OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Occupational Health I_Smedley_prelims.indd 1 12/24/2012 3:50:47 PM Published and upcoming Oxford Handbooks Oxford Handbook of Genetics Oxford Handbook of Genitourinary Oxford Handbook for the Foundation Program 3e Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Oxford Handbook of Acute Medicine 3e Medicine Oxford Handbook of Anesthesia 3e Oxford Handbook of Applied Dental Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Sciences Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Laboratory Investigation 3 e Oxford Handbook of Clinical Evidence Oxford Handbook of Medical Dermatology Oxford Handbook of Medical Imaging Oxford Handbook of Medical Dentistry 5e Oxford Handbook of Clinical Sciences 2e Diagnosis 2e Oxford Handbook of Medical Statistics Oxford Handbook of Nephrology and Oxford Handbook of Clinical Examination and Practical Skills Hypertension Oxford Handbook of Clinical Oxford Handbook of Neurology Oxford Handbook of Nutrition and Hematology 3e Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine \200\223 Mini Edition 8e Oxford Handbook of Clinical Dietetics 2e Oxford Handbook of Obstetrics and Gynecology 2e Oxford Handbook of Occupational Health 2e Medicine 8e Oxford Handbook of Oncology 3e Oxford Handbook of Ophthalmology 2e Oxford Handbook of Clinical Pathology Oxford Handbook of Clinical Drugstore 2e Oxford Handbook of Oral and Oxford Handbook of Clinical Maxillofacial Surgery Rehabilitation 2e Oxford Handbook of Pediatrics 2e Oxford Handbook of Pain Management Oxford Handbook of Pall iative Care 2e Oxford Handbook of Practical Drug Oxford Handbook of Clinical Specialties 9e Oxford Handbook of Clinical Surgery 4e Therapy 2e Oxford Handbook of Complementary Oxford Handbook of Pre-Hospital Medicine Care Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Oxford Handbook of Psychiatry 3e Oxford Handbook of Public Health Care 2e Practice 2e Oxford Handbook of Dialysis 3e Oxford Handbook of Emergency Oxford Handbook of Reproductive Medicine & Family Planning Oxford Handbook of Respiratory Medicine 4e Oxford Handbook of Endocrinology Medicine 2e and Diabetes 2e Oxford Handbook of Rheumatology 3e Oxford Handbook of Sport and Oxford Handbook of ENT and Head and Neck Surgery Exercise Medicine Oxford Handbook of Epidemiology for Oxford Handbook of Tropical Clinicians Medicine 3e Oxford Handbook of Expedition and Oxford Handbook of Urology 3e Wilderness Medicine Oxford Handbook of Gastroenterology & Hepatology 2e Oxford Handbook of General Practice 3e I_Smedley_prelims.indd 2 12/24/2012 3:50:47 PM Oxford Handbook of Occupational Health Second Edition Edited by Dr Julia Smedley Consultant Occupational Physician, Lead consultant Occupational Health, University Hospital Southampton NHS Foundation Trust, and Honorary Senior Lecturer, University of Southampton, UK Dr Finlay Dick Senior Occupational Physician, Capita Health and Wellbeing, Aberdeen, and Ho norary Senior Lecturer in Occupational Medicine, University of Aberdeen, UK Dr Steven Sadhra Senior Lecturer and Director of Education for Occupational Health, Institu te of Occupational and Environmental Medicine, College of Medical and Dental Sciences, Univ ersity of Birmingham, UK 1 I_Smedley_prelims.indd 3 12/24/2012 3:50:47 PM 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Oxford University Press, 2013 The moral rights of the authors have been asserted First edition published 2007 Second edition published 2013 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with t he appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, a t the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloging in Publication Data Data available ISBN 978 \200\2230 \200\22319 \200\223965162 \200\2237 Printed in China by C&C Offset Printing Co. Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and c linical procedures with the most up-to-date published product information and data sheets p rovided by the manufacturers and the most recent codes of conduct and safety regulations. T he authors and the publishers do not accept responsibility or legal liability for any error s in the text or for the misuse or misapplication of material in this work. Except where ot herwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast feeding. I_Smedley_prelims.indd 4 12/24/2012 3:50:47 PM v Preface This second edition of the former newcomer to the handbook series cov- ers the broad \201 eld of occupational health (OH) and wellbeing. It is aimed primarily at occupational healt h professionals from all disciplines, including general practitioners (GPs) who practice OH on a sessional basis and a new breed of non-medical