Pak

(1)

(2)

(3)

OCCUPATIONAL HEALTH

(4)

WITH MONEY YOU

GO SEE A DOCTOR

BUT NOT HEALTH

(5)

• Tenaga kerja dalam melaksanakan

pekerjaannya memiliki risiko terpapar

berbagai faktor bahaya di tempat kerja,

baik sebagai akibat dari pekerjaannya maupun kondisi lingkungan kerja, yang dapat mengakibatkan berbagai gangguan kesehatan atau timbulnya penyakit akibat kerja.

• _{Salah satu upaya yang perlu dilakukan untuk}

(6)

WHAT IS OCCUPATIONAL HEALTH ?

• The discipline of occupational health

is concerned with the two-way

relationship of work and health.

• Occupational health involves

maintaining the state of well-being

and freedom from occupationally

related disease of injury.

(7)

OCCUPATIONAL HEALTH

The provision of occupational health service

to

the workforce requires managerial and union

involvement. A large number of

professionals

are also involved, including :

• Physicians

• Nurses

• Occupational hygienists

(8)

OCCUPATIONAL HEALTH

Continued …………

• Toxicologists

• Health physicists

• Microbiologists

• Epidemiologists

• Ergonomics

• Safety engineers

(9)

OCCUPATIONAL MEDICINE

Occupational medicine (kedokteran

kerja) is the clinical speciality

concerned with the diagnosis,

management and prevention of

diseases due to or exacerbated by,

workplace factors.

(10)

The main attributes and functions of a

doctor

working in industry are

working in industry are :

a. Knowledge of the work environment

b. Clinical skill in the early detection of ill health c. Knowledge of relevant legislations

d. Pre-placement, periodic and special medical examinations

e. Administrative responsibility for nursing and first-aiders

f. Treatment

g. Health education and health promotion h. Rehabilitation

(11)

11

Continued ………

i.

Teaching and research

j. Advice to individuals , management, organized

labor and safety representatives

k. Maintenance and review of clinical and

environmental records

l. Surveillance of groups at specific risk, e.g., lead

workers, compressed air workers, occasional drivers

m. Liaison with outside organizations ---- government,

The main attributes and functions of a

doctor

working in industry are

(12)

Industrial Hygiene

AIHA (American Industrial Hygiene

Association) defines Industrial Hygiene as :

“ the science and art devoted to the anticipation, recognition, evaluation, and control of those

environmental factors or stresses arising in or from the workplace which may cause sickness, impaired health and well-being, or significant discomfort among workers or among the

(13)

OCCUPATIONAL HEALTH NURSING

• Attention in the field of occupational health nursing has shifted from a narrow focus on communicable disease, maternal and child health issues, and emergency treatment of

injured workers to a much broader focus today.

• Presently, the occupational health nurse (OHN) applies public health principles to meet the

needs of workers in an ever-changing work environment.

(14)

OCCUPATIONAL HEALTH NURSING

•

The focus of the OHN have thus expanded to include integration of many areas, including epidemiology, industrial hygiene,

environmental health, toxicology, safety, management, health education, early

disease detection, disease prevention, health promotion, and health and environmental

(15)

OCCUPATIONAL HEALTH NURSING

• The OHN, whether employed as a single health care provider at a small plant or as a member of a multidisciplinary health unit, must balance ethical and clinical responsibilities to

employees with ethical and administrative responsibilities to management.

• This balance requires the OHN to assist

management in providing a safe and healthful work environment through disease prevention and health promotion activities.

(16)

OCCUPATIONAL HEALTH NURSING

Some of the responsibilities include :

•

_{The daily operation of a comprehensive}

health care program;

•

_{Development of treatment and}

surveillance protocols;

•

_{Keeping informed about health and}

safety regulation;

(17)

OCCUPATIONAL HEALTH NURSING

•

_{Identification of high risk areas;}

clinical intervention, including delivery

of health care and counseling

services;

•

_{Record keeping;}

•

_{Liaison with managers, workers, and}

health and safety colleagues; and

•

_{Implementation of health-related}

(18)

OCCUPATIONAL HEALTH NURSE

• _{The role of the occupational health nurse has}

changed rapidly over the past two decades.

• _{Originally, the nurse was employed in the}

organization to provide a treatment and

first-aid service, dealing with accidents and illness at work.

• _{The provision of nursing has developed to}

encompass all aspects of preventive health care.

(19)

OCCUPATIONAL HEALTH NURSING

• _{It is important for everyone to understand}

the role of the nurse in the workplace. It should encompass all those factors which affect the health of people at work.

• _{The occupational health nurse must be}

pro-active and flexible in order to

influence the health of employees and those within the wider sphere of

(20)

OCCUPATIONAL HEALTH NURSE

The qualified occupational health nurse

may be an autonomous practitioner who

can perform many functions either

alone, or as part of a wider team of

physicians, hygienists, safety officers,

etc.

(21)

OCCUPATIONAL HEALTH NURSE

He or she will carry out functions such as health supervision including :

• Pre-employment health assessment;

• Follow-up assessments following illness or injury;

• Assessment of those with known health problems and those working in potentially hazardous

environments;

• Development and implementation of immunization and vaccination programs;

• Hazard identification and control;

• Counseling;

• Health promotion and supervision and training of first-aid personnel.

(22)

OCCUPATIONAL HEALTH NURSE

• The occupational health nurse is an “advisor” to both management and employees; therefore it is imperative that the advice given is correct, is given in the right manner and is unbias.

• In the United Kingdom, there are approximately 9000 nurses working in the field of occupational health, the majority of which work without the support of a full-time medical officer; many

have only a visiting GP with little or no

(23)

OCCUPATIONAL HEALTH NURSING

The American Association of Occupational Health

Nurses (AAOHN) defines occupational health nursing as :

The application of nursing principles in conserving (dalam melindungi) the health of workers in all

occupations.

It emphasizes prevention, recognition, and treatment of illnesses and injuries and requires special skill and knowledge in the fields of health education and

counseling, environmental health and human relations.

(24)

DONAL HUNTER

(1898-1978)

“No one can be expected to be

familiar with the details of all

occupations and every working

environment, but at least he should

take the opportunity to study those

industries which fall within the area

(25)

De Morbis Artificum Diatriba

Bernardino Ramazzini (1633-1714) :

“ I hesitate and wonder whether I should bring bile to the noses of doctors ---- they are so

particular about being so elegant and

immaculate ---- if I invite them to leave the

apothecary’s shop which is usually redolent of cinnamon and where they linger as in their

own domains, and to come to the latrines and observe the diseases of those who clean out the privies”.

