OCCUPATIONAL INFECTIONS DISEASES AND OTHER DISEASES OF BIOLOGICAL ORIGIN Tartu 10.-11.3 OCCUPATIONAL HAZARDS physical chemical biological psycho-social Markku Seuri, FIOH, 2004

BIOLOGICAL OCCUPATIONAL HAZARDS = occup. biohazards infectious allergic toxic carcinogenic Markku Seuri, FIOH, 2004

BIOLOGICAL AGENTS viruses bacteria fungi plant substances invertebrate animals substances derived from vertebrate animals (hazards of accidental) Markku Seuri, FIOH, 2004

BIOHAZARDS VS. CHEMICAL AND PHYSICAL AGENTS less well known problems in definition less important in industrialized countries changing nature of the exposure seldom an essential part of the work task difference in prevention: as few exposed as possible Markku Seuri, FIOH, 2004

SPREADING by inhalation by ingestion (from hand to mouth) by sharps injuries by blood or other body fluid contact by bites or stings of vectors Markku Seuri, FIOH, 2004

GENERAL MEASURES OF PREVENTION -1 avoid hazardous agents whenever possible minimize the exposure by proper working practice, technical solutions and personal hygiene minimize the number of exposed Markku Seuri, FIOH, 2004

GENERAL MEASURES OF PREVENTION -2 inform the workers written guidelines guidance and instructions use signs (health check-ups have a limited role) Markku Seuri, FIOH, 2004

bacterial and fungal spores 264 TBC 16 THE INCIDENCE OF WORK-RELATED DISEASES OF BIOLOGICAL ORIGIN IN FINLAND IN 2002 - 1 bacterial and fungal spores 264 TBC 16 bacteria, virus, fungi and protozoa 134 all biological agents (not including allegens of biological origin) 414 (8,5 % of the total number) Markku Seuri, FIOH, 2004

bacterial and fungal spores 264 THE INCIDENCE OF WORK-RELATED DISEASES OF BIOLOGICAL ORIGIN IN FINLAND IN 2002 - 2 bacterial and fungal spores 264 in farming 43 public administration 49 education 42 health care 71 damp and mouldy work-places are often found in the public sector Markku Seuri, FIOH, 2004

OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS AGENTS - 1 Agriculture epidemic nephritis mycosis, tularemia Forestry Lyme disease Fishermen Skin infections Waste management Hepatitis A and C intestinal parasites Markku Seuri, FIOH, 2004

OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS AGENTS - 2 Veterinarians Zoonotic microbes, toxoplasma, listeria Slaugherhouse workers dermatomycosis, erysipelothrix Fishermen Skin infections Health care workers blood borne diseases, TBC, MRSA Markku Seuri, FIOH, 2004

OCCUPATIONAL GROUPS THREATEND BY INFECTIOUS AGENTS – 3 Security professions blood borne diseases Laboratory workers what ever handled in the laboratory Teachers, day care workers viruses causing epidemics among children Personal care workers (cosmeticians, hairdressers) dermatophytic fungi Markku Seuri, FIOH, 2004

EU DIRECTIVE 2000/54/EC 18th of Sept EU DIRECTIVE 2000/54/EC 18th of Sept. 2000 On the protection of workers from risks related to exposure to biological agents at work Tartu 10.3.-11.3. Markku Seuri, FIOH, 2004

OBJECTIVE "protection of workers against risks to their health and safety, including the prevention of such risks, arising or likely to arise from exposure to biological agents at work" Markku Seuri, FIOH, 2004

DEFINITION OF BIOLOGICAL AGENTS micro-organisms, which may be able to provoke any infection allergy toxicity Markku Seuri, FIOH, 2004

DEFINITION OF MICRO-ORGANISM microbiological entity, cellular or non-cellular and capable of replication or of transferring genetic material Markku Seuri, FIOH, 2004

DEFINITION OF EXCLUDES microbial toxins if the replicating cell is not present plant substances (allergens) substances derived from vertebrate animals (allergens) => definition is very close to the concept of "occupational infections" Markku Seuri, FIOH, 2004

CLASSIFICATION OF BIOLOGICAL AGENTS - 1 GROUP 1: unlikely to cause human disease GROUP 2: can cause human disease may be an occupational hazard unlikely to spread to the community usually an effective prophylaxis or treatment Markku Seuri, FIOH, 2004

CLASSIFICATION OF BIOLOGICAL AGENTS - 2 GROUP 3: can cause human a severe disease serious occupational hazard may spread to the community usually an effective prophylaxis or treatment GROUP 4: causes severe human disease may present a high risk of spreading usually no effective prophylaxis or treatment Markku Seuri, FIOH, 2004

DETERMINATION AND ASSESSMENT OF RISKS - 1 where workers are or are potentially exposed to biological agents biological agents are present deliberately in the occupational activity (e.g. laboratories) or workers may be exposed to the agent not essential to the occupational activity (work in forests and Lyme disease) Markku Seuri, FIOH, 2004

DETERMINATION AND ASSESSMENT OF RISKS - 2 if a risk of exposure to biological agent nature, degree and duration of the exposure must be determined for the assessment of the risk and to lay down measures Markku Seuri, FIOH, 2004

DETERMINATION AND ASSESSMENT OF RISKS - 3 for all agents renewed regularly on request authorities must by supplied by information on the assessment process Markku Seuri, FIOH, 2004

EMPLOYERS´ OBLIGATIONS whenever possible replace the agent if not possible reduce the risks information for the authority hygiene and individual protection information and training of workers list of exposed workers consultation and participation of workers notification of the authority Markku Seuri, FIOH, 2004