case managers who advise on occupation al rehabilitation. The book will also be useful for trainees in occupational medicine who a re preparing for professional examinations. We have retained the basic structure and features of the \201 rst edition which received good feedback from readers. Six main areas (occupational hazards, occupational diseases, OH practice, specialist disciplines, practi- cal procedures, and emergencies) are covered in twelve sections. The new edition still provides a \200\230quick look-up \200\231 tool (par ticularly for speci \201 c hazards and diseases), and gives a structured overview of some important operational issues such as service provision and the legal framework. The special ist chapters (occupational hygiene, toxicology, epidemiology, envi- ronmental medicine, and safety science) aim to give an overall approach to problem-solving, helping to identify th e need for (and interpretation of) specialist advice. The inevitable overlap between topics has been mini- mized by cross-referencing other pages in the handbook, but we have deliber ately retained limited duplication where this avoids excessive \200\230 \202 it- ting \200\231 between pages. The new material for the second edition re \202 ects developments in the \201 eld of OH and the increasing web-based information store. The principal changes are: \200 The updat ing and signposting of evidence-based and other important guidance where applicable for each topic, including more web references than the previous e dition A new emphasis on wellbeing to re \202 ect the changing role of OH practitioners in optimizing health at work, and minimizing the negative impact of work loss on health New pages on managing chronic pain, psychological therapies, managing psychiatric emergencies, REACH legislation, obesity, policy writing, voice disorde rs, and evidence-based guidelines in OH. We hope that the second edition will be as success ful as the \201 rst, and look forward to hearing your feedback via the OUP website (M htt p:// www.oup.com/uk/medicine/handbooks). We are particularly interested in views on the ove rall emphasis and level of detail of pages, and any topics that we have omitted. JS FD SS January 2012 II_Smedley_preface.indd v 1/2/2013 1:20:33 PM vi Acknowledgements We would like to give special thanks to those who supported us during the revision of this handbook. JS is indebted to her tolerant and supportive family, Andrew, Ben, and Alex. FD thanks his family, Smita, Ananya, Cara, and Rohan for their encouragement and support. SS thanks his f amily, in particular his parents Tarsem Singh and Gurdev Kaur for their encouragement and f or the work ethic they instilled in him. We also thank Michael Hawkes from OUP who helped to keep us on track. Contributors The following colleagues kindly gave up their time to update topics, or to con tribute the initial drafts for new topics or chapters. Professor Jon Ayres, Dr David Brown, Dr John Cherrie, Professor David Coggon, Dr Hilary Cro ss, Dr Steve Deacon, Dr Mike Doig, Dr Clive Harker, Dr Kit Harling, Dr Max Henderson, Profe ssor Craig Jackson, Dr Bob Jefferson, Professor Susan Klein, Professor Diana Kloss, Profess or Ewan Macdonald, Dr Ira Madan, Dr Stuart Mitchell, Professor Keith Palmer, Dr Cathy Price , Dr Paul Sclare, Dr Alan Smith, Dr Jon Spiro, Dr Andrew Wheatley, and Dr Nerys Williams. Expert advisers We are particularly grateful to Dr Fortune Ncube who gave extremely helpful comments on \201 tness for exposure prone procedures. III_Smedley_Acknowledgment.indd vi 1/2/2013 1:20:54 PM vii Foreword The plain clear message at the center of this authoritative text is that occu- pational med icine is preventive medicine practiced in the workplace \200\224 safeguarding and promoting health and wellbeing among the workforce. Occupational health is now seen as a major aspec t of public health. Specialist services have a responsibility both to respond effectively t o unforeseen threats to individual and population health arising in the con- text of workin g life, and wherever possible to act to prevent work-related ill-health. Whilst the Handbook is a detailed and comprehensive text for special- ists in occupational health it also meets important needs of a much wider readership. The tenets of occupational health are increasingly observed by other health professionals, and by farseeing employers , largely because of evidence that being in work is generally good for health and wellbeing and worklessness is harmful, and also because not being wholly \201 t is still compatibl e with work of the right kind. The Handbook reinforces the view that safeguarding health at work, preventing