Retrospective Cohort

Retrospective Cohort Study Study and Prospective Cohort Study

Prospective Cohort
Study
A retrospective cohort study starts A prospective cohort study starts at
at a point in the past and follows the present time and follows cohort
cohort forward in order to
Both methods involve looking for forward and enables monitoring of
determine past exposure histories
a link between cause exposure and health outcomes
and health outcomes from records
(exposure) and effect
(disease);
using two cohorts in order to
compare those that have been Cohort size;
Reliability may be affected by exposed against those that
factors such as: were unexposed and looking Accuracy of historical data on
for a dose/response link exposure and health effects;
Accuracy of diagnosis;
Long latency periods for the effect;
Non-occupational exposure;

Frequency of disease in unexposed

cohort;
Lifestyle factors such as alcohol
consumption, diet, smoking etc; Difficulty in following all of cohort for instance
a geographic move, non co-operation

Selection bias (cohort may not be

representative of exposed
population); the healthy worker
effect (sick people leave);
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees
exposed since effect of exposure is
dose dependant.
Specific doses stated in Ionising
Radiation Regulations for classified
workers.
Likely to receive doses over 6 mSv
a year.
Non particulate electromagnetic
radiation
Artificially generated, normally by the
use of electrical energy and emitted
when a machine is switched on.

Over exposure to be investigated

and reported to enforcement
authority.
X- Rays Can travel a few metres in air, present an
external radiation hazard for an
Monitoring of staff overseen by a individual in the same room or space.
Radiation Protection Supervisor,
records kept for fifty years or until
person they refer to has reached
seventy five years of age.

Can penetrate much further into body

Monitored by use of personal
but can be shielded with lead or
devices such as film badges or
concrete.
thermoluminescent dosimeters
(tlds). These should then be
processed by an approved
dosimetry service and results
checked against specified regs.
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees
exposed since effect of exposure is Type of ionising radiation formed as
dose dependant. a result of radioactive decay.

The source should be shielded or

contained in a sealed unit or
container and where possible the
work undertaken in a glove box or Consists of two protons and neutrons
fume cupboard to minimise chance (ie a Helium nucleus)
of ingestion, inhalation or
absorption.
Alpha Particles
Travel for only a few centimetres
Equipment and surfaces should be
through air
decontaminated following work
with the particles. Can be stopped by skin or paper

Taking of food and drink should not

be allowed in areas where the
particles are likely to be present.

Ensure all wounds cuts and

More hazardous if source is taken into
grazes are covered and
body
protected.

Use of a Radiation protection

adviser / supervisor.
Surveillance
 Controls Nature and properties

Maximise distance from source and

minimise amount of time employees
exposed since effect of exposure is Type of ionising radiation formed as
dose dependant. a result of radioactive decay.

The source should be shielded or

contained in a sealed unit or
container and where possible the
work undertaken in a glove box or Consists of two protons and neutrons
fume cupboard to minimise chance (ie a Helium nucleus)
of ingestion, inhalation or
absorption.
Beta Particles
Longer range than Alpha Particles
Equipment and surfaces should be
decontaminated following work Low energy can be stopped by skin
with the particles. High energy can penetrate soft tissue to
a depth of over 1cm.
Taking of food and drink should not
be allowed in areas where the
particles are likely to be present.

Ensure all wounds cuts and

More hazardous if source is taken into
grazes are covered and
body, but not as intense as Alpha
protected.
particles.

Use of a Radiation protection

adviser / supervisor.
Surveillance
 Occupational
Health

Practitioners Information from RIMEC

Ergonomists
Toxicologists
Epidemiologist
Occupational Hygienists
Occupational Health physicians
Occupational Health nurses
Occupational Psychologists
Radiation Protection Advisers /
supervisors / health physicists.
EMAS - (Employment Medical Recognition / Identification
Advisory Service)
Measurement
THOR - The Health and
Evaluation
Occupational Reporting Network
Control
Industrial Injuries Disabled Board
HSE fatality statistics
 Structure of the blood vessels - Tubes that carry

