AUDIOMETRIC TESTING - what you should know

Today is 'Gawai Dayak' Day in Sarawak, so we have Public Holiday for two days(1st & 2nd June). I would like to wish all my friends who celebrate Gawai - Selamat Ari Gawai - Gayu Guru Gerai Nyamai. 

I am now in the midst of reporting audiograms of workers from few industries.
What is audiometric testing? Have you done one ?
AUDIOMETRY is the testing of hearing ability. It is done using audiometer(see second photo above) and the person tested must be in silent booth. FMA (Noise Exposure) Regulation 1989, recommends to use a pure tone audiometry (PTA) (air conduction) at 500, 1000, 2000, 3000, 4000 & 6000 Hz each ear separately. The worker must have a minimum prior quiet period for 14 hours.
A lot of workers exposing to noise has high frequency hearing loss ( A dip in the above audiogram at 4000 Hz). From the audiogram we can determine hearing loss, hearing impairment and standard threshold shift (STS). A terminology used in the regulations.
Hearing loss is defined as hearing threshold of equal or more than 25 dB(A) at any frequency. *The above audiogram shows that the worker has hearing loss (45 - 55 dB for both ears (O label for right, X label for left) at 4000 & 6000 Hz.

 Hearing Impairment is an average permanent hearing threshold at 500, 1000, 2000 and 3000 Hz shifted 25 dB(A) and above.
STS on the otherhand is an average shift of more than 10 dB at frequency 2000,3000 and 4000 Hz relative to baseline audiogram in either ear. STS can only be identified by comparing the current audiogram with the previous baseline audiogram.
STS can be of two types : temporary (due to hair cell fatigue) or permanent ( due to hair cell atrophy). In order to declared the STS is permanent (PSTS), an audiometric testing must be repeated in 3 months (a requirement in FMA (Noise Exposure) Regulation 1989).
Tips: As a simple rule of thumb, you can find out whether you have STS or not by the doing this simple test. When you drive to your workplace in the morning, switch on your car radio to the volume level that you can hear. When you park your car, switch off the radio BUT dont change the volume level. When you go back home in the evening  switch on your radio with the previous volume level in the morning, if you cannot hear the radio at this previous volume level, that means you experience STS.

Note:

Three problems I always encounter in audiometric testing are (take note SHO) :

1. The worker does not bring  the previous audiogram (?employer fault) ; therefore cannot determine STS

2. The worker does not in prior quiet period for 14 hours, some of them come to do the audiometric testing immediately after their night shift, therefore the audiogram if done is not reliable

3. The worker does not know the noise level at their workplace. Therefore difficult to recommend the frequency of next audiometric testing ( 2 yearly for those who expose to noise at action level but less than PEL( 85 dB - 89 dB(A)). Annually for those who expose to noise at or above PEL(90 dB(A)) or with problem in their hearing ability). 

**Action level = 85 dB(A), PEL (Permissible Exposure Limit) at 8 hours TWA= 90 dB(A)

FMA (Noise Exposure) Regulation 1989 - how to comply?

In order to comply with FMA (Noise Exposure)Regulation 1989, all workplaces with noise hazards (PEL equal or more than 90 dB(A)) must have Hearing Conservation Program (HCP). 

HCP is very important because Noise Induced Hearing Loss (NIHL) is a permanent injury and has no remedy, prevention is the only solution. HCP is an effective means of primary prevention which is one of the main functions of occupational health services(OHS).

HCP as the primary prevention activity has the following components :

1. Auditable written policy with financial commitment and must be signed by top management

2. Comprehensive noise exposure assessments

3. Noise control measures following the hierarchy of controls

4. Workers' education and training

5. Audiometric testing program

6. Medical Evaluation & Treatment

7. Provision, training and utlilization of Hearing Protective Devices (HPD)

8. Good records keeping

RTW and Sickness Absenteeism

Sickness absenteeism(SA) is one of the main issue in any organisation. SA literally means absent from work due to medical reasons. SA is related to illness or injury. When a worker get ill or injury, he/she usually goes to see a doctor to request for medical sick certificate(MSC). Therefore, SA must be certified via medical sick certificate (MSC) issued by a registered medical doctor.

According to Employment Act 1955, every employee is entitled to 14 days paid sick leave upon commencement of employement (refer to this article for more details on sick leave).

