Injury and Illness Surveillance

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Injury and Illness Surveillance
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Global Burden Non-fatal Occ Illness Injury, WHO
TRAUMATIC INJURY
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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

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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.
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Opportunities for Prevention
Primary Secondary Tertiary Prevention Preventio
n Prevention
time
Healthy Asymptomatic Symptomatic Worker
Disease Disease
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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

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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

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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

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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

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Techniques Keep Log
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Techniques Examine existing databases

• Death certificates
• Hospital Discharges
• Laboratory reports
• Workers compensation reports
• National surveys
• Clinics that treat workers

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Techniques Questionnaire Survey

• Demographic variables
• Work history job tasks, hazards
• Health history current, prior
• Symptoms
• Social, confounding factors

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Techniques Physical examination

• Respiratory
• Skin
• Others

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Techniques Laboratory Reports

• Require labs to report abnormal results above a
  specific level (e.g., Pbgt25mg/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

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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

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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

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Case Studies

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

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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.

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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.

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Case Two

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

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Case Two

• Sentinel event death
• Collect information
• accident investigation
• review logs or medical records of injuries
• Use results
• Policy change to improve enforcement

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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.

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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