SHE
Management System
Safety, Health and
Environmental Guidelines
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These guidelines have been written with the intention of providing non medical personnel, who are responsible for interviewing and recruiting staff, with basic information on how the presence of a medical condition will affect a prospective employee’s ability to undertake the role for which they are being considered.
Decisions on placement must depend on many factors, and with the vast array of medicines that are being prescribed along with the many different conditions which exist it would be impossible to publish guidelines which cover every eventuality. Even nurses and physicians, who have spent many years in the field of Occupational Health, will occasionally be faced with some obscure syndrome, or medication, they have not encountered before. They then need to rely on their experience and seek further advice from colleagues before making suitable recommendations on placement of job seekers.
It is hoped these guidelines will cover the majority of common conditions, be a source of reference and be of some assistance to the interviewers when considering applicants with known medical conditions.
In many cases the presence of a medical condition may not exclude a candidate completely from employment, but may require a modification of some kind in the tasks he/she would be expected to undertake. It should also be remembered that many chronic conditions would affect an individual differently, as they get older, or as the disease progresses. These people will need to be monitored from time to time to ensure they can still cope with the demands of the job without adversely affecting their health.
Health and Safety at Work Act 1974 clearly defines employer’s responsibilities to the workforce. Under section 2 the employer has to ensure, ‘so far as is reasonable and practicable’, the health and welfare of all his employees, and must avoid putting at risk the health and safety of others through his work activities. The act does not refer specifically to disabled employees, but applies equally to all employees, whatever their health status.
Under the act the employer thus has a statutory duty to an employee with a medical condition or disability assuming that he is either aware, or ought reasonably to have known, of the employees condition. In such cases the employer should assess any problem likely to arise from the condition and make proper arrangements to avoid risks or hazards.
The act also, under section 7, imposes duties on the employee, whilst at work, to take ‘reasonable care’ for the health and safety of him and of others who may be affected by his acts or omissions. This duty could be taken to include disclosing a medical condition which he knew might have health and safety implications in the workplace although there is no legal obligation to disclose matters of heath to an prospective employer
Employment Rights Act & Unfair Dismissal
Every dismissal is presumed unfair, and it is the employer who has to prove the action was justified in each case. Under the act employees have to meet a certain criteria in order for an Employment Tribunal to hear an action for unfair dismissal, the principal criteria being continuous employment for one year in the job concerned. (The qualifying period of service is likely to be further reduced)
In defending an action the employer must show a fair reason for the dismissal and that he acted in a reasonable manner. There are five fair reasons; the most important from a health point of view is that of capability. Ill health can be judged fair grounds for dismissal if an employee, because of his heath problem, becomes incapable of carrying out his work; this could include cases where health and safety at work could be at risk. Another fair reason is illegality, if, for example the employee lost his driving licence because of a medical condition he would not be able to continue driving at work and it would be illegal to employ him as a driver.
In order to show that an employer acted in a reasonable manner before finally dismissing an employee he must be able to demonstrate that he: a) discussed the circumstances fully with the employee, b) obtained medical advice, with the employees consent either from the general practitioner, specialist practitioner or consultant, and c) offered alternative suitable employment, if available. If none of the actions were attempted it may be adjudged that the dismissal was unfair. However, if the employee refused to co-operate or refused consent for the employer to approach his doctors the decision may be judged as fair.
Similar action by the employer is also recommended if dismissal is being considered as a result of absence from work through sickness, especially if long lasting or recurrent. The factors which have to be taken into account are a) the nature of the illness, b) the likely length of absence, and c) the likelihood of a return to work in the near future. During the consultation process with the employee he should be warned of the possible outcomes and given time to improve his attendance.
Continuing irregular sickness, even with a medical certificate, may be judged a conduct issue rather than a medical one by tribunals.
Disability Discrimination Act 1995
A disabled person under the act is anyone with ‘a physical or mental impairment, which has a substantial and long term adverse effect upon his ability to carry out normal day to day activities’. An explanation of the wording used can be found in the booklet;
The Disability Discrimination Act 1995 – What employers need to know. (DL170)
The act protects those individuals whose health has been affected through conditions such as heart disease, arthritis and Multiple Sclerosis, or from accidents which may have resulted in severe disfigurement as well as physical impairment, (This list is not exhaustive).