loss of occup ation as a result of ill health, and supporting prompt treatment and rehabilitation to enab le people to return to work following absence through illness or injury, are not for occupa tional health services alone. They are joint enterprises requiring collaboration between em ployers and occupational health services, the services set up under health and safety legis lation, and the NHS. Issues arising in the practice of occupational health are not limited to specialists in thi s discipline. They are also the concerns of other people whose advice and actions can in \202 uence the balance of understanding between employer and employee, especially when the employee is a patient under the care of other health professionals. The Handbook is a source of guidance on the occupational signi \201 - cance of many health conditions. This information serves to strengthen clinical management, relieving uncertain ty about the implications of ill- ness for working life, and enabling sound advice on the s teps to be taken for the best outcome. The Handbook contains information that should be rea dily accessible to any professional in primary and second- ary health care. At a time marked by an inescapable awareness of serious inequalities in health and life cha nces, and a climate of economic stringency, we have become familiar with the costs, burdens , and social consequences of impaired health among working age people. There is widening recognition of the interplay of health with work and of work and the cond itions of work with health, and of the many factors that in \202 uence health, health beli efs, and behavior. Often they are deeply embedded in the history and culture of societies. Some can be changed for the better and that is what the practice of a more fully engaged oc cupation IV_Smedley_foreword.indd vii 1/2/2013 1:21:20 PM FOREWORD viii health discipline aims to do. Such engagement requires further changes in culture and in pr actice, and in the education and training of professionals in health care, and in business and management, necessary to bring about those changes. The Handbook provides a vade mecum in this task. Professor Dame Carol Black National Director for Health and Work June 2012 IV_Smedley_foreword.indd viii 1/2/2013 1:21:20 PM ix Contents Preface v Acknowledgements vi Foreword vii List of contributors xii Symbols and abbreviatio ns xiv Section 1 1 Physical hazards 2 Chemical hazards 3 Biological hazards 4 Mechanical and ergon omics hazards 5 Psychosocial hazards Occupational hazards 3 41 103 117 133 Section 2 6 Occupational infections 7 Respiratory and cardiovascular disorders 8 Skin disor ders 9 Musculoskeletal disorders 10 Gastrointestinal and urinary tract disorders 11 Eye dis orders 12 Neurological disorders 13 Psychiatric disorders 14 Reproductive disorders 15 Hema tological disorders 16 Medically unexplained occupational disorders Occupational diseases 149 197 241 253 263 277 287 305 317 323 331 V_Smedley_contents.indd ix 1/2/2013 3:17:40 PM CONTENTS x Section 3 17 Operational issues 18 Ethics 19 Policies 20 Sickness absence, rehabilitation, and retirement 21 Principles of risk assessment and risk management 22 Health surveillance Occupational health practice 339 359 365 393 415 423 Section 4 23 Generic \201 tness for work issues and Fitness for work speci \201 c disorders 443 471 24 Fitness for speci \201 c work Section 5 25 UK health and safety legislation 26 Employment law 27 Legislation related to o ccupational Occupational health law 509 557 health records 577 585 28 Environmental legislation Section 6 Occupational hygiene 29 Occupational hygiene overview 30 Monitoring exposure 31 B iological monitoring 32 Prevention and control of exposure 597 603 623 633 Section 7 33 Principles of toxicology Toxicology 671 Section 8 34 Epidemiology Epidemiology in occupational health 683 V_Smedley_contents.indd x 1/2/2013 3:17:40 PM CONTENTS xi Section 9 35 Environmental protection Environmental medicine 709 Section 10 36 Safety science Safety science 727 Section 11 Practical procedures 37 Clinical tasks and procedures 38 Non-clinical tasks and procedures 747 771 Section 12 Emergencies in occupational health 39 Acute poisoning 40 Non-chemical emergencie s 41 Terrorism 791 813 827 Appendices 835 Index 891 V_Smedley_contents.indd xi 1/2/2013 3:17:40 PM xii List of contributors Professor Jon Ayres Professor of Environmental and Respiratory Medicine, Institute of Occup ational and Environmental Medicine, University of Birmingham, UK Dr Mike Doig Regional Medical Manager, Chevron Corporation, London, UK Dr Clive Harker Consultant Occupational Physician, Occmed Ltd, Carlisle, UK Dr David Brown