An Introduction to OHCOW

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An Introduction to OHCOW

• CSSE
• October 2, 2008

Leah Casselman Executive Director
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Occupational Health Clinics for Ontario Workers
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OHCOW

• An inter-disciplinary occupational health team
• Occupational Physicians
• Occupational Health Nurses
• Ergonomists
• Occupational Hygienists
• Funded by WSIB Prevention Services

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Clinic Services

• Individual Client (clinical)
• Answer Questions (work/health related)
• Informational Presentations
• Workplace Visits
• requested by co-chairs of JHSC
• Exposure Investigations/Research
• medical/hygiene/ergonomic combined

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VISION STATEMENT

• The detection, prevention and elimination of
  occupational injuries and illnesses.
• The promotion of the highest degree of physical,
  mental and social well-being for all workers.

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Mission statement

• To protect workers and their communities from
  occupational injuries and illnesses, and to
  promote their social, mental and physical
  well-being through
• Clinical services
• Providing multi-disciplinary services to workers
  who are concerned about their occupational health
  and to the families of workers who fall victim to
  occupational disease

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Mission statement

• To protect workers and their communities from
  occupational injuries and illnesses, and to
  promote their social, mental and physical
  well-being through
• Prevention services
• Identifying and analyzing occupational hazards
  and exposures, and developing effective programs
  for prevention and elimination.
• Participating in prevention initiatives which
  address environmental or public health as well as
  occupational health.

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Mission statement

• To protect workers and their communities from
  occupational injuries and illnesses, and to
  promote their social, mental and physical
  well-being through
• Research, knowledge transfer, tool development
  and educational services
• Conducting and supporting participatory research
  and promoting its contribution to knowledge
  transfers and development of prevention tools and
  resources.
• Educating and learning from workers, workplaces
  and the community about occupational hazards,
  exposures and prevention solutions

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Mission statement

• To protect workers and their communities from
  occupational injuries and illnesses, and to
  promote their social, mental and physical
  well-being through
• Partnerships
• Building and maintaining strong relationships
  with workers and unions and, wherever possible,
  with employers through joint health and safety
  committees, trades committees and health and
  safety representatives.
• Building and maintaining strong partnerships
  within the Ontario prevention system, to further
  our vision and mission.

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Mission statement

• To protect workers and their communities from
  occupational injuries and illnesses, and to
  promote their social, mental and physical
  well-being through
• Commitment to service excellence and to the
  wellbeing of our staff
• Dedicating ourselves to the highest degree of
  service and respect to those we serve, and to
  being an exemplary healthy, safe, supportive and
  respectful workplace, focusing our resources on
  the most important priorities and operating in a
  cost efficient, accountable and effective way.

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We are.
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Ergonomics at OHCOW

• Curtis VanderGriendt, BSc, AE
• Ergonomist

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Ergonomic Services

• Review relationship between work exposures and
  Musculoskeletal Disorders (MSDs) for individuals
• Wide range of educational presentations and
  workshops to workplaces, classes, conferences,
  etc.
• Workplace consultations with the JHSC can be
• Detailed assessment report with recommendations
• Exposure questionnaires including discomfort
  survey
• Roundtable meetings to discuss ergonomic
  improvement action plan or program development
• Always insist on worker involvement

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Ergonomic Services

• We focus on Health-Based Assessments
• Often use an inter-disciplinary approach
• Ergonomist
• Occupational Health Nurse
• Hygienist
• Build capacity within workplace for
  self-sustaining ergonomic improvement

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Neck
Upper Back
Left Shoulder
Right Shoulder
Left Upper Arm
Right Upper Arm
Left Elbow
Right Elbow
Left Forearm
Right Forearm
Left Wrist
Right Wrist
Left Hand
Right Hand
Mid/Low Back
Buttocks
Left Thigh
Right Thigh
Right Knee
Left Knee
Right Lower Leg
Left Lower Leg
Right Foot/Ankle
Left Foot/Ankle
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legend
Marley and Kumar (1996)
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Department X (n36)
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Department X Right Side
legend
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Department X Neck and Back
legend
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Workplace Example
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Bathroom Fixture Manufacturer

