Health surveillance All those who are exposed to a signi \201 cant risk of allergic diseas e must have health surveillance as required by the Management of Health and Safety at Work Regulations. \200 Regular symptoms questionnaire and lung function \200 Follow-up posit ive symptoms with further investigation: serial peak \202 ow tests \200 skin prick tests \200 skin patch tests \200 total Ig E and speci \201 c IgE for suspect agent (e.g. latex). Exclude if exposure cannot be controlled adequately, or use PPE and monitor extremely closely. Further information and guidance Medical Aspects of Occupational Asthma . MS25, HSE ISBN 07 17615472. HSE (1994). Preventing asthma at work: how to control respiratory sensitisers . I SBN 0717606619. HSE (1996). Controlling grain dust on farms , Agricultural information shee t No. 3. Available at: M http://www.hse.gov.uk/pubns/ais3.pdf 03_Smedley_Chap03.indd 115 1/2/2013 1:25:35 PM This page intentionally left blank 117 Chapter 4 Mechanical and ergonomics hazards Ergonomics hazards: overview 118 Lifting and handling 120 Posture 124 Repetitive work 128 M echanical hazards 130 04_Smedley_Chap04.indd 117 12/31/2012 8:47:06 PM CHAPTER 4 Mechanical and ergonomics hazards 118 Ergonomics hazards: overview De \201 nitions Ergonomics (or human factors) is the scienti \201 c discipline concerned with the understa nding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human wellbein g and overall system performance. International Ergonomics Association Human factors refer to environmental, organizational and job factors, and human and individ ual characteristics, which in \202 uence behavior at work in a way which can affect health and safety. HSE Industries Ergonomics hazards to employees are ubiquitous, affecting almost every type of w ork. Ergonomics issues can also affect service users, the general public, and the environme nt. They are most important in safety-critical industries, e.g. transportation and nuclear industries, and in the health services. Speci \201 c ergonomics factors The most important of these are covered separately in this chapter. However, ergonomics hazards often occur i n combination with each other, and are commonly addressed together in designing risk contro ls. This list is not exhaustive. Task-related (physical or cognitive) \200 Loading (lifting and handling) \200 Poor post ure \200 Repetition, particularly at high speed \200 High forces \200 Poor equipment and workplace design \200 Task overload/under load \200 Mental workload \200 Poor sys tem reliability \200 Poor design of information, displays, controls. Individual factors \200 Anthropometry \200 Social support \200 Personality \200 Attitude and behavior \200 Risk perception \200 Human error. Organizational factors \200 Long working hours \200 Shift work \200 Short deadlines \200 Poor staf \201 ng levels \200 Lack of wo rker involvement in system design \200 Control over work. 04_Smedley_Chap04.indd 118 12/31/2012 8:47:06 PM ERGONOMICS HAZARDS: OVERVIEW 119 Adverse effects of poor ergonomics design (including health effects) \200 Accidents \200 Injuries \200 Musculoskeletal disease (back, neck, and upper limb pain) \200 Psycholo gical morbidity (including stress) \200 Critical incidents (including environmental disas ters) \200 Decreased ef \201 ciency, poor productivity \200 Failure of complex systems \200 Job dissatisfaction \200 Low staff morale \200 High job turnover. Ergonomics risk management Speci \201 c aspects of risk assessment and control are covered under each ergonomics hazard (see b p. 120, Lifting and handling, b p. 124, Posture, and b p. 128, Repetitive work, and also b p. 776, Carry out an ergonom- ics assessment and b p. 780, Carry out a display screen assessment). Relevant legislation There is no speci \201 c legislation on ergonomics hazards, but some statutory instruments contain direction on erg onomics issues: \200 Control of Major Accident Hazards Regulations 1999 (COMAH) \200 Ra ilways (Safety Critical Work) Regulations 1994 \200 The Manual Handling Operations Regula tions 1992 (as amended) \200 The Health and Safety (Display Screen Equipment) Regulations 1992 \200 Provision and Use of Work Equipment Regulations 1998 (PUWER) \200 The Workin g Time Regulations. Further information International Ergonomics Association. Available at: M http://www.iea.cc/ Ergonomics society. Available at: M http://www.ergonomics.org.uk/ Eur opean Agency for Safety and Health at Work. Available at: M http://osha.europa.eu/en/ front-page Health and Safety Executive: human factors guidance. Available at: M http://hse.gov.uk/huma nfac- tors/index.htm 04_Smedley_Chap04.indd 119 12/31/2012 8:47:06 PM CHAPTER 4 Mechanical and ergonomics hazards 120 Lifting and handling Manual lifting or handling