Consultant Occupational Physician, EDF-Energy Nuclear Generation, Gloucester , UK Dr Kit Harling Retired Consultant Occupational Physician, Devon, UK Dr John Cherrie Research Director, Institute of Occupational Medicine, Edinburgh, UK Dr Max Henderson Consultant Psychiatrist, Institute of Psychiatry, Kings and The Maudsley, Senior Lecturer in Epidemiological & Occupational Psychiatry, Kings College London, Institu te of Psychiatry, Weston Education Center, London, UK Professor David Coggon Professor of Occupational and Environmental Medicine, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Professor Craig Jackson Professor of Occupational Health Psychology/Head of Psychology, Bir mingham City University, Birmingham, UK Dr Hilary Cross Honorary Senior Lecturer in Occupational Toxicology, Institute of Occupatio nal and Environmental Medicine, College of Medical and Dental Sciences, University of Birmi ngham, UK Dr Bob Jefferson Consultant in Environmental Medicine & Deputy Director, Medical Toxicology Center, Newcastle University, UK Dr Steve Deacon Consultant Occupational Physician, Avondale Medical Consultancy Ltd, Waltha m on the Wolds, Leicestershire, UK Professor Susan Klein Director, Aberdeen Center for Trauma Research, Institute for Health & Welfare Research, Robert Gordon University, Aberdeen, UK Dr Finlay Dick Senior Occupational Physician, Capita Health and Wellbeing, Aberdeen, and Ho norary Senior Lecturer in Occupational Medicine, University of Aberdeen, UK Professor D Kloss MBE Hon. FFOM, Barrister and Chair, Council for Work and Health, Manchest er, UK VI_Smedley_contributors.indd xii 1/2/2013 1:23:08 PM LIST OF CONTRIBUTORS CONTENTS xiii Professor Ewan Macdonald Head of Healthy Working Lives Research Group, University of Glasgo w, UK Dr Paul Sclare Consultant in Adult Psychiatry, NHS Grampian, Cornhill Hospital, Aberdeen, U K Dr Ira Madan Consultant and Honorary Senior Lecturer in Occupational Medicine, Guy \200\231 s and St Thomas \200\231s NHS (Foundation) Trust, London, UK Dr Julia Smedley Consultant Occupational Physician, Lead consultant Occupational Health, Un iversity Hospital Southampton NHS Foundation Trust, and Honorary Senior Lecturer, Universit y of Southampton, UK Dr Stuart Mitchell Head of Aeromedical Center and Occupational Health Safety Regulation Gro up, UK Civil Aviation Authority, Gatwick Airport, UK Dr Alan Smith Lighting Consultant, Honorary Research Fellow, Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, U K Professor Keith Palmer Professor of Occupational Medicine & Honorary Consultant Occupationa l Physician, MRC Lifecourse Epidemiology Unit, University of Southampton, UK Dr Jon Spiro Independent Specialist in Occupational Medicine, UK Dr Cathy Price Consultant in Chronic Pain Management, University Hospital Southampton NHS F oundation Trust, Southampton, UK Dr Andrew Wheatley Honorary Senior Research Fellow, Institute of Occupational and Environme ntal Medicine, College of Medical and Dental Sciences, University of Birmingham, UK Dr Steven Sadhra Senior Lecturer and Director of Education for Occupational Health, Institu te of Occupational and Environmental Medicine, College of Medical and Dental Sciences, Univ ersity of Birmingham, UK Dr Nerys Williams Independent Consultant Occupational Physician and NHS Non Executive Direc tor, UK VI_Smedley_contributors.indd xiii 1/2/2013 1:23:08 PM xiv Symbols and abbreviations i d 2 (cid:2) (cid:2) b M \231\202 \231\200 A(8) Increased Decreased Important Warning Controversial Book reference Web reference Male Female 8-h energy equivalent acceleration (of vibration) AAS atomic absorption spectroscopy ABS acrylonitrile-butadiene-styrene plastic AC air conduction (of sound in hearing) ACD allergic contact dermatitis ACDP Advisory Committee on Dangerous Pathogens ACE-R Addenbrooke \200\231s Cognitive Examination \200\224Revised ACGIH American Conference of Governmental Industrial Hygienists AChE acetyl cholinesterase ACOP Approved Code of Practice ACTS Advisory Committee on Toxic Substances AD Alzheimer \200\231s disease ADS approved dosimetry service AED automated external de \201 brillator AER auditory evoked response ahw frequency-weighted measurement (of hand-transmitted vibration) AIDS acquired immunode \201 ciency syndrome ALARP as low as reasonably practicable -aminolaevulinic acid dehydratase alkaline phosphatase ALA-D AlkPhos ALL acute lymphoblastic leukemia ALT alanine aminotransferase VII_Smedley_symb01.indd xiv 1/2/2013 1:23:47 PM SYMBOLS AND ABBREVIATIONS xv AMED HSE approved medical examiner of divers AML acute myeloid leukemia ANOVA analysis of variance ANR active noise reduction (in hearing protectors) AP anteroposterior (usually of a chest X-ray) APrV assigned protection value (of respiratory protective equipment) APF assigned protection factor APV assumed protection values (of hearing protectors) ARDS adult respiratory distress syndrome ARF acute renal failure ART assessment of repetitive tasks tool ART anti-retroviral therapy ASH Action on Smoking and Health (UK charity) ASHRAE American Society of Heating, Refrigerating and Air-conditioning Engineers Scale AST aspartate aminotransferase ATM automated teller machine AtW Access to Work scheme AUDIT Alcohol Use Disorders Identi \201 cation Test B 12 BA vitamin B 12 breathing apparatus BAT biological tolerance values (Germany) BATNEEC best available techniques not entailing excessive cost BBV blood-borne viruses BC bone conduction of sound in hearing BCG Bacillus Calmette \200\223Gu rin \200\224a tuberculosis vaccine BCME bis-chloromethyl ether BDI-II Beck Depression Inventory BEIs Biological Exposure Indices (USA) BeLPT blood beryllium lymphocyte proliferation test BEM biological effect monitoring BM biological monitoring BMA British Medical Association BMGV Biological Monitoring Guidance Value (UK) body mass index (kg/m 2 ) BMI BOHRF British Occupational Health Research Foundation BOHS British Occupational Hygiene Society VII_Smedley_symb01.indd xv 1/2/2013 1:23:47 PM SYMBOLS AND ABBREVIATIONS xvi bp boiling point Bq becquerel (rate of transformations in radioactive material) BS British Standard BSE bovine spongiform encephalopathy BSIF British Safety Industry Federation BTPS body temperature and pressure standard CAA Civil Aviation Authority (UK) CABG coronary artery bypass graft CAPS Clinician-Administered Assessment Scale for PTSD CAR Control of Asbestos at Work Regulations 2006 CAS Chemical Abstracts Service registry number Carc carcinogen CBD chronic beryllium disease CBI Confederation of British Industry CBRN chemical, biological, radiological, and nuclear CBT cognitive behavioral therapy CCHF Crimean/Congo haemorrhagic fever CD compact disk Cd candela CDC Centers for Disease Control and Prevention (USA) CDSC Communicable Disease Surveillance Center CDT carbohydrate de \201 cient transferrin CE Conformit Europ ene CEN European Committee for Standardization CET corrected effective temperature CFS chronic fatigue syndrome CHIP Chemical (Hazards Information and Packaging for Supply) Regulations CIBSE Chartered Institution of Building Service Engineers CIDR Coal Mines (Control of Inhalable Dust) Regulations 2007 CISD critical incident stress debrie \201 ng CJD Creutzfeldt \200\223Jakob disease CLAW Control of Lead at Work Regulations clo clothing insulation (unit of measurement) CLP Classi \201 cation, Labeling and Packaging of Substances and Mixtures CML chronic myeloid leukemia CMV cytomegalovirus VII_Smedley_symb01.indd xvi 1/2/2013 1:23:47 PM SYMBOLS AND ABBREVIATIONS xvii CNAWRs Control of Noise at Work Regulations 2005 CNS central nervous system COMAH Control of Major Accident Hazards Regulations COPD chronic obstructive pulmonary disease COSHH Control of Substances Hazardous to Health Regulations CoV coronavirus (see SARS) CPT cold provocation test (see HAVS) CPU central processing unit CSA chemical safety assessment (REACH) CSM Committee on Safety of Medicines CSR Chemical Safety Report CT computed tomography CTS carpal tunnel syndrome CVA cerebrovascular accident CVAAS cold vapor atomic absorption spectroscopy CWP coal worker \200\231s pneumoconiosis CXR chest X-ray DB dry-bulb temperature dB decibel DBCP dibromochloropropane D&C dilatation and curettage \200\224a gynecological procedure DDA Disability Discrimination Act DEEE Diesel engine exhaust emissions DEFRA Department for Environment, Food, and Rural Affairs DFG Deutsche Forschungsgemeinschaft (Germany): the German Research Foundation DH Department of Health (England) DIY do it yourself dL decilitre DNA deoxyribonucleic acid DNEL derived no-effect level (REACH) DOB date of birth DPH local Director of Public Health \200\224UK DPT diptheria, pertussis, tetanus immunization DSE display screen equipment DSEAR Dangerous Substances and Explosive Atmospheres Regulations DSM IV Diagnostic and Statistical Manual of Mental Disorders, 4th edition VII_Smedley_symb01.indd xvii 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xviii DTS Davidson Trauma Scale DU downstream user (REACH) DVLA Driver and Vehicle Licensing Agency DVT deep venous thrombosis DWP Department for Work and Pensions E illuminance EA Environment Agency EAA extrinsic allergic alveolitis EAGA Expert Advisory Group on AIDS (UK) EAP Employee Assistance Program EASA European Aviation Safety Agency EAV exposure action value EC elemental carbon ECG