Health protection and prevention of the noise exposure related

diseases - a monitoring program developed during 2000-2005 in Bucharest

municipality

Liliana Rapas M.D., Ph.D.Liliana Rapas M.D., Ph.D.

Corha Yvonne M.D. Corha Yvonne M.D.

Direction of Public Health M.B.

• Statistics - 2000 – 2005, BucharestStatistics - 2000 – 2005, Bucharest

Occupational noise surveillanceOccupational noise surveillanceRisk assessmentRisk assessmentHealth surveillance – National Health surveillance – National

Occupational Diseases DatabaseOccupational Diseases Database

• THE IMPACT OF THE NOISE ON THE EMPLOYEES HEALTH STATUS IN A TRADE COMPANY WITH ENGINEERING PROFILE

Framework Framework europeaneuropean nationalnational

• 86/188/EEC86/188/EECfull transposition underfull transposition under

MLSSF and MLSSF and MHMH

• 2003/10/EEC2003/10/EEC 87 dB(A) 87 dB(A)

????????

MethodMethod TechnologieTechnologie

Measurement Measurement

* directly * directly - integration sonometer SR CEI 804+A1+A2- integration sonometer SR CEI 804+A1+A2- sonometer CEI 651- sonometer CEI 651

* * indirectlyindirectly exposure timeexposure timeacustic preassure fieldacustic preassure fieldsamples and statistic distributionsamples and statistic distribution

2000 - 20022000 - 2002 90dB(A)90dB(A)

0

5

10

15

20

25

30

35

40

I. Metallurgy I.food I.wood I.printing. I.plastics I.met.mft. I.car mf. I.tex.mf. Ifarm.com I.elec. I. Ch. I.Transp. I.gls.cerm. I.shoes. Construc.

21 000 workers

The Main Industries with Occupational Noise Surveillance Policy

2003 – 20052003 – 2005 87 dB(A)87 dB(A)The Main Industries with Occupational Noise

Surveillance Policy

0

5

10

15

20

25

30

2000 – 2005 50 – 75 dB(A)2000 – 2005 50 – 75 dB(A)

0

2

4

68

10

12

1416

18

20

servicies education administration culture

200020012002200320042005

Health RiskHealth Risk

• Work related stressWork related stress

• An increasing injuries risksAn increasing injuries risks

• Phisiology effects (cardiovascular diseases) Phisiology effects (cardiovascular diseases)

• Communication disturbancesCommunication disturbances

• Pregnancy risksPregnancy risks

• Hearing lossHearing loss

• Occupational health surveillanceOccupational health surveillance

• Screening: tonal liminar audiometry Screening: tonal liminar audiometry

• Occupational disease diagnosticOccupational disease diagnostic

• Diagnostic of hearing loss typeDiagnostic of hearing loss type

• Diagnostic for difference;Diagnostic for difference;

• Diagnostic of occupational etiologyDiagnostic of occupational etiology

•signalling

•pronuacement

• expertise of working capacity

Occupational diseases frequency Occupational diseases frequency versus occupational hearing lossversus occupational hearing loss

451

24 3540

50100150200250300350400450500

Freq.(no.) Freq.(%)

200020012002200320042005

132155

0

50

100

150

200

RL deafness L deafness R deafness RL p deafness R p deafness L p deafness

Occupational diseases frequencies due to noise exposure

2000 2001 2002 2003 2004 2005 total

Presbiacusie ?Presbiacusie ?

• Hearing status when exposure started Hearing status when exposure started

• Enough exposureEnough exposure

• Present exposure versus exposure Present exposure versus exposure historyhistory

• AgeAge

• Hearing loss Hearing loss << hearing loss estimated hearing loss estimated for the ageing for the ageing

• Time Time

THE IMPACT OF THE NOISE ON THE THE IMPACT OF THE NOISE ON THE EMPLOYEES HEALTH STATUS IN A EMPLOYEES HEALTH STATUS IN A

TRADE COMPANY WITH ENGINEERING TRADE COMPANY WITH ENGINEERING PROFILEPROFILE

- Study-- Study-

Dr. Yvonne Corha Dr. Yvonne Corha OOccupational Healthccupational Health

• The main activity object of the trade company where we are The main activity object of the trade company where we are performed this study is: railway frame production, equipments performed this study is: railway frame production, equipments repair, carriages, engines, etc.repair, carriages, engines, etc.

• The technology process has the following stages:The technology process has the following stages: 1. Dismantle – disassemble of the tread and addle equipments;1. Dismantle – disassemble of the tread and addle equipments;

2. The repairs of this components or producers to new bench-2. The repairs of this components or producers to new bench-mark;mark;3. Assembling;3. Assembling;4. The complying of the equipments to trial.4. The complying of the equipments to trial.

• The most frequent occupations of this trade company are: fitters, The most frequent occupations of this trade company are: fitters, cutting worker (lathe mans, milling-machine operators, cutting worker (lathe mans, milling-machine operators, rectification man), fitters, electricians. rectification man), fitters, electricians.

• Within the Within the security and health auditsecurity and health audit, has been assessed the , has been assessed the working conditions by sides and plants of the company. The working conditions by sides and plants of the company. The physical agents and chemical substances were identified in this physical agents and chemical substances were identified in this workplaces.workplaces.

• The noise was identified like the most aggressive The noise was identified like the most aggressive noxious and for this reason was measured every year noxious and for this reason was measured every year (continuous survey). (continuous survey).

• The noise investigation and the quantification during The noise investigation and the quantification during the 25 years, since the company existence, has been made in the 25 years, since the company existence, has been made in the the Ergonomic Laboratory of D.S.P.-M.B. and Noise Ergonomic Laboratory of D.S.P.-M.B. and Noise Laboratory of I.N.C.D.P.M.Laboratory of I.N.C.D.P.M.