Sickness absence can affect the productivity of an organisation. Frequency in taking MSC should be investigated to find out the health status of the employee. It is important for Human Resource personnel with the help from Occupational health doctor(OHD) to manage sickness absence in their organisation to see the trend and also to find out and monitor employee who has taken frequent MSC. It is not surprising if the investigation will find the real cause(s) contribute to the sickness. Prolonged SA is also an important issue in organisation because it affects productivity, manpower as well as medical costs. RTW program is the best way to handle this issue. RTW is designed in such away to assess a worker's ability (after illness or injury) to do his current job  and modify  and accomodate the task accordingly. The main issue in RTW program is to find out how early the affected worker can return to work - Early Return To Work (ERTW) program.

The popular term 'Loss Time Injury' (LTI) used in industry simply means workplace injury which cause a victim worker away from work. Normally LTI needs MSC. LTI is one of the key performance indicator in many organisation. However, what worry most is in the attempt to achieve zero percentage LTI, a worker is denied his right to have a MSC. Sometimes to achieve LTI, ERTW program is used as an excuse and a MSC issued by a medical doctor is cancelled by the management. If not well handle, ERTW can contribute to Presenteeism which simply means come to work  instead of illness or injury but unable to do his job or perform below par. Presenteeism is the hidden costs of business. 

RETURN TO WORK(RTW) PROGRAM - an introduction

Return to Work(RTW) Program is becoming an important program provided by the Occupational Health Services (OHS) in developed countries. I dont know how many organisations in Malaysia has implemented this program BUT I know one well established organisation in Kuching has a very good RTW program. I have attended the briefing about the program by their senior occupational physician 2 years ago. So what is RTW?

RTW is a program designed to REDUCE THE NEGATIVE EFFECTS of injury and illness on the employee. RTW is a well designed program to provide a support in navigating medical and disability benefit, planning the return to work as early as possible and giving an opportunity to do light duty assignment to the injured worker.

The main objectives of RTW program are to return the injured employee to work quickly and SAFELY and IDENTIFY & MANAGE their temporary or permanent disability.

So RTW program will involve in the managing the burden of prolonged sickness absenteeism as well as assessing the impairment caused by the injury/illness to the worker.

Here is the Guide For Managing The Return To Work by Canada Human Right Commission.

EDOSH Sarawak Teaching Session

Starting from 16th May 2009, I was involved in Teaching Session for EDOSH Sarawak. The module I taught was Occupational Health Services which consisted of 12 topics :

1. Occupational Health Services Overview

2. Fitness For Work

3. Return to Work

4. Medical Surveillance

5. Sickness Absence

6. Emergency Medical Team

7. Travel Health

8. Total Health Promotion

9. Smoking Cessation

10. Principle of Impairment Assessment

11. Drug & Alcohol at the workplace

12. Hearing Conservation Program & Audiometry

The class has 23 registered students. My teaching sessions were 4 days on 16th. 17th, 23rd & 24th May 2009. You can download the lecture notes here, uploaded by the student who owned the safeselamat webblog. I have listed his webblog in my local bloggers list.

I wish all the student HAPPY GAWAI and study hard for your coming examination on 14th June 2009. Read my lecture notes as well as your textbook provided by OUM/IPD and sure you will pass the exam.

Malaysia's First Case of H1N1 Influenza A infection

MOH in its statement today, confirmed that 21 year old student who just came back from US on 13th May, 2009 and was admitted to Sungai Buloh Hospital on 14tth May, 2009 with symptoms of flu-like illness is confirmed as positive H1N1 case. For detail, click here.

REFLECTION

I attended the briefing session on H1N1 infection organised by Sarawak Health Dept. on 7th May, 2009 at 2:30 pm. The session was attended by about 30 people, representatives from all hospitals (including private hospitals) and Divisional Health Depts. in Sarawak. I am impressed that Sarawak Health Dept. has a very effective Emergency Response Plan (ERP) to handle any possible infectious diseases outbreak in the state. The briefing on the H1N1 infection was given by Dr Rohani Mahbah, Public Health Physician and Dr Chua Hock Hin, Infectious Disease Physician.

The following are my reflections after handling the case mentioned in my previous posting.

1. In this Era of Globalisation; the world is already a global village. We cannot be too complacent if there is crisis in other part of the world because it can affect our place any time. In this case, WHO put the pandemic alert level to phase 5 on 30 April 2009, we in Sarawak already got the suspected case on the 4th May 2009 (only 4 days later). Praised to God, the case was cleared of H1N1 virus.

