Alcohol & Drug Free Workplace Part 3

Alcohol & Drug Free Workplace Program must starts with a good policy statement. The policy which shows the full commitment of the top management on the program as well as allocation of a budget to run the program. The policy also clearly determines when to do the urine drug screens (UDSs)- randomly as well as when there is an incident/accident occured or other indications such as 'tell tale ' signs amongst the worker. 'Tell tale' signs such as odd behaviour like in the case mentioned in my previous posting. Possible other 'tell tale' signs such as frequent sickness absence, poor health ec cetera. After confirmation of the urine result, the policy must clear in the 'action to be taken' whether to send the worker for rehabilitation or disciplinary actions. If the worker voluntarily come forward for the test, the policy must clear enough not to punish the worker.

Beside the policy, the procedures to perform the test and how to randomly pick up the worker for the test must crystal clear , cannot just do a selective random check up only.

The lab. where the test done must have a high quality standard with recognition by an international body such as NATA. The appointed person who collects the urine and the doctor who interpretes the result must have a proper training in this field of specialisation. In Malaysia, SOEM-MMA regularly conduct a MRO course for doctors.

Alcohol & Drug Free Workplace Part 2

The worker’s blood test result (which is quiet comprehensive -Full Blood count, Kidney function,Liver function ec cetera) are all normal. The urine drug screens (UDSs) showed the following results:
Cannabinoids & Opiates Class were Negative & Coccaine/Metabolite was not detected. AMPHETAMINE was detected.
The other UDSs for Barbiturate Class and Benzodiazipine class will be performed in Australia together with confirmation test (GCMS) for the positive drugs.
Exactly one week later, the urine confirmation test (GCMS) done in Australia was ready and shows the following result:
UDSs (EMIT) for Benzodiazepine Class was detected.
Urine GCMS analysis identified both Ephedrine and Pseudoephedrine and 7-1 amino-Clonazepam.
I consulted Prof. Dr Aishah Latiff of DOPING Centre USM Penang (one of resource persons during the MRO course in 2005) for advised. She agreed with me that the Test for Amphetamine is NEGATIVE and Benzodiazipine Class is POSITIVE.
This official result will be revealed to the management of the company. I called the worker for the last time to inform him about the official results.He denied taking any drug from benzodiazepine class. He sworn for only taking cough syrup. He strongly persuaded me to help him. Based on my strong ethical and religion belief I cannot act wrongly and I have to reveal the TRUTH. BUT I advised him to quit the job before his employer dismissed him. The rest of the story are history.
There are few lessons we can learned from this incidence. The most important lesson is to have a proper well designed policy and program for handling alcohol and drug abused case at your workplace.
I will discuss on the elements of proper Alcohol & Drug-Free Workplace in my next posting.
For this posting I want to discuss few terminologies which are commonly used in handling drug abused case.
1. Chain of Custody (COC) : the procedures used to document handling of urine specimen from the time donor gives it to the COLLECTOR until it is destroyed.
2. Collector is a person specially trained to collect the urine
3. Medical Review Officer (MRO) is a doctor with special training in interpreting and handling drug testing. This position is only available in US.
4. Urine drug Screens(UDSs) : the lab. test designed to detect the drug in the urine. It is of 2 types : Screening test normally using immunoassay such as enzyme multiplied immunoassay technique(EMIT) and confirmation test using Gas chromatography-mass spectrometry (GC-MS).
5. POSITIVE RESULT : Screening and Confirmatory are Positive
6. NEGATIVE RESULT: Screening or/and Confirmatory is Negative
7. FALSE POSITIVE or EXCUSE POSITIVE : Screening and Confirmatory are positive but with legal/ authorised drug used
For the start, you can use Code of Practice on Prevention and Eradication of Drug, Alcohol and Substance abuse in the workplace, 2005 for reference (you can download a copy from DOSH website by clicking here)

Alcohol & Drug Free Workplace Part I

Last Friday, my friend who is a HR personnel from one company called my handphone to consult about urine testing for drug abused. Instead of just telling the name of the lab. I decided to give brief explanation on how important to have a proper Alcohol & Drug Free Workplace policy or/and program. I recalled handling one drug abused case in early 2008. Here is the story:

“Doc, can you please check the urine of one of my worker to rule out drug abused?”, asked a supervisor who walked into the clinic , during my relief duty at one of an in-house clinic in January 2008. I quickly asked back ,“Why?, why drug test?”.
Then the HR personnel of the company came in and interrupted, “ He is suspected of drug abused because he has odd behaviour lately. Just now, he switched off the machine unncessarily, causing interuption in our production.” “OK,OK! I said....Let me handle the case properly”. Then the mentioned worker came in with another personnel. I told the personnel that I will perform full medical checkup with general blood screening test including the urine test for drugs. They agreed and left the clinic.

I asked the nurse in-charge about the Alcohol & Drug-Free Workplace Policy. The nurse looked puzzle about the policy. I explained to her what I learned from The First Medical Review Officer (MRO) Course organised by SOEM-MMA in November, 2005. She understood.
I instructed the nurse to collect the urine and also to maintain a chain of custody (COC) when sending the urine to the private lab. The nurse called the security department and one of the guard came and went to the toilet with the worker to get his urine specimen. I sent his urine for a battery of tests for drug-abused and his blood for screening test to assess his baseline health. I did a full physical examinations to find out any signs of drug-abused.
The next morning, the nurse informed me that the urine test was positive for Amphetamines. I asked the nurse to instruct the lab. to do the confirmation test . The private lab. sent the urine specimen to their HQ in Australia to do the confirmation test. "The result will be only available in one week", informed the lab. personnel.
Meanwhile, I take detail history from the worker including questions about the latest medication he took which can cause False Positive screening test result for amphetamine. There are some agents contributing to positive (False Positive) result by immunoassay screening test such as ephedrine,pseudoephedrine which is the common ingredients of flu and cough medicine. He told me he took syrup sedilix prescibed by one of a panel clinic a night before. I asked him to bring the cough syrup bottle for my reference(See photo above- the bottle box he handed to me). I called the clinic and the doctor confirmed his prescription on the cough syrup.
Sedilix-DM Linctus contained Dextromethorphan,Promethazine,Psudoephedrine and parabens. As mentioned earlier, this cough syrup contained Pseudoephedrine which can cause False Positive for amphetamine.
So, I reserved my judgment as False Positive or Excused Positive urine test at this junction.

Good Occupational Health Practice(GOHP)

Here is a good reference book(in pdf) on Good Occupational Health Practice in providing Occupational Health Services from Finnish Institute of Occupational Health.

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.