of loads constitutes one of the most common and important ergonomics hazards. De \201 nitions The term manual handling comprises any non-mechanized (or incompletely mec hanized) manipulation of a load, including lifting, pushing, pulling, slid- ing, or carryin g. Loads may be inanimate or living (people and animals). Speci \201 c industries Manual h andling is a ubiquitous exposure, which is common in a wide range of industries. However, o f particular note are: \200 Construction \200 Warehousing and logistics \200 Heavy en gineering \200 Airport baggage handling \200 Agriculture \200 Health care (patient-ha ndling). Risk assessment See Table 4.1. Risk controls The following list is not exhaustive, but incl udes the most common examples of risk controls. Extensive guidance on risk controls (includ ing industry-speci \201 c guidance) is readily available (references under Further informa tion and guidance on p. 122). \200 Divide load into smaller units, or scale loads up, and switch to bulk handling systems Ensure load is easy to grip and stable \200 Arrange lifting environment free from obstacl es and on level surface \200 Address extremes of height, e.g. restrict transfers to level s below elbow and above knee height. Avoid lifting from the \202 oor \200 Mechanical lifting ai ds appropriate to the task. There are many examples for different purposes. More common examples include: \200 hoists, cranes, and v ehicles \200 powered and non-powered trucks and trolleys \200 scissor lifts or other he ight-adjustable surfaces \200 tracks, conveyors, chutes, and rollers \200 specialized e quipment for \200\230live \200\231 loads (patients), e.g. slide sheets. Health effects \200 Low back pain \200 Neck/shoulder pain \200 Osteoarthritis of the hip. 04_Smedley_Chap04.indd 120 12/31/2012 8:47:06 PM LIFTING AND HANDLING 121 Table 4.1 Manual handling risk assessment i Risk d Risk Factor Load: weight shape stability others 15 kg or more Awkward shape, large size, poor grip Liable to shift or move Sharp edges, hea vier thananticipated by the handler Center of gravity of load eccentric <15 kg Small, easy to grip Stable, predictable Lever (distance from employee \200\231s center of gravity) Load held away from body Load close to body, with arms vertical and parallel to trunk Vertical distance (height) Lifts above elbow height Transfer at trunk height Lifts below knee height Posture Bent or twisted trunk Straight trunk Constrained posture Task Long carrying distances (>4m = moderate risk) Short distance Short duration Frequent or repetitive lifting Prolonged lifting High effort (resistance) Environment Limited space Level non-slip surface Steep slopes Comfortable temperature Slip or trip hazards Poor visibility Extremes of temperature Individual susceptibility Previous history of back pain Pregnancy Work organization Short deadlines Reasonable pace of work Poor communication Good support Lack of control Good control and \202 exibility Excessive demands Reasonable volume of work 04_Smedley_Chap04.indd 121 12/31/2012 8:47:06 PM CHAPTER 4 Mechanical and ergonomics hazards 122 Speci \201 c legislative requirements The Manual Handling Operations Regulations 1992 (ame nded) give a framework for the generic risk assessment, risk control, review cycle that is speci \201 cally relevant for hazards associated with manual handling. Further information and guidance Health and Safety Executive guidance and tools. Manual han dling. Available at: M http://www.hse. gov.uk/msd/manualhandling.htm HSE (2004). The Manual Handling Operations Regulations 1992 . Available at: M http://www.hs e. gov.uk/pubns/priced/l23.pdf 04_Smedley_Chap04.indd 122 12/31/2012 8:47:06 PM This page intentionally left blank CHAPTER 4 Mechanical and ergonomics hazards 124 Posture The main component of risk is non-neutral posture. De \201 nitions Non-neutral means that the head, trunk, or limbs deviate from the normal a natomical (neutral) position. Speci \201 c industries Adverse posture is widespread across many industries, affecting wo rkers in of \201 ce environments as well as heavy manual occupations. In particular: \200 Call center operators \200 Display screen equipment users \200 Food industry, meat ha ndlers \200 Assembly line workers. Potential health effects \200 Low back pain \200 Upper limb pain (neck \200\223shoulder , elbow, forearm, and wrist pain). Risk assessment \200 Non-neutral posture is associated with i risk of health effects if i t is: \200 persistent \200\224 prolonged, constrained or awkward position of the trunk or limbs (e.g. sustained stooping) repetitive \200\224 repeated adverse posture (e.g. bending up and down) Extreme deviation from the anatomical position increases risk: head or trunk \202 exed or extended, especially (cid:2) 20 \200 upper limbs \200\224 extreme \202 exion or abduction of the shoulders (work with arms above shoulder height), elbows, or wrists; as a general rule, risk increases most with upper arm \202 exion (cid: 2) 90 , elbows \202 exed (cid:2) 90 , and wrists \202 exed or extended ? 