• Invited by the JHSC to address MSDs and worker
  discomfort related to tub sprayers
• Video taped workers performing daily tasks and
  talked with them about their concerns
• Returned to workplace, presented detailed report
  that also included recommendations
• Facilitated a roundtable problem solving session
  with workers, supervisor, engineering, HR and
  JHSC members

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Bathroom Fixture Manufacturer

• Identified items that could be implemented
  immediately
• Developed an action plan to investigate other
  recommendations further

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Before
After

• Also height adjustable table being investigated

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Pushing Carts
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Gun Use - Fatigue
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Ergonomic Committees
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Ergonomic Committees

• Best way for workplaces to develop capacity to
  address MSDs/ergonomics
• Raise awareness throughout organization
• Provides venue to voice concerns and
  problem-solve identified hazards
• Develop prevention measures into new designs,
  equipment purchases etc.

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Ergonomic Committees

• Who Should be on the Committee?
• Workers
• Supervisors
• Engineers
• Maintenance
• Management
• Any others that would improve its function

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Ontario MSD Prevention Documents
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Where Our Services Stop

• We do not complete PDDs for workplaces
• We do not complete individual assessments
• We do not assist with Return to Work issues
• Cost ? There is no fee for any of the services
  OHCOW provides including the ones discussed today.

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Contact Information

• Occupational Health Clinics for Ontario Workers
• 848 Main Street East
• Hamilton, ON
• L8M 1L9
• Tel [phone] or 1-800-263-2129
• www.ohcow.on.ca

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Case 2 Indoor Environment Problem Investigation
Occupational Health Clinics for Ontario Workers
Inc.
Hamilton CSSE Chapter Monthly Meeting
John Oudyk MSc CIH ROH Occupational
Hygienist October 2, 2008
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Problem

• A number of occupants of the municipal office
  experienced episodes of passing out
• A hygiene consulting firm was retained to
  determine if there were any exposures in the
  building which might explain these episodes
• they measured temp, RH, CO2, CO dust
• they could not associate any of their
  measurements with the symptoms reported
• The occupants and the HS staff were frustrated
  so they called OHCOW (staff had used OHCOW
  services in previous workplace)

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Process

• Met with JHSC, HS staff and worker reps of
  areas of concern
• Invited symptomatic worker to be seen medically
  at clinic (confidential)
• Collect simultaneous symptom and exposure data
  (questionnaires, logs and datalogging equipment)
• Inspect ventilation system and conduct
  cross-sectional measurements in offices

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Measurements

• A datalogging air monitoring machine was placed
  in selected locations for 24 hour periods
• The machines log the following parameters over
  this time (5 minute averaging)
• temperature (C) (temp)
• relative humidity () (RH)
• carbon dioxide (in ppm) (CO2)
• carbon monoxide (in ppm) (CO)
• Occupants located near monitor are asked to fill
  out an workplace conditions/symptom log each hour
  while the monitor is in their work area (1 day)

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Office (May 13/08)
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Saturday-Sunday May 3-4/08
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Office (May 3-4/08)
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Measurement Findings

• comparison of measurements with ASHRAE guidelines
  for thermal comfort and outdoor air supply, and
  CO guidelines
• temperature too low (lt20.5?C) 0 of 15 days
• temperature too high (gt25.5?C) 0 of 15 days
• temperature fluctuations were detected 0 of 15
  days
• relative humidity too high (gt60) 0 of 15 days
• relative humidity too low (lt30) 10 of 15 days
• carbon dioxide exceeded levels expected (900 ppm)
  if the minimum outdoor air supply rate was 17
  cfm/person was achieved (i.e. not enough outdoor
  air) 0 of 15 days
• carbon monoxide above 2 ppm was detected 0 of 15
  days
• (except for Saturday night when it
  reached 18 ppm)

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Context IAQ standards

• ASHRAE 62.1-2007 Ventilation for Acceptable
  Indoor Air Quality states
• 3. acceptable indoor air quality air in which
  there are no known contaminants at harmful
  concentrations as determined by cognizant
  authorities and with which a substantial majority
  (80 or more) of the people exposed do not
  express dissatisfaction.
• ANSI/ASHRAE Standard 55-2004, Thermal
  Environmental Conditions for Human Occupancy,
  specifies the combinations of indoor space
  environment and personal factors that will
  produce thermal environmental conditions
  acceptable to 80 percent or more of the
  occupants. http//www.ashrae.org/pressroom/page/
  934

