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Occupational Health Clinics for Ontario Workers Inc


Occupational Health Clinics for Ontario Workers Inc. Centres de sant des ... SOLVENTS: toluene, VM&P naphtha, latex paint solvents (glycol ethers) LEAD, CHROMIUM: ... – PowerPoint PPT presentation

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Title: Occupational Health Clinics for Ontario Workers Inc

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

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

Occupational Health Clinics for Ontario Workers
  • an inter-disciplinary occupational health team
  • occupational physicians
  • occupational health nurses
  • ergonomists
  • occupational hygienists
  • occupational health coordinators
  • administrative personnel
  • funded by WSIB Prevention Services

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

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

What OHCOW does
  • Exposure
  • to what
  • how much
  • how long
  • toxicology
  • Medical
  • symptoms
  • tests results
  • physical exam
  • diagnosis

Service Niche
  • Generally, consultants do not combine medical
    with hygiene/ergonomics in the services they
  • 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)

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

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

How issues involving groups of workers arise?
  • 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

Some Examples of OHCOW work with municipalities
  • Workers in LTC setting find out they have been
    exposed to asbestos and have concerns about their
  • 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

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

Case 1Line painters and exposure to toluene
How the issue arose?
  • CUPE group concerned about toluene exposures
    (particularly historical exposures) among line
  • 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

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

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

Summary of Exposures (past present)
  • SOLVENTS toluene, VMP naphtha, latex paint
    solvents (glycol ethers)
  • ISOCYANATE methylene bis-phenyl di-isocyante
  • PHTHALATES di(2-ethylhexyl)phthalate
  • GLASS DUST amorphous silica

Anticipated health effects (based on
  • 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,
  • vibration white finger (vibration)
  • kidney? cancer? other?

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

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

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
  • Use of vibrating equipment
  • Continuing exposure to solvents during the
    painting process
  • Noise

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
  • 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

Case 2 Indoor Environment Problem Investigation
John Oudyk Occupational Hygienist
  • 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)

  • 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

  • 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)

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
  • 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
  • (except for Friday night when it reached 18

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/

r2(adj) 70.5
Cross-sectional measurements
  • Measurements were taken cross-sectionally for the
    following parameters
  • lighting
  • noise
  • ultrafine particulate (low)
  • volatile organic compounds (low)

  • 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

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

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

  • 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

Case 3Back Injuries in Paramedics
Steve MacDonald Ergonomist
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

Problems with Work/Training
  • Paramedics are exposed to various hazards, for
  • 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

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.

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)

Back Care in Paramedics
  • A municipal EMS service contacted OHCOW looking
    for help in creating a program tailored to their
  • 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

  • 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
  • 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

  • All parties (union, management, HS) agreed to
  • 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
  • Drafts of the program have garnered interest from
    workers who want the program available immediately

Samples of Prevention Activities
Snow Shoveling
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
  • Knowledge transfers to educate all outside staff
  • 9 presentations at various sites throughout the
  • All staff received a copy of the fact sheet

Snow Shovelling 2
  • Staff were extremely happy with the knowledge
  • 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
  • Injuries related to snow shovelling
  • 2006 (2 injuries)
  • 2007 (2 injuries)
  • 2008 (1 injury) worker who did not receive the
  • Prevention YES

2007 Humidex Response Plan
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

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

in summary
  • Were different (clinic vs. training/safety
  • 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
  • bridging the academic work with the shop floor
  • There is no charge for our services

Thanks, any questions?
Contact Info
Speaker Contacts John Oudyk (Hamilton)
joudyk_at_ohcow.on.ca Michelle Tew (Hamilton)
mtew_at_ohcow.on.ca Steve Macdonald (Sudbury)
  • Hamilton
  • 848 Main Street EastHamilton, Ontario L8M 1L9
    Tel 905.549.2552 1.800.263.2129Fax
    905.549.7993Email hamilton_at_ohcow.on.ca
  • Sudbury84 Cedar Street, 2nd FloorSudbury, ON
    P3E 1A5Tel 705.523.2330 1.800.461.7120Fax
    705.523.2606Email sudbury_at_ohcow.on.ca
  • Windsor3129 Marentette Avenue, Unit 1Windsor,
    Ontario N8X 4G1Tel 519.973.4800
    1.800.565.3185Fax 519.973.1906Email
  • Sarnia-Lambton171 Kendall StreetPoint Edward,
    Ontario N7V 4G6Tel 519.337.4627Fax
    519.337.9442Email sarnia_at_ohcow.on.ca 
  • Toronto970 Lawrence Ave. West, Suite
    110Toronto, Ontario M6A 3B6Tel 416.449.0009
    1.888. 596.3800Fax 416.449.7772Email
  • Provincial office 15 Gervais Drive, Suite
    601Don Mills, ON. M3C 1Y8Tel 416.510.8713
    1.877.817.0336Fax 416.443.9132Email
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