, Dr. D. Waddington,
  Dr. M. Adams (2005)
• add 5 dB for steady state noise
• add 5 dB for daytime noise

http//www.defra.gov.uk/environment/noise/research
/lowfrequency/pdf/nanr45-criteria.pdf
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LFN Observations

• It was quickly noticed when measuring the noise
  frequencies that the office area1 had a
  significant spike at 63 Hz
• For this reason measurements were noted at
  various locations in both offices and are mapped
  in the following slide
• OHCOW staff and the Facilities manager noticed
  peculiar sensations in the head and ears when
  standing in certain locations where these spikes
  were most prominent

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Outcomes

• Staff felt their concerns were finally addressed
  seriously although it wasnt a definite answer
• The building management are working with the
  manufacturers of the HVAC system to reduce low
  frequency noise

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Case 3Back Injuries in Paramedics
Steve MacDonald Ergonomist
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How the issue arose?

• Paramedics hardly ever retire in the field they
  retire in an office, or while working in a
  different career
• Standard back care education focuses on lifting
  with the legs rather than the back
• However, this is in an ideal working environment

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Problems with Work/Training

• Paramedics are exposed to various hazards, for
  example
• Lifting in bathrooms
• Carrying down awkward stairs
• Maintaining the spine in an over-turned vehicle,
• Etc.
• These hazards are never recognized in back care
  training programs

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Back Problems in EMS Work

• According to the American Journal of Emergency
  Medicine, back injuries are the leading causes of
  on-duty injuries among EMS personnel.
• 30 of EMS injuries are a result of lifting and
  twisting tasks, 11 from bending and lifting and
  9 from pulling (Mitterer, 1999).
• Jones Lee (2005) reported that almost 60 of
  EMS workers complain of back strain after
  administering CPR.

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EMS Work

• EMS workers are particularly susceptible to back
  injuries due to emergency circumstances,
  unavoidable awkward lifting, excitement of
  crisis, lack of continued training, and the size
  of ambulance compartments.
• - Terribilini (1989)
• Ambulance staff showed by far the highest rate of
  Early Retirement on Medical Grounds at 55.9/1000
  eligible employees/year.
• - Rogers (1998)

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Back Care in Paramedics

• A municipal EMS service contacted OHCOW looking
  for help in creating a program tailored to their
  needs
• Through a community partnership, the union,
  management, the health/safety officer and OHCOW
  began tailoring a program specific to paramedics
• The program focuses on lifting scenarios along
  with practical ideas/solutions for lifting in
  different scenarios
• The program also discusses the anatomy and
  physiology of how the back works
• Something paramedics enjoy

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Objectives

• Back injuries are a major concern in EMS workers.
  For this reason, we want to help EMS workers to
• Identify hazards in the environment that can be
  avoided
• Put your back health as a priority (Avoid patient
  first, me last)
• Identify hazards that put you at risk for injury
• Teach you strategies that are beyond normal back
  care training that will help you during lifting,
  transporting, CPR administration and more
• Help with using your equipment more efficiently

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Outcomes

• All parties (union, management, HS) agreed to
  participate
• Occupational Health Physician consulted regarding
  program principles
• Total agreement with what has been created
• Program is still being drafted with most of the
  specific situations complete
• Paramedics with 25 years of experience could not
  believe some of the practical solutions that were
  presented
• Drafts of the program have garnered interest from
  workers who want the program available immediately

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Samples of Prevention Activities
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Snow Shoveling
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Snow Shovelling

• Inquiry Safe shovelling techniques
• Research ? answers
• There was nothing other than some work by CCOHS
• Fact sheet was created
• Goal Educate workers who have to shovel about
  proper shoveling techniques and hints and tips to
  
• avoid injury
• Contacted a municipality in our catchment area to
  discuss educating workers about snow shovelling
  hazards
• Knowledge transfers to educate all outside staff
• 9 presentations at various sites throughout the
  city
• All staff received a copy of the fact sheet

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Snow Shovelling 2

• Staff were extremely happy with the knowledge
  transfers
• many workers admitted they did not realize the
  hazards associated with shoveling
• A need was identified to discuss safe operation
  of snow blowers and additional training on
  shovelling stairs
• The municipality reported the following
  statistics
• Injuries related to snow shovelling
• 2006 (2 injuries)
• 2007 (2 injuries)
• 2008 (1 injury) worker who did not receive the
  training
• Prevention YES

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2007 Humidex Response Plan
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OHSCO Heat Stress Awareness Guide

• Summarizes causes, symptoms treatment of heat
  related illness
• Presents a 5-step approach for using humidex to
  assess heat stress hazards
• Outlines specific actions for managing and
  controlling heat stress

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OHSCO Pocket Wheel
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New Noise Regulation
old table
new table
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solution on-line calculator
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Voice level noise assessment
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LHIN Occupational Health Project

• Aim is to ?capacity of PHCP (primary health care
  providers) develop an integrated, coordinated
  approach to the identification of work-related
  health problems and their resolution
• Development implementation of care path
  guidelines for PHCPs
• Development of partnerships (health care, public
  health, occ health communities) focused on
  prevention management of work-related illness

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in summary

• Were different (clinic vs. training/safety
  audits)
• Focus on health issues and their prevention
  (through recognition)
• We react to special needs requiring a high level
  of expertise
• Interested in building workplace problem solving
  capacity
• bridging the academic work with the shop floor
• There is no charge for our services

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Thanks, any questions?
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Contact Info
Speaker Contacts John Oudyk (Hamilton)
joudyk_at_ohcow.on.ca Michelle Tew (Hamilton)
mtew_at_ohcow.on.ca Steve Macdonald (Sudbury)
smacdonald_at_ohcow.on.ca

• Hamilton
• 848 Main Street EastHamilton, Ontario L8M 1L9
  Tel [phone].263.2129Fax
  905.549.7993Email hamilton_at_ohcow.on.ca
• Sudbury84 Cedar Street, 2nd FloorSudbury, ON
  P3E 1A5Tel [phone].461.7120Fax
  705.523.2606Email sudbury_at_ohcow.on.ca
• Windsor3129 Marentette Avenue, Unit 1Windsor,
  Ontario N8X 4G1Tel [phone]
  1.800.565.3185Fax [phone]Email
  windsor_at_ohcow.on.ca

• Sarnia-Lambton171 Kendall StreetPoint Edward,
  Ontario N7V 4G6Tel [phone]Fax
  519.337.9442Email sarnia_at_ohcow.on.ca 
• Toronto970 Lawrence Ave. West, Suite
  110Toronto, Ontario M6A 3B6Tel [phone]
  1.888. 596.3800Fax [phone]Email
  toronto_at_ohcow.on.ca
• Provincial office 15 Gervais Drive, Suite
  601Don Mills, ON. M3C 1Y8Tel [phone]
  1.877.817.0336Fax [phone]Email
  info_at_ohcow.on.ca