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    Work Place Hazards

    2 page AMA format for citations

    Read Exhibit 5.1 (page 3) below and answer the following-

    · What are the identified hazards in EXHIBIT 5.1?

    · From the reading this week you were exposed to different types of workplace hazards and interventions proposed to solve the issues. What intervention could you propose to address the situation identified in this exhibit?

    · State the level under which your intervention falls (engineering, administrative, and/or PPE).

    · Provide your reasoning for suggesting the intervention.

    ————————————————————————————————Introduction

    Workplace physical hazards include exposures to radiation, noise, and the related phenomenon of vibration, as well as exposures to extreme ambient temperatures and risks associated with atmospheric variations. Physical hazards occur in a wide variety of occupations and are an important cause of injuries. Workers impacted by physical hazards can endure permanent adverse health outcomes such as hearing and vision loss and, in some instances, mortality. This chapter considers the sources and impacts of physical hazards in the workplace in more detail.

    One type of physical hazard covered in this chapter is oscillatory vibrations. The term oscillatory vibrations refers to noise from sources in the work environment as well as physical vibrations of the human body caused by machinery. These work-related physical hazards are associated with deleterious effects to hearing and the body. “Noise and vibration are both fluctuations in the pressure of the air (or other media), which affect the human body. Vibrations that are detected by the human ear are classified as sound. We use the term ‘noise’ to indicate unwanted sound.”1

    Noise and vibration are associated with fields such as construction, firearms testing, manufacturing, and entertainment (e.g., performing at rock concerts) as well as a plethora of other work settings. With respect to occupational exposure to noise, the Bureau of Labor Statistics estimates that as many as 125,000 U.S. workers have sustained permanent hearing loss since 2004; moreover, in a single year (2009), approximately 21,000 workers experienced hearing loss.1 In addition to noise, two other forms of vibrations that affect the human body are called whole-body vibration and hand-transmitted vibration, both of which have been linked to musculoskeletal and other deleterious effects.

    A second physical hazard is exposure to ionizing and non-ionizing radiation. “Radiation may be defined as energy traveling through space.”2The various forms of radiation described in this chapter affect diverse groups of employees, ranging from electricians, electronics workers, and miners to employees in healthcare specialties, nuclear facilities, and science laboratories. Radiation is associated with a variety of adverse health outcomes, such as cancer, burns, and eye diseases.

    A third physical hazard stems from atmospheric variations: heat, cold, and high and low air pressures. An example is extreme ambient temperatures—either high or low—that can cause heat stroke, heat exhaustion, frostbite, and death from hypothermia. Affected employees have a variety of occupations—for example, carpenters and laborers on construction projects whose assignment entails remaining outdoors on a blistering summer day or during the frigid winter. Similarly, farm workers often are required to harvest crops when the temperature has reached searing levels.

    TABLE 5.1 Physical Hazards in the Work Environment

    Physical HazardExamplePotential Occupational Exposures
    Oscillatory vibrationsNoise and vibrationConstruction, weapons firing ranges, manufacturing, truck driving
    Atmospheric variationsHeat, cold, air pressureAgriculture, construction, deep-sea diving, tunnel construction
    Radiation: ionizing radiation

    Alpha particles

    Beta particles

    Protons

    Neutrons

    Gamma rays and X-rays

    Biologists, chemists, and physicists

    Dental assistants

    Physicians and veterinarians

    Radiologists/X-ray technicians

    Uranium miners

    Radiation: non-ionizing radiationUltraviolet lightMany occupations, including laboratory workers, tanning booth operators, and welders
    Infrared radiationMany occupations, including bakers, glass furnace workers, and kiln operators
    Microwaves

    Radio frequency radiation

    Many occupations, including medical/diathermy personnel, plastic heat-sealing workers,

    and food product workers

    Variations in air pressures occur at high altitudes where air pressure is reduced and in pressurized environments in which atmospheric pressures are higher than at sea level. These pressure variations can impact workers at high altitudes or deep-sea divers and underground construction personnel. TABLE 5.1 summarizes the types of physical hazards in occupations that involve potential exposure to these physical hazards.