This is also reflected in the current world economy crisis.

2. Emergency Preparedness Plan (ERP); must be in place all the time to face any crisis. Proper and clear flow chart and guidelines are all important in handling any crisis. To get,the document on the Recommendations for Influenza Pandemic Preparedness for Industry, click here. Adopt and customise it for your industry.

3. Effective Communication; all guidelines must be communicated to all employees especially those who are front line employee. Never ASSUME.

4. Update the knowledge; we need to update our knowledge on the current issue. Read all the informations and instructions provided by the authority body. It is our responsibility to help the authority to control the crisis.

4. At all the time, we must adhere to the universal principle of precaution,droplets precaution, cough etiquette and personal hygiene practice. This simple practices will safe your day from the infections.

Last but not least, check with your management, are your industry already has its ERP and contingency plan in facing any crisis and disaster. We need to emulate the aviation industry, they have all the 'what to do' manual in facing any crisis during the flight.

The man was cleared of H1N1 infection

Alhamdulillah, praised to Allah, the gentleman who was on newspaper headline has been cleared of influenza H1N1 after testing. Today, the home quarantine on me and other collegues was lifted. Now I am at work again :)

So everyone was relieved by the good news. So MALAYSIA is still free from H1N1 infection.

ALERT ON SUSPECTED H1N1 Infections

On the 4th May, I was involved in handling 31 year old gentleman who came to our Emergency Dept. with fever, sorethroat and Shortness of breath after 3 days returned from a visit to US. The fact that he visited US from 24th April 2009 to 1st May enough for us to suspect him of possibility of H1N1 infection. We alert Sarawak General Hospital about the case and he was rushed to Isolation Ward specifically prepared for H1N1 infection suspect case.

All of us who were working and has contact with the man was instructed by Ministry of Health to be on home quarantine until the blood test result which was sent to IMR KL ready. So yesterday 5th May, I have to stay at home.

SWINE FLU RESOURCE

WHO raised its pandemic alert level over the deadly swine flu virus to PHASE 5.

What is Swine Flu?

Swine influenza or "Swine Flu" is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses.

For detail, click the following resource websites:

1. Ministry of Health Malaysia website on Swine Flu

2. Dr Vadivale's website on Swine Flu

3. WHO website: Swine Influenza Frequently Asked Questions

4. MOH & SOEM's Recommendations on Influenza Pandemic Prepareness for Industry in Malaysia

SELAMAT HARI PEKERJA KEPADA SELURUH PEKERJA MALAYSIA

Saya mengucapkan selamat menyambut Hari Pekerja yang disambut pada setiap tahun pada 1 Mei, kepada seluruh kaum pekerja Malaysia. Pekerja adalah aset utama sesebuah organisasi dan anggota penduduk yang produktif yang menjadi nadi utama ekonomi sesebuah negara. Pada 28 April 2009 yang lalu, seluruh dunia telah menyambut Hari Sedunia Untuk Keselamatan & Kesihatan di tempat kerja dengan tema 'Kesihatan & Kehidupan di tempat kerja : Asas Hak Asasi Manusia'. Semuga seluruh pekerja Malaysia akan menitikberatkan kesihatan dan keselamatan mereka kerana itulah sahaja aset yang paling berharga yang menjadi milik setiap pekerja.

Selamat Hari Pekerja dan Selamat Hari Keselamatan & Kesihatan di tempat kerja Sedunia 2009

Quit Smoking Talk

On 26 April, I was invited by Pengangkutan Mekar Tiasa (PMT), one of SHELL Timur Sdn Bhd's haulier to give a talk to their HGV drivers.

I gave an hour health talk on Tobacco Addiction.

My talk covered the following topics:

1. Who and Why people smoke?

According to National Health & Mortality Survey 3 (NHMS3 2006), it is estimated about 3 million smokers in Malaysia in 2007. 1 in 2 males population is smokers. At workplace, (study by Giovino GA: NIOSH US Scientific Workshop on Work, Smoking & Health, 2000) showed that more smokers amongst blue collar and service workers as compare to white collar. Blue collar are usually a heavier smoker and less likely to quit.

