1. Primary Prevention Initiative: Occupational Safety & Health

2. Objectives Upon completion of this module, learner will be able to: –Define levels of prevention –Describe how to select relevant topic, locate data, and identify an appropriate intervention 2

3. The Levels of Prevention PRIMARY Prevention SECONDARY Prevention TERTIARY Prevention DefinitionAn intervention implemented before there is evidence of a disease or injury An intervention implemented after a disease has begun, but before it is symptomatic. An intervention implemented after a disease or injury is established IntentReduce or eliminate causative risk factors (risk reduction) Early identification (through screening) and treatment Prevent sequelae (stop bad things from getting worse) ExampleEncourage exercise and healthy eating to prevent individuals from becoming overweight. Check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese. Help obese individuals lose weight to prevent progression to more severe consequences. Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3); 001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm 3

4. Primary Prevention Initiative (PPI) Established by Dr. Dreyzehner in 2012 Goal is to focus the Department’s energy on primary prevention—eliminating risk factors for later problems Intent is for all TDH employees to engage in primary prevention efforts in their community Statewide Roll- out January, 2013

5. PPI Process –All counties participating in Primary Prevention Initiatives –County forms PPI Team –PPI Team meets to determine focus areas –Counties may utilize Community Health Assessments to determine priority topics –PPI Team submits PPI Proposal –PPI Team submits reports on each Activity –Process continues 5

6. Team Work Your county may have multiple teams working on different community activities Teams will spend 5% of their time working on PPI –Approximately ½ day every other week 6

7. PPI Teams Team members will be: –Catalysts –Encouragers –Resource providers –Data keepers/providers Team members are not sole workers –Teams will engage community partners to accomplish activities 7

8. PPI Teams Team size will vary –Teams of 3, 5, or 7 depending on health department size Team composition: –Include community members –Teams should be multidisciplinary (clerical, nursing, clinical, administrative) –Include Regional office staff i.e. Health Promotion Coordinator and/or Community Health Council Coordinator, county staff such as Health Educator, Health Care Provider, and administrative staff 8

9. Topics for PPI Activities –Tobacco –Obesity –Teen Pregnancy –Infant Mortality –Substance Use and Abuse –Immunizations –Suicide Prevention –Occupational Safety –Healthcare Associated Infections 9

10. Selecting a Topic There are so many things you could choose to work on—but time and resources are limited! You will need to prioritize your efforts based on the specific need(s) in your community Needs (and therefore, projects) will likely vary across the State 10

11. Selecting a Topic What can you use to help you prioritize? –Community Health Assessment Tools –County Health Council Priorities –Needs Assessments –Strategic Plans –Ranking/Report Card findings 11

12. Locating Data Once you’ve selected the topic on which you plan to focus, you will need to locate data that is relevant to the topic Data can help you: –Confirm “suspicions” or “hunches” –Sharpen your focus on a particular aspect of the topic –Identify baseline for measuring improvement 12

13. Locating Data Some Potential Data Sources: –Birth/death certificates –Hospital Discharge data –Health Information Tennessee (HIT) website –Behavioral Risk Factor Surveillance System (BRFSS) –Youth Risk Behavior Survey (YRBS) –Pregnancy Risk Assessment Monitoring Survey (PRAMS) –Data from community health assessments 13

14. Identifying An Intervention Once you’ve selected your topic and gathered appropriate data, it’s time to decide what you’re actually going to do There is no need to “re-invent the wheel” Explore what others have done, what has been tested, and what has been shown to work 14

15. Identifying An Intervention Some Sources for Identifying an Intervention: –Guide to Community Preventive Service http://www.thecommunityguide.org/index.html –Healthy People 2020, Community Interventions http://www.healthypeople.gov/2020/topicsobjectives2020/ebr. aspx?topicid=33#interhttp://www.healthypeople.gov/2020/topicsobjectives2020/ebr. aspx?topicid=33#inter –Institute of Medicine http://www.iom.edu/~/media/Files/Report%20Files/2012/APO P/APOP_insert.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2012/APO P/APOP_insert.pdf –Tennessee State Plan on Nutrition, Physical Activity and Obesity http://www.eatwellplaymoretn.org/assets/files/plan.pdf 15

16. PPI Proposal Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link: http://www.surveygizmo.com/s3/1537642/PPI-Proposal 16

17. PPI Proposal cont ains County Topic Objective Activities Team members Primary contact Community partners Estimated Start Date Estimated Completion Date 17

18. PPI Activity Reporting As the PPI Team completes each activity, report in PPI Activity Reporting Survey Gizmo link: http://www.surveygizmo.com/s3/1458250/PPI-V3-0 18

19. PPI Activity Reporting Contains County name Division/Office Topic Objective Activity description Key Partners/Contributions Start date of activity Facilitating factors of success Barriers encountered Plans to overcome barriers Unanticipated outcomes Impact measures- numbers served Stage of Change Success Stories 19