(26)

Kesehatan Kerja

Menurut komite bersama ILO dan WHO,

Kesehatan Kerja (Occupational Health) didefinisikan sebagai suatu aspek atau unsur kesehatan yang erat berhubungan dengan lingkungan kerja dan pekerjaan, yang secara langsung maupun tidak langsung dapat meningkatkan efisiensi dan

(27)

TUJUAN KESEHATAN KERJA

1.Meningkatkan dan memelihara derajat kesehatan tenaga kerja yang setinggi-tingnya baik jasmani, rohani maupun sosial untuk semua lapangan

pekerjaan.

2. Mencegah timbulnya gangguan kesehatan yang disebabkan oleh kondisi kerja.

3. Melindungi tenaga kerja dari bahaya kesehatan yang timbul akibat pekerjaan.

4.Menempatkan tenaga kerja pada suatu

lingkungan kerja sesuai dengan kondisi fisik, faal tubuh dan mental psikologis tenaga kerja yang bersangkutan.

(28)

PROGRAM KESEHATAN KERJA

1. Pemeriksaan kesehatan

2. Diagnosis dan pengobatan

3. Pemantaun/monitoring tempat kerja 4. Pengamanan bahaya bahan kimia di tempat kerja

5. Pelatihan dan pendidikan

6. Pengadaan alat pelindung diri 7. Pencatatan dan pelaporan

8. Penilaian epidemiologis 9. Evaluasi secara berkala 10. Usaha lainnya.

(29)

(30)

Permen Nakertrans No. 3 Tahun 1982

Dalam peraturan ini, yang dimaksud dengan Pelayanan Kesehatan Kerja adalah suatu usaha kesehatan yang dilaksanakan dengan tujuan : 1. Memberikan bantuan kepada tenaga kerja

dalam

penyesuaian diri baik fisik maupun mental,

terutama dalam penyesuaian pekerjaan dengan tenaga kerja;

2. Melindungi tenaga kerja terhadap setia gangguan kesehatan yang timbul dari

(31)

Permen Nakertrans No. 3 Tahun 1982

3. Meningkatkan kesehatan badan,

kondisi

mental (rohani), dan kemampuan fisik

tenaga kerja;

4. Memberikan pengobatan dan

perawatan serta rehabilitasi bagi

tenaga kerja yang menderita sakit.

(32)

Tugas Pokok Pelayanan Kesehatan

Kerja

a. Pemeriksaan kesehatan sebelum kerja,

pemeriksaan berkala dan pemeriksaan kesehatan khusus;

b. Pembinaan dan pengawasan atas

penyesuaian pekerjaan terhadap tenaga kerja;

c. Pemembinaan dan pengawasan terhadap

lingkungan kerja;

d. Pembinaan dan pengawasan perlengkapan

sanitasi;

(33)

Tugas Pokok Pelayanan Kesehatan

Kerja

f. Pencegahan dan pengobatan terhadap penyakit umum dan penyakit akibat kerj g. Pertolongan pertama pada kecelakaan; h. Pendidikan kesehatan untuk tenaga kerja dan latihan untuk petugas pertolongan pertama pada kecelakaan;

(34)

Tugas Pokok Pelayanan Kesehatan

Kerja

i. Memberikan nasehat mengenai

perencaan dan pembuatan tempat

kerja, pemilihan alat pelindung diri

yang diperlukan dan gizi serta

(35)

j. Membantu usaha rehabilitasi akibat kecelakaan

atau penyakit akibat kerja;

k. Pembinaan dan pengawasan terhadap tenaga kerja yang mempunyai kelainan tertentu

dalam

kesehatannya;

l. Memberikan laporan berkala tentang pelayanan

kesehatan kerja pada pengurus.

Tugas Pokok Pelayanan Kesehatan

Kerja

(36)

Penyelenggaraan

Pelayanan Kesehatan Kerja

Penyelenggaraan Pelayanan Kesehatan

Kerja dapat :

1. Diselenggarakan sendiri oleh pengurus;

2. Diselenggarakan oleh pengurus dengan mengadakan ikatan dengan dokter atau Pelayanan Kesehatan lain;

3. Pengurus dari beberapa perusahaan secara bersama-sama menyelenggarakan suatu Pelayanan Kesehaan Kerja (Pasal 4 PerMen

(37)

Penyelenggaraan

Pelayanan Kesehatan Kerja

• Penyelenggaraan Pelayanan

Kesehatan Kerja dipimpin dan

dijalankan oleh dokter yang disetujui

oleh Direktur(pasal 5 PerMen

Nakertrans No. 3 tahun 1982).

• Pengurus wajib memberikan

kebebasan profesional kepada doker

yang menjalankan Pelayanan

(38)

Penyelenggaraan

Pelayanan Kesehatan Kerja

• Dokter dan tenaga kesehatan dalam

melaksanakan Pelayanan Kesehatan

Kerja, bebas memasuki

tempat-tempat kerja untuk melakukan

pemeriksaan dan mendapatkan

keterangan yang diperlukan (pasal 6

KepMen No. 3 tahun 1982).

(39)

Penyelenggaraan

Pelayanan Kesehatan Kerja

• Pengurus wajib menyampaikan laporan pelaksanaan Pelayanan Kesehatan Kerja kepada Direktur (pasal 7 KepMen Nakertrans No. 3 tahun 1993).

• Dokter maupun tenaga kesehatan wajib

memberikan keterangan tentang pelaksanaan Pelayanan Kesehatan Kerja kepada Pegawai

Pengawas Keselamatan dan Kesehatan Kerja jika

diperlukan (pasal 8 KepMen Nakertrans No. 3 tahun 1983).

(40)

Masalah Kesehatan Kerja Di

Perusahaan

• Pelayanan kesehatan kerja di perusahaan umumnya bersifat kuratif, sedangkan

pendekatan preventif biasanya kurang mendapat perhatian.

• Pengertian dan kesadaran pimpinan perusahaan dan pekerja terhadap kesehatan kerja umumnya masih jauh dari apa yang diharapkan, kecuali di beberapa perusahaan saja dimana kesehatan kerja betul-betul telah diterapkan.