    Noise in the Workplace

    Noise-induced hearing loss is one of the leading forms of occupational illness.3 Hearing loss is a significant concern for occupational health because the manufacturing sector in the United States employs approximately 16 million people, or around 13% of the workforce.3 This section covers measurements of sounds, the physiology of hearing, hearing loss, and procedures for protecting workers against hearing loss. EXHIBIT 5.1 gives an overview of hearing loss among military veterans: Hearing impairment among veterans is the most frequent service-related disability.4

    EXHIBIT 5.1 Severe Hearing Impairment among Military Veterans

    Military service can entail harmful exposure to high-intensity noise from firearms, explosives, jet engines, machinery, and other sources during combat operations, [during] training, or in the course of general job duties. Such exposures can cause or contribute to hearing impairments, including hearing loss, if adequate hearing protection is not available and properly used…. Noise-induced hearing loss is a permanent disability, although the impairment sometimes can be rehabilitated with hearing aids.

    Since 1978, the Department of Defense (DoD) policy has required each of the armed services to have in place HCPs [hearing conservation programs] incorporating noise hazard identification, safety signs and labels, noise mitigation, education and training, audiometric surveillance, and program evaluation…. However, a 2005 Institute of Medicine report identified certain shortcomings in military HCPs…. Between 10% and 18% of service members enrolled in military HCPs had standard threshold shifts∗ in hearing, … a prevalence two to five times higher than would be considered acceptable in a civilian, industrial HCPs [sic]….

    Noise-induced hearing loss is preventable. The observed association of SHI [severe hearing impairment] with military service, and particularly with service in the United States or overseas after September 2001, underscores the need for improved HCPs in the various service branches and the importance of hearing loss surveillance in military and VA health systems.

    ∗A standard threshold shift is a change of 10 dB or more in the average hearing thresholds at 2000, 3000, and 4000 Hz in comparison with a baseline audiogram. (Refer to text for more information on these terms.)

    Reproduced from Centers for Disease Control and Prevention (CDC). Severe hearing impairment among military veterans—U.S., 2010. MMWR. 2011;60(28):955–958

    Measures of Sound: Hertz and Decibels

    Sound is classified according to its frequency and pressure. The term hertz (Hz) refers to the number of cycles per second (frequency) associated with the oscillation of a given sound wave, with high and low hertz numbers characterizing high and low tones, respectively. Human beings are able to perceive sounds in the range of approximately 20 Hz to 20,000 HZ.

    The scale for measurement of sound pressure is called decibels (dBs). “Noise is measured in units of sound pressure levels called decibels, named after Alexander Graham Bell, using A-weighted sound levels (dBA). The A-weighted sound levels closely match the perception of loudness by the human ear. Decibels are measured on a logarithmic scale, which means that a small change in the number of decibels results in a huge change in the amount of noise and the potential damage to a person’s hearing.”1 When a sound increases by 10 units on the decibel scale, its loudness becomes 10 times more powerful.5 FIGURE 5.2 gives the levels of typical sounds in decibels.

    Physiology of Hearing

    The human ear translates the energy from sound waves into neurologic impulses that are heard as sound through the actions of the ear canal, eardrum, ossicles in the middle ear, cochlea, and the cochlear nerve (FIGURE 5.3). After sounds enter and pass through the ear canal, they cause the tympanic membrane (eardrum) to vibrate. These vibrations are transferred to the ossicles, a series of bones (hammer, anvil, and stirrup) in the middle ear. The ossicles amplify the sounds, which move the oval window of the cochlea. In turn, this movement causes fluid in the cochlea to move and stimulate hairs, which next activate cells that send neurologic impulses along the cochlear nerve to the brain. These impulses are perceived as sound. When workers are exposed to very intense sounds in an occupational setting, the delicate mechanisms in this sound pathway can be damaged.