20. Applying Primary Prevention Principles to Occupational Safety and Health

21. Tennessee Occupational Safety & Health Administration (TOSHA) Mission – committed to helping Tennesseans improve workplace safety and health. Some of these services include outreach, training and education, consultation and enforcement efforts. TOHSA: “Saving Lives, Preventing Injuries, Protecting the Health of Workers”

22. Tennessee Data: 2012 Occupational Fatality Investigations Data Source: Tennessee OSHA Struck By9 Falls7 (1 event/2 victims) Crushed/Caught Between5 Fire/Explosion/Chemical3 (1 event/2victims) Electrocution2 Equip. Mechanical Failure1 Cave in1 Asphyxiation1 Drowning1 Overturned Equipment1 Workplace Violence1 Total32 34 Victims

23. Tennessee Data: 2012 Fatality Investigations Sorted by Industry Data Source: Tennessee OSHA Construction12 General Industry11 Service05 Shipping02 Retail01 Public Sector01 Total32

24. TOSHA Believes Institution of a safety and health management program in these workplaces could have prevented these deaths and the approximately 95,000 injuries and illness that occur to Tennessee workers each year.

25. Why Do We Want a Safe and Healthful Workplace? It’s the Law – –29 CFR 1910 General Industry –29 CFR 1926 Construction –29 CFR 1928 Agriculture It’s the right thing to do –Every day in America, 13 people go to work and never come home. –Every year in America, nearly 4 million people suffer a workplace injury from which some may never recover. –These are preventable tragedies that disable our workers, devastate our families, and damage our economy. It’s Good Business –Medical Costs –Workers compensation insurance –Indemnity payments for an injured or ill worker

26. Source: Tennessee Occupational Safety and Health

27. IT’S GOOD BUSINESS How Much Does it Cost? COSTS: Tennessee State Workers’ Comp Insurance Annually $950,000,000 (ALMOST ONE BILLION) Tennessee Claims Per Year Over 100,000 Tennessee Medical Claim Cost (Avg.) $30,000

28. How Do You Prevent Injuries and Illness and Save Money? TOSHA’s four point safety and health management system 1.Management commitment and Employee involvement 2.Hazard analysis 3.Hazard prevention and control 4.Employee safety and health training

29. Proven Primary Prevention Strategies Promote Workplace Health and Safety Objective: Increase the number of local businesses who implement a Four Point TOSHA Safety and Health Management System Activity: Support business efforts to initiate TOSHA Programs –Partner w/TOSHA to encourage businesses to implement TOSHA Safety and Health Management System https://www.osha.gov/Publications/smallbusiness/small-business.html –Build community support (i.e. chamber of commerce, civic club, and other recognition) for change –Implement local government policies to promote safe workplaces –Engage Management and Leadership

30. Proven Primary Prevention Strategies Use Tennessee OSHA’s Consultation Service Objective: Work with TOSHA Consultation staff to inspect the workplace and identify safety and health hazards. Activity: Work with TOSHA to recruit one or more local small businesses (less than 250 employees or 500 employees corporate wide) to utilize the free, confidential service. A full report with recommendations will be issued. –No Direct Cost –No Penalties issued –Confidential –Effective

31. Proven Primary Prevention Strategies Promote Tennessee Workplace Safety Recognition Awards to local businesses Objective: Work with TOSHA to promote the Tennessee Volunteer Protection Program (VPP) to local community businesses and government agencies Activity: Work with TOSHA to recruit one or more local businesses to pursue recognition for safety activities via TOSHA programs such as: –Volunteer STAR Award –SHARP Award –Governor’s Award –Commissioner’s Award

32. Additional Resources Tennessee Occupational Safety and Health http://www.state.tn.us/labor-wfd/tosha.html http://www.state.tn.us/labor-wfd/tosha.html TOSHA Consultative Services http://www.state.tn.us/labor-wfd/tosha/toshcons.shtml http://www.state.tn.us/labor-wfd/tosha/toshcons.shtml TOSHA Training Services http://www.state.tn.us/labor-wfd/tosha/tande.shtml http://www.state.tn.us/labor-wfd/tosha/tande.shtml Federal OSHA www.osha.gov www.osha.gov Centers for Disease Control www.cdc.gov www.cdc.gov National Institute of Occupational Safety and Health www.cdc.gov/niosh www.cdc.gov/niosh Jim Flanagan, Star Program Manager (615) 741-5421 James.Flanagan@tn.gov James.Flanagan@tn.gov

33. FOR TECHNICAL ASSISTANCE Rachel Heitmann, MS Injury Prevention/ Child Fatality Review/ Infant Mortality Director Rachel.Heitmann@tn.gov (615) 741-0368 Rachel.Heitmann@tn.gov Terry Love, MS Injury Prevention Program Manager Terrence.Love@tn.gov (615) 532-7778 Terrence.Love@tn.gov