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Indoor Air Quality Survey

• To evaluate the indoor environmental quality
  systematically we used a validated survey the
  Swedish MM-040 Indoor Climate questionnaire
• Kjell Andersson et al., Questionnaire
  as an Instrument when Evaluating Indoor Climate,
  Healthy Buildings 88, 3139-145 (1988)

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SBS Case Definition

• NIOSH investigators (App Occ Environ Hyg J
  11540-545 (1996)) devised a Sick Building
  Syndrome (SBS) case definition
• 3 or more of the following symptoms on a weekly
  basis and improving when away from work
• dry or irritated eyes
• sore or dry throat
• stuffy or runny nose
• unusual tiredness or fatigue
• headache

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SBS Cases

• overall there were 57 in the office who reported
  symptoms which fit the MM IAQ survey case
  definition of the NIOSH SBS case definition
• NIOSH investigators found an average of 18 of
  respondents fit the SBS case definition in
  buildings they were asked to investigate due to
  IAQ concerns
• The US EPA 1994-96 random sampling of government
  buildings in the US northeast found 9.3

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Predictors of Symptom Factor Scores

• the following statistical model was tested using
  multiple linear regression
• symptom
• demographic factors environmental
  perceptions job variables stressors
  personal health factors smoking
  status

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r2(adj) 70.5
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Decision Latitude Job Demands Scores
ACTIVE
RELAXED
HIGH STRAIN
PASSIVE
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By JCQ quadrant
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Cross-sectional measurements

• Measurements were taken cross-sectionally for the
  following parameters
• lighting
• noise
• ultrafine particulate (low)
• volatile organic compounds (low)

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Lighting
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Lighting

• Generally, the eye sub-consciously tends to go to
  the brightest area in the field of vision, thus
  if something other than the computer screen is
  about 400-500 lux, the eye will be pulled into
  that direction (the screen being about 200-250
  lux).  This can cause tension which contributes
  to eye and neck strain and headaches. 
• Lighting levels were lowered on average about 100
  lux by removing various lights (from 400-500 lux
  down to 300-400 lux). 
• Anecdotally, the people consulted while taking
  the measurements after lowering the lighting
  levels, all stated that there was a significant
  improvement.

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Background Noise Levels
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Full noise spectrums
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Low Frequency Noise (LFN)Criteria (UK)

• Proposed criteria for the assessment of low
  frequency noise disturbance
• by Dr. A. Moorhouse, Dr. D. Waddington,
  Dr. M. Adams (2005)
• add 5 dB for steady state noise
• add 5 dB for daytime noise

http//www.defra.gov.uk/environment/noise/research
/lowfrequency/pdf/nanr45-criteria.pdf
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Office Meeting Room
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LFN Observations

• It was quickly noticed when measuring the noise
  frequencies that the office area1 had a
  significant spike at 63 Hz
• For this reason measurements were noted at
  various locations in both offices and are mapped
  in the following slide
• OHCOW staff and the Facilities manager noticed
  peculiar sensations in the head and ears when
  standing in certain locations where these spikes
  were most prominent

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Measured 63 Hz noise levels (in dB)
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Conclusions

• Some aggravation of pre-existing allergies are to
  be expected when moving into newly renovated
  office space due to residual construction dust,
  and off-gassing of VOCs from paint, furniture,
  carpeting, etc.
• There was little evidence of the presence of
  allergens, therefore, the likely mechanism for
  those suffering allergic reactions was irritant
  (VOC) aggravation of pre-existing sensitivities

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Conclusions

• Carbon monoxide poisoning was not likely the
  cause of occupants passing out although the
  single episode on a Saturday night is
  disconcerting
• The offices were over-illuminated which may
  contribute to feelings of dizziness, however,
  lighting levels have been reduced
• Low frequency noise exposures seem to be the most
  likely explanation of the dizziness symptoms
• (although over-illumination, earlier reactions
  to dust VOCs and job-content stress may be
  co-contributors)

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Outcomes

• Staff felt their concerns were finally addressed
  seriously although it wasnt a definite answer
• The building management are working with the
  manufacturers of the HVAC system to reduce low
  frequency noise