15 Risk assessment tools are used for assessing posture ( b p. 776, Carry out an ergonomics as sessment and b p. 780, Carry out a display screen assessment). Risk control Risk reduction is mainly by the application of good ergonomics principles to t ask and equipment design (see Fig. 4.1). Extensive guidance on risk controls is readily ava ilable (see b p. 126, Relevant legislation and guid- ance). Common examples include: \200 Appropriate seating that is adjustable to allow for anthropometric variations between operators Controls that are within reach to avoid over-reaching or stretching \200 Attention to the height at which tasks are carried out in order to minimize bending or stooping Task rotation, regular breaks, or variation in position in order to avoid prolonged constrained posture. 04_Smedley_Chap04.indd 124 12/31/2012 8:47:06 PM POSTURE 125 Fig. 4.1 Risk controls for poor posture Common adverse posture Example of control Bent trunk File between shoulder and thigh height Scissor platform Bent neck Adjustable inspection table Outstretched shoulder/upper arm Scissor platform File between shoulder and thigh height (Continued) 04_Smedley_Chap04.indd 125 12/31/2012 8:47:07 PM CHAPTER 4 Mechanical and ergonomics hazards 126 Fig. 4.1 Risk controls for poor posture (Cont \200\231d) Common adverse posture Example of control Extended unsupported wrists Forearms supported, wrists neutral Relevant legislation and guidance \200 The Display Screen Equipment (DSE) Regulations. Av ailable at: M http://www.opsi.gov.uk/si/si1992/UksI_19922792_En_1.htm \200 HSE (2004). Th e Manual Handling Operations Regulations 1992. Guidance on regulations Available at: M http://www.hse.gov.uk/pubns/ priced/l23.pdf M http: //www.hse.gov.uk/msd/uld/art/posture.htm Health and Safety Executive. Reducing awkward postures. Available at: 04_Smedley_Chap04.indd 126 12/31/2012 8:47:08 PM This page intentionally left blank CHAPTER 4 Mechanical and ergonomics hazards 128 Repetitive work De \201 nition Repetitive work includes activities that are physically rep etitive, or cogni- tively repetitive or monotonous. Physical and cognitive aspects of repet i- tiveness in work tasks often interact. Speci \201 c industries/tasks \200 Packaging \200 Assembly lines \200 Textile/garment production (sewing machine operators, cutting r oom) \200 Poultry processing (plucking, evisceration) \200 Fruit pickers \200 Compute r data entry operators. Health effects Musculoskeletal disorders \200 Neck \200\223shoulder pain \200 Elbow, wr ist pain \200 Low back pain. Risk assessment See Table 4.2. Table 4.2 Risk assessment for repetitive tasks i Risk d Risk Risk factor Cycle time Rapid Slow Grip strength Tight grip Loose grip Recovery time Short Long Synergism with posture Awkward posture Supported neutral posture Psychosocial factors Lack of control over work (e.g. forced pacing) Able to determine speed of work Able to intersperse repetitive tasks with other activities (both physical and cognitive) Excessive workload Risk controls The following list is not exhaustive, but includes the most common exam- ples of risk controls. Extensive guidance on risk controls is readily available ( b p. 129). \200 Frequent rest breaks \200 Task rotation \200 Avoid forced pacing \200 Job enric hment and variety 04_Smedley_Chap04.indd 128 12/31/2012 8:47:08 PM REPETITIVE WORK 129 Automation \200 Mechanization \200 Worker participation in job design and organization. Further information HSE (2002). Upper limb disorders in the workplace. HSG (60). ISBN 07176 19788. HSE (2003). Work with Display Screen Equipment: Health and Safety (Display Screen Eq uipment) Regulations 1992 as amended by the Health and Safety (Miscellaneous Amendments) Re gulations 2002, L(26). ISBN 0717625826. HSE (2003). The law on VDUs: an easy guide, HSG (90). ISBN 0717626024. Health and Safety Ex ecutive. Assessment of repetitive tasks (ART) tool. M http://www.hse.gov.uk/ msd/uld/art/index.htm 04_Smedley_Chap04.indd 129 12/31/2012 8:47:08 PM CHAPTER 4 Mechanical and ergonomics hazards 130 Mechanical hazards In the operation of machines a person may be injured as a result of: \200 Machine movement \200 Being trapped between the machinery and materials \200 Bein g struck by materials ejected from the machinery. Identi \201 cation of machinery hazards It is useful to consider three factors: \200 The different phases of the machine \200\231 s life : design and construction \200 installation \200 commissioning \200 operation \200 cl eaning \200 