(41)

Masalah Kesehatan Kerja Di

Perusahaan

•

Lingkungan kerja di perusahaan sering kurang/ tidak manusiawi dan bahkan tidak jarang

keadaannya berada pada tingkat yang

membahayakan baik terhadap kesehatan maupun keselamatan tenaga kerja.

•

Keadaan gizi tenaga kerja umumnya masih belum menguntungkan produktivitas kerja.

•

Perencanaa dan pemikiran tentang penserasian manusia dan mesin atau

pekerjaan serta usaha perbaikan sikap dan

cara kerja yang sesuai dengan prinsip-prinsip ergonomi umumnya belum/tidak diperhatikan.

(42)

Peranan dan

_{Peranan dan}

Fungsi Personil Kesehatan

Kerja

Di perusahaan-perusahaan dimana Pelayanan Kesehatan Kerja ditangani oleh seorang

perawat perusahaan yang bekerja secara full time dan seorang dokter yang bekerja secara part time, maka dalam keadaan ini peranan perawat tersebut dalam menerapkan

kesehatan kerja di perusahaan sangat ditentukan oleh pengetahuan dan

(43)

Peranan dan

_{Peranan dan}

Fungsi Personil Kesehatan

Kerja

• Pada prinsipnya adalah tidak

_{Pada prinsipnya adalah tidak}

beralasan bila perawat yang telah

terdidik dan terlatih di bidang

kesehatan kerja dan keselamatan

kerja tidak dibenarkan untuk

menyelenggarakan pelayanan secara

kompeten program keseahatan kerja

di perusahaan.

(44)

Peranan dan

Fungsi Personil Kesehatan

Kerja

•

Dokter perusahaan harus benar-benar Dokter perusahaan harus benar-benar dapat bertindak sebagai “occupational

dapat bertindak sebagai “occupational

physician” dan merupakan “key individual”

serta berperan aktif dalam proses penentuan

suatu keputusan yang berkaitan dengan

program kesehatan kerja di perusahaan.

•

Keterlibatan dokter perusahaan dalam Keterlibatan dokter perusahaan dalam aktifitas manajemen terutama yang

aktifitas manajemen terutama yang

berhubungan dengan kesehatan kerja akan

semakin dibutuhkan.

(45)

(46)

Where an occupational

disease is suspected, Donald

Hunter’s advice is “ to ask

whether any similar illness has

occurred in a fellow

(47)

Paracelsus

sebagai seorang dokter di Villach Austria dan seorang pakar

metalurgi (metallurgist) antara lain mengatakan bahwa :

“We must have gold and silver, also other metals, iron, tin, copper, lead and mercury. If we wish to have these, we must risk both

life and body in a struggle with many enemies that oppose us”.

(48)

Agricola’s

statement that in

the

mines of the Carpathian

mountains,

women are found who have

married

seven husbands, all of whom

this

terrible consumption has

carried off

(49)

DE RE METALLICA

(AGRICOLA, 1556)

The disease that prevailed in the mining community.

At that time mortality from pulmonary diseases was not recorded, nor were the

causes known, but they would have included deaths from silicosis and tuberculosis, and

from lung cancer due to the mining of a radioactive or in siliceous rock.

(50)

PENYAKIT AKIBAT KERJA

Penyakit akibat kerja adalah istilah yang dipakai dalam peraturan yang dibuat atas dasar UU No. 1 tahun 1970 tentang

keselamatan kerja, sedangkan penyakit yang timbul karena hubungan kerja merupakan

istilah yang erat kaitannya dengan

(51)

Permen Nakertrans No. 1 Tahun 1981

•

Setiap penyakit akibat kerja yang

ditemukan dalam pemeriksaan kesehatan berkala atau khusus harus dilakukan secara tertulis kepada Kandep Tenaga Kerja

setempat selambat-lambatnya 2 x 24 jam setelah penyakit tersebut dibuat

diagnosisnya.

•

Dalam peraturan ini dilampirkan penyakit akibat kerja yang harus dilaporkan.

(52)

UU No. 3 tahun 1992 mengatur tentang Jaminan Sosial Tenaga Kerja (Jamsostek)

Peristilahan dalam UU Kecelakaan tahun

1947 dilanjutkan penggunaannya dalam UU No. 3 tahun 1992 tentang Jamsostek.

Menurut UU No. 3 tahun 1992, penyakit yang timbul karena hubungan kerja termasuk

kecelakaan kerja atau kecelakaan yang

(53)

Kepres No. 22 Tahun 1993

• Didalam Kepres ini tercantum berbagai jenis penyakit yang berkaitan dengan hubungan kerja.

• Setiap tenaga kerja yang menderita penyakit yang timbul karena hubungan kerja berhak

mendapat jaminan kecelakaan kerja baik pada saat masih dalam hubungan kerja maupun

(54)

Baik penyakit akibat kerja maupun penyakit

yang timbul karena hubungan kerja

mempunyai pengertian yang sama

yaitu

penyakit yang disebabkan oleh pekerjaan

atau lingkungan kerja. Dengan kata lain

penyakit akibat kerja sama dengan penyakit

yang timbul karena hubungan kerja.

(55)

Menurut literatur dan bukan menurut

ketentuan perundang-undangan yang berlaku, penyakit yang bertalian dengan pekerjaan

yang merupakan terjemahan dari

work-related disease diartikan sebagai

penyakit yang penyebabnya

multifaktor/jamak, sedangkan pekerjaan

atau lingkungan kerja adalah salah satu dari penyebab tersebut.

(56)

Work-related diseases may be partially

caused by adverse working conditions.

They may be aggravated, accelerated, or

exacerbated by workplace exposures, and

they may impair working capacity. Personal characteristics and other

environmental and sociocultural factors usually play a role as risk factors in work-related diseases, which are often more common than occupational diseases.

(57)

Outline of The Occupational

• Descriptions of all jobs held

• Work exposures

• Timing of symptoms

• Epidemiology of symptoms or illness

among

other workers

(58)

DESCRIPTIONS OF ALL JOBS HELD

•

Job titles alone are not sufficient :

An electrician may work in a plant where lead storage batteries are manufactured;

It may be useful to have the patient describe a typical work shift from start to finish and simulate the performance of work task by demonstrating the body movement associated with them.

A visit to the patient’s workplace by the physician

(59)

Work Exposure

• The patient should be carefully

questioned about working conditions

and past and present chemical,

physical, biologic, and psychologic

exposures.

