Markku Seuri, FIOH, 20041 OCCUPATIONAL INFECTIONS DISEASES AND OTHER DISEASES OF BIOLOGICAL ORIGIN...

Markku Seuri, FIOH, 2004 1

OCCUPATIONAL INFECTIONS DISEASES AND OTHER

DISEASES OF BIOLOGICAL ORIGIN

Tartu10.-11.3

OCCUPATIONAL HAZARDS physical chemical biological psycho-social


BIOLOGICAL OCCUPATIONAL HAZARDS

= occup. biohazards– infectious

– allergic

– toxic

– carcinogenic


BIOLOGICAL AGENTS viruses bacteria fungi plant substances invertebrate animals substances derived from vertebrate animals (hazards of accidental)


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


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


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


GENERAL MEASURES OF PREVENTION -2

inform the workers written guidelines guidance and instructions use signs

(health check-ups have a limited role)


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)


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


OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS

AGENTS - 1

Agriculture epidemic nephritis

mycosis, tularemia

Forestry Lyme disease

Fishermen Skin infections

Waste management Hepatitis A and C

intestinal parasites



AGENTS - 2

Veterinarians Zoonotic microbes, toxoplasma, listeria

Slaugherhouse workers

dermatomycosis, erysipelothrix

Fishermen Skin infections

Health care workers blood borne diseases, TBC, MRSA



AGENTS – 3

Security professions blood borne diseases

Laboratory workers what ever handled in the laboratory

Teachers, day care workers

viruses causing epidemics among children

Personal care workers (cosmeticians, hairdressers)

dermatophytic fungi


EU DIRECTIVE 2000/54/EC18th of Sept. 2000

On the protection of workers from risks related to exposure to biological

agents at workTartu

10.3.-11.3.


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"


DEFINITION OF BIOLOGICAL AGENTS

micro-organisms, which may be able to provoke any–infection

–allergy

–toxicity


DEFINITION OF MICRO-ORGANISM

microbiological entity, cellular or non-cellular and

capable of replication or of transferring genetic material


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"


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


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

GROUP 4: – causes severe human disease– serious occupational hazard– may present a high risk of spreading– usually no effective prophylaxis or treatment


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)



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



for all agents renewed regularly on request authorities must by

supplied by information on the assessment process


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


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


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


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)


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


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


TRAINING OF WORKERS at the begining of work involving

contact with biological agents new or changed risks repeated periodically if necessary


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


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


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)


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



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



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


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


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)


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


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



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



indications:– A possible allergic effect– D keep the list of exposed workers more

than 10 years– T toxin production– V effective vaccine available


GROUP 4 only viruses 11 viruses rare like

– Ebola– Marburg– Lassa– Junin


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


Group 2 120 bacteria 66 viruses 60 parasites 20 fungi

NB! Direktiiv on tõlgitud eesti keelde:

http://europa.eu.int/eur-lex/et/dd/docs/2000/32000L0054-ET.doc




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Markku Seuri, FIOH, 20041 OCCUPATIONAL INFECTIONS DISEASES AND OTHER DISEASES OF BIOLOGICAL ORIGIN...

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