    C:\Users\Carissa.Dvay\Desktop\fig5-2.jpg

    FIGURE 5.2 Levels of typical sounds in decibels (dBs)

    Reproduced from U.S. Department of Labor, Occupational Safety and Health Administration, Occupational noise exposure. https://www.osha.gov/SLTC/noisehearingconservation/index.html. Accessed August 23, 2013.

    C:\Users\Carissa.Dvay\Desktop\fig5-3.jpg

    FIGURE 5.3 The sound pathway

    Hearing Loss

    Exposure to loud noises in the occupational environment may cause two types of changes in hearing sensitivity: a temporary threshold shift (TTS)in hearing sensitivity or a permanent threshold shift (PTS). A TTS is a short-term loss in hearing sensitivity that lasts for several hours—for example, 14 hours or longer in certain situations.6 A PTS is “any change in hearing sensitivity, which is persistent.”6(p. 92) A noise-induced permanent threshold shift (NIPTS) is “a permanent threshold shift [that] can be attributable to noise exposure.”6(p. 91)

    Audiometry is the testing of a person’s ability to hear various sound frequencies. The test is performed with the use of electronic equipment called an audiometer. This testing is usually administered by a trained technician called an audiologist.”7 Audiometry is essential to tracking hearing loss among employees who work in noisy occupations. The results of hearing tests for these employees can be compared periodically with baseline measurements of hearing taken when they began employment.

    Protecting Workers Against Noise

    To protect workers from high noise levels, a company may decide to monitor hearing hazards and, based on these assessments, introduce measures to reduce noise exposures. Several types of instruments and procedures for measurement of hazards are available. “The most common measurements are area surveys, dosimetry, and engineering surveys.”6(p. 13) EXHIBIT 5.2 describes the purposes of hearing hazard exposure monitoring.

    EXHIBIT 5.2 Hearing Hazard Exposure Monitoring

    Hearing hazard exposure monitoring is conducted for various purposes:

    •    To determine whether hazards to hearing exist

    •    To determine whether noise presents a safety hazard by interfering with speech communication or the recognition of audible warning signals

    •    To identify employees for inclusion in the hearing loss prevention program

    •    To classify employees’ noise exposures for prioritizing noise control efforts and defining and establishing hearing protection practices

    •    To evaluate specific noise sources for noise control purposes

    •    To evaluate the success of noise control efforts

    Reproduced from Centers for Disease Control and Prevention, Franks JR, Stephenson MR, Merry CJ. eds. Preventing Occupational Hearing Loss: A Practical Guide. Cincinnati, OH: DHHS, CDC, NIOSH; 1996. Publication No. 96-110, p13.

    Area Survey

    In an area survey, “environmental noise levels are measured, using a sound level meter to identify work areas where employees’ exposures are above or below hazardous levels, and where more thorough exposure monitoring may be needed. The result is often plotted in the form of a ‘noise map,’ showing noise level measurements for the different areas of the workplace.”6(p. 13) “A sound level meter (SLM) is the basic instrument for investigating noise levels.”8 In the upper image in FIGURE 5.4, a woman is using a sound level meter to measure noise levels in a work area. “She will also measure exposure levels by placing the microphone in the hearing zone of the workers.”6(p. 15)

    Dosimetry

    Dosimetry involves the use of body-worn instruments (dosimeters) to monitor an employee’s noise exposure over the work-shift. Monitoring results for one employee can also represent the exposures of other workers in the area whose noise exposures are similar. It may also be possible to use task-based exposure methods to represent the exposures of other workers in different areas whose exposures result from having performed the same task(s).”6(p. 14)