2. The dangers of smoking

Cigarette contains 4000 chemicals of which 43 are confirmed carcinogenic including benzene. All these chemicals except one causing health problem. The one that has short term pleasure BUT causing addiction to smoker is nicotine. Nicotine increases the production of dopamine in the brain which cause a feeling of calmness and peaceful. But the problem is this effect is only short term and smoker keeps taking another cigarette (craving) after the effect decreases. Nicotine also causes withdrawal symptoms. Craving and withdrawal symptoms are the two problems that cause majority of smokers fail to quit.

Smoking also costly to safety and workplace productivity. Ill health and damage to property and life as well as decrease productivity due to smoking cause leakage of money to the employer/s income.

3. How to Quit Smoking?

Quit smoking is a long process and it cannot be done overnight although few people claimed they quit by so called 'cold turkey' method. Pharmacotherapy and Behaviour Counselling need to be used to help heavy smoker who are addictive with Fagerstrom Score > 4 or smoking > 10 sticks per day, to quit.

ERGONOMICS PART 8

So far, I am talking about ergonomics hazards which affect our physical body (hardware) namely the musculoskeletal system. Based on the definition and concept of ergonomics in my previous ergonomics series posting, it is clear that ergonomics hazards not only affecting our physical body(hardware) but also our psychological domain(software). Before I go into detail about Musculoskeletal disorders (MSDs), here is the list of the most common and important ergonomics hazards (ergonomics risk factors) :

1. Physical (causing human physical/hardware overburden):

•Loading (lifting and handling)

•Poor posture

•Repetition particularly at high speed

•High forces

•Individual differences e.g. extremes of anthropometry

•Poor equipment and workplace design

(mentioned in my previous postings)

2. Psychological (causing human psychological/software overburden)

•Task overload/underload

•Mental workload

•Control over work

•Social support

•Individual differences e.g. poor reaction times,mental ill health

•Poor design of information, displays, controls

•Poor system realiability

•Human error

3. Organizational (can cause both human hardware and software overburden)

•Long working hours

•Shift work

•Short deadlines

•Excessive workload

•Poor staffing levels

•Lack of worker development in system design

*Reference: Oxford handbook of occupational Health (Chapeter 4: pg 156)

It is obvious that ergonomics hazards cause overburden of human physical body in the form of musculoskeletal disorders (MSDs) and also overburden of human psychological domain in the form of STRESS which will affect their mental health.

My New Reference Book

I ordered this Oxford Handbook of Occupational Health, from PageOne Bookstore in Singapore. Its price is SGD78.52. This book is a newcomer to the oxford handbook series.

This book provides a comprehensive summary of the theory and practice of occupational health. This handbook contains 12 Sections as follows:

1. Occupational hazards

2. Occupational Diseases

3. Occupational Health Practice

4. Fitness for work

5. Occupational Health law

6. Occupational Hygiene

7. Toxicology

8. Epidemiology in occupational health

9. Environmental Medicine

10. Safety science

11. Practical procedures

12. Emergencies in occupational health

Appendices

I found this book is very handy and portable. In every chapter of each sections, there are a list of references.

FYI : I found this very good electronic booklet entitiled " Smart Guide To Start Business" published by DOSH, Malaysia. Click on the title to download your copy.

HEALTH Talk at ASSAR Senari Group (ASG)

Today, ASSAR Senari Group(ASG) Sarawak, the owner of Independence Oil Termional(IOT) invited me to give a health talk on 'Chemical Hazards' in conjunction with their HSSE Week. About 20 audiences attended the talk.

In my presentation, I started by informing the audience that everyday, thousand of chemicals are used in our workplace, home and environment. Chemical hazards is common hazards found at workplace and every worker is exposed to it. I stressed that we have no choice except to continue the battle proactively to protect our health from the effect of hazardous chemicals.

To help the audience in understanding the chemical hazards, I divided my health talk in three(3) short chapters :

Chapter One : Understanding chemical hazards: Hazardous chemicals and how it enters and effects our body

Chapter Two: Understanding the Malaysian Law pertaining to Chemical hazards

Chapter Three: Control the chemical hazards in workplace

In summary, I told the audience the following most important steps in fighting chemical hazards:

1. Awareness and Knowledgeable on chemicals used in workplace : read the Material safety Data Sheet (MSDS)

2. Practice Personal Hygiene

3. Perform Industrial Hygiene requirement as mentioned in OSHA 1994 and FMA 1967

4. Go for health and medical surveillance regularly or annually

KUMON & ERGONOMICS CONCEPT

This evening I went to KUMON Centre in Kuching City, operated by a wife of a doctor, attending their free preview on KUMON method in teaching mathematic.