electrocardiogram ECHA Central European Chemical Agency ECL exposure control limits (of respirable dust) EDTA ethylene diamine tetra-acetic acid EEF UK manufacturers \200\231 organization EFQM European Foundation for Quality Management EHO environmental health of \201 cer EH40 list of workplace exposure limits for use with COSHH EIA environmental impact assessment EINECS European Inventory of Existing Commercial Chemical Substances EIR Environmental Information Regulations ELF extremely low-frequency \201 elds ELINCS European List of Noti \201 ed Chemical Substances ELV exposure limit value EMA employment medical adviser EMDR eye movement desensitization and reprocessing EMF electromagnetic \201 elds EMG electromyography EmT employment tribunal ENT ear, nose, and throat ENWHP European Network for Workplace Health Promotion EPA Environmental Protection Agency EPP exposure prone procedure (of healthcare) ERPC evacuation of retained products of conception VII_Smedley_symb01.indd xviii 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xix ESA Employment and Support Allowance (UK disability bene \201 t) ESR erythrocyte sedimentation rate ET effective temperature ETS environmental tobacco smoke EU European Union EWI Expert Witness Institute (UK) EWTD European Working Time Directive FCA \202 ux cored arc (welding) FEP free erythrocyte protoporphyrin FEV1 forced expiratory volume in 1 second FFP ferrous foundry particulate FFP3 \201 ltering face-piece respirator conforming to EN149:2001 FFP3 FHP farmer \200\231s hypersensitivity pneumonitis FII fabricated or induced illness \200\224previously Munchausen \200\231s syndrome and Munchaus en \200\231s syndrome by proxy FOD Field Operations Directorate of HSE FOH Faculty of Occupational Hygiene FOM Faculty of Occupational Medicine FRP \201 bre-reinforced plastic FSBP \201 nger systolic blood pressure test FVC forced vital capacity G6PD glucose-6-phosphate dehydrogenase GC gas chromatography GC-FID gas chromatography \200\223 \202 ame ionization detection GC-MS gas chromatography \200\223mass spectroscopy G-CSF granulocyte-colony stimulating factor GDG Guideline Development Groups GET graded exercise therapy GGT gamma glutamyl transferase GI gastrointestinal GM genetic modi \201 cation GM geometric mean GMC General Medical Council \200\224UK regulatory body for doctors GM-CSF granulocyte-macrophage colony-stimulating factor GMO genetically-modi \201 ed organisms GMM genetically-modi \201 ed micro-organisms VII_Smedley_symb01.indd xix 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xx GP general practitioner GRADE Grading of Recommendations Assessment, Development and Evaluation GSD geometric standard deviation GT globe thermometer temperature GTC generalized tonic \200\223clonic convulsions Gy gray: unit of absorbed radiation HAART highly active anti-retroviral therapy HACCP Hazard Analysis and Critical Control Points \200\224of food safety HADS Hospital Anxiety and Depression Scale HAVS hand \200\223arm vibration syndrome HBIG hepatitis B speci \201 c immunoglobulin HBV hepatitis B virus HCN hydrogen cyanide HCV hepatitis C virus HCW health care worker HDI 1,6-hexamethylenediisocynate HDV hepatitis D virus HELA Health and Safety Executive/Local Authority Enforcement Liaison Committee HEPA high-ef \201 ciency particulate absorption ( \201 lters) HG hazard group (microbial pathogens) HGV heavy goods vehicle HHG health hazard group (of substances \200\224based on risk phrases) HIA health impact assessment HIDL high-intensity discharge lamp HIV human immunode \201 ciency virus HP hearing protectors HML high, medium, and low frequencies HP hypersensitivity pneumonitis HPA Health Protection Agency HPLC high-performance liquid chromatography HPS Health Protection Scotland HR human resources (personnel) HRT hormone replacement therapy HSAC HSE Health Services Advisory Committee HSC Health and Safety Commission VII_Smedley_symb01.indd xx 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xxi HSE Health and Safety Executive HSW Health and Safety at Work etc. Act HVLV high-velocity low-volume extraction system HWDU Health and Work Development Unit HWI Healthy Workplace Initiative Hz Hertz IAPT Improving access to psychological therapies \200\224a UK National Health Service program IARC International Agency for Research on Cancer ICAO International Civil Aviation Organization ICD-10 International Classi \201 cation of Diseases, 10th edition IrCD irritant contact dermatitis ICNIRP International Commission on Non-ionizing Radiation Protection ICO Information Commissioner \200\231s Of \201 ce ICOH International Commission on Occupational Health ICP inductively coupled plasma