maintenance \200 disposal The circumstances giving rise to the injury \200 The hazards that can cause the injury. Types of machinery hazards For the different types and range of machines used, their hazard s can be summarized as follows: \200 Traps: reciprocating traps due to vertical or horizontal motion of machines shearing traps produced by a moving part traversing a \201 xed part, and in-running nips where limbs are drawn in to a trap (e.g. where a moving belt or chain m eets a roller or a tooth wheel). Impact: machinery parts, which can cause injuries by their speed or movement if the person gets in the way Contact: this may cause burns, lacerations, or injuries due to sharp, abrasive, hot, cold, or electrically live machine components Entanglement: limbs, hair, or clothing may become entangled with unguarded moving parts Ejection: machines may eject particles, metals, or actual parts of machines (e.g. grinding machines) Injection: machinery leaks may inject hydraulic \202 uid into the skin at high pressure. Risk assessment \200 Is the equipment \201 t for purpose? \200 Is it suitable for use in the intended work conditions? \200 Is it maintained in a safe condition? \200 Some equipment should be regularly inspected to ensure it remains \201 t for use, e.g. power presses: \200 any inspection should be by a competent person \200 a record should be kept of the inspection. 04_Smedley_Chap04.indd 130 12/31/2012 8:47:08 PM MECHANICAL HAZARDS 131 Risk controls \200 Mechanical hazards should be considered when purchasing equipment \200 Machinery should be \201 tted with suitable safety devices, e.g. machine guards \200 emergency stop buttons \200 interlocks to prevent operation if guar ds are removed Machinery should have appropriate warning signs \200 Worker information, instruction, and training \200 Safe systems of work including machine isolation before maintenance \200 Personal protective equipment, e.g. safety goggles. Relevant legislation and guidance \200 HSE (2008). Approved Code of Practice Safe use of work equipment. Provision and Use of Work Equipment Regulations 1998, L22. HSE Books, Sudbury. HSE (1999). Simple guide to the Provision and Use of Work Equipment Regulations 1998, INDG 291. Available at: M http://www.hse.gov.uk/ pubns/indg291.pdf 04_Smedley_Chap04.indd 131 12/31/2012 8:47:08 PM This page intentionally left blank 133 Chapter 5 Psychosocial hazards Organizational psychosocial factors 134 Violence and aggression 136 Lone working 138 Shift and night work 140 Long working hours 142 Time zone changes 144 05_Smedley_Chap05.indd 133 12/31/2012 8:48:35 PM CHAPTER 5 Psychosocial hazards 134 Organizational psychosocial factors De \201 nition The term \200\230psychosocial hazard \200\231 is used to describe any factor that may cause distress or psychological harm (see Table 5.1). Table 5.1 Psychosocial hazards Organization of work Shift work, long working hours, unsociable hours, unpredictable workin g hours, organizational restructuring, non-consulted changes, time-zone changes Content of job Work overload, deadlines, dif \201 culty of work, time pressures, underload ing (work too easy), safety critical work Workplace culture Communication, involvement in decision making, feedback, resources, suppo rt Work role Clarity of job, con \202 ict of interests and beliefs, lack of control over work Structure Over-promotion (self/others), under-promotion (self/others), redundancy threats, pay structure/ inequalities Relationships Poor communication, harassment, bullying, verbal abuse, physical abuse/intimi dation Environment Noise, temperature, lighting, space, ergonomics, perceived hazard exposure Home \200\223work interface Childcare issues, transportation problems, commuting, relocatio n, housing issues Health effects \200 Stress \200 Musculoskeletal disorders \200 Meta-analyzes of the l iterature on stress show that many physical changes occur in stressed people, either direct ly or indirectly: \200 cardiovascular problems (direct physiological) \200 infections ( direct physiological) \200 immunosuppression (direct physiological) \200 mental health problems; anxiety, depression (direct psychological) \200 cancers associated with increas ed use of drink, tobacco, and drugs (indirect physiological) musculoskeletal problems (direct psychological). Other adverse effects \200 Low morale and job satisfaction \200 Low productivity \200 Increase in industrial disputes \200 Increased accidents and injuries. 