At the centre, I saw a very interesting poster of KUMON concept on teaching which I managed to take the photo using my Nokia E71. The quality of the image is not that good or less ergonomcis due to my shaking hand.

But in this posting, I would like to share this KUMON's concept on teaching :

Let Fit the shoe to the foot rather than fit the foot to the shoe. In another word, this concept if we apply to workplace is similar to ergonomics approach.

ERGONOMICS PART 7

ERGONOMICS RISK FACTORS (ERF)

ERF arises due to poor design of the workstation and job. There are 7 ERFs found in the workplace namely
1. Force or Workload
2. Frequency of the job
3. Awkward posture during the job
4. Static position
5. Lack of Recovery
6. Contact stress
7. Vibration
Study done by NIOSH,US found that 3 Risk Factors above (1,2 &3) are consistently found in precipitating musculoskeletal disorders (MSDs).

Health Talk on Ergonomics at Proton Edar Sdn Bhd

On 21st February 2009, Proton Edar Sdn Bhd Kuching Office, invited me to give a talk on Ergonomics in colloboration of their Health,Safety and Environment(HSE) Week. Around 100 employees attended the talk. I chose 'Ergonomics & Productivity' as the title of my talk. In Act 1(introduction) of my talk, I stressed that in global economic competition, maintaining and maximising productivity is a must for the survival of any organisation. Workers as the primary tool of business play an important role in organisation's productivity. However, in many organisations, workers' health and safety is always under threat in the effort to achieve maximum productivity. Productivity can only be maintained and maximised by protecting the health and safety of the workers. To achieve this, all organisations must implement ergonomics program or approach in their workplace in order to maintain and maximise their productivity. Ergonomics approach means fitting the work environments and the job to the workers capability.

ERGONOMICS PART 6

Ergonomics Risk Factor(ERF) is a factor, which can cause trauma to the musculoskeletal system.
Ergonomics risk factor is the end product of disequilibrium of the W-WE ecosystem. This disequilibrium is normally caused by the component of work environment in the form of flaws in workstation and machine design, poor work procedure standard and non-conducive workplace environment. When this happen, the work environment will cause strain to the W-WE relationship, which will result in disequilibrium of the ecosystem.

This poor work environment condition and arrangement will produce strain in the form of ergonomics risk factors.

The magnitude of the risk factors will determine the course of the injury. If the magnitude of the risk factors above tolerance to human body, it will cause macro trauma in the form of sprain and strain.
On other side, if the magnitude of the risk is below tolerance, it only causes micro trauma, which can recover overtime. This process is called wear and tear of the musculoskeletal system. However, the micro trauma will accumulate and turn into major trauma if the risk is persistently imposed on the musculoskeletal system.  The bottom line is ergonomics risk factors will cause MUSCULOSKELETAL DISORDERS (MSDs).

ERGONOMICS PART 5

The work environment (WE) – the second component of the W-WE ecosystem consist of the work environment, secondary tools and the job procedure. The work environment including all the hazards existed in the environment such as noise, temperature, vibration etc. The secondary tools are the tools used in business other than the worker. The job procedure including all the standard and non-standard work practices at workplace. It is clear that all the above are human created: the human determines the environment, the machine and the job procedures. This statement is very important because it brings us to the conclusion that the work environment component of W-WE ecosystem is adjustable and  can be redesigned.
The first component of the ecosystem is not adjustable although from physiological perspective our body system tends to adjust to the strain arose from the external before it ends up with serious injury.
Factors in work environment such as vibration can cause harm to the worker. Flaws in design of the workstation will impose strain to the human who try to adjust their body by adopting an awkward posture. Poor work/job standard procedures will cause inefficiency and constant injury to the musculoskeletal system.
Interesting to point out here that although the human body system is not adjustable in the sense of major changing in its size and measurement,the human body is naturally adjusting to the work environment factors until the body system cant resist the strain further. When this happened, it will cause injury to the musculooskeletal system .
This is the challenging that we face if we want to implement ergonomics at workplace.
Any attempt to change the workstation design and improving the inefficient standard procedure of practice will face a resistance from both workers and the management.
The management will label this attempt as challenging the decision of the past policy maker and management leadership.

