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Occupational Diseases | Nursing Assignment

Introduction

There are several Respiratory Diseases that are covered under occupational lung diseases and black lung or coal workers pneumoconiosis is a serious disease caused by the inhalation and deposition of inorganic particles and mineral dust in the lungs. The problem is considered a disease of the past in Australia as it has been classified by Safe Work Australia as a deemed disease (Yeung and Lam, 2013). The disease is considered specifically related to working conditions and activities and in this case caused due to prolonged exposure to coal dust. However, there is a re-emergence of the disease in Australia claimed as eradicated decades ago (Brook, 2017 and Gibson, 2016).

The disease has become an emerging issue not only in Australia but also in several other developing countries reporting black lung on the rise. It is to be noted that in developing countries, often it is not feasible to remove patient from exposure without taking away their livelihood and those of their families (Yeung and Lam, 2013). This makes the situation worse as workers do not want their employers to learn about the illness and therefore do not report it to compensation boards or similar agencies. Moreover, physicians may not be interested in managing the hassle of submitting a claim for patients with black lung disease making the illness often unreported in a majority of developing countries (AIHA, 2016). A better awareness and recognition about the disease process and exposure to control measures have improved the situation in developed countries. However, in case of developing nations, pneumoconiosis is still very prevalent because of poor working conditions, inadequate exposure control and in a majority of cases because of lack of education among workers about the safety concerns and recognition of products that are hazardous for them.

Keeping this background in mind, the following sections presented a risk assessment profile of ........

lia as it has been classified by Safe Work Australia as a deemed disease (Yeung and Lam, 2013). The disease is considered specifically related to working conditions and activities and in this case caused due to prolonged exposure to coal dust. However, there is a re-emergence of the disease in Australia claimed as eradicated decades ago (Brook, 2017 and Gibson, 2016).

The disease has become an emerging issue not only in Australia but also in several other developing countries reporting black lung on the rise. It is to be noted that in developing countries, often it is not feasible to remove patient from exposure without taking away their livelihood and those of their families (Yeung and Lam, 2013). This makes the situation worse as workers do not want their employers to learn about the illness and therefore do not report it to compensation boards or similar agencies. Moreover, physicians may not be interested in managing the hassle of submitting a claim for patients with black lung disease making the illness often unreported in a majority of developing countries (AIHA, 2016). A better awareness and recognition about the disease process and exposure to control measures have improved the situation in developed countries. However, in case of developing nations, pneumoconiosis is still very prevalent because of poor working conditions, inadequate exposure control and in a majority of cases because of lack of education among workers about the safety concerns and recognition of products that are hazardous for them.

Keeping this background in mind, the following sections presented a risk assessment profile of black lung disease in developing countries. The focus of the assessment is on identifying the hazard, assessment of hazard, assessment of exposure and characterization of the risk associated with the illness. The assessment will help in identifying the major cause of the growing cases of black lung illness and the control measures that should be adopted to handle the issues and reduce the cases in developing countries.

Risk Assessment of Black Lung disease in developing nations

Hazard identification

In case of developing countries, a large workforce is employed in the mineral sector with more than one-third in the coal-mining sector. These workers are daily exposed to silica dust or coal mine dust that is a major reason of the lung disease known as pneumoconiosis or black lung disease. The incidences of disease are declining in developed countries, but in case of developing nations the lack of occupational hygiene measures is a major reason of rising cases of black lung disease (Gibson, 2016). There is lack of worker safety guidelines attracting mining and other industries from wealthy nations in search of mineral resources, lax rules and low cost of labour. These reasons become the cause of increasing lung diseases in developing countries (Ross and Murray, 2012). Additionally, workers in these countries do not want their employers to know about the illness as this could result in loss of job and hardships for their families. This makes a majority of cases going unreported leading to severe cases of disease and people are not treated on time.