spectrometry ICP-AES inductively coupled plasma atomic emission spectrometry ICRP International Commission on Radiation Protection IEGMP independent expert group on mobile phones IES-R Impact of Event Scale \200\224Revised IgE immunoglobulin E IHD ischaemic heart disease IHR ill-health retirement IIAC Industrial Injuries Advisory Council IIDB Industrial Injuries Disablement Bene \201 t ILEA International League Against Epilepsy ILI in \202 uenza-like illness ILO International Labor Organization ILS immediate life support IM intramuscular IOM Institute of Occupational Medicine (Edinburgh) IOSH Institution of Occupational Safety and Health IPC Integrated Pollution Control IPL intense pulsed light IR infrared radiation IREQ minimum clothing insulation required in cold environments IRR Ionizing Radiation Regulations VII_Smedley_symb01.indd xxi 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xxii ISO International Standard Organization IT information technology IV intravenous IVP intravenous pyelogram IVS identi \201 ed validated sample (of healthcare workers) J joule KCN potassium cyanide L luminance L \200\231 A L Aeq L Cpeak L EP,d LA noise level at the ear continuous equivalent A-weighted sound pressure level peak sound pressure level (pascals) daily personal noise exposure level (Db(A)) A-weighted sound pressure levels LBP low back pain LC C-weighted sound pressure levels LD 50 LEV lethal dose in 50% of experimental animals local exhaust ventilation LFT liver function test LGV large goods vehicle LOAEL lowest observable adverse effect level LOD limit of detection LOLER Lifting Operations and Lifting Equipment Regulations LRU Leptospira Reference Unit LSA low speci \201 c activity scale Lx Lux \200\224a measure of light MAC manual handling assessment chart MAK maximum allowable concentration of a substance (Germany) MAPP major accident prevention policy MASTA Medical Advisory Service for Travelers Abroad MbOCA dichloro-4,4-methylene dianiline MCA Maritime and Coastguard Agency MDA 4,4-diaminodiphenylmethane MDHS methods for the determination of hazardous substances MDI methylenebis (phenyl isocyanate) MDR-TB multidrug-resistant tuberculosis ME myalgic encephalomyelitis MEDIF medical information form ( \201 tness to \202 y) VII_Smedley_symb01.indd xxii 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xxiii MEK methyl ethyl ketone MHOR Manual Handling Operations Regulations MHRA Medicines and Healthcare Products Regulatory Agency MHSWR Management of Health and Safety at Work Regulations MI myocardial infarction M/I manufacturers and importers MIG metal inert gas (welding) MMA manual metal arc (welding) MMMF machine-made mineral \201 bre MMR measles, mumps, rubella vaccine MMSE Mini Mental State Examination MOD Ministry of Defense (UK) MOSS Musculoskeletal Occupational Surveillance Scheme MP Member of Parliament mp melting point MPE maximum permissible exposure value (of lasers) MPTP 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine MRI magnetic resonance imaging MRO Medical Review Of \201 cer (of drug test results) MRSA multiresistant Staphylococcus aureus MS member states of EU MSD musculoskeletal disorder MSDS Manufacturer \200\231s Safety Data Sheet MSLA minimum school-leaving age mSv millisieverts MUC maximum use concentration (of respirators) Muta. mutagen MWF metal-working \202 uid NaCN sodium cyanide NCGC National Clinical Guideline Center (UK) NEBOSH National Examination Board in Occupational Safety and Health NEQAS UK National External Quality Assessment Service NHS National Health Service (UK) NI National Insurance (UK) NIBSC National Institute for Biological Standards and Controls NICE National Institute for Health and Clinical Excellence (UK) NIHL noise-induced hearing loss VII_Smedley_symb01.indd xxiii 1/2/2013 1:23:48 PM SYMBOLS AND ABBREVIATIONS xxiv NIOSH National Institute for Occupational Safety and Health (USA) nm nanometer NMC Nursing and Midwifery Council NOx oxides of nitrogen NOAEL no observable adverse effect level NPIS National Poisons Information Service NRL natural rubber latex NRPB National Radiological Protection Board NRT nicotine replacement therapy NRTIs nucleoside analog reverse transcriptase inhibitors NSI needle stick injury NTE neuropathy target esterase OA occupational asthma OA osteoarthritis OASYS computer based analytical tool of serial measurements of peak expiratory \202 ow OC organochlorine OCD obsessive compulsive disorder OCP oral contraceptive pill OD occupational dermatitis ODTS organic dust toxic syndrome OEL occupational exposure limit OH occupational health OHA occupational health adviser \200\224an occupational health nurse OHN occupational health