Which is the best method an occupational health nurse can use when assessing workplace hazard?

Now that we have focused on hazards’ inventory and detection presented by chemical agents, we can move on to the second stage, that is risk assessment. The risk of a substance is the likelihood that it will be harmful in real conditions of use. The risk therefore depends on the intrinsic hazard and control of the exposure conditions.

«Strict procedures can minimize the risk of the most hazardous substances. Poor control can create a major risk even with a substance posing little threat».

The employer must conduct risk assessment for health and safety at workstations including new activities. This assessment must be renewed regularly so as to take into account knowledge advances concerning products used.

Objectives

Risk assessment for chemicals is a prerequisite prior to any risk prevention programme in general. Well conducted, it should lead to the construction of preventive actions plan which will find its rightful place in the Occupational Health Nurse’s ‘OHN’ project approach. For that purpose, it is important to collect and provide comprehensive data on risks related to use, storage, chemical exposures or mixtures as well as toxicological data.

Risk assessment

To ensure risk assessment, the employer takes into account in particular hazardous properties of chemicals, hazardous situations and all exposures likely to exist via exposure scenarios. Various chemical risk assessment methods are available. There is no universal method, and the employer, who is responsible and the most competent for this assessment, is free to choose the one that seems to be the most suitable to the company’s specific needs.

Methodology

  • Know and understand the intrinsic nature of chemical hazard related to the molecular structure and detailed on data labels and safety data sheets, ‘ SDS’ to compile an inventory of hazards (see Dossier 1).
  • Analyze chemical risk on the basis of workstations’ analysis (see Dossier 3)
  • Collect data related to health and safety provided by the chemical supplier, containers’ labels, technical sheets, and Safety Data Sheets.
  • Note nature, degree and duration of exposure as well as frequency through all routes of entry (skin, inhalation, ingestion) which must be taken into account.
  • Assess degree of exposure. The level of exposure may in practice be classified simply as low, medium or high.
  • Analyze workers’ exposure conditions by examining all work situations involving chemicals and the circumstances in which they are undertaken.
  • Analyze actual work based on employees’ knowledge regarding their activities and their jobs and not solely on procedures described.
  • Measure the effect of preventive measures taken or to be taken at the chemical risk level.
  • Match up with the findings provided by the Occupational Health Physician,’OHP’ during his/her prevention activity at the work place and during medical consultations.
  • Look for research conducted and recommendations submitted by of occupational risks prevention stakeholders (multidisciplinary team).
  • Obtain, if need be, additional information from supplier and consult for instance monographs of the International Agency for Research on Cancer (IARC), the International Chemical Safety Cards drafted under the auspices of the United Nations (UN), the International Labor Organization (ILO), the World Health Organization (WHO) or material safety data sheets in France from the National Institute for Research and Safety (INRS). There is also the evaluation guide for occupational safety and health ‘OSH’ experts and auditors published by ILO-OSH and many other resources generally accessible on the web.
  • Check the existence of occupational exposure limit values called Threshold Limit Values (TLV) or Biological Exposure Indices (BEI), company record card filed by the Occupational Health Physician identifying all occupational risks and employees exposed.
  • Rely, where appropriate on workplace accidents and incidents as they may also provide relevant data and guidance regarding occupational risks. The OHN is among those in the best position to exploit these data. Also because he/she is often the only one detaining valuable information, sometimes more informal from employees themselves.
  • Participate, whenever possible, in risks analysis carried out by the Industrial Health and Safety and Working Conditions Committee ‘CHSCT’.
  • Furthermore Occupational Health Nurses are active participants as regards compiling the single document.

Sharing experience within the multidisciplinary team, occupational health physician and others: The OHN is considered an integral partner of prevention stakeholders. She/he accompanies the employees regarding management of their health and safety. She/he shares information that may help without losing sight of her general obligation to discretion.

Conclusion

The risk assessment process should be adapted to each company. It is necessary to ensure employees’ collaboration. Indeed the ultimate goal is to implement a prevention plan, collective and/or, individual. But without direct employees’ implication, these objectives cannot be achieved. Therefore, risk assessment is teamwork.

NB: You have personally contributed towards risk assessment in your company in France, in Europe or elsewhere in the world. You wish to talk about this issue, discuss it, share with us your experience, do not hesitate anymore. Contact us. Take advantage of this space, it is yours!

Janine Bigaignon

The first industrial nurse is considered to be:a. Betty Moulderb. Ada Mayo Stewartc. Lillian Wald

d. Florence Nightingale

ANS: B
Ada Mayo Stewart was hired in 1885 by the Vermont Marble Company.