05_Smedley_Chap05.indd 134 12/31/2012 8:48:36 PM ORGANIZATIONAL PSYCHOSOCIAL FACTORS 135 Further information and guidance HSE What are psychosocial risk factors? Available at: M ht tp://www.hse. gov.uk/msd/mac/psychosocial.htm Risk controls These primary interventions decrease adverse organizational factors: Workplace demands \200 Ensure employees are able to cope with the demands of their jobs \200 Provide achievable demands relative to the hours of work \200 Match people \200\231 s skills and abilities to the job demands \200 Design jobs within the capabilities of emp loyees \200 Address employees \200\231 concerns about their work/environment. Maintaining control \200 Employees can have a say about how they do their work \200 Employees have control over the pace of work \200 Employee initiative and skills are encouraged \200 Employees encouraged to develop new skills and remain challenged \200 Employees can have a say when breaks are taken \200 Employees are consulted over work issues whenever possib le. Workplace relationships \200 Employees are not subjected to unacceptable behavior, e. g. bullying \200 Promote positive working and ensure fairness \200 Avoid con \202 ict and deal with unacceptable behavior \200 Employees share information relevant to their wo rk \200 Policies and procedures to address unacceptable behavior \200 Managers are able to deal with unacceptable behavior \200 Employees are able to report unacceptable behavi or. Workplace roles \200 Ensure clarity of roles within organizations and avoid role con \202 icts \200 Employees understand their role and responsibilities \200 Ensure differ ent roles placed upon employees are compatible \200 Check employees \200\231 understandin g of their roles and responsibilities \200 Employees can raise concerns about role uncert ainties or con \202 icts. Organizational change \200 Engage employees frequently when un dergoing organizational change \200 Ensure adequate employee consultation on changes \200 Make employees aware of the impact and time frames of changes \200 Employees have a ccess to relevant support during changes. Employee support \200 Employees receive adequat e support from colleagues and superiors \200 Policies and procedures to support employees \200 Encourage managers to support their staff \200 Encourage employees to support the ir colleagues \200 Employees know what support is available and how to access it \200 E mployees know how to use any resources to do their job \200 Employees receive regular and constructive feedback. 05_Smedley_Chap05.indd 135 12/31/2012 8:48:36 PM CHAPTER 5 Psychosocial hazards 136 Violence and aggression De \201 nition Any incident in which a person is abused, threatene d, or assaulted in circumstances relating to their work, whether by colleagues or others. T his can include verbal abuse or threats as well as physical attacks. Incidence \200 The B ritish Crime Survey (2009/10) estimated the number of violent incidents experienced by workers in England and Wales to be 310,000 in 2009 \200\2232010 For most workers the risk of threats of violence or actual violence at work is low (1.4%) and has been falling for some years Groups at high risk of experiencing threats or actual violence include: protective services e.g. police of \201 cers (9%) \200 health care workers (3.8%) There were 6017 Reporting of Injuries, Diseases, and Dangerous Occurrence Regulations (RIDDOR) reported injuries, including one fatality, due to workplace violence in 2009/10 Violence from colleagues represents only 5% of workplace violent incidents; 65% of physical and verbal attacks come from strangers and 18% from clients or c ustomers. Risk factors Workplace violence can occur in different environments, including health care, public spaces, and commercial premises. Those most at risk from violence in the workplace include those who: \200 Provide (medical/health/social) care for others \200 Deliver/co llect goods \200 Control/schedule services \200 Represent authority \200 Provide a se rvice \200 Deliver education \200 Transact cash or valuables. Causes Common causes of violence in workplaces include: \200 Alcohol/drug intoxication \200 Those wanting immediate attention \200 Dissatisfaction with the (lack of) attention /treatment received \200 Dissatisfaction with inappropriate or unsuccessful treatment rec eived \200 Robbery. Behavioral markers of potential aggressors \200 Previous history of violence \200 Frustration (with the victim \200\231s organization) \200 Emotional prob lems \200 Social isolation with limited outlets \200 Interpersonal problems 05_Smedley_Chap05.indd 136 12/31/2012 8:48:36 PM VIOLENCE AND AGGRESSION 137 Antagonistic relationships with others (e.g. victim or bully) \200 Obsessive behavior (e. g. romantic, political, religious, racial). Ris k control Eliminating workplace violence should be a high priority for managers and tea m leaders. 