• Also inquire about unusual accidents or

incidents such as spills of hazardous

materials that may be related to

(60)

Work Exposure (Continued)

It should be determined if personal protective equipment /PPE (such as

gloves, work clothes, masks, respirators, and hearing protectors) has been

provided, and if yes, when, and how often the workers have used this

(61)

Work Exposure

If PPE is being used, determine if it

appears to fit and work properly.

Ask whether protective engineering

systems and advices such as ventilation

systems are present in the workplace

and whether they seem to function

adequately.

(62)

Timing of Symptoms

• Information on the time course of the patient’s symptoms is often vital in

determining a given diseases or syndrome is work-related or not.

• Since latent periods vary, occupational

etiologies should not be ruled out because timing of symptoms does not initially

(63)

Timing of Symptoms

The following questions are often useful :

• Do the symptoms begin shortly after the start of the workday?

• _{Do they disappear shortly after leaving work?}

• _{Are they time-related to certain processes, work}

task, or work exposure?

• Have you recently begun a new job, worked with a new process or been exposed to a new

(64)

Epidemiology of Symptoms or

Illness

• Further what the affected workers share in

common such as similar job, exposure,

physical location in the workplace, age, or sex. Birth defects among offspring, fertility problems, cancer incident, and high

turnover workers or their early retirement for health reasons.

(65)

Epidemiology of Symptoms or Illness

• The patient’s knowledge of other workers

at the same workplace or in similar jobs as well who are suffering from the same

symptoms or illness may be important clue to recognizing work-related disease.

• Unfortunately, workers may not always be

(66)

Non Work Exposure and Other

Factors

• _{A synergistic relationship between}

occupational and non occupational

factors in causing disease;

• _{The physician should ask if the patient}

smokes cigarettes or drink alcohol;

Regarding recent exposure to new

soaps, cosmetics, and clothes.

(67)

Non Work Exposure and Other

Factors

The physician should also ask :

a. Does the patient have hobbies (such

as wood-working or gardening) or

other non work activities that involve

potentially hazardous chemical,

physical, biologic or psychologic

exposures that may account for the

symptoms?

(68)

Non Work Exposure and Other

Factors

b. Does the patient live near any factories,

waste dump sites, or contaminated sources

of water?

c. Does the patient live with someone who

brings hazardous workplace substances

home on work clothes, shoes, or hair?

(69)

OCCUPATIONAL DISEASE

WHO has classified occupational diseases into the

following categories :

 1. Diseases directly caused by occupation,  e.g. pneumoconiosis.

 2. Diseases where an occupation is an etiologic  factor, e.g. bronchogenic carcinoma.

 3. Diseases where an occupation is one of the  etiologic factors in a complex situation,

 e.g. chronic bronchitis.

(70)

WHO membedakan empat kategori penyakit akibat

kerja, yaitu :

1. Penyakit yang melulu disebabkan karena pekerjaan, misalnya pneumokoniosis.

2. Penyakit yang salah satu faktor penyebabnya

adalah pekerjaan, misalnya karsinoma bronkogenik. 3. Penyakit dimana pekerjaan merupakan suatu faktor

penyebab dalam situasi yang kompleks, misalnya bronkitis kronis.

4. Penyakit dimana pekerjaan dapat memperberat keadaan yang sudah ada sebelumnya, misalnya

(71)

Penyakit Akibat Kerja

Setiap penyakit yang disebabkan oleh pekerjaan atau lingkungan kerja (pasal 1, Peraturan Menteri

Tenaga Kerja dan Transmigrasi No.PER/01/MEN/1981 tentang Kewajiban Melaporkan Penyakit Akibat Kerja). Definisi yang digunakan dalam keputusan Menteri

Tenaga Kerja RI No. KEPTS. 333/MEN/1989 tentang Diagnosis dan Pelaporan Penyakit Akibat Kerja

Merujuk ketentuan PerMen Nakertans No. PER 01/MEN/1981.

(72)

Jenis PAK

Dalam Keppres No. 22 tahun 1993 terdapat 31 jenis penyakit akibat kerja, 29 dari 31 jenis

penyakit akibat kerja tersebut adalah PAK yang bersifat international; Penyakit-penyakit ini

mengikuti standar ILO.

Dua jenis penyakit lainnya yaitu penyakit yang disebabkan oleh paparan suhu udara tinggi atau rendah (thermal stress) dan penyakit yang

(73)

73

Jenis Penyakit akibat Kerja

Tiga puluh satu jenis (31) jenis PAK sebagaimana tercantum dalam Lampiran Keppres No. 22 tahun

1993

adalah sebagai berikut :

1. Pneumokoniosis yang disebabkan debu mineral pembentuk jaringan parut (silikosis,

antrakosilikosis,

asbestosis) dan silikotuberkulosis yang silikosisnya merupakan faktor utama penyebab cacat dan

kematian.

2. Penyakit paru dan saluran pernapasan

(bronkhopulmoner) yang disebabkan oleh debu logam

(74)

Jenis Penyakit akibat Kerja

3. Penyakit paru dan saluran pernapasan

(bronkhopulmoner) yang disebabkan oleh

debu kapas, vlas, henep dan sisal (bissinosis). 4. Asma akibat kerja yang disebabkan oleh

penyebab sensitisasi dan zat perangsang yang dikenal dan berada dalam proses

(75)

Jenis Penyakit akibat Kerja

5. Alveolitis alergis dengan penyebab dari luar sebagai akibat penghirupan debu-debu

organik.

6. Penyakit yang disebabkan oleh berilium atau persenyawaannya yang beracun.

7. Penyakit yang diebabkan oleh kadmium atau

persenyawaannya yang beracun.

8. Penyakit yang disebabkan oleh fosfor atau persenyawaannya yang beracun.

(76)

Jenis Penyakit akibat Kerja

10. Penyakit yang disebabkan oleh mangan atau persenyawaannya yang beracun.

11. Penyakit yang disebabkan oleh arsen atau persenyawaannya yang beracun.

12. Penyakit yang disebabkan oleh air raksa atau persenyawaannya yang beracun.

13. Penyakit yang disebabkan oleh timbal (Pb, timah

(77)

77

Jenis Penyakit akibat Kerja

15. Penyakit yang disebabkan oleh karbon

disulfida.