Skin blood as it circulates. Arteries bring

oxygenated blood from the heart
and lungs; veins return oxygen-
depleted blood back to the heart
and lungs.
Sebaceous gland - a small, sack-
shaped gland that releases oily
(fatty) liquids onto the hair follicle
(the oil lubricated and softens the
skin). These glands are located in
Epidermis - the outer layer of the dermis, usually next to hair
the skin. follicles.
Dermis - the layer of the skin just Sweat gland - a tube-shaped
beneath the epidermis. gland that produces perspiration
Subcutaneous tissue - fatty (sweat). The gland is located in the
tissue located under the dermis epidermis; it releases sweat onto
the skin.
hair follicle - a tube-shaped
sheath that surrounds the part of
the hair that is under the skin. It is
located in the epidermis and the
dermis. The hair is nourished by
the follicle at its base (this is also
where the hair grows).
Heat and Cold receptors- Detect
heat and cold and pass info via
nerves to central nervous system.
 The Human Ear
1. Pinna - (also called the
auricle) the visible part of the
outer ear. It collects sound
and directs it into the outer
ear canal.
2. Outer ear canal - the tube 7. Oval Window- link between
through which sound travels stirrup and cochlea.
to the eardrum. 8. Semicircular canals - three loops
of fluid-filled tubes that are
attached to the cochlea in the
inner ear. They help us maintain
our sense of balance.
9. Cochlea - a spiral-shaped, fluid-
filled inner ear structure; it is lined
with cilia (tiny hairs) that move
when vibrated and cause a nerve
impulse to form.
10. Auditory nerve - this carries
electro-chemical signals from the
inner ear (the cochlea) to the
brain.
11. Eustachian tube - a tube that
3. Hammer - (also called the malleus) a tiny connects the middle ear to the
bone that passes vibrations from the eardrum back of the nose; it equalizes the
to the anvil. pressure between the middle ear
and the air outside. When you
4. Anvil - (also called the incus) a tiny bone that "pop" your ears as you change
passes vibrations from the hammer to the altitude (going up a mountain or in
stirrup. an airplane), you are equalizing
5. Stirrup - (also called the stapes) a tiny, U- the air pressure in your middle
shaped bone that passes vibrations from the ear.
stirrup to the cochlea. This is the smallest
bone in the human body.
6. Eardrum - (also called the tympanic
membrane) a thin membrane that vibrates
when sound waves reach it.
 LD50 and LC50

LC50 (lethal concentration, 50%) or LCt50

LD50 In toxicology, the median
lethal dose, (abbreviation for
lethal dose, 50%), relates to a
single oral dose) of an agent
required to kill half the members of
a tested population.
Since it is oral dose it is measured
in grams or mg per Kilogram body
weight.
(lethal concentration & time) Inhaled
concentration of an agent required to kill
half the members of a tested population
after a specified test period.
Measured in ppm (parts per million )or
NOAEL No Observed Adverse Effect Level grams / milligrams per cubic metre of air.
Exposure level at which there are no statistically or
biologically significant increases in the frequency or No account is taken of bodyweight in this
severity of adverse effects between the exposed measurement.
population and its appropriate control; some effects may
be produced at this level, but they are not considered as
adverse.
LOAEL - Low Observed Adverse Effect Level
lowest concentration or amount of a substance found by
experiment or observation that causes an adverse
alteration of morphology, function, capacity, growth,
development, or lifespan of a target organism
distinguished from normal organisms of the same species
under defined conditions of exposure.

Limitations
Ethics / Public opinion Advantages

Avoids human exposure.