2 Organizations should not wait until violent events occur before prepar- ing pl ans to combat violence and aggression, and should train their staff to prevent violence. All organizations should have, and enforce, a zero-tolerance violence policy, which is comm unicated to both employees and non-employees. Actions that can reduce workplace violence in clude; \200 Employee training \200 Disciplinary or legal action when required \200 Ef fective security measures. See b p. 388, Violence management policies, for speci \201 c gu idance and examples of good practice. 05_Smedley_Chap05.indd 137 12/31/2012 8:48:36 PM CHAPTER 5 Psychosocial hazards 138 Lone working De \201 nition Lone working can be de \201 ned as \200\230any situation or location in which some- one works without a colleague nearby; or when someone is working ou t of sight or earshot of another colleague \200\231. 1 This de \201 nition includes those who are not obviously lone workers, e.g. school teachers working in iso- lated classrooms, remote from the assistance of colleagues. Risk factors Lone working of itself is not the is sue \200\224it is the lack of immediate assist- ance available to the worker. The main conc erns are: \200 Illness \200 Accidents \200 Personal safety (see also b p. 134, Organi zational psychosocial factors and b p. 388, Violence management policies). Exposed occupations Many employers have staff who work alone. \200 Those who work in the community, e.g. social workers \200 traf \201 c wardens \200 district nurses \200 lorry, bus, and ta xi drivers Those who work in single-occupancy premises, e.g. gasoline stations \200 shops \200 those who work from home Those who work in isolated areas of large buildings, e.g. reception staff \200 teachers Those who work in premises outside of \201 ce hours, e.g. cleaners \200 engineers \200 security staff. Risk assessment Factors to consider in a r isk assessment include the following: \200 People: the client group and the public \200 Location \200 Timing \200 Task: hazardous procedures \200 dealing with valuables or cash \200 enforcement activity (e.g . traf \201 c wardens) Travel and accommodation. 1 NHS Security Management Service. (2009). \200\230Not alone \200\231: a guide for the bet ter protection of lone workers in the NHS. Available at:M http://www.nhsbsa.nhs.uk/Document s/SecurityManagement/ Lone_Working_Guidance_ \201 nal.pdf 05_Smedley_Chap05.indd 138 12/31/2012 8:48:36 PM LONE WORKING 139 1 Where a risk assessment indicates inadequate controls, lone working should not proceed. C onsider working in pairs, an alternative location for meeting, etc., to eliminate or reduce risk. Control measures \200 Employers of lone workers should have a lone-working policy \200 Information, instruction, and training for lone workers and managers \200 Access controls in buildings \200 Internal alarm systems including panic buttons or fob-operated alarms are useful for premises (e.g. psychiatric hospitals) Lone-worker protection systems linked to a central control room (with or without a global p ositioning system) for mobile workers \200 Personal attack alarm (although use may in \202 ame dif \201 cult situations) \200 Mobile phone: check that it is fully charged, ha s available credit, and that reception is adequate in that area Information sharing between public bodies regarding individuals with a history of violence towards staff Visit log: who is being visited, contact details, arrival/departure times, but this require s the co-operation of all staff to operate effectively. Lone worker details held in personal \201 le. Include: \200 make, model, and registrati on of vehicle \200 next of kin \200 home and mobile phone numbers. 1 Do not place undue reliance on lone-worker protection systems. Relevant legislation \200 Under the Health and Safety at Work, etc., Act 1974 employers h ave a duty to protect worker \200\231s health and this would include lone workers \200 Ma nagement of Health and Safety at Work Regulations 1999 requires that employers undertake a suitable and suf \201 cient risk assessment of the risks to the health and safety of staff and others (regulation 3), which would include lone working. Further information and guida nce Health and Safety at Work, etc., Act 1974, Chapter 37. HSE Management of Health and Saf ety at Work Regulations (1999) Approved Code of Practice and Guidance. Available at: M http://www.hse.gov.uk/pubns/books/l21.htm NHS Security Management Service. (2009). \200\230 Not alone \200\231: a guide for the bett er protection of lone work- ers in the NHS. Available at: M http://www.nhsbsa.nhs.uk/Docume nts/SecurityManagement/ Lone_Working_Guidance_ \201 nal.pdf 05_Smedley_Chap05.indd 139 12/31/2012 8:48:36 PM CHAPTER 5 Psychosocial hazards 140 Shift and night work De \201 nition Night work is de \201 ned as at least 3h of work taki ng place between 23.00 and 06.00 hours. Epidemiology \200 Approximately 14% of all employ ees in