16. Penyakit yang disebabkan oleh derivat

halogen dari persenyawaan hidrokarbon

alifatik atau aromatik yang beracun.

17. Penyakit yang disebabkan oleh benzen atau homolognya yang beracun.

18. Penyakit yang disebabkan oleh derivat nitro dan amina dari benzen dan homolognya

yang beracun.

(78)

Jenis Penyakit akibat Kerja

20. Penyakit yang disebabkan oleh alkohol, glikol atau keton.

21. Penyakit yang disebabkan oleh gas atau uap penyebab asfiksia atau keracunan seperti karbon monoksida, hidrogen

sianida, hidrogen sulfida, atau derivatnya yangberacun, amoniak, seng, braso dan nikel.

(79)

Jenis Penyakit akibat Kerja

23. Penyakit yang disebabkan oleh getaran

mekanis (kelainan otot, urat, tulang ,

persendian, pembuluh darah tepi atau saraf tepi).

24. Penyakit yang disebabkan oleh

pekerjaan dalam udara yang bertekanan lebih.

(80)

25. Penyakit yang disebabkan oleh radiasi

elektromagnetik dan radiasi yang mengion. 26. Penyakit kulit (dermatosis) yang disebabkan

oleh penyebab fisik, kimiawi atau biologis. 27. Penyakit kulit epitelioma primer yang

disebabkan oleh ter, pitch, bitumen, minyak mineral, antrasen atau persenyawaan, produk atau residu dari zat-zat tersebut.

28. Kangker paru atau mesotelioma yang disebabkan oleh asbes.

(81)

Jenis Penyakit akibat Kerja

29. Penyakit infeksi yang disebabkan oleh virus, bakteri atau parasit yang didapat dalam

suatu pekerjaan yang memiliki risiko kontaminasi khusus.

30. Penyakit yang disebabkan oleh suhu tinggi atau rendah atau panas radiasi atau

kelembaban udara tinggi.

31. Penyakit yang disebabkan oleh kimia lainnya termasuk bahan obat.

(82)

(83)

Faktor Penyebab PAK

1. Faktor fisik a. Kebisingan b. Getaran

c. Radiasi Non-ionisasi (ultraviolet, cahaya

tampak/visible light, inframerah, gelombang radiofrekwensi/gelombang mikro) dan radiasi

mengion (sinar X, sinar gamma partikel alfa dan beta)

d. Mikroklimat/thermal stress (heat stress and cold stress), abnormal pressure (hypo and hyperbaric environment).

(84)

Faktor Penyebab PAK

2. Faktor Kimia (gas, uap, fume,mist/kabut, debu, larutan)

3. Faktor biologis (virus, bakteri, parasit, jamur dll.)

4. Faktor fisiologis/ergonomi (sikap /cara kerja yang

salah)

(85)

HEALTH

(86)

Health Hazards

Definition Examples

Irritants Inflame living tissue on contact

Sulfur dioxide

Corrosives Destroy or “eating away” living tissue

Phenol, sulfuric acid, HF, chromic acid,

caustic

Sensitizers Cause allergic reaction

Nickel, formaldehyde

(87)

Health Hazards

Definition

Examples

Reproductive hazards Mutagens Teratogens Change genetic information in the sperm or egg Damage fetus after conception Lead and PCBs

Cancer Cause or are

suspected or are suspected of

Vinyl chloride, benzene

(88)

Central nervous system Tetrachloroethane Mercury Carbon disulfide Heart Chloroform Kidneys Mercury Methyl bromide Uranium Lungs Cotton dust Aluminium dust Asbestos fiber Silica Liver Tetrachloroethan e Vinyl chloride Carbon tetrachloride

(89)

CHEMICAL ASSOCIATED

WITH CANCER IN HUMANS (IARC)

BLADDER : 4-Aminobiphenyl Auramine Magenta Benzidine Chlornaphazine 2-Naphthylamine

Soot, Tars, Mineral oils Cyclophosmide (?) Phenacetin (?) BRAIN : Vinyl chloride KIDNEY : Phenacetin (?) GASTROINTESTINAL TRACT : Asbestos Ethylene oxide (?) LIVER :

Vinyl chloride, Arsenic, CCl₄

Aflatoxins (?),Oxymetholone

SKIN :

Arsenic, PCBs (?), Soot, Tars,Mineral oils

BLOOD : Benzene Melphalan Chloroambucil Cyclophosphamide (?) Ethylene oxide (?) Thiotepa (?) LUNG :

Asbestos, Vinyl chloride, CMME, BCME, Iron oxide (?), Arsenic (?)

(90)

ASFIKSI

Bilamana kadar oksigen dalam udara

menurun sampai dibawah 16%, maka

seseorang yang mengalami defisiensi

oksigen akan mengeluh pusing, sakit

kepala, telinga mendengung, badan

terasa lemah, sesak napas dan sulit

berkonsentrasi.

(91)

ASFIKSI

• Dibedakan 2 macam asfiksi yaitu

simple asphyxiants dan chemical

asphyxiants.

• Kadar normal oksigen dalam udara

atmosfir adalah 20,95%, dan kadar

oksigen minimum yang dibutuhkan

oleh manusia adalah 19,5%.

(92)

Defisiensi Oksigen

(93)

Oxygen deficiency

in the confined space

which may be caused by :

a. Slow oxidation reactions of either

organic or inorganic substances.

b. Rapid oxidation (combustion).

c. The dilution of air with inert gas.

d. Absorption by grains, chemicals or soils.

e. Physical activity.

(94)

Simple Asphyxiants

 Simple asphyxiants adalah bahan kimia yang

menyebabkan jaringan tubuh mengalami kekurangan oksigen (hypoxia) karena

kehadiran bahan kimia tersebut akan

mengencerkan kadar oksigen dalam udara

(tanpa reaksi kimia/without chemical

action) sehingga tekanan parsial oksigen

(95)



Asetilen



Gas argon, neon, helium dan karbon

dioksida (CO

2

)



Dikloromonofluorometan (Freon 21)



Diklorotetrafluoroetan



Gas metan, etan dan butan.



Liquefied Petroleum Gas (LPG)



Gas hidrogen (H

₂

)

(96)

Chemical Asphyxiants

 Bahan kimia lain seperti gas CO dalam tubuh

akan memblokir pengangkutan oksigen ke jaringan tubuh atau mengganggu

penggunaan oksigen oleh jaringan tubuh.