nurse OHP occupational health physician OHS occupational health service ONS Of \201 ce for National Statistics (UK) OP organophosphate OPCS Of \201 ce of Population Censuses and Surveys OPIDN organophosphate-induced delayed neuropathy OPRA Occupational Physicians Reporting Activity OSHA Occupational Safety and Health Administration (USA) OSSA Occupational Surveillance Scheme for Audiological Physicians OSHCR Occupational Safety and Health Consultants Register Pa pascal (SI unit of pressure) PAP 3-(N-phenylamino)-1,2-propanediol VII_Smedley_symb01.indd xxiv 1/2/2013 1:23:49 PM SYMBOLS AND ABBREVIATIONS xxv PAHs polycylic aromatic hydrocarbons PBG porphobilinogen PBT persistent bioaccumulative and toxic (REACH) PC personal computer PCBs polychlorinated biphenyls PCDF polychlorinated dibenzofuran PCR polymerase chain reaction PCV passenger-carrying vehicle PD Parkinson \200\231s disease PDA personal digital assistant \200\224a palmtop computer pdf portable document format PEF peak expiratory \202 ow PEP post-exposure prophylaxis for blood-borne virus exposures PGD patient group direction (for vaccine administration) PHLS Public Health Laboratory Service (UK) PHQ9 Patient Health Questionnaire PI protease inhibitor PM2.5 particulate matter <2.5 m in diameter PM10 particulate matter <10 m in diameter PMF progressive massive \201 brosis PMV predicted mean vote PPC pollution prevention and control PPD predicted percentage of persons dissatis \201 ed with the thermal environment PPE personal protective equipment ppm parts per million PTFE polytetra \202 uoroethylene PTO power take-off PTSD post-traumatic stress disorder PULHHEEMS UK military grading scheme: Physique, Upper and Lower limbs, Hearing, Eyesight, Mental func tion, Stability PUWER Provision and Use of Work Equipment Regulations Pv velocity pressure (of ventilation systems) PVA polyvinyl alcohol PVC polyvinyl chloride QEC Quick Exposure Check tool RAST radio-allergosorbent test VII_Smedley_symb01.indd xxv 1/2/2013 1:23:49 PM SYMBOLS AND ABBREVIATIONS xxvi RBP retinol binding protein RCN Royal College of Nursing RCT randomized controlled trial REACH Registration, Evaluation, Authorization and Restriction of Chemicals Repr reproductive toxin RF radiofrequency radiation RIDDOR Reporting of Injuries, Diseases, and Dangerous Occurrence Regulations RMM risk management measures (REACH) RMO Review Medical Of \201 cer (of drug screen results) RMP registered medical practitioner rms root mean square RNA ribonucleic acid RO Responsible Of \201 cer (for revalidation of UK doctors) RPA radiation protection adviser RPE respiratory protective equipment RPS radiation protection supervisor RR relative risk RULA Rapid Upper Limb Assessment tool SaO 2 SARS oxygen saturation (%) severe acute respiratory syndrome SARs structure \200\223activity relationships (of toxicology) SBS sick building syndrome SCL skin contamination layer SD standard deviation SEA strategic environmental assessment Sen sensitizer (term used in HSE publication EH40) SEPA Scottish Environmental Protection Agency SEQOHS Safe effective quality occupational health service \200\224UK occupational health accredita tion scheme SI Le Syst me International d \200\231Unit s \200\224the metric system of measurements SIDAW Surveillance of Infectious Diseases at Work SIEF substance information exchange forum (REACH) SIGN Scottish Intercollegiate Guideline Network Sk substance can be absorbed through the skin (term used in HSE publication EH40) SLM Sound level meter VII_Smedley_symb01.indd xxvi 1/2/2013 1:23:49 PM SYMBOLS AND ABBREVIATIONS xxvii SMEs small- and medium-sized enterprises SMR standardized mortality ratio SN sensorineural \200\224of hand arm vibration syndrome grading SNR single rating number (of hearing protection) SOM Society of Occupational Medicine SOP standard operating procedure SOSMI Surveillance of Occupational Stress and Mental Illness SPRU Special Pathogens Reference Unit SSP statutory sick pay SSRI selective serotonin-reuptake inhibitor STEL short-term exposure limit STOT/SE speci \201 c target organ toxicity \200\224single exposure STOT/RE speci \201 c target organ toxicity \200\224repeated exposure Sv Sievert SVHC substance of very high concern (REACH) SWASH Survey of Workplace Absence Sickness and (Ill) Health -UK SWI Self-reported Work-related Illness survey SWORD Surveillance of Work-related and Occupational Respiratory Disease TB tuberculosis TDI toluene-2,4-diisocyanate TENS transcutaneous electrical nerve stimulation THOR The Health and Occupation Reporting network TIA transient ischaemic attack TIG tetanus immunoglobulin TIG tungsten inert gas (welding) TLD thermoluminescent dosemeter TLV 