the UK usually work shifts \200 A further 3% take part in shift work occasionally \200 Shift work is only slightly more prevalent in men than women: most common in personal protective services ( 45% men and 27% of women in the sector) and p lant and machine operators (31% of men and 22% of women in the sector) nurses are the most common group of female shift workers. Health effects \200 Fatigue and sleep de \201 cits \200 Anxiety/depression \200 Incr eased substance use (eating, smoking, drinking) \200 GI disorders: peptic ulcer, altered bowel habit \200 CVD \200 Neurological disorders \200 Menstrual disorders \200 Acut e changes in cholesterol, uric acid, glucose, potassium, and lipids \200 There is evidenc e of an association with miscarriage, preterm birth, and low birth weight, but it is not cl ear if the association is causal There is evidence of an association between long term night shift work and cancer, but it i s not clear if the association is causal (see M http:// monographs.iarc.fr/ENG/Monographs/v ol98/index.php) Complications of night work Much research has gone into determining whether or not night wo rking imposes extra health effects. Evidence is inconclusive, but it seems likely that circ adian disruption, fatigue, and sleep de \201 cit will be exacerbated by a 12-h shift syste m. Other s factors affecting health and safety should be considered, such as exposure to to xic materials where occupational expo- sure limits appropriate for 8h would no longer be sa fe for 12h. Effects on function Risk of injury is 30% higher on night shifts than on mornin g shifts, and is usually highest in the \201 rst 2 \200\2233h, with the risk i over succe ssive nights. By the fourth night shift, there is 1.3 times greater risk of accident than o n the \201 rst night. The use of sedatives to aid sleep at unusual times may lengthen rea ction times and exacerbate the i risk of accidents. Risk factors Factors associated with ad verse effects of night/shift work include: \200 Incomplete circadian adjustment \200 Ir regular food intake leading to stomach complaints \200 Impairment of social or family lif e, and disrupted child-care. 05_Smedley_Chap05.indd 140 12/31/2012 8:48:36 PM SHIFT AND NIGHT WORK 141 Risk control Employees should \200 Drink coffee in the \201 rst half of the shift only \200 Take s hort \200\230power naps \200\231 \200 Take small breaks at least every hour \200 Take a main meal break between midnight and 01.00 hours \200 Take a smaller food break between 03.00 and 04.00 hours \200 Be aware of subjective feelings of inertia for 15min after wa king \200 Avoid driving to and from work after prolonged periods of night shifts Eat healthily and keep \201 t/active \200 Design and de \201 ne their own shifts whene ver possible \200 Take up \202 exible working if possible \200 Advice is available fo r shift workers on how to cope with the demands of night working. The HSE offers tips on dealing with sleep problems, eating, physi cal \201 tness, and social contact. (http://www. hse.gov.uk/humanfactors/topics/shift-wor kers.htm). Employers should \200 Minimize permanent nights \200 Ensure safe travel to and from wor k at unusual hours \200 Limit consecutive night shifts to no more than four \200 If pos sible allow 24h between two night shifts \200 Some weekends should be completely free of night shifts \200 Consider making night shifts shorter than day shifts \200 Avoid compr essed working periods \200 The length of night shifts should be related to the tasks perf ormed \200 Forward rotation of shifts is preferable to continuous night shifts \200 Mor ning shifts should start later rather than sooner \200 Rotas should be as regular as poss ible \200 Allow opportunities to swap shifts and change handover times \200 Avoid exces sive short-term rota changes \200 Good notice should be given of changes in shift pattern s \200 Allow return to day work without penalty (especially older workers) \200 Ensure availability of hot food and drinks, rest areas, and \201 rst aid \200 Night workers ne ed the same access to training as other workers \200 Allow access to union representation or daytime meetings \200 Offer access to health checks for night workers. 2 The ability to cope with changed sleep patterns varies considerably and should be conside red when selecting night workers. Relevant legislation Workers who normally work at night ( excluding those who only occasion- ally work nights) are protected under the Working Time R egulations (see b p. 574, Working Time Regulations 1998). This includes provision of health checks for night workers. 