MEASURES TO REDUCE THE RISK OF EXPOSURE -1 minimize the number of workers exposed design of work processes and engeneering control measures collective protection measures and/or individual protection measures hygiene measures to prevent accidental transfer from the workplace Markku Seuri, FIOH, 2004

MEASURES TO REDUCE THE RISK OF EXPOSURE -2 use warning signs plans to deal with accidents testing the presence of the agent outside the primary physical confinement safe waste handling safe handling and transport within the workplace Markku Seuri, FIOH, 2004

INFORMATION FOR THE COMPETENT AUTHORITY results of the assessment activities where exposed (or potentially) number of exposed name and capabilities of the person responsible for safety and health at work protective and preventive measures taken emergency plan for the loss of physical containment (group 3 and 4) Markku Seuri, FIOH, 2004

HYGIENE AND INDIVIDUAL PROTECTION no eating or drinkin in working areas where there is a risk of contamination protective clothing (for free) adequate washing and toilet facilities any necessary protective equipment procedures for taking, handling and processing samples of human or animal origin Markku Seuri, FIOH, 2004

INFORMATION OF WORKERS potential risks to health precautions to be taken to prevent exposure hygiene requirements use of protective equipment and clothing steps to be taken by workers in the case of incidents and to prevent incidents Markku Seuri, FIOH, 2004

TRAINING OF WORKERS at the begining of work involving contact with biological agents new or changed risks repeated periodically if necessary Markku Seuri, FIOH, 2004

LIST OF EXPOSED WORKERS for group 3 and 4 agents the list shal be kept for 10 years (for some agents 40 years) the doctor and/or authority for health and safety shall have access to the list Markku Seuri, FIOH, 2004

NOTIFICATION OF THE COMPETENT AUTHORITY prior (30 days) notification for group 2, 3 and 4 agents subsequent notification of new group 4 agents (excluding diagnostic laboratories) renotification if substantial changes information content of the notification is defined Markku Seuri, FIOH, 2004

HEALTH SURVEILLANCE "The Member State shall establish, in accordance with national laws and practice, arrangements for carrying out relevant health surveillance of workers for whom the results of the assessment referred to in Article 3 reveal a risk to health or safety." (underlined by MS) Markku Seuri, FIOH, 2004

RELEVANT HEALTH SURVEILLANCE - 1 principles and practices of occupational medicine in the light of the most recent knowledge available to occupational medicine evidence based medicine Markku Seuri, FIOH, 2004

RELEVANT HEALTH SURVEILLANCE - 2 depends on risk assessment not only on the biological agent if a worker is suffering of infection or an illness suspected to be the result of exposure, surveillance should be offered to other workers similarly exposed Markku Seuri, FIOH, 2004

RELEVANT HEALTH SURVEILLANCE - 3 can be done prior to exposure and at regular intervals thereafter doctor shall propose protective and preventive measures all cases of diseases and death shall be notified to the comptent authority Markku Seuri, FIOH, 2004

VACCINATION if risk and effective vaccination exist, employers should offer vaccination workers should be informed of the benfits and drawbacks of both vaccination and non-vaccination vaccination must be offered free of charge to workers Markku Seuri, FIOH, 2004

HEALTH AND VETERINARY FACILITIES OTHER THAN DIAGNOSTIC LABORATORIES in risk assessment consider: uncertanties about the presence of biological agents suspected biological agents in particular decontamination and disinfection procedures special containment measures for group 3 or 4 agents (Annex V) Markku Seuri, FIOH, 2004

containment measures according to the agent (levels 2,3 and 4) SPECIAL MEASURES FOR INDUSTRIAL PROCESSES, LABORATORIES AND ANIMAL ROOMS for group 2, 3 and 4 agents containment measures according to the agent (levels 2,3 and 4) separate containment measures for laboratories and industrial processes Markku Seuri, FIOH, 2004

CLASSIFICATION OF BIOLOGICAL AGENTS 1 in four groups on the basis of four features: ability to cause diseases ability to cause occupational diseases risk of spreading to the community treatment or prophylaxis Markku Seuri, FIOH, 2004

CLASSIFICATION OF BIOLOGICAL AGENTS 2 based on healthy adults not considering: pre-existing disease medication compromised immunity pregnancy or breast feeding those agents not listed in groups 2, 3 or 4, are not implicitly group 1 agents Markku Seuri, FIOH, 2004

CLASSIFICATION OF BIOLOGICAL AGENTS 3 indications: A possible allergic effect D keep the list of exposed workers more than 10 years T toxin production V effective vaccine available Markku Seuri, FIOH, 2004

GROUP 4 only viruses 11 viruses rare like Ebola Marburg Lassa Junin Markku Seuri, FIOH, 2004

GROUP 3 27 bacteria, like 52 viruses, like 16 parasites, like Brucella, Bacillus anthracis, Coxiella, several Mycobacteria 52 viruses, like hepatitis viruses, HIV, Creutzfeldt-Jacob, Rabies, Kumlinge 16 parasites, like Echinococcus, Plasmodium falciparum 6 fungi, like Histoplasma capsulatum Markku Seuri, FIOH, 2004

NB! Direktiiv on tõlgitud eesti keelde: Group 2 120 bacteria 66 viruses 60 parasites 20 fungi NB! Direktiiv on tõlgitud eesti keelde: http://europa.eu.int/eur- lex/et/dd/docs/2000/32000L0054-ET.doc Markku Seuri, FIOH, 2004