 Gas CO akan mengikat Hb sehingga fungsi

Hb untuk mengangkut oksigen ke sel-sel jaringan tubuh terganggu.

(97)

Chemical Asphyxiants

Gas HCN dalam tubuh akan menghambat

aktivitas enzim cytochrome oxidase

sehingga sel-sel jaringan tidak dapat

menggunakan oksigen yang terbawa

oleh aliran darah.

(98)

Chemical Asphyxiants

 Asetonnitril  Akrilonitril

 Karbon monoksida (CO)

 Sianida (Kalium atau Natrium Sianida)  Hidrogen Sianida (HCN)

 Metilen klorida (dalam tubuh akan

mengalami tranformasi metabolik dan membentuk karbon monoksida)

(99)

Airborne Dust

 The entry of dust particles into the body

depends on their size and solubility.

 Only small particles (less than seven

thousandths of a millimeter in diameter) will be able to reach the gas exchange area.

 This respirable dust (which reaches the

gas exchange area) will either be deposited there or diffused into the bloodstream,

(100)

Airborne Dust

 Insoluble dust particles are mostly eliminated

by the clearing mechanisms of the lungs.

 The larger dust particles are filtered by the

hairs of the nostrils or deposited along the path from the nose to the air passageways.

 They will eventually be transported to the

throat where they will be either swallowed, or spat or coughed out.

(101)

Airborne Dust

Dust is dangerous because it can cause :

 Lung damage, such bronchitis, emphysema,

pneumoconiosis, asthma, or even cancer.

 Damage to the nose and throat, leading to

colds, and other infections, or even nasal cancer.

 Skin damage, leading to dermatitis, ulcers,

(102)

Airborne Dust



Eye damage, including conjunctivitis; and



Internal effects including damage to the brain

and nervous system, blood disorders, stomach

cancer, liver and kidney diseases, or bladder

cancer.

(103)

Efek Debu

1. Menyebabkan iritasi pada saluran pernapasan. 2. Menyebabkan fibrosis paru (pulmonary fibrosis). 3. Menimbulkan reaksi alergi (occupational asthma). 4. Menyebabkan reaksi alergi (allergic alveolitis)

5. Diduga dapat menyebabkan kanker pada saluran pernapasan/paru.

(104)

 PNOS : particles not otherwise specified  There are many insoluble particles of low

toxicity for which no TLV has been established.

 ACGIH believes that even biologically inert,

insoluble, or poorly soluble particles may have adverse effects and suggests that

airborne concentration should be kept below

3 mg/m3, (respirable particles), and 10

(105)

PNOS

 Do not have an applicable TLV

 Are insoluble or poorly soluble in water (or

preferably, in aqueous lung fluid if data are available)

 Have low toxicity (i.e., are not cytotoxic,

genotoxic, or otherwise chemically reactive with lung tissue, and do not emit ionizing radiation, cause immune sensitization, or cause toxic effects other than by

(106)

(107)

(108)

 Mineral dusts are formed from the rocks,

stones, and ores found in the earth’s crust.

 These dusts are often called inorganic dusts

because they are formed from non-living materials.

 Coal is an unusual case. In occupational

disease studies, it is usually grouped with the mineral dusts because it behaves as inorganic dusts do.

(109)



Pneumoconioses

caused by sclerogenous

mineral dusts include : silicosis, asbestosis, and

anthracosilicosis.



Silicosis

with pulmonary tuberculosis is also

regarded as a dust-related pneumoconiosis,

when silicosis is an essential factor in causing

the resultant incapacity or death.

(110)



Dusty lung, or pneumoconiosis

, is a

condition caused by the deposit of small

dust particles in the gas exchange areas

of the lung and the reaction of the

tissue to their presence.



Changes in the lungs are extremely

difficult to detect at the early stage, and

deterioration occurs long before such

(111)



With pneumoconiosis

the capability

of the lungs to absorb oxygen will be

reduced and the victim will develop

shortness of breath during strenuous

activities.



The effect is irreversible

. Examples

of substances causing pneumoconiosis

are crystalline silica, asbestos, talc, coal

and beryllium.

(112)

Non-Fibrotic Pneumoconioses



Aluminium

(powder)



Kaolin



Silika amorf



Talk (non

asbestiform)



Barium dan

persenyawaanny

a



Hematite



Fumes oksida

besi (Fe

₂

O

₃

)



Mika



Oksida timah

putih/stannum



Soapstone

(113)



Silicosis

is a pneumoconiosis caused by

inhalation of crystalline particles of free

silica (silicon dioxide).



Silicosis with tuberculosis

refers to

the disease resulting from the

interaction of silicosis with tuberculosis

of the lungs.

(114)

Free Silica (SiO2)

The main crystalline mineral forms

referred to as free silica (SiO2) are :



Quartz



Tridymite

(115)

Occupational Exposure

 Hard rock mining

 Civil engineering work with hard rock  Stone polishing

 Casting, fettling and sandblasting in

foundries

 Preparation and removal of refractory linings

to furnaces

 Boiler scaling

(116)

Mechanism of Action

Retention

 The dust particles of 5-15 um in diameter

deposited in the airways are cleared by

mucociliary movement, but particles of 0,5-5 um in diameter landing in terminal airways or

beyond may be retained.

 The dust particles retained in the lungs are taken

up by macrophages (mononuclear phagocytes) and transported either to the airways and

(117)

Mechanism of Action

 Most particles below 0,5 um in diameter

remain suspended in the air and are breathed out.

 When the dust-containing cells die, other

cells take up the released particles, but

these too are killed, creating a continuous low-grade reaction leading to the formation of localized scars (nodules), which mostly

(118)

Mechanism of Action



Free silica dusts vary in their ability to

cause cell death, and this activity can

be delayed by the presence of other

dusts (e.g., oxides of iron and

aluminium) and chemicals (e.g.,

polyvinylpyrrolidine N-oxide) that affect

the surface of the quartz particles.

(119)

Elimination

 The elimination of quartz particles, especially

when mixed with other dusts, may occur in the first few days after inhalation via the

bronchi and trachea.

 The percentage of the dust retained increases

with :

a. Increase in exposure level

b. Higher past exposure to dust; and

c. The presence of lung diseases (especially tuberculosis).

(120)

 Acute silicosis is a rapidly progressive disease.  In extreme conditions, breathlessness and dry

cough may develop within a few weeks of exposure.