05_Smedley_Chap05.indd 141 12/31/2012 8:48:36 PM CHAPTER 5 Psychosocial hazards 142 Long working hours De \201 nition \200\230Long-hours \200\231 workers are those who work >48h/wk. Epidemiology \200 The average length of the European working week is decreasing. In the European member states, it has fallen from 40.5h in 1991 to 37.5h in 2010 The proportion of the working population in Europe working longer than 48h has fallen from 15% in 2000 to 12% in 2010 Long working hours are more common in men than women. Health effects \200 Generalized fatigue, both physical and psychological \200 Anxiety/d epression. Effects on function \200 Poor performance \200 i Risk of accident or injury: exponential increase with long hours \200\224by the twelfth hour of work risk is double that during the \201 rst 8h not taking a regular break linearly i the risk of injury \200\224the risk of injury 1.5h a fter taking a break is twice that when resuming work immediately after the break. Risk factors A number of factors increase the likelihood of adverse effects from work- ing longer hours: \200 Female sex \200 Older age \200 Poor diet \200 Little exercise \200 Pre-existing poor health: examples of medical conditions that may be adversely affect ed include asthma, depression, and diabetes. These need to be considered before selecting i ndividuals for long working hours duties (although they are not an absolute contraindicatio n to long hours) Complex or demanding domestic situation. Relevant legislation The European Working Time Directive enforces standards on working time (see b p. 574, Working Time Regulations 1998). Further information and guidance European Foundations for the Improvement of Living and Wor king Conditions. (2010). Changes over time \200\224First \201 ndings from the \201 fth European Working Conditions Survey . Available at: M http:// www.eurofound.europa.eu/pubdoc s/2010/74/en/3/EF1074EN.pdf 05_Smedley_Chap05.indd 142 12/31/2012 8:48:36 PM This page intentionally left blank CHAPTER 5 Psychosocial hazards 144 Time zone changes Crossing time zones is commonly associated with jobs that require frequen t international travel. Health effects Transmeridian displacement, or dysrhythmia (jet lag) is a disturbance of the internal circadian rhythm (body clock) caused by crossing inter- national time zones. Cros sing time zones when traveling east (traveling back in time) is usually worse than when tra veling west (forward in time). Symptoms include: \200 Tiredness \200 Disorientation \200 Lack of concentration \200 Broken sleeping/night wakefulness \200 Cognitive impai rment \200 Irritability \200 GI upset. Epidemiology of health effects The impact of jet lag upon long-haul travelers is particular ly high, with approximately 90 \200\22394% of travelers feeling some \200\223 ve effects a fter \202 ying. Some surveys have shown that 96% of experienced \202 ight attendants co n- tinue to feel jet-lagged after long-haul \202 ights. Risk factors \200 Number of tim e zones crossed ( (cid:3) \201 ve time zones greatly i risk) \200 Cabin pressure \200 Being a person of \200\230set routine \200\231 \200 Pre- \202 ight condition (e.g. tir edness, stressed, nervous, drunk/hung-over) \200 Caffeine, alcohol, fruit juice \200 De hydration \200 Poor fresh air supply \200 Limited movement/stretching \200 Flying at night time \200 Older age. Risk control There are a number of preventive measures that travelers can take. Pre- \202 ight \200 Ensure a good night \200\231s sleep before travel \200 Be calm \200 Exercise the day before the \202 ight. Flight factors \200 Direction of \202 ig ht (if possible) \200\224may be a personal preference \200 Daytime \202 ights preferabl e to night time \202 ights. 05_Smedley_Chap05.indd 144 12/31/2012 8:48:36 PM TIME ZONE CHANGES 145 In- \202 ight behavior \200 Drink plenty of water or other non-alcoholic \202 uids \200 Using sleeping aids: pillows, neck-rests, blindfolds, earplugs \200 Remove footwear \200 Exercise as much as possible \200 Take walks at stop-overs if possible \200 Sho wer if available (refreshing, and activates muscles and circulation). Management Some resea rch suggests that phototherapy and bright-light therapy can be useful in speeding up the ci rcadian adaptation in those who are suffering ill effects. The ef \201 cacy of melatonin i s uncertain. 05_Smedley_Chap05.indd 145 12/31/2012 8:48:36 PM This page intentionally left blank Section 2 Occupational diseases 6 Occupational infections 7 Respiratory and cardiovascular disorders 8 Skin disorders 9 Mus culoskeletal disorders 10 Gastrointestinal and urinary tract disorders 11 Eye disorders 12 Neurological disorders 13 Psychiatric disorders 14 Reproductive disorders 15 Hematological disorders 16 Medically unexplained occupational disorders 149 197 241 253 263 277 287 305 317 323 331 06_Smedley_Chap06.indd 147 12/31/2012 8:50:41 PM This page intentionally left blank 149 Chapter 6 Occupational infections