This particular disease is responsible for affecting the gas exchanging tissues of the lungs and can affect the passages in lungs called airways in a negative manner. Prolonged exposure to dust in mines results in large amount of dust settling down in lungs of workers that often goes unreported further exaggerating the issue in developing nations. Therefore, the exposure to silica dust results in fibrotic diseases where the lung tissues are damaged or even destroyed over long exposure (AIHA, 2016). This hazard is identified among coal workers in the form of pneumoconiosis and silicosis.

These diseases cannot be cured and therefore prevention is the only option to save workers from fibrotic lung diseases. Pneumoconiosis is the chronic disease of lungs that results of deposits of dust in the lungs and results in damaging tissues of lungs and cause scarring (Brook, 2017). The disease develops with continuous exposure over a long period of time and impairs the inhalation process of workers constantly exposed to silica dust. Secondly, the exposure to silica dust results in airflow diseases where the movement of air in and out of lungs is blocked to certain degree (Samantra et al., 2017). This exposure results in bronchitis, emphysema or mineral dust airway disease.

Hazard assessment dose-response assessment

The incidence of above identified hazards of fibrotic lung disease and pneumoconiosis is directly associated with the exposure to coal dust and depends upon composition and direction of exposure to inhaled dust. The disease may progress into progressive massive fibrosis with long-term exposure to high doses of silica dust and the disease can prove to be fatal for the patient. The current evidence on the dose-response assessment reveals that even in the absence of pneumoconiosis, the workers in coal mining activities have a high risk of chronic bronchitis, emphysema and chronic limitation of airflow within lungs. The coalmine dust is a major cause of impaired lung function and the best estimate of the loss of forced expiratory volume in 1 s (FEV) as associated with exposure of workers is 0.76 ml/g h/m3 (Graeme et al., 2016).  Moreover, the exposure to silica dust is directly associated with respiratory diseases like black lung disease regardless of the source of silica and dose of exposure. The health hazard results when workers despite of the small amount of such exposure face a continuous exposure to silica dust (Samantra et al., 2017).

However, despite of being the most documented workplace exposure, the quantitative relationship between the inhalation of silica dust and the development of disease often remains an issue of controversy. The available scientific evidence demonstrating the exposure to silica dust over a workers’ working lifetime (0.1 mg/mg3) resulting in a significant burden of silicosis and black lung disease is proven to be insufficient to indicate a relationship in real terms (Mahdevari and Shahriar, 2016). The available evidence does not indicate whether this level can be taken to 0.05 mg/m3 and therefore, it is often argued to lower the level of exposure to 0.1 mg/mg3 (Mahdevari and Shahriar, 2016).

Exposure assessment

The exposure to silica occurs in several fields like mining, quarrying, sculpting and jobs using abrasives containing silica. The risk of silicosis is well recognized in the field of mining, tunnelling and quarrying. Here, it is to be noted that any occupation that disturbs the crust of earth or comprise of any processes using silica-containing sand or rock are responsible for potential risk for silicosis. The workers working in any of these activities are regularly exposed to silica and these activities are prevalent in developing countries without any occupational standards of health and safety defined and applied to ensure the limitation over exposure levels (Samantra et al., 2017).

The risk is also prevalent in construction industry as often remains unrecognized especially in developing countries. Although several developed countries have limited the use of sand for sandblasting, it is commonly used in developing countries. Several other rusks of silicosis are not even recognized in these countries and are being continuously used in paints and cosmetics (WHO, 2007). However, in relation to occupational hazard, silica causes unexpected serious illness that remains unrecognized in a majority of developing countries. Even if the illness is recognized under some epidemiological studies related to occupational health, the incidence and prevalence of pneumoconiosis is high, as mining and mineral extraction remains the backbone of economic development of several developing nations. With the expansion in these industries, more and more workers are exposed to silica dust or coal dust with complete absence of dust control measures putting workers at high risk of black lung disease (Samantra et al., 2017). It is to be noted that pneumoconiosis develops after a short period of exposure and progress in a rapid manner. As tuberculosis remained prevalent in developing countries, silicotuberculosis also became a major health hazard for workers exposed to silica dust and coal dust in mines.