ERGONOMICS PART 4

The Worker(W) or Human as the primary tool of business has limited capability in term of their physical, mental and physiology. Human physical is formed by muscle, bone, nerve, tendon, ligaments and joints. In anatomy, it is called Musculoskeletal System. So the worker is basically the Musculoskeletal system. Our physical measurements are fixed. We cannot increase our height, the length of our upper and lower limbs etc, although we can increase our weight which can gives burden to our body if it is above the ideal body weight. Human has physical variation. The study of human physical measurements and its variation is called Anthropometry. The developed countries like US has their own anthropometric table. The muscle and joint has its movement limitation. This is the focus of study in the Biomechanic field. The study of how human body functions is called physiology. 

Inorder to understand human limited capability, we need to have some knowledge in Anthropometry, Biomechanics, Anatomy, Physiology and also Pyschology.

What is the indicator to say that the human limited capability is overburdened by the factors existed in the work environment? 

Generally, we can say that when the safety and health of the human is affected, there is a factor in the environment causing it. To be specific, from ergonomics perspective, if the human or worker suffers from Musculoskeletal disorder(MSDs), there is always a physical overburden created by his work environment.

God The AlMighty had created human with this limited capability and we cannot change it. The only thing we can change is what we have created in our work environment : - the workplace design and the work (job & task) arrangement, i.e. the second component of the worker-work environment (W-WE) ecosystem.

ERGONOMICS PART 3

The Worker(W) as the the component of worker-work environment(W-WE) ecosystem was first came into the mainstream of ergonomics focus during the World War II (WWII). Previously, the engineering experts only focused on machine-work environment system, they never thought of the human as one of the vital component of the system. Only during the WWII, they realised that the military machines were very complex to operate and very heavy in size for human capability. For instance, the design of Fighter Plane Cockpit which would only fit  for 5 feet 8 inches and 150 Ib male. 

After the WWII, the human become the main focus in designing the machine and workstation, giving birth to the field of Ergonomics.

Why worker is so important in the worker-work environment ecosystem? 

The worker is the primary tool of the organisation to do their business. The term primary tool was first coined by our very own renowned  Ergonomist, Dr Jalaludin Dahalan of Ergoworks. 

Without the worker, the business in any organisation will collapse. If the worker cannot function to the optimum, the business productivity will be jeopardised. The worker cannot function to the optimum, if the work environment components cause overburden to their capability.This will cause inequlibrium of the system.  

ERGONOMICS PART 2

The Worker-Work Environment (W-WE) relationship formed a system. This concept is very important in-order to understand Ergonomics.

First let us understand what is a system? 

*A system can be defined as an aggregate of interactive components operating together to perform a function. The key words here is aggregate and interactive. Aggregate - loose association of a components that are not necessary homogenous, but nevertheless are brought together to serve a purpose. These components is interactive which means they have a mutual or reciprocal effect, one upon other. Interactive in the sense that they are working in mutual harmony to perform a function. (source: The Worker at Work by T. Morris Fraser)

The harmony of this relationship will keep the equilibrium of this system. This is the MAIN FUNCTION of ERGONOMICS. 

ERGONOMICS PART 1

OSHA 1994 (Act 514) in its section 4(c), Object of the Act says:

'To Promote environment for persons at work which is ADAPTED to their physiological and psychological needs'. 

The above object, simply means ERGONOMICS. So what is Ergonomics?

Ergonomics, from two words of Greek origin - Ergon which means work and Nomos - Natural laws. Ergonomics simply means FITTING the work environment to the worker capability using scientific approach. 

The key words here are: FITTING, WORK ENVIRONMENT, WORKER CAPABILITY and SCIENTIFIC APPROACH.

Fitting is the process of designing and arranging the work environment so that it is suitable to the human capability. This process of fitting the work environment to the worker capability should be based on scientific approach. Therefore Ergonomics is a field which consist of multiple disciplines of knowledge from human anthropometry, physiology to industrial engineering.

More on ergonomics definition here and here.

Do you have FLU? Dont drive because you are at risk of Road Accident

Telegraph.co.uk reported today  that : 

Driving while suffering from flu increases the risk of a road accident, as much as two glasses of whisky, according to a British new study.

Read the detail of the report here.

KPJ National Patient Safety GOAL No. 2

IMPROVE EFFECTIVE COMMUNICATION

Effective communication is essential in any relationship including patient-care provider relationship. Communication is a two way pipeline. Effective communication means the message from the messenger perceived by the receiver accurately.