Costly and time consuming
Data can be collected more quickly than for epidemiological
Dose response varies.
studies.
May not display synergistic effects that may arise in humans
Animals provide good models due to their close genomic
exposed to other agents at the same time.
relation to humans.
Difficulty with no observed effects level for carcinogens.
More likely to show carcinogenic potential than in-vitro tests
There can be wide variability between species as well; what is such as the Ames test.
relatively safe for rats may very well be extremely toxic for humans,
and vice versa.
For example, chocolate, harmless to humans, is known to be toxic to
many animals.
 Accidents, incidents and emergencies
Reg 13
Requires that employers prepare for
possible accidents, incidents and
emergencies involving hazardous
substances by:
Preparing emergency procedures,
including provision of First Aid;
Making available technical information
on possible accidents and hazards
and bringing it to the attention of the
emergency services; and
Installing alarms and other warnings
and communication systems
Information, instruction and training
Reg 12
Demands that all employees liable to
exposure to hazardous substances are
provided with suitable and sufficient
information, instruction and training,
Health surveillance Reg 11
Requires that health surveillance of employees
is carried out where:
An identifiable disease or adverse health
effect may be related to the exposure;
There is a "reasonable likelihood" that the
disease or health effect may occur under the
particular conditions of work;
Valid techniques exist for detecting
indications of the disease of health effect; and
The technique presents a low risk to the
employee;
where there is exposure to certain
substances in specified occupations:
Risk assessment Reg 6
Requires that an employer not carry out work liable to expose employees and non
Employees to a substance hazardous to health without a risk assessment and
implementation of the steps necessary to comply with the regulations.
The assessment must include consideration of any information provided by the supplier
of a substance (CHIP)
Must be reviewed regularly, and also when there is reason to think the assessment is no
longer valid, if the system of work is changed
Because of the results of health Monitoring. The assessment must also consider any
occupational exposure limit, in particular, those mandated by the HSE.
COSHH as Prevention or control of exposure Reg 7
Requires that an employer prevent
Amended exposure to hazardous substances or, if this
is not reasonably practicable, that he
adequately controls exposure.
Use of control measures Reg 8
Employers must take all reasonable steps to
ensure that control measures, and any
necessary equipment of facilities, are properly
used or applied. Employees must use the
Monitoring Exposure Reg 10 control measures properly, return them after
Where the risk assessment use and report any defective equipment.
indicates that workplace
monitoring of exposure is
necessary, the employer
must perform such Maintenance and testing of control measures
monitoring Reg 9
unless he can demonstrate Requires that employers maintain control
another means of preventing measures in efficient working order and in
or controlling exposure good repair
Monitoring must be at
regular intervals in addition
to when a change occurs
that may affect exposure
6 Risk assessment
7 Prevention or control of
Exposure. (Adequate control)
Principles of good practice
8 Use of control
measures
9 Maintenance and
testing of control
measures
amended L5
10 Monitoring exposure
11 Health Surveillance
- Schedule 6 - Benzene
Manufacturing
process
12 Information,
instruction and training
13 Accidents, incidents
and emergencies
Schedule 2 of Reg
7
Design process to minimise
ex.
COSHH Route of exposure.
Controls proportionate to
risk
Escape of substance
minimised
PPE in addition
Review effectiveness
Info., training and
instruction
Higher risk do not
introduce.
 Controls Zoonoses are animal infections which may be
transmitted to people in the course of their Anthrax is an acute infectious disease of
work. Common examples include: farm animals caused by a bacterium
First stage of control strategy is to Anthrax Transmitted to man by contact with
assess those people at risk Factors to Brucellosis infected hair, hides, excrement or
consider include: Orf products such as bonemeal
Work being carried out Glanders Fatal without treatment
Susceptibility to infection of the Initial lesion rapidly becomes ulcerated
workers Treatment is by penicillin
How infections might occur Inhaling the pathogen causes pulmonary
How likely exposure to infection is. anthrax which is usually fatal in 3 or 4
days
Most common route of entry is via
the skin, by way of open cuts, sores Brucellosis caused by the bacterium
or abrasions which provide direct Brucella abortus, which may infect
entry to blood stream, people handling cattle or pigs or their
inhalation of contaminated dusts, carcasses in abattoirs
Contact with conjunctiva of eyes, Zoonoses Not very severe but involves loss of
Direct injection by cuts from infected appetite, headache, insomnia and slight
animals or animal bites fever
Direct ingestion via hands In the UK a policy of eradication has
been pursued since the 60s by
destroying any infected cattle
Where animal products likely to emit infected dust are
handled (e.g. wool, skin, hides, pelts), LEV and possibly
RPE should be provided to prevent airborne infection Orf is a contagious pustular dermatitis of viral
Specific immunisation of workers may be necessary origin, mainly affecting farm workers, shepherds,
Clean & hygienic animal living conditions and disinfection sheep shearers, butchers and abattoir workers
of stalls will also ensure better hygiene in factory Lesion enlarges and often becomes ulcerated,
premises and will reduce probability of infection exuding fluid and pus
Complete recovery occurs in about 3 weeks