 Chest tightness and incapacity to work develop

within months, and death due to respiratory

failure or cor pulmonale may occur in 1-3 years.

 On examination, restricted chest movement,

cyanosis, and late inspiratory rales are found, with restrictive lung function abnormality and

(121)

Silicosis

• This occurs most frequently in the upper and

middle zones of the lungs and is seen on the X-ray as irregular shadowing with coalescence and calcification. The calcification of enlarged hilar nodes is also common.

• The early stages of silicosis are as a rule not

accompanied by any symptoms or signs of

respiratory disease. Also, the basic ventilatory lung function test remain with the normal

(122)

Silicosis



In more advanced stages, dyspnea on

exercise develops.



Because of insidious onset, the

dyspnoeic symptoms may be

attributed to aging; X-rays are

therefore a relatively more specific

method of detection.

(123)

Silicosis (Continued)

 The coalescence of shadows is

accompanied by more rapidly progressive breathlessness during exercise and by

depressed respiratory function, which is mainly restrictive in type.

 Bronchitic symptoms, e.g., cough and

phlegm due to the deposition of larger dust particles in the airways are less important and sometimes reversible.

(124)

 Workers exposed to silica are at an

increased risk of tuberculosis, a risk that is

substantially and permanently increased once X-ray changes are manifest.

 The risk increases with severity of silicosis, and

factors favorable for spreading tuberculosis include, for example, crowded working

conditions, poor nutrition, and a high

(125)

Silicosis With Tuberculosis (Continued)

 It is supposed that increased susceptibility of

silicosis patients to lung tuberculosis is due to the damage caused by the dust to

macrophages and to the lymphatic and immune systems, which normally protect against pulmonary tuberculosis.

 The suspicion of tuberculosis in silicosis

should arise whenever there is a sudden

increase in symptoms or X-ray changes, fever, loss of weight, or haemoptysis.

(126)

Silicosis With Tuberculosis (Continued)

 The progression of X-ray changes continues to

be more rapid even when the infection is controlled.

 The most reliable index of diagnosis or cure is

the culture of micro bacteria in sputum; other indices are less reliable.

 Previous tuberculosis, treated or not ,

probably increases the risk and severity of silicosis.

(127)

What Is Asbestos ?

 Asbestos is a soft mineral rock.

 Asbestos is made of millions of light,

indestructible fibers that make it a valuable but hazardous material.

 There are three main types of asbestos that

you find at work : crocidolite (blue

asbestos); amosite (brown asbestos); and chrysotile (white asbestos).

(128)

Why is Asbestos Dangerous ?

 The tiny, indestructible, often invisible

fibers that make asbestos so useful are

harmful to the delicate cells in the human body when they are inhale.

 The main diseases caused by asbestos

dust are : asbestosis, heart failure,

mesothelioma, lung cancer and other cancers.

(129)

Asbestosis

 A type of pneumoconiosis (Greek for dust in

the lungs) caused by accumulation of dust-lungs scarred and shrunken, increasing

breathlessness and paint in chest.

 The disease can get worse even if the sufferers

are no longer exposed to asbestos dust.

 Sufferers often die from the additional strain

(130)

Lung Cancer



The difference in risk depends on sex

(women face less risk than men) and on

whether a person smokes.



Given a US urban population of 180

million people, this risk estimate

translates into 1800 to 52.200 expected

cancer from asbestos.

(131)

Expected Cancers per 100.000 People

Group Medium exposure (0,0004 fiber/cm3) High exposure(0,002 fiber/cm3) Lung cancer Male smokers 29,2 146 Female smokers 10,5 52,4 Male nonsmokers 2,7 13,2 Female nonsmokers 1,4 6,8 Mesothelioma, All groups 15,6 78

(132)

Mesothelioma



A cancer of the lining of the chest

cavity and less frequently the lining of

the abdominal cavity.



It can not be cured and leads to early

(133)

Mesothelioma

 Mesotheliomas are a group of rare human

cancers caused almost exclusively by exposure to asbestos.

 These cancers occur in the membranes

(mesothelia) that line body body cavities.

 Mesotheliomas can occur in the lung (pleural

mesothelioma) and in the abdomen (peritoneal mesothelioma).

(134)

Asestos and Tobacco Smoke

 Asbestos and tobacco smoke have a strong

synergistic interaction in producing lung cancer;

 Asbestos exposure appears to multiply by a

factor of 5 rather than simply adding to the underlying lung cancer risk from smoking.

 Most people who develop lung cancer die

(135)

Threshold Limit Values



All forms of asbestos : 0,1 fiber /cc



Notation : A1 (confirmed

human

carcinogen)



Critical effects : Asbestosis,

(136)

(137)

 Organic dusts are derived from living materials ---- plants, animals,

microorganisms --- and from such natural products as wood and leather.

 Organic dusts are generated during the harvesting, storage, transportation, and processing (milling, chopping, spinning, sawing) of plant products.

 These products include cereal grains, coffee beans, paprika, cotton, flax, and timber.

(138)

 Animal and poultry husbandry produces dusts

consisting of animal hair and dander, bird feathers, and droppings.

 Wood working and leather working entail

considerable exposure to organic dusts.

 All these dusts are recognized causes of lung

(139)

Chemical Dusts

 In addition to the naturally occurring mineral and organic dusts provided by nature, humans have invented many of their own.

 An increasing number of synthetic chemicals are used in industries, business, agriculture, and the home.

 Many of these synthetic chemicals are in

powder form ---- bleaching powder, catalysts, pesticides, dyes --- and their dust may cause disease if inhaled.

(140)

Vegetable dusts

• _Sisal •_Jute •_{Hard hemp} •_{Indian hemp} •_{Manila hemp} •_Kapok

•_{Coir (coconut husk)}

Other effects

Byssinosis

Possibly

occupational asthma

(141)

Grain dusts  Corn, wheat, barley  Rice  Tea  Coffee Other effects Occupational asthma and allergic alveolitis Occupational asthma Occupational asthma Occupational asthma

(142)

Debu Penyebab Asma

Jenis debu Pekerja yang terpapar

Efek lain

Gandum, padi-padian dan hasil olahannya Petani, penggiling (millers) COPD, dan extrinsic allergic alveolitis

Debu kayu (red

cedar, iroko) Penebang kayu, _{tukang kayu} COPD dan extrinsic allergic alveolitis

Teh Pencampur dan pengepak

Kemungkinan COPD

Tembakau Pemotong dan Kemungkinan COPD

(143)

Debu Penyebab Asma

1.