To improve effective communication we need to eliminate communication barriers. There are a lot of communication barriers but I would like to highlight three barriers as follows:

1.Assumption : Never assume the receiver understand technical term without checking their understanding

2. Avoid Curse of Knowledge(COK): COK is a condition when you become expert in particular subject,but it is hard to imagine not knowing what you do.

3. Closed Mind :  a condition when you are resistance to new ideas or informations.

Spanish Philosopher,Jose Ortega Y Gasset called it  'the barbarism of specialization' in one chapter of his famous book:  Revolt of The Masses

KPJ National Patient Safety GOAL No. 1

IDENTIFY PATIENTS CORRECTLY

The first step in patient safety goals in healthcare service is to identify patients correctly. This is the most important goal because without proper and correct identification of the patient, the patient safety is in danger - the medical treatment will be given to wrong patients. Imagine you are given radiotherapy but you are not having any indication for it. Imagine the doctor is operating on the wrong patient and the consequence is very costly.

Identification of patients correctly need a simple , accurate and standard process. One of the way is by identifying them using their National Identification Card (NRIC). Call the name written in NRIC and compare the image in the NRIC to the patient. Then register the patient by giving them unique Registered Number. Dont use location such as room number to identify the patient correctly. 

KEMENTERIAN KAJI HENTI PERJALANAN BAS EKSPRESS TENGAH MALAM

Kementerian Pengangkutan  mengkaji untuk hentikan perjalanan bas ekspres tengah malam, begitulah saranan menterinya, Datuk Seri Ong Tee Keat. Dalam tulisan dalam blog saya sebelum ini, saya menyatakan salah satu faktor utama penyebab kemalangan jalanraya ialah keletihan atau fatigue yang disebabkan kekurangan tidur atau HUTANG TIDUR. Kajian menunjukkan tahap konsentrasi kognitif seseorang yang kurang tidur kerana berjaga melebihi 15 jam adalah sama dengan tahap konsentrasi kognitif orang yang mengandungi 0.1% tahap alkohol dalam darah (Blood alcohol level/BAC). Di Malaysia, seseorang itu akan didakwa memandu di bawah pengaruh alkohol sekiranya tahap alkohol dalam darahnya menjangkau 0.08%. Saya mengalu-alukan saranan tersebut dan berharap ianya menjadi realiti.

Untuk maklumat lanjut, sila rujuk pautan berikut:

1. Quantifying the performance impairment associated with fatigue

2. Sleep deprivation concerns in the transportation industry

3. Reducing American Sleep Debt : Guest Editorial

2. Quantitative similarity between the cognitive pyschomotor performance decrement associated with sustained wakefulness and alcohol intoxication (pdf)

HAPPY NEW YEAR 2009

The year 2008 has gone, the year 2009 is here. Let us celebrate this new year by examining our OSH performance & achievement in 2008. How is our OSH SCOREBOARD in 2008? Based on our achievement, let us PLAN our OSH program for the year 2009. We have to continue our struggle toward HEALTHY WORKFORCE, SAFE WORKPLACE in our effort to face the uncertainty in economic scenario ahead.

AWARENESS TALK ON HIV & AIDS

My 2nd Health Talk for IOT staff was held on 22 Dec. 2008 at its conference room. 15 staff attended the talk. To share some information of the latest statistic of HIV/AIDS in Malaysia:

Since 1986 until Dec. 2008 : 80 938 of HIV infected cases was reported in Malaysia. 13 636 were confirmed to have AIDS and 10 334 of them died.*This figure is from MAC & MOH.

The above figures revealed that 13 Malaysian were infected by HIV per day and 3 Malaysian suffering from AIDS per day.

HIV and AIDS is NOT the same ; HIV is the virus, AIDS is the disease. HIV only can be transmitted through blood, body fluid (semen & vagina fluid) and from mother to her fetus.

HIV carrier normally appears healthy as you and me, so it is difficult to differentiate them. The only way to fight HIV/AIDS is through PREVENTION. HIV/AIDS is not merely medical problem, it is a social problem....... everybody needs to fight inorder to prevent it from spreading. One of the preventive measures is to have a healthy life style. Note: 1 December every year is WORLD AIDS DAY.

You can visit Malaysian AIDS Council (MAC), here

Here is the list of reference, click

SOEM Workshop on Lung Function Test & Audiometry

At Hotel Istana, Kuala Lumpur - on 8 & 9 November, 2008 SOEM organised Continue Professional Development (CPD) on Occupational Medicine & Workshop on Spirometry & Audiometry.