 

 

Risk characterization

Pneumoconiosis in the form of silicosis is the well-known lung disease that results in black lungs and is considered under ILO and WHO for timely prevention and eradication (WHO, 2007). The management of the disease has a long history, but is still prevalent in several developing countries. A vast number of workers engaged in hazardous mining activities are daily exposed to the risk of black lung disease in several developing countries.

The risk associated with silica dust or coal mine dust exposure is highly prevalent in developing nations. This is due to the lack of occupational health and safety standards making the magnitude of the risk high. Moreover, the risks in developing countries comes from coal mines as well as other activities and occupations like sculpturing and construction of buildings where workers are regularly exposed to high doses of silica dust (Yeung and Lam, 2013). There lie some significant uncertainties because of lack of health and safety standards and lack of harmonisation with international regulations. The situation in developing countries worsens in lack of a national screening programs and non-reporting of illness incidences by the workers. The character of the risk associated with exposure of silica dust and coal dust in mines in relation to developing countries presented a grim situation where the reporting of CWP to centralized occupational lung disease register is not mandatory making it even more difficult to identify the cases and conduct and analysis to understand the frequency of incidences, causes of disease, and conduct a dose-response assessment (AIHA, 2016).

Here, it is also to be noted that silicosis is generally diagnosed at late stages of the disease and is a progressive disease that may appear after several years of exposure to the particles. The illness does not have any permanent cure and increases the risk of tuberculosis especially in developing countries that already have a high relevance history of this disease. Furthermore, silicosis is associated with HIV infection that acts multiplicatively thereby increasing the risk of tuberculosis (Mahdevari and Shahriar, 2016).

Another important point to be noted is that the brief history of exposure is sufficient for diagnose silicosis through the characteristics of radiographic changes. However, sometimes even advanced silicosis many not be easily diagnosed through chest radiography and it remains unclear whether miners exposed to smoking can have any direct impact on this health condition. This is so as many a times the radiographic changes occurring because of smoking are misinterpreted as black lung disease making it even more complicated to identify the cases and take proper precautionary steps.

Risk Management of Black Lung Disease in Developing countries

In order to manage the risk of black lung disease in developing countries, there is a need to follow a systematic approach through a well-defined model including precautionary measures, medical examinations and remedial measures. These measures needs to work in collaboration with each other as discussed in following sections:

Precautionary measures

The first step to resolve any issues is to take some precautions to prevent the disease and reduce exposure of workers towards the identified hazard. It is important to understand the activities involved in coal mining are inherently dangerous and this calls for key precautionary measures to control the unwanted hazards. The precautionary measures can be applied at two important levels, namely the design and engineering stages (Brook, 2017). In case of design stage, the precautions should be based on principles of eliminate, reduce, substitute and isolate. Here, suitable ventilation systems, regular checks and controls and dissemination of dust needs to be managed in a continuous manner. On the other hand the engineering level steps should focus on controlling the dust wherever possible and most important at the source of the coal dust. The objectives under this stage can be achieved through increasing awareness among workers about the health hazard of avoiding precautionary steps, establishing workplace safety procedures, identifying strategies to monitor and keep information related to health and safety updates, regular communication and training of workers to take responsibility of health and safety measures at workplace.

Furthermore, the prevention of the disease involves reducing the exposure to coal dust through regular monitoring of levels of dust and making efforts to bring a reduction on cost dust exposure among workers of mines in developing nations (Gibson, 2016). There is a progressive improvement of mining practices over the years but in developing nations the lack of rules and regulations along with proper standards of dust levels and mining activities becomes the major reason of growing cases of black lung disease.

This makes it important to define and apply uniform standards of acceptable levels of dust exposure in these countries and focusing in defining the exposure limited for workers. Workers must be given regular training and knowledge about the standards of safety and mining companies should be regularly checked and monitored to ensure following the standards of occupational health in relation to exposure to coal dust.