Which population would have been the focus of care for an occupational health nurse in the early 1900s?a. Injured workersb. All workersc. Families

d. The community

ANS: C
In the early days of occupational health nursing, the nurse’s work was holistic and centered on the family.

A nurse working in an occupational health setting will most likely work as a nurse:a. Administratorsb. Clinicians/practitionersc. Consultants

d. Educators

ANS: B
The majority of occupational health nurses work as nurse clinicians/practitioners.

A nurse is pursuing certification as an occupational health nurse. Which organization will provide this certification?a. American Board for Occupational Health Nursesb. Center for Occupational and Environmental Healthc. National Institute for Occupational Safety and Health

d. Occupational Safety and Health Administration

ANS: A
Certification in occupational health nursing is provided by the American Board for Occupational Health Nurses.

Secondary prevention in the occupational health arena may include:a. Providing education on safety in the workplace to prevent injuryb. Working with chronically diabetic workers to ensure appropriate medicationsc. Screening for hearing loss resulting from noise levels in the plants

d. Ensuring that a person with cardiovascular disease attends a rehab program

ANS: C
Secondary prevention occurs after a disease process has already begun. The other answers are examples of primary and tertiary levels of prevention.

The nurse doing a walk-through to identify workplace hazards is providing which level of prevention?a. Primary preventionb. Secondary preventionc. Tertiary prevention

d. Assessment

ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

Limited duty programs after a cumulative trauma injury is an example of which level of prevention?a. Primary preventionb. Secondary preventionc. Tertiary prevention

d. Assessment

ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability.

Which activity would be the primary role of an occupational health nurse?a. Caring for employees and their familiesb. Providing health promotion and emergency carec. Updating the Material Safety Data Sheets

d. Reporting communicable diseases

ANS: B
The customary role of the occupational health nurse extends beyond emergency treatment and prevention of illness and injury and also includes the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce health-related costs in business.

Which is the best method an occupational health nurse can use when assessing workplace hazards?a. Review incident reports.b. Walk through the worksite.c. Interview key employees.

d. Read the Standard Industrial Classification Code.

ANS: B
One of the best methods an occupational health nurse can use in assessing workplace hazards is to walk through the worksite.

Which was the first legislation that specifically required certain prevention programs for workers?a. Occupational Safety and Health Act (OSHA)b. National Institute for Occupational Safety and Health (NIOSH)c. Mine Safety and Health Act

d. Standard Industrial Classification (SIC) Code

ANS: C
The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required certain prevention programs for workers.

Which types of industries are noted for high degrees of hazards associated with the work?a. Data entry, animal rescue, and hospiceb. Engineering, science, and laboratoriesc. Manufacturing, mining, and agriculture

d. Aeronautics, plastics, and nursing

ANS: C
Even though these are known for high degrees of hazard, no worksite is free of occupational health and safety hazards.

The most disabling occupational condition reported in 2005 was:a. Cuts and puncturesb. Fracturesc. Bruises

d. Sprains and strains

ANS: D
In 2005, sprains and strains were by far the most frequent disabling conditions, accounting for 40.7% of the cases of days away from work.

Which work-related hazard may be encountered by all workers?a. Workplace stress leading to hypertension and cardiovascular diseaseb. Asbestos, plastics, lead, and solvents leading to dermatitisc. Cement dust and metals leading to bronchitis

d. Hormones and nitroglycerine leading to reproductive effects

ANS: A
All the other answers are specific to certain occupations and jobs.

Which would be considered agents in the epidemiologic triad?a. Flexible management styles of the authoritiesb. Temperature extremes and crowdingc. Susceptible human beings

d. High-risks groups of individuals

ANS: B
Temperature extremes and crowding are agents.

In the epidemiologic triad, an example of a host factor would be:a. Crowdingb. Shift workc. Worker’s family

d. Chemical exposure

ANS: C
Crowding and shift work are environmental factors, and chemical exposure is the agent factor.

Which population is at greatest risk for experiencing work-related accidents with subsequent injuries?a. Workers of childbearing ageb. Workers with less than 1 year of experiencec. Workers with diminished sensory abilities

d. Workers with chronic illnesses

ANS: B
New workers with less than 1 year of experience on the current job are at greatest risk for experiencing work-related accidents with subsequent injuries.