The Workshop on Spirometry was coordinated by Prof. Dr K.G. Rampal from UKM and practical session was leaded by Dr Abed Onn. Just to mention few important points given by Prof. Rampal - Spirometry only need to be done 2 yearly because of the spirometer machine error causing declination about 50 mls of lung function , compares to reduction of human lung function approximately 25 mls per year of age. 

The spirometer needs to be calibrated daily using syringe provided with the machine. There are 2 normal value which are determined by age, gender and height :-  Percentile & Predictive Value (75%/80%) which is unique to race of one particular population. Since the spirometer came with the predictive value for western population, this value needs to be corrected between *8 - 12% for our population. *Can use any figure between 8 -12% for correction BUT must stick to the same figure for validity of interpretation of the result.

Dr Abed gave the following important techniques for good spirometry result : 1. Full inspiration (using abdominal muscle) 2. The mouth piece must fit tightly by the lips and 3. Give force expiration to the maximum and very fast. The followings are the contraindication for spirometry : 1. Recent smoking 2. Upper Respiratory Tract Infection 3. After heavy meals

KPJ National Patient Safety GOALS

On 30th November until 2nd December, 2008 I represented Kuching Specialist Hospital together with  Medical Director, Dr. David Ling, General Manager, Mdm Mah Lai Heng, Nursing Chief Officer, Mdm Ting Lay Hua, one Staff nurse and physiotherapist, attending KPJ Annual Health Conference @ PERSADA Convention Johore Bharu.

Amongst the presentations at that conference was KPJ National Patient Safety Goals as stated in the left image. As OH Practitioner, I am proud that KPJ has dwelled deeply in pioonering this field ahead of other hospital in Malaysia.

A Must Buy 'OH Book' for the year 2009

This book is the "MUST BUY" Occupational Health Book for the year 2009. Edited by 2 prominence Malaysian Occupational Health Expert, Dr G Jayakumar & Dr M Retneswari, contains 22 chapters discussing all aspects of occupational health concerning the Health Care workers, contributing by 28 experts in occupational health from both local and international.  This 280 pages hard cover book, was published by Malaysian Medical Association (MMA) and cost only RM88.00

You can buy the book from MMA, call 03-40411375

SELAMAT MENYAMBUT MAAL HIJRAH 1430H

Saya mengucapkan Selamat meyambut Maal Hijrah 1430H kepada semua rakan-rakan pengunjung laman blog ini. Saya mendoakan semuga tahun 1430H akan memberikan kita ruang untuk terus meningkatkan aras prestasi segala aktiviti perjuangan kita untuk menjadikan tempat kerja kita lebih selamat dan sejahtera.

SHELL KUCHING SAFETY WEEK

SHELL TIMUR Sdn Bhd  launched their HSSE Week from 21 -24 October 2008. I was invited by PMT, one of Shell's haulier to give a health talk on Stress Management. I delivered my health talk for one hour from 4 pm to 5 pm on 21 Oct, 2008 at SHELL Kuching's Canteen.

Here is the outline of my health talk :

1. Understanding what is stress? In this section, I discussed the definition of stress. Like beauty, stress is in the eye of the beholder. Basically, it occurs in situation where our life's demand exceeds our capability. The most important things in understanding stress is to know the two components model of stress. The two components are the stressor - the situation which cause the stress and our response - how we response to the stressor. To understand more, I presented the biochemical and physiological changes in our body during the stress process.

2. What causes stress?  There are a lot of things that can cause stress. In the nutshell, it can be divided into recent event and on-going event: both can be in a form of threat or loss. These two events can occur at the workplace or outside the workplace. So, we can classify stress into occupational stress which happens because of factors at workplace and non-occupational stress, because of factors in our life. However, these classification is to simplify our understand but in reality stress does not have boundary, it affect us both at work and out of work. Other important things to know is the 3 Ps factors viz.  predisposing, precipitating and perpetuating factors, which we need to identify in order to manage the stress effectively.

3. Basic Stress management? Effective management of stress must using the holistic approach. Holistic domains of life (physical,social,psychologicall and spiritual)  need to be revisited by identifying the shortage in each domain. This shortage could be the 3 Ps factors which need to be addressed. The 2 components of stress also needs to be explored. Then the stress management can be constructed by using individual and/or workplace approach.