The prevention of silicosis has remained successful in reducing the rate of incidence, but this trend is visible only in developed or industrial countries. In case of developing nations there is lack of effective prevention leading to increased cases of silicosis, coal workers; pneumoconiosis (CWP) and asbestosis leading to some of the most serious respiratory diseases (Yeund and Wah, 2013).

Further, the International Occupational Risk Management Toolbox is an efficient instrument to address the knowledge-application gap in an effective manner. The tool comprises of toolkits like chemical toolkit and the silica essential toolkits helping to understand the implement the principles to control the exposure to silica (Gibson, 2016). The toolkit contains proper guidelines to propose low-cost simple solutions to control the workplace hazards in mining companies. This toolkit is essential for developing countries where a majority of employees working in informal sector and small-scale industries are exposed to silica on a daily basis (Gibson, 2016).

Along with preventing the hazard, it is equally important to deal with the consequences of the exposure to silica dust. There is a need to define a formal system of proper diagnosis and reporting of silicosis in a timely manner. This system will help in identifying areas of exposure, limits of exposure and possible ways of limiting such exposure to help other employees in preventing the ill effects of silica exposure while working in coal mines (Ross and Murray, 2012). The focus needs to be on implementing controls at the source of exposure along with controlling at the path of transmission and controlling at the level of workers. The control measures implemented at the source help in prevention as well as minimization of the exposure to a great extent. This can be achieved through use of safety equipment, better awareness of safety measures among workers, using better materials and equipment and modification of processes to reduce the dose of exposure to hazardous material. However, in cases where such control is not possible, it is advised to implement control over path of transmission for preventing hazardous materials to disseminate. This can be achieved by performing some operations in isolation, local exhaust ventilation and maintaining efficient housekeeping to avoid accumulation of dust particles and thereby avoiding secondary source of exposure for workers.

Medical Examinations

The prevention of the disease should be focused on regular medical examination of workers even when the cases of any illness are not reported or recorded. The regular screening and medical examination will ensure timely reporting of illness as well as monitoring the exposure limits with the impact on workers’ health and making adjustments wherever necessary (Mahdevari and Shahriar, 2016). Such steps need to be considered on a national level and without any direct involvement of mining companies to ensure transparency of process and focusing on workers health and not the benefits of the mining companies.

Regular medial surveillance is required as initial health assessment as well as a regular or periodic health assessment of all the employees working in coalmines. Such efforts will ensure early diagnosis of the disease and providing treatment as per the history of dust exposure, thereby avoiding any serious illness like lung impairment.

Remedial Measures

As the third and final step of the risk management, there is a need to apply some remedial measures. Here, measures focused on personal hygiene and occupational safety should be implemented to ensure maintenance of a safe occupational culture of health and safety across the organizations. A regular communication with workers should be maintained ensuring a development of trustworthy relationship between employers and employees. This will motivate workers to report any illness or incidence of diseases without any fear of losing their job or any other hardships. As a remedial measure, companies should support workers with black lung disease to get proper treatment, regular medical examinations and possible interventions to improve the health condition.

Conclusion

The above risk assessment of exposure to silica dust and coal dust in coalmines and other occupations popular in developing countries shows that there are several reasons of increases cases of black lung disease in these regions. The disease is avoidable because of the impossibility of shifting the patient from workplace due to non-reporting and fear of job loss among workers. In case of developing countries, the lack of proper occupational health and safety standards and advantages gained by mining companies makes it even more difficult to implement precautionary types and reduce the cases of black lung diseases. There is a need for these countries to work on a national level and define policies and standards of health and safety without any interference of mining companies. The standards f safety can only be achieved through regular screening and medical examination of workers to ensure that the dose-response assessment can be regularly conducted and incidence of disease can be reported on a timely basis. A standardization of coal dust exposure limited along with harmonization of international regulation can serve the purpose. Here, appropriate training material should also be prepared and used to create awareness about the disease, its impact, associated complications and precautionary methods among workers so that they can take the responsibility of their health and wellbeing while working in coal mines.