    The lower image in Figure 5.4 shows a noise dosimeter. “A noise dosimeter measures and stores sound energy over time. It can be worn in the pocket, as shown [in Figure 5.4], or attached to the belt. The microphone is positioned on the shoulder in the hearing zone of the wearer. The wearer goes about a normal work shift while wearing the dosimeter.”6(p. 15)

    Engineering Surveys

    Engineering surveys typically employ more sophisticated acoustical equipment in addition to sound level meters. [This equipment furnishes] … information on the frequency/intensity composition of the noise being emitted by machinery or other sound sources in various modes of operation. These measurements are used to assess options for applying engineering controls.”6(p. 14)

    Hearing Loss and Occupational Noise

    Hearing loss—the most commonly recorded occupational illness—can result from sustained exposure to occupational noise; exposure to sounds of 85 dB or higher may result in hearing loss.5 According to the National Institute on Deafness and Other Communication Disorders (NIDCD), “when we are exposed to harmful noise—sounds that are too loud or loud sounds that last a long time—sensitive structures in our inner ear can be damaged, causing noise-induced hearing loss (NIHL)…. NIHL can be caused by a one-time exposure to an intense ‘impulse’ sound, such as an explosion, or by continuous exposure to loud sounds over an extended period of time, such as noise generated in a woodworking shop.”5(p. 1) Once hearing loss results from high noise levels, interventions such as surgery and hearing aids cannot reverse the loss.1

    Occupational hearing loss accounts for nearly one out of nine cases of occupational illnesses in manufacturing and, therefore, is the most commonly recorded occupational illness. Moreover, occupational hearing loss tends to happen gradually over time. Because this disability usually develops gradually, many employees are unaware of their hearing loss.3

    Occupational settings with high noise levels may include construction sites, airports, shooting ranges, steel foundries, boiler-making factories, and fishing vessels. FIGURE 5.5 shows a worker using a saw without hearing protection or other personal protective equipment. Commercial fishermen and other personnel working on fishing vessels are also exposed to high noise levels for long time periods. Often, these noise levels exceed recommended standards and pose risks for hearing loss.9

    In addition to being implicated in diminished hearing, noise has been studied as a risk factor for conditions such as stress, annoyance, cardiovascular effects, and acoustic neuromas (intracranial tumors). For example, workers who had prolonged exposure to noise levels greater than 85 dBA were found to be at increased risk of hypertension in comparison with those who had noise exposures less than the 85 dBA level.10 Another hypothesized consequence of occupational noise exposure is the development of acoustic neuromas. However, Edwards et al. did not observe an association between occupational noise exposure and acoustic neuroma.11

    Occupational Vibration

    Many occupations expose workers to vibration. For example, FIGURE 5.6 depicts a worker who is exposed to noise and vibration from a jackhammer. Two important characteristics of vibration are its magnitude and its frequency. Magnitude of a vibration is defined by displacement velocity or acceleration; frequency is defined by cycles per second or hertz.12 The health effects of exposure to vibration can include lower-extremity effects, low-back pain (LBP), sensorineural complaints, joint pain, vascular problems, and musculoskeletal impacts. The common types of vibration are whole-body vibration and hand–arm vibration (FIGURE 5.7).

    C:\Users\Carissa.Dvay\Desktop\fig5-5.jpg

    FIGURE 5.5 Worker using a saw without hearing protection or other personal protective equipment

    © Gala_Kan/ShutterStock

    C:\Users\Carissa.Dvay\Desktop\fig5-6.jpg

    FIGURE 5.6 Worker exposed to noise and vibration from a jackhammer

    Courtesy of U.S. Department of Labor, Occupational Safety and Health Administration.

    C:\Users\Carissa.Dvay\Desktop\fig5-7.jpg

    FIGURE 5.7 Occupational exposure to hand-arm vibration (HAV) [left panel] and whole body vibration (WBV) [right panel]

    Courtesy of World Health Organization, Occupational Exposure to Vibration from Hand-held Tools, Teaching materials, http://www.who.int/occupational_health/pwh_guidance_no.10_teaching_materials.pdf?ua=1. Accessed February 14, 2014.

