1 Injury and Illness Surveillance

2 Global Burden Non-fatal Occ Illness & Injury, WHO TRAUMATIC INJURY

3 What is Occupational Surveillance? Systematic monitoring of: –Hazardous exposures –Adverse health events FOR THE PURPOSE OF Prevention and control of: –Occupational hazards –Occupational diseases and injuries

4 Types of Prevention Primary – Target: those with potential for exposure; no disease yet. Goal: change exposure conditions Secondary – Target: those with early stage of disease, no symptoms yet Goal: reverse disease, delay symptom onset Tertiary – Target: those with clinical disease Goal: cure or control of disease.

5 HealthyAsymptomaticSymptomatic Worker Disease Disease PrimarySecondaryTertiary PreventionPreventionPrevention Opportunities for Prevention time

6 Why might you start an occupational surveillance program? Identify a problem and estimate its magnitude Identify groups at risk Monitor illness/injury trends in time and geography Identify cases, workplaces, and industries for attention Identify new illnesses Identify new hazards

7 How might you use a surveillance program? Prioritize health problems Determine whether you need an intervention program Evaluate progress, success, or failure of an intervention program Provide planning data for cost-effectiveness and benefit analysis

8 Surveillance Techniques Keep log of new injuries and illnesses Examine existing databases for specific, sentinel diseases Conduct questionnaire survey of workers Conduct physical examinations Conduct laboratory examinations Conduct job hazard analysis

9 How would you organize surveillance? HAZARD BASED Characterize hazards –Observation/checklist Monitor environment Test workers HEALTH BASED Acute or chronic injuries/illnesses List of insurance claims Death certificates Health questionnaire Physical examination Lab testing for disease markers

10 Techniques: Keep Log NameDate of Injury DiagnosisCausative Factors

11 Techniques: Examine existing databases Death certificates Hospital Discharges Laboratory reports Workers compensation reports National surveys Clinics that treat workers

12 Techniques: Questionnaire Survey Demographic variables Work history: job tasks, hazards Health history: current, prior Symptoms Social, confounding factors

13 Techniques: Physical examination Respiratory Skin Others

14 Techniques: Laboratory Reports Require labs to report abnormal results above a specific level (e.g., Pb>25mg/dl) –May tie lab certification to reporting Set up reporting agency protocol (e.g., health department accepts reports on pre- made forms or electronically) Decide what level will trigger an intervention

15 Techniques: Workplace investigation Investigate and record information about fatal injuries (i.e., accident investigation) Visit industries with a particular hazard Require reporting of certain injuries and set up a mechanism for reporting, however do not have to get every event to have an effective surveillance program

16 What are the components of a surveillance system? Gather information on exposure & disease Analyze data Disseminate data in an organized form Use data to target or evaluate an intervention On-going

17 Case Studies For each of the cases, ask these questions 1.What is the sentinel health event of interest 2.What is the best way to collect information about it? (consider cost, time it takes to collect, how you will use results) 3.How could you use these results?

18 Case One You have heard about a small, rural community where most of the adults work in agriculture. There is concern about pesticide poisoning among adults and children because housing is located right next to farms.

19 Case One Sentinel event: pesticide poisoning Collect information: –Questionnaire of community –Blood testing of community –Reports from local hospitals/clinics Use results: –For example, design pre and mid season cholinesterase testing. Remove workers with decrease.

20 Case Two A scaffold fell off the side of a building on a windy day. Two workers were killed.

21 Case Two Sentinel event: death Collect information: –accident investigation –review logs or medical records of injuries Use results: –Policy change to improve enforcement

22 Case Three A group of rubber workers notice that several of their co-workers have developed leukemia. They are concerned about the hazards of their industry.

23 Case Three Sentinel event: Leukemia Collect information: –medical records of workers, if possible –conduct survey of workers –compare rates to those expected Use results: –If elevated rates, determine related exposure –reduce hazard –collect ongoing CBCs to follow trend; –inform workers of results of study