Department Order No. 73-05 Series of 2005Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace

The Healthy LungA Diseased Lung

TUBERCULOSIS

What is TB? 152 x 255

Tuberculosis (TB) - short for tuberculosis / Tubercle Bacillus Scrofula (swollen neck glands) Pott's disease of the spine Miliary TB (x-ray lesions look like millet seeds) Tabes mesenterica (TB of the abdomen) Lupus vulgaris (the common wolf - TB of the skin) Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

Tuberculosis (TB)is a potentially fatal contagious disease

- an infection with the bacterium Mycobacterium tuberculosis,

- the bacteria usually invades the lung (pulmonary TB) (90%), but also invade other parts of the body such as the central nervous system (meningitis), lymphatic system, circulatory system (miliary TB), genitourinary system, bones and joints.

(WHO estimates in 2006)More than 14M with TB9.2M new cases of TB worldwideApproximately 1.7 M died 4.1M diagnosed by lab. Testing

Tuberculosis in Philippines247,740: Estimated incidence (all new cases) (2006) 287: Estimated incidence (all newcases per 100,000 population) (2006)

129: Estimated incidence (new sputum smear positive [ss+] per 100,000 population) (2006)

100%: DOTS population coverage (2006)

77%: DOTS detection rate (new ss+)(2006)

89%: DOTS treatment success (new ss+) (2005)

10 most common causes of death:

Most common sickness of Filipinos:

Global rank: 9th largest TB burden

Regional Rank: 3rd among WPR (Western Pacific Region) countries

Case detection rate: 73%

Cure rate (new smear +): 81%

About 75 Filipinos die of TB everyday

Out of 384,400 new active cases:Only 28% are diagnosed (276,768 are undiagnosed & continue to spread disease)

20% die without diagnosis

6% of those diagnosed die because of inadequate treatment

Hemoptysis

TB SymptomsChest and back pains

TB Symptoms

Occasionally some patients may have no symptoms. Depending on the site of the body being affected, other symptoms may also occur.

Among those with TB infection, who is at high risk to develop active TB disease? People with HIV infectionPeople exposed to TB within 2 yearsBabies and young childrenPeople who inject illegal drugsPeople sick with other diseases that weaken the immune system

Elderly peopleHomeless peopleJailed people in 3rd world countriesPeople incorrectly treated for TB in the past

People with:- diabetes mellitus - malnutrition - malignant disease- chronic kidney disease - alcoholism- silicosis (dse. Of the lungs)- impaired immunity due to certain drugs (e.g., steroids, anti-cancer drugs)

How is the disease transmitted?

TB is an airborne disease. When a TB patient coughs, sneezes, speaks, sings, or spits, small droplets containing the tubercle bacilli are generated and spread in the air. When another person breathes in these small air droplets, he may be infected with the germ. Prolonged exposure, however, is usually required for the disease to be transmitted.

Probability of transmission depends upon:Number of infectious droplets expelled by the carrier;Effectiveness of ventilation;Duration of exposure;Level of immunity in the uninfected person

How can TB be diagnosed?

The usual tests employed by doctors to diagnose TB include chest x-ray examination and sputum smear examination. Sputum examination is done by direct smear under microscopy as well as culture for the germs. Further investigations may be required, e.g., computerized tomography, bronchoscopy, lung biopsy, etc.

What happens after infection with the tubercle bacilli?About 1 in 10 of the infected persons will develop the disease If someone does become infected, it typically takes 3 to 4 weeks before the newly infected person infectious enough to transmit the diseasecan occur weeks, months, years, or even decades later.

What is the treatment for TB? Nowadays, the treatment for TB is very effective.

What is the treatment for TB?

-TB & Chest Service of the Department of Health provides treatment to patients free of charge.

- drug treatment lasts 6 months

If the treatment is taken irregularly, there may be serious consequences: - the TB germs become resistant to the drugs - the disease cannot be cured - the disease can be spread to others - death

MYTHS AND MISCONCEPTIONSMYTH: TB is inheritedFACT: TB is not inheritedMYTH: TB can be acquired thru: using eating utensils used by TB patient, sleeping late in the evening, kissing and sexFACT: TB can be acquired only when a person inhales the bacteria from air dropletsMYTH: Only malnourished and poor people can get TBFACT: TB can also affect healthy and rich people

Pursuant to Executive Order No. 187 Instituting a Comprehensive and Unified Policy for the TB Control in the Philippines

Signed by President GMA on March 21, 2003

Why the Workplace?Existing organizational structureExisting resources (manpower, facilities and equipment, logistics)Easy to implement health promotion activities and convenient site for TB-DOTS programFacilitates monitoring, recording and reportingWorkers spend a significant portion of their day at work Presence of existing facilities, services, personnel for health care deliveryOccupational Safety and Health is part of the Social Corporate Responsibility

Workplace Issues on TB TransmissionWork Environment factors that enhance the likelihood of transmission include:exposure in relatively small, enclosed spaces; inadequate local or general ventilation that results in insufficient dilution and/or removal of infectious droplet nuclei; and Re-circulation of air containing infectious droplet nuclei.