A worker who has a health reaction to “safe” low-level exposures is experiencing:a. An allergic reactionb. A compromised immune systemc. Hypersusceptibility

d. Malnutrition

ANS: C
A worker who has a health reaction to “safe” low-level exposures is experiencing hypersusceptibility.

Which statement about chemical agents is accurate?a. Chemicals are not ordinarily found in the body tissues of the general population.b. Most chemicals have been studied to determine the effects of exposure on humans.c. Chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk.

d. Human effects of chemical exposure are associated with single agents rather than with the interaction of agents.

ANS: C
It is true that chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk.

An occupational health nurse has conducted a walk through assessment and has identified potential hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard?a. Bacteriab. Aerosolsc. Noise

d. Burnout

ANS: C
Controlling physical agents, such as noise, can usually be accomplished through engineering strategies and personal protective equipment. It is much harder to change biological agents (bacteria), chemical agents (aerosols), and psychosocial agents (burnout).

An employee has come into contact with a biological agent. The occupational health nurse recognizes that a biological agent:a. May cause accidents in the work environmentb. Is commonly found in the agriculture industryc. May potentiate stress in the workplace

d. Indicates exposure to bacteria, viruses, fungi, or parasites

ANS: D
Biological agents are living organisms whose excretions or parts are capable of causing human disease, usually by an infectious process. Biological hazards are common in workplaces such as health care facilities and clinical laboratories where employees are potentially exposed to a variety of infectious agents, including viruses, fungi, and bacteria.

Slippery floors are an example of which type of hazard?a. Enviromechanicalb. Physicalc. Chemical

d. Psychosocial

ANS: A
Slippery floors cause or potentiate accidents, injuries, strain, or discomfort.

An occupational health nurse refers an employee to an employee assistance program. Which problem will most likely be addressed?a. Obesityb. Smokingc. Alcohol abuse

d. Lack of exercise

ANS: C
Employee assistance programs are designed to address personal problems such as marital/family issues, substances abuse, or financial difficulties.

Why would a nurse conduct an occupational health assessment?a. It is required by the Occupational Safety and Health Administration (OSHA).b. It is required by the National Institute for Occupational Safety and Health (NIOSH).c. It helps to identify agent and host factors that place employees at risk.

d. It helps to educate workers about potential hazards.

ANS: C
The reason to obtain an occupational health assessment is to identify agent and host factors that place employees at risk.

What is the purpose of the Occupational Safety and Health Administration?a. To educate occupational health and safety professionalsb. To identify and research occupational health and safety hazardsc. To distribute research findings relevant to occupational health and safety

d. To educate employers about occupational health and safety

ANS: D
OSHA educates employers about occupational health and safety.

What is the purpose of the National Institute for Occupational Safety and Health?a. To examine potential hazards of new work technologies and practicesb. To educate employees about environmental risks and hazardsc. To develop and maintain a database of work-related deaths

d. To set standards that regulate workers’ exposure to potentially toxic substances

ANS: A
The National Institute for Occupational Safety and Health examines potential hazards of new work technologies and practices.

Which item found in the workplace would require a Material Safety Data Sheet (MSDS)?a. Hand soapb. Eye gogglesc. Aprons

d. Earplugs

ANS: A
Eye goggles, aprons, and earplugs are not toxic agents and therefore do not need an MSDS.

Which is a requirement of the Superfund Amendment and Reauthorization Act (SARA)?a. Applying stricter rules to determine Superfund sitesb. Sharing written disaster plans with key resources in the communityc. Authorizing each industry to write their own disaster plan

d. Evaluating the effectiveness of a written disaster plan

ANS: B
SARA requires that written disaster plans be shared with key resources in the community.

Which action would an occupational health nurse take while involved in disaster planning?a. Assess for possible disasters.b. Prevent injuries and death of workers.c. Store Medical Data Sheets in a safe place.

d. Collaborate with government authorities to plan disaster management.

ANS: B
The occupational health nurse is a key player in occupational disasters.

An occupational health nurse working in an occupational health and safety program is likely to provide which services? Select all that apply.a. Health/medical surveillanceb. Health screeningc. Case management

d. Job task analysis

ANS: A, B, C, D
An occupational health and safety program may include health/medical surveillance, health screening, case management, and job task analysis.

An occupational health nurse has become a member of the American Association of Occupational Health Nurses (AAOHN). Why would a nurse join this organization? Select all that apply.a. To promote the health and safety of workersb. To lobby in Congress for safer work placesc. To advance the profession by supporting research

d. To promote and provide continuing education in the specialty

ANS: A, C, D
AAOHN does not lobby in congress for safer work places.

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