    Whole-Body Vibration

    Whole-body vibration (WBV) is defined as the form of vibration that “occurs when the human body is supported on a surface which is vibrating.”12(p. 58) WPV occurs among heavy machinery operators—for example, bulldozer drivers, transport drivers, and operators of some other types of machinery.

    Occupational exposures to whole-body vibration are common in many occupations. In a British study, workers whose exposures to WBV exceeded recommended standards included forklift truck drivers, agricultural owners and employees, and truck drivers. Among the sources of occupational exposures to WBV noted in this study were tractors, forklifts, trucks, and buses.13

    Whole-body vibration is thought to contribute to low back pain. According to Bovenzi, “Long-term occupational exposure to intense WBV is associated with an increased risk for disorders of the lumbar spine and the connected nervous system.”12(p. 58) The workers most likely to be affected by low back disorders from WBV include crane operators, bus drivers, tractor drivers, and fork-lift truck drivers.

    The relationship between WBV and LBP was examined among a group of professional drivers. A dose–response pattern was reported between WBV and driving-related LBP. The findings suggested that exposure to WBV may contribute to LBP.14 However, other research has suggested that occupational exposure to WBV is a less important contributor to LBP than lifting at work.15 Nevertheless, although definitive evidence regarding a causal relationship is lacking, current information suggests that exposure to WBV should be kept at a minimum.16

    A case-control study demonstrated that high levels of WBV were associated with increased odds of Parkinson’s disease. An inverse relationship (protective effect) was found for low levels of WBV.17 A hypothesized explanation for this finding is that higher-intensity WBV can cause microinjuries to the head.

    Hand-Transmitted Vibration/Hand–Arm Vibration Syndrome

    Hand-transmitted vibration (HTV) is defined as vibration entering “the body through the hands.”12(p. 58) This form of vibration occurs among people who use hand-held power tools. Prolonged exposure to HTV “from powered processes or tools is associated with an increased occurrence of symptoms and signs of disorders in the vascular, neurological, and osteoarticular systems of the upper limbs.”12(p. 60) Examples of conditions associated with vibrating hand-held power tools are vibration-induced white finger (VWF) and Raynaud’s phenomenon of occupational origin.18

    Hand–arm vibration syndrome (HAVS) refers to the group of symptoms that result from hand-transmitted vibration.19 “The syndrome includes vascular, neurological, and musculo-skeletal disorders that may become manifest individually or collectively.”20(p. 16) For example, one musculoskeletal symptom of exposure to hand–arm vibration is neck pain.21 The mechanisms underlying the development of HAVS are not understood fully.

    One symptom of HAVS, vibration-induced white finger, is related to the influence of vibrations upon the circulatory and neurologic structures in the fingers. Another symptom of HAVS, Raynaud’s phenomenon, consists of a combination of effects upon the vascular and neurologic systems that can be induced by vibration.12 Raynaud’s phenomenon is the most frequently observed symptom of occupational exposure to vibration.22 In a French study of employees in poultry slaughterhouses and canning factories, investigators determined that Raynaud’s phenomenon was associated with continuous repetition of tasks, exertion of the hands and arms, and taking breaks in a cold environment.23

    Research with a sample of metalworkers reported a dose-response relationship between total lifetime dosage of hand–arm vibration and development of symptoms, which could include finger blanching, sensorineural complaints, and musculoskeletal issues.24 Exposure over long time periods to hand-held vibrating tools usually is required to produce HAVS. However, Gerhardsson found that signs and symptoms of vibration exposure can appear after only short time periods among young workers.25 HAVS is also reported to be associated with vascular symptoms that appear in the lower extremities of the body.26

    Book: Friis RH. Occupational health and safety for the 21st century. Burlington, MA: Jones & Bartlett Learning; 2016.

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