• The both laboratories has distinguished over fulfilled of The both laboratories has distinguished over fulfilled of M.A.L. with 10-20 dBA in majority side and plants. It is point out M.A.L. with 10-20 dBA in majority side and plants. It is point out that the noise is not continuous and in such plants has impulse that the noise is not continuous and in such plants has impulse character. character.

• In this trade company labour 1100 employees and In this trade company labour 1100 employees and approximately approximately 1 000 are exhibited to noise. 1 000 are exhibited to noise.

• This study was accomplished after the This study was accomplished after the DSP- MB Occupational Medicine DSP- MB Occupational Medicine OfficeOffice w was received a number of 12 as received a number of 12 signalling cards (B.P1) with the signalling cards (B.P1) with the industrial disease presumption, in this industrial disease presumption, in this case the occupational hearing loss, case the occupational hearing loss, made by physician which is performed made by physician which is performed the employees periodically check up in the employees periodically check up in the foregoing company. the foregoing company.

Nr. Cr.Employe

eWorking place

Age(years)

ProfessionAncientness(years)

1. D.C. S.III.FD-M.MAS.TRA 50 Fitter 26

2. G.N. S. II - reducers 52 Locksmith 19

3. I.A. S. II - reducers 54 Plumber 36

4. N.C. Hall 52 Lathe man 25

5. O.M. S.I. electricians 50 Electrician 26

6. S.A. S.III coiling 51 Electrician 5 years and 10 month

7. T.C. S.II..FDM Pr Aux. 46 Locksmith 25

8. V.M. S.II..FDM Pr Aux. 37 Locksmith 13

9. Z.V. S.I. electricians 56 Electrician 37

10. N.I. S.III. Dr. M. Aux. 51 Lathe man 25

11. P.C. S.II. Form. reducers 53 Locksmith 28

12. P.T. S.III coiling 50 Lathe man 30

• The investigation of the industrial disease has the following stages:The investigation of the industrial disease has the following stages:

• I. Particularly assignment of the noise exhibition: I. Particularly assignment of the noise exhibition:

– 1. The examination of the result of analyses 1. The examination of the result of analyses through the through the identification and quantification of the noise in the company identification and quantification of the noise in the company plants;plants;

– 2. The examination of the authorized documents (work card) with 2. The examination of the authorized documents (work card) with

the effective time of work in noise (ancientness in noise).the effective time of work in noise (ancientness in noise).

• II. The examination of the case history at the following point of view:II. The examination of the case history at the following point of view:

Occupational case history with the distinguishing of the work places Occupational case history with the distinguishing of the work places with more A.M.L. noise;with more A.M.L. noise;

The general pathology with distinguishing :The general pathology with distinguishing :• Hearing affections;Hearing affections;• The ingestion of the toxic medicines;The ingestion of the toxic medicines;

Another sonorous trauma or exhibition to toxic chemical substances;Another sonorous trauma or exhibition to toxic chemical substances; • III. The liminar tonal audiometry performed in standard condition – III. The liminar tonal audiometry performed in standard condition –

the audiogram carry out in CPM ( periodical check up). the audiogram carry out in CPM ( periodical check up).

The pronouncement criteria of the earlier occupational hearing loss:

The permanent increases of the auditory

threshold ( auditory definitely deficit) to 4000 Hz frequency with over 30 dB(A) inclusively.

After the application of the hearing correction. For perception type, bilateral and symmetrical in

generally, without frequency conversational involvement.

Occupational etiology.

Conclusion: Conclusion: • From the documents study of the employees which From the documents study of the employees which

has had card signalling hearing occupational disease. It was has had card signalling hearing occupational disease. It was declared a hearing occupational case, if was made the declared a hearing occupational case, if was made the proof of the noise exhibition over 86 dB(A) , the during of the proof of the noise exhibition over 86 dB(A) , the during of the noise exhibition was over 15 years ( and in audiogram was noise exhibition was over 15 years ( and in audiogram was presented un deficit to 4000 Hz at over 50 dB (A)).presented un deficit to 4000 Hz at over 50 dB (A)).

• The reasons that was carried to the confutation of the The reasons that was carried to the confutation of the industrial diseases was been:industrial diseases was been:

• Two cases was been confutation owing to the existence of Two cases was been confutation owing to the existence of un otitises affection since a child.un otitises affection since a child.

• Nine cases was been confutation because the application Nine cases was been confutation because the application of the presbiacusie correction, that, after 50 years the of the presbiacusie correction, that, after 50 years the auditory deficit is lesser to 30 dB(A).auditory deficit is lesser to 30 dB(A).

• One case was confutation because the employee has 46 One case was confutation because the employee has 46 years old, and the presbiacusie correction mean the years old, and the presbiacusie correction mean the decreases to 21 dB(A), and the staying deficit is lower to 30 decreases to 21 dB(A), and the staying deficit is lower to 30 dB(A).dB(A).

ProposalProposal

• The exclusion of the The exclusion of the obligatory obligatory application criteriaapplication criteria of of the the ageingageing correction in correction in pronouncement of pronouncement of earlier earlier occupational hearing lossoccupational hearing loss. .

Recommendation:

The trade companies where the noise has a level which

surpass the LMA, to have a program to prevention of the

noxious result of the noise which is take part from the

security and health management.

This program will included the following main stages:

Health and security audit original and annual,

Periodical evaluation of the noise exhibition,

The nurture and motivation of the workers – her

supporting to adopt un preventive behavior and in

the situation when does not work in unity, but are

exhibited to these noxes ( ex: housekeeping work

with instruments generating of noise – drill press,

electrical cutter, electrical screw driver, etc.)

Occupational Health TeamOccupational Health Team

Thank you!Thank you!