Automation to reduce human contact and enclosure of
aerosol-producing activities will reduce exposure to
infection
Finally, medical checks, training and information,
procedures, instruction and records will give added
protection to workers
Glanders is an infectious disease of horses, donkeys and
mules caused by the pathogen Pseudomonas mallei
Transmitted to humans by nasal or mouth secretions from
the infected animal
Abscesses appear on hands, arms or face
Lasts up to 4 months but is treatable with modern
antibiotics
 Aids
Acquired Immune Deficiency
Hepatitis
Syndrome Caused by Human
Those at risk include doctors,
Immunodeficiency Virus (HIV), which
surgeons, nurses and porters
attacks the immune system
Infection amongst health
Virus is found in most body fluids but is
workers is a result of contact
delicate and relatively easy to kill with
with blood or excreta of patients
heat and chemicals
It has low infectivity and transmission is
Aids and suffering from viral hepatitis or in
whom the disease is still in its
thought to be more likely with repeated Hepatitis incubation stage
exposure to infection rather than to a
Porters and refuse disposal are
single contact
Occupational risk comes from at risk from carelessly discarded
syringes and other sharps - the
accidental inoculation or contamination
problem is becoming worse with
of a cut or abrasion with blood or body
the increase in drug addiction
fluids of an infected person
Doctors, nurses, dentists, laboratory
and hospital staff are at some risk,
since they may come into close contact
with body fluids
Other workers possibly at risk might
Course of disease is similar to
include community, welfare, custodial
Weils Disease, but is usually much
and emergency service workers and
less severe and normally self-
first aiders
limiting with recovery in about 6
weeks
Many of the precautions taken against other In about 5% of cases, chronic
infections, especially Hepatitis B, will be equally infectious hepatitis follows, leading
effective against HIV. They include: to cirrhosis and possibly death
Prevention of puncture wounds, cuts and Persons exposed to risk can be
abrasions in the presence of blood and body protected with injections of
fluids; gammaglobulin
Protection of existing wounds and skin lesions In all cases, protective disposable
Control of surface contamination by gloves should be worn and hands
containment and disinfection and arms washed regularly with
Safe disposal of contaminated waste, disinfectant
especially sharps

Demands this
includes issues such
as workload, work
patterns and the work
environment.
HSE Stress
Control how much Management
say
the person has in the
way
they do their work.
Change how
organisational
change(large or small) is
managed and
communicated in
the organisation
Support this
includes the
encouragement,
sponsorship and
resources
provided by the
organisation, line
management and
colleagues.
Relationships this
includes promoting
Hazards positive working to
avoid conflict and
dealing with
unacceptable
behaviour.
Role whether people
understand their role
within the
organisation and
whether the
organisation ensures
that they do not have
conflicting roles.
 Cold Stress Pre-employment
Difficulty in screening
controlling core body And on-going
temp. surveillance
Provision and
Reduction in heart wearing of
rate thermal clothing,
footwear
undergarment ,high
CLO
Monitor activity level,
Persistent shivering
rating
to
with blue
fingers and lips Cold Stress generate some heat
but not
Mental impairment to sweat. Breaks
with stress with warm
No possibility of
rest area.
being locked
in, ability to open
from inside
Hypothermia and
Regular maintenance
frost bite
and
which is inflammation
alarm to detect
of the
leaking
skin and tissue
refrigerant
Training on hazards
damage.
Chillblains causing involved
redness, with cold working
tingling and pain in
the
affected area.
Physiological Controls in Garage
Effects
Carbon monoxide
absorbed via the Minimising duration of
lungs engine
into bloodstream, running time.
displaces Oxygen by
chemically bonding to
the Local exhaust
Haemoglobin. ventilation
Reducing Carbon attached to hose pipes
oxygen carrying Monoxide as well
capacity as good ventilation to
CO only slowly
of blood and workshop and pits.
displaced Regular maintenance of
therefore
from body. LEV
supply to tissues.
system and fitting CO
alarms
Causes drowsiness,
headaches, skin colour Specific CO hazard
changes (blue lips), training to
dizziness employees .
breathlessness,
unconsciousness and Segregating area from
death customers
above 5%
Regulations Main Function and
factors to
consider
Regulation 3
Duty of employer to Preservation of life and
make provision for first minimisation of the
aid. consequences of injury
Assessment of need until
First aid materials, medical help is
eqpt and facilities Health and obtained, and
First-aid personnel Safety (First- treatment of minor
Number,
injuries. composition
Aid) and
Regulation 4 Regulations distribution of
Duty of employer to
provide information
1981 workforce.
to employees on first- Hazard and level of risk
aid present and past
accidents.
Regulation 5
Self employed duty Distance from medical
to provide first-aid facilities
eqpt
Duties of self
employed
Number of first-aiders
and
level of training as well
as
cover for shifts, leave
Health effects Factors to consider
Control of Asbestos at and control
Mesothelioma Work regs 2012 measures
A form of cancer that
affects the RA to contain
external lining of the lung Type of asbestos
or Likely to become
the peritoneum. Long airborne and in what
latency concentration.
period and almost always
Asbestosis
terminal
Form of pneumoconiosis
lung Limit number of people
Asbestos exposed
fibrosis.
Scarring and
inflammation of
the lung tissue. Limit contamination
Irreversible, chest pain, spread.
fatigue pleural
Diffuse Limit fibre emission at
laboured breathing
thickening source
Non- Cancerous Licencing and Training
(work methods)
Causes thickening of the on
tissue removal
which makes it less able
Cancer
to of the
bronchus Use of specific PPE
expand during breathing
Malignant growth within
bronchus of lung,
terminal
 Exposure limit value 87dB
Information to Upper exposure action value Noise survey and
gather 85dB Eqpt.
Lower exposure action value
80dB Personal noise
Review of previous surveys L108 - Controlling noise at monitoring and
Basic survey followed
work frequency analysis
by a Competent assessor
Assessment of current more detailed survey eqpt calibrated before
controls Consultation and
after measurements
Use results to plot
Legal requirements and
Control of noise map
limits
Basic Survey
for area.
Site layout and location
Noise at Simple sound level
of Work R. meter for spot checks
machines. 2005 and integrating sound
Number and location of level meters.
workers and audiometry Measure at planned
records points to ID exposures
at action levels. Noting
Shift times and patterns machinery in operation
with at time.
Detailed Survey
likely duration of
Integrating sound level meters
exposure
Identify noisy machines Appropriate sample times to measure Leq (equivalent
and continuous sound level), use nonogram to calculate
review maintenance exposure LEPw, LEPd
records Measurement of peak noise levels and plotted on noise
for identification map.
Manufacturers
purposes. data Use of frequency analysis useful to decide on controls such
as enclosure
 Signs Reasons for
Introduction and
Difficulties
Sudden mood changes Safety critical posts.
Following accident or
Becoming confused incident.
Part of rehabilitation
Abnormal fluctuations in stage
concentration and following discovery of
energy use. statement of
General
levels Pre-employment.
aims.
Impaired job Responsibilities.
performance / Drug and Definition of drug misuse.
more accidents Alcohol Abuse Rules that will apply.
Poor time keeping and Notification of prescribed
more drugs.
short term sickness Reporting suspicions.
Procedure following failed
Deterioration in
test.
relationship
Support and help
with colleagues
available.
Dishonesty or theft Union agreement staff
Howtrust
to return following
Data protection Treatment.
of alcohol or presence of Cost lab, competent tester
drugs False positives / Unexpected results
paraphernalia
Change in appearance,
scruffy
or needle marks, slurred
speech.
Measuring
Instruments