Transmission is most likely to occur from TB infected workers :

who have unrecognized pulmonary or laryngeal TB;who are not on effective anti-TB therapy; and who continue to work

Depending on the type of workplace:the risk may be higher in areas where patients with TB are provided care before diagnosis and initiation of TB treatment and isolation precautions e.g., in clinic waiting areas and emergency departments

where diagnostic or treatment procedures that stimulate coughing are performed e.g., microscopy centers

Workplace Settings with Increased TB riskHealth care facilitiesPrisonsWorkplaces with exposure to silica and other inorganic dustIndustries with large migrant workforceSweatshops(Extreme exploitation, including the absence of a living wage or long work hours, * Poor working conditions, such as health and safety hazards )

Components of a TB workplace prevention and control policy and program

I. Preventive strategiesProgram on TB Advocacy, Education and Training must be carried out (TB Awareness Program)

Awareness program shall deal with the nature, frequency, and transmission, treatment with the DOTS, control and management of TB in the workplace.

Directly Observed Treatment Short-course

What is DOTS?A comprehensive strategy endorsed by the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD) to detect and cure TB Patients

DOTS: Transferring the Burden of Curing the Patient to the Health SystemPrime Elements: Political will Microscopy-based diagnosis Free and uninterrupted drug supply Direct supervision of treatment Recording and monitoring system

Improving workplace condition

Control of contaminationAdequate and appropriate ventilationAdequate sanitary facilities for workersAppropriate worker density (1 worker /11.5 m3)

Capability BuildingTB awareness raising and trainingTB Case FindingTB Case HoldingReporting and Recording of casesImplementation of DOTS

Workers must be given proper information on ways of strengthening their immune system

STRENGTHENING THE IMMUNE SYSTEM AGAINST TB INFECTION

STRENGTHENINGthe IMMUNE SYSTEM againstTB INFECTION

STRENGTHENING the IMMUNE SYSTEM against TB INFECTIONWakeful RestSleep

What does sleep do to us?

Through adequate rest nerve energy is restored!

With adequate rest the body revitalizes, repairs, restores, renews & rejuvenates!

Sleep provides us with these 2 primary needs: Revitalization of the nervous system. Repair of organic damages & rebalancing of body chemistry.

Significant decrease in the metabolic activity of the brain after 24 hours of sustained wakefulness. SLEEP DEPRIVATION CAN CAUSE THE FOLLOWING: Reduction in body temperature, a slowing down of immune system function and an inadequate release of growth hormone.

Continued sleep deprivation may cause hallucinations and mood swings. (Essential hormones that effect the breakdown of proteins, maintain optimal emotional functioning and that fight invaders like viruses and bacteria are released in sleep.)

Increased heart rate and nervous system malfunction. Memory and physical performance impairment; reduction in the ability to carry out mathematical calculations.

STRENGTHENING THE IMMUNE SYSTEM AGAINST TB INFECTION

When you smoke you inhale up to 4000 chemicals including these Poisons:

Causes causes BLINDNESS

II. MEDICAL MANAGEMENTAdopt DOTS in management of TB in workers and dependents

Refer workers and family members with TB to private or public DOTS centers

TB Benefits Policy of ECC, SSS, and PhilHealth shall be followed

III. RECORDING, REPORTING AND SETTING-UP A DATABASECompanies shall report all diagnosed cases of TB to the Department of Labor and EmploymentUse appropriate form, i.e., the Annual Medical Report (OSHS RULE 1965.01 (4) and Rule 1053.01 (1)).

SSS will report to Philippine Coalition Against Tuberculosis (PhilCAT)

IV. SOCIAL POLICY1. Non-discrimination:Workers who have or had TB shall not be discriminated againsta. Support for adequate diagnosis and treatmentb. Ensure continuing employment for as long as they are certified by the companys accredited health provider as medically fitc. Restoration to work as soon as their illness is controlled

2. Work Accommodation- Based on agreements between the management and workersMeasures to accommodate and support workers throughflexible leave arrangementsrescheduling of working timesarrangements for return to work

3. Restoration to Work- The worker may be allowed to return to work with reasonable working arrangements as determined by the company Health Care Provider and/or the DOTS provider.

V. ROLES AND RESPONSIBILITIES OF WORKERS WITH TB OR AT RISK FOR TBWorkers who have symptoms of TB shall seek immediate assistance from their health service provider

Also those at risk, i.e., those with family members with TB, shall do the same

Once diagnosed, they shall avail of the DOTS and adhere to the prescribed course of treatment

VI. ROLES AND RESPONSIBILITIES OF EMPLOYERSAny contact in the workplace shall be traced and the contacts shall be clinically assessed.

