The Workplace

Associations between occupations and specific diseases have been recognized for many centuries, from lead exposure among metallurgists, to pneumoconiosis, or “black lung”, among coal miners, to scrotal cancer among chimney sweeps in Victorian England. These associations have sometimes even found their way into the English lexicon, as with the phrase “mad as a hatter”, which evokes the neurological signs and dementia once seen in hatmakers from chronic exposure to the mercury used to cure animal pelts.

Despite the long-standing recognition of occupational risks, though, government agencies, at least in the US, have often been reluctant to institute safety standards.  Workers compensation laws to provide recompense for on-the-job injuries, for instance, were not in place in all states until 1948. The first law protecting non-federal employees, the Federal Coal Mine Health and Safety Act, wasn’t enacted by Congress until 1969, and the Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) weren’t created until the 1970 Occupational Safety and Health Act.

The Toxic Substances Control Acts of 1976 and 2000 set in place rules requiring employers to inform employees about potential hazardous exposures in the workplace, and the Pollution Prevention Act of 1990 established a policy of reducing pollutant levels at the source, also reducing occupational exposures. All of the above have had a positive impact on reducing and mitigating workplace-related injuries and disease, though the institution of certain safety standards has, perhaps unsurprisingly, not been without controversy (Heyden and Pratt, 1980).

Although these measures have had a great impact on workplace safety, with deaths per 100,000 workers decreased by 60% between 1990 and 2005, there were still 4 million disabling occupational injuries and work-related illnesses in 2007, resulting in 75 million person-days of lost productivity. Additionally, this may not be an adequate reflection of the true cost of workplace-related illness, since data may be incomplete or incorrect, the long-term effects of occupational exposures may occur with sufficient delay that they are not recognized as being work-related, or exact relationships between occupational exposure and disease may not be adequately understood.

Certainly everyone within the US work force now has some acquaintance with workplace safety regulations. Manufacturing workers are required to wear clothing to minimize risk of getting caught in machinery or protective headgear, eyewear, earplugs or covering, or face masks/respirators as their situation demands. Office workers have standards of ergonomic design to help protect them against repetitive strain injuries. Agricultural equipment has built-in safety mechanisms to help reduce the risk of serious injury or death in farm workers. Chemical workers have personal protective equipment or work with ventilator equipment to minimize dermal and respiratory exposures.

As a clinical healthcare worker, I work with disinfectants and chemicals which can have hazardous effects, sharps which can both cause physical injury and potentially transmit toxic biological or chemical agents. I work frequently with ionizing radiation and have to use lead-lined apron, thyroid shield, and gloves when doing so. While as a veterinarian I don’t have the same level of risk and require the same degree of personal protective equipment that a practitioner working with human patients might have, I still have to be mindful of possible zoonotic exposures and take steps to minimize those risks. I also have to remain mindful that my patients have the potential to inflict significant physical injuries through bites or scratches and can transmit infectious biologic agents.

Additionally, the clinic must maintain material safety data sheets (MSDS) on all chemicals and products used in the clinic. An injury report log is also maintained for any workplace-related injuries or exposures employees may sustain, and all personnel are required to attend training session to make sure everyone is aware of information available, proper personal protective equipment usage, exposure first aid and mitigation, and appropriate measures to take in the event of an exposure, injury, or other emergency situation.

Although these measures are all OSHA-mandated and appropriate to the type of work that is done in our facility, some more general public health measures can also have a positive effect on workplace environments. Since about 1995, a number of municipalities, states, and even countries have instituted bans on smoking in public indoor spaces in order to reduce exposure of both employees and of the general public to secondhand smoke. Studies looking at bar employees and other hospitality workers in many of these localities have found significant decreases in reported symptoms of irritation from smoke exposure; significant decreases in salivary levels of cotinine, a marker for tobacco smoke exposure; and, in studies where it has been evaluated, significant improvements in pulmonary function (Eisner, Smith, & Blanc, 1998; Farrelly, et al., 2005; and Goodman, et al., 2007).

References

Moeller, D.W. Environmental Health, Fourth Edition. Harvard University Press. 2011.

Heyden, S., and Pratt, P. “Exposure to cotton dust and respiratory disease: textile workers, “brown lung”, and lung cancer”. Journal of the American Medical Association. 1980 Oct 17; 244(16):1797-1798. doi:10.1001/jama.1980.03310160013014

Eisner, M.D., Smith, A. K., and Blanc, P.D. “Bartenders’ respiratory health after establishment of smoke-free bars and taverns”.  Journal of the American Medical Association. 1998 Dec 9; 280(22):1909-1914.

Farrelly, M.C., et al. “Changes in hospitality workers’ exposure to secondhand smoke following the implementation of New York’s smoke-free law”. Tobacco Control. 2005 Aug; 14(4):236-241. doi: 10.1136/tc.2004.008839.

Goodman, P., et al. “Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs”. American Journal of Respiratory & Critical Care Medicine. 2007 Apr 15; 175(8):840-845. doi: 10.1164/rccm.200608-1085OC.