Kobal (fume dan debu)

2. Debu gandum 3. Nikel (logam) 4. Garam platina 5. Tungten carbide

6. Detergent (enzymatic detergent)

7. MDI (methylene diphenyl isocyanate) 8. Debu kayu (wood pulp/dust)

(144)

Occupational Asthma

1. Biji-bijian (grains), debu tepung (fluor), getah tanaman (gums).

2. Serangga (insects), produk binatang (animal products), jamur (fungi) dll.

3. Logam seperti nikel dan kobal.

4. Obat-obatan (drugs), isosianat (isocyanates). 5. Debu kayu dan debu tumbuh-tumbuan

(145)

•

Hypersensitivity pneumonitis

(allergic alveolitis) results from the

body’s reaction to inhaled antigens.

•

_{The antigens come from molds, other}

microorganisms

, and animal protein.

•

Farmer’s lung

is the best known

example of hypersensitivity

pneumonitis, a disease caused by fine

organic dust that is inhaled deep into

the lung’s smaller airways.

(146)

 Farmer’s lung is caused by mold on hay,

straw, grains, and other organic materials found on farms.

 Other dusts known to be involved in

hypersensitivity pneumonitis include moldy

sugar cane and barley, maple bark, cork, animal hair, bird feathers and droppings, mushroom

compost, coffee beans, and paprika. Often the disease is named for the occupation mushroom worker’s lung, paprika - splitter’s lung.

(147)

Hypersensitivity Pneumonitis

 The symptoms of hypersensitivity

pneumonitis begin some hours after exposure to the offending dust.

 The patient fells tired and short of breath, and has a dry cough, fever, and chills.

 Inside his lungs, the alveoli are inflamed , inudated (dibanjiri) by white blood cells and sometimes filled with fluid.

(148)

148

TYPES OF EXTRINSIC ALLERGIC ALVEOLITIS Type Exposure

to

Allergen

Farmer’s lung Moldy hay Micropolyspora faeni,

thermoactinomyces vulgaris

Bagassosis Moldy sugar

cane Thermoactinomyces sacchari Suberosis Moldy cork Penicillium

frequentants Bird facier’s

lung Droppings and feathers

(149)

Characteristics Extrinsic allergic Asthma (type I)

Extrinsic allergic alveolitis (type III)

Predisposing factors

Atopy None known Region affected Conducting system

of the lung (bronchi to terminal

bronchioles)

Acini, respiratory bronchioles and alveoli

Histology Mucus plugging, bronchial edema and eosinophilic infiltration Granulomatous pneumonitis, occasionally undergoing organization and leading to interstitial fibrosis

(150)

Pulmonary Responses

to Inhalation of Organic Particles

Characteristics Extrinsic allergic Asthma (type I)

Extrinsic allergic alveolitis (type III)

Onset of

symptoms Immediate 4-6 hours Systemic reaction none Usual and

accompanied by fever

(151)

Debu Penyebab Asma

_{Debu Penyebab Asma}

Jenis debu Pekerja yang terpapar

Efek lain

Gandum, padi-padian dan hasil olahannya Petani, penggiling (millers) COPD, dan extrinsic allergic alveolitis

Debu kayu (red

cedar, iroko) Penebang kayu, _{tukang kayu} COPD dan extrinsic allergic alveolitis

Teh Pencampur dan pengepak

Kemungkinan COPD

Tembakau Pemotong dan Kemungkinan COPD

(152)

(153)

(154)

• It is customary to call any undesirable

sound “noise”.

• The disturbing effects of noise depend both

on the intensity and the frequency of the

tones. For example, higher frequencies

are more disturbing than low ones.

• Pure tones are more disturbing than a

sound made up of many tones.

(155)

Kebisingan (Noise)

Kebisingan adalah suara yang tidak dikehendaki (unwanted/undesired sound).

Pemaparan kebisingan yang berulang dan menahun pada intensitas yang tinggi dapat

menyebabkan tuli saraf yang sulit disembuhkan. Ketulian akibat paparan kebisingan

(NIHL=Noise-Induced Hearing Loss) umumnya terjadi setelah 10 tahun paparan atau lebih.

(156)

Kebisingan

Faktor-faktor yang mempengaruhi terjadinya NIHL (Noise-Induced Hearing Loss) :

1. Lamanya pemaparan (duration of exposure) 2. Tingkat intensitas suara (sound intensity

level)

3. Spektrum atau komposisi frekwensi suara (Noise spektrum)

4. Frekuensi/pola pemaparan (frequency or temporal pattern of noise exposure)

(157)

NAB Kebisingan

Noise level (dBA) Exposure Time (hours)

Daily Noise Dose

85 8 1 88 4 1 88 8 2 91 2 1 91 8 4 94 1 1 94 4 4 97 0,5 1 97 1 1

(158)

Efek Kebisingan



Trauma akustik



Ketulian sementara (temporary threshold

shift/TTS)



Ketulian permanen (permanen threshold

(159)

Trauma Akustik



Gangguan pendengaran yang

disebabkan oleh pemaparan tunggal

(single exposure) terhadap intensitas

kebisingan yang sangat tinggi dan

terjadi secara tiba-tiba.

(160)

Temporary Threshold Shift

(TTS)

• _{Bilamana seseorang masuk ke suatu tempat}

kerja yang bising, maka mula-mula orang

tersebut akan merasa terganggu dengan adanya kebisingan tadi.

• _{Namun, setelah beberapa jam berada di tempat}

kerja tersebut, orang yang bersangkutan merasa tidak begitu terganggu lagi atau ia merasa

bahwa suara tadi tidak lagi sekeras semula., atau dengan kata lain orang tersebut telah mengalami ketulian.

(161)

• _{Bilamana orang tersebut keluar dari tempat}

kerja yang bising, daya dengarnya sedikit demi sedikit akan pulih kembali seperti semula.

• _{Gangguan pendengaran yang dialami oleh}

orang tersebut sifatnya sementara (Temporary Threshold Shift).

• _{Waktu yang diperlukan untuk beberapa menit}

sampai beberapa hari (3 – 7 hari), namun paling lama tidak lebih dari 10 hari (ISO).