In the context of their Corporate Social Responsibility and OSH and related programs, employers are encouraged to extend the TB program to their workers families and their respective communities.

VII. IMPLEMENTATION AND MONITORINGThe Occupational Safety and Health Center (OSHC) shall provide preventive and technical assistance in the implementation of the Workplace TB program at the enterprise level. The BWC and DOLE Regional Offices through their labor inspectors shall enforce these guidelines.

All employers shall disseminate these guidelines in their respective workplaces.

EFFECTIVITYAll concerned shall comply with all the provisions of this Department Order within 30 days from its publication in a newspaper of general circulation.

March 30, 2005

Wakeful rest restorative and intentional inactivity.

Sleep a period of complete unconsciousness of the individual and a function of the nervous system exclusively: it shuts down consciousness.

Even if you do not feel sleepy, the sleep debt can have a powerful negative effect on your daytime performance, thinking, and mood, and cause you to fall asleep at inappropriate and even dangerous times.

When we get less sleep (even 1 hour less) than we need each night, we develop a "sleep debt.

SnoringBreathing Pauses during sleepProblems with sleeping at nightDifficulty staying awake during the dayUnexplained decrease in Daytime Performance

How much SLEEP is enough?

0 2 months old 10 to 18 hours including naps

2 12 months old 14 to 15 hours including naps

12 to 18 months old 13 to 15 hours including naps

18 months to 3 years old 12 to 14 hours including naps

3 to 5 years old 11 to 13 hours including naps

5 to 12 years old 9 to 11 hours

5 to 12 years old 9 to 11 hours

8 to 9 hours

at least 7 to 9 hours

FALLACY9 11 PM (evening)time for eliminating unnecessary/toxic chemicals (DETOXIFICATION) from the antibody system (lymphnodes.)

this time duration should be spent by RELAXING or LISTENING to music

Cont9 11 PMIf during this time a housewife is still in an unrelaxed state such as WASHING the DISHES or MONITORING CHILDREN doing their homework, this will have a NEGATIVE IMPACT ON HEALTH.

11 PM 1 AM is the DETOXIFICATION process in the liver, and ideally should be done in a deep sleep state.

1 3 AM DETOXIFICATION process in the GALL, also ideally done in a deep sleep state.

3 5 am DETOXIFICATION process in the LUNGS. there will be severe cough for cough sufferers during this time. Since the detoxification process had reached the respiratory tract, there is no need to take cough medicine so as not to interfere with toxin removal process.

5 7 AM DETOXIFICATION process in the COLON, you should empty your bowel.

7 9 AM absorption of nutrient in the small intestine, you should be having breakfast at this time

Breakfast should be earlier, before 6:30 AM, for those who are sick.

Breakfast before 7:30 AM is very beneficial to those wanting to stay fit

Those who always skip breakfast, they should change their habits, & better to eat breakfast late until 9 10AM than no meal at all

Sleeping so late and waking up too late will disrupt the process of removing unnecessary chemicals.

Therefore, have a good sleep and dont sleep late.

Whats yourPOISON?

The cigarette is the most common method of smoking tobacco.

Hydrogen Cyanide(Poison used in gas chambers)* Toluidine

Ammonia (Floor Cleaner)

* Polonium - 210

* Dibenzacridine

* Urethane

Arsenic(White Ant Poison)PhenolButane(Lighter fuel)Toluene(Industrial solvent)DDT (Insecticide)Acetone(Paint stripper)* Naphthylamine

Methanol(Rocket fuel)* PyreneDimethylnitrosamine* Cadmium(used in car batteries)Napthalene(Mothballs)Carbon Monoxide(Poisonous gas in car exhausts)* Benzopyrene* Vinyl Chloride* KNOWN CANCER CAUSING SUBSTANCE

The Healthy LungA Diseased Lung

Cancerous Human LungThis dissection of human lung tissue shows light-colored cancerous tissue in the center of the photograph. At bottom center lies the heart. While normal lung tissue is light pink in color, the tissue surrounding the cancer is black and airless, the result of a tarlike residue left by cigarette smoke. Most lung cancer begins in the cells lining the main air passages, or bronchi. In their cancerous state, these cells lack the cilia that normally catch and eliminate foreign particles inhaled into the lung. Mucous ordinarily cleared by bronchial cilia becomes trapped, blocking air passages. Lung cancer accounts for the largest percentage of cancer deaths in the United States, and cigarette smoking is directly responsible for the majority of these cases.Microsoft Encarta Reference

Preventive StrategiesMembers of the Health and Safety Committee Penalty / Sanction to violators on Non discrimination of TB Patient employeesPenalty / Sanctions on Smoking and Drinking

Preventive StrategiesMedical ManagementRecording, Reporting and Setting up a databaseSocial Policy (no discrimination/ work accommodation) Roles and Responsibilities of workers and employers with TB or at risk for TB Implementation and monitoring

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