Black globe thermometer - Radiant Sorbent tube full of adsorbent e.g.

Temperature charcoal.
Dry bulb thermometer Normal air Cellulose filter paper, Acetone bath.
temp. Cowl
Wet bulb thermometer - covered in Dry weight filter paper Cyclone
muslin sleeve head - Respirable
(found in psychrometer. )
Wet bulb Thermomter Index Used for Simple sound level
heat stress. Measuring Instruments meter
Integrated sound level
Humidity Hygrometer meter
(psychrometer) Octave band frequency
Combination of wet and dry Vaneanalysis
anemometer Wind
bulb speed
thermometers. Kata Thermometer low
wind speed
Wet bulb globe
temperature index Smoke tube
To measure heat stress. Manometer Pressure differentials
Pitot Tube Static pressure or velocity by
using calculation
Accelerometer Measures Thermal or hot wire anemometer air velocity
vibration
Regulations
Control of Noise at Work Regs
Health and Safety (First-Aid) Regulations 1981 2005
Management of Health and Safety at Work regs Exposure limit value 87dB
1999 Upper exposure action value
Workplace Health safety and Welfare regs 1992 85dB
Manual Handling Operations regs 1992 L23 Lower exposure action value
Personal Protective Eqpt regs 1992 80dB
Health and Safety (DSE) regs 1992 L108 - Controlling noise at
PUWER 1998 work

Control of Artificial Optical Radiation at

Work regs 2010 COSHH 2002 as Amended L5
Ionising Radiation regs 1999 Legionella L8
Radiation Protection Adviser Control of Lead at Work Regs 2002
Radiation Protection Supervisor L132
Control of Asbestos at Work Regs
2012

Control of Vibration at Work Regs 2005 (L140 HAVs)

Exposure action value of 2.5 m/s2 A(8) at which level
employers should
introduce technical and organisational measures to
reduce exposure.
Exposure limit value of 5.0 m/s2 A(8) which should
not be exceeded