The act applies to all employers of 20 people or more, and with the exception of: Prison Officers, Fire Fighters, Police Forces, Members of the Armed Forces, those working aboard ships and aircraft and those employees who work largely outside the UK.
Under the act an employee is expected to make reasonable adjustments to the premises or employment arrangements in order to order to reduce or remove any substantial disadvantage to a disabled employee or job applicant, and each case must be considered individually.
The PACT Officer
PACT (Placing, Assessment and Counselling Teams), who acts on behalf of the employment service, can be contacted by employers through the local Jobcentre. PACT officers are available to provide advice on the recruitment and employment of disabled persons, accessibility of the premises, and ways of developing awareness in the workplace.
The consumption of medicines continues to rise in the UK, and studies undertaken indicate the prevalence of medication will depend on a number of factors, in particular age and sex. Studies in the 80’s indicated that where more women are working more psychotropic drugs such as antidepressants, tranquillisers and sedatives would be taken. Where there are more men drugs acting on the cardiovascular system, particularly beta-blockers will be used.
For many people the fact that they take or are dependant on medicines, to control long term or chronic medical conditions, means they are to function in a reasonably normal manner and are, in fact, able to work. However, the use of medicines, for whatever reason, at work arte of concern for several reasons, namely a) The ways in which the medicines interfere with normal bodily functions, b) The effects medicines have on performance or concentration, c) Unwanted interaction between the medicine and other chemicals employees may be exposed to at work, d) The effects of a changing shift pattern upsetting consistency in drug regimes.
Effects on performance
Drugs which act on the central nervous system, are known to cause lethargy and drowsiness, and under the EU council Directive 92/27 EEC and the medicines (labelling) Amendment Regulations warnings have to be printed on the packaging of such medicines. If employees are affected this is likely to reduce their work capacity and concentration. However, there are a number of other medicines, such as the beta-blockers used for reducing blood pressure, which are commonly supplied and have the side effect of reducing stamina or causing lethargy.
Interference with normal body functions
There are a number of drugs that will have an effect on the normal functions of the body, namely in the way in which temperature is regulated and control achieved. Some groups of drugs will diminish the ability to sweat, others may impair response to cold conditions. In some cases vasoconstriction may occur leading to poor blood supply to extremities causing coldness of hands, fingers and feet, chilblains, Raynauld’s phenomenon or the development of more common ischaemic changes. There are also drugs that depress temperature regulation, making individuals dependant on their surroundings for temperature control.
Interaction with other chemicals
Many chemicals found in the workplace have the effect of increasing the rate the body metabolises substances through the liver, and studies on animals have shown this also affects the rate drugs are inactivated in the body. The importance of this is not fully understood, but it could be assumed the drugs become less effective.
Other chemicals such as degreasers, solvents and adhesives can suppress the central nervous system (CNS) causing drowsiness, these effects may increase if drugs that also suppress the CNS are being taken for therapeutic reasons.
Effects of an altering shift pattern
Many medications are designed to give a slow release of the drug over a long period of time, they are prescribed and taken in such a way as to give maximum effect when a patient most requires the beneficial effects. It could be difficult for some people to adjust the medication, or physically adapt themselves, especially when working times alter quickly as in a continental type patter, (i.e. 2 days, 2 nights, 2 afternoon shifts then rest days).
Hypnotics and Sedatives
All these drugs depress the central nervous system, and most have been shown to impair co-ordination and slow down responsiveness. When used as sleeping tablet some drugs in this group do have a residual effect the following morning.
In susceptible people there is a greater risk to their safety and the safety of others when they are driving or operating machinery.
Antipsychotics
Again these drugs may reduce responsiveness, but this will be dependant on the amount of sedation they produce. They will also interfere with the temperature regulation of the body, and may cause side effects such as tremor. As a result employees may be at risk when working in extremes of temperature, either hot or cold. Their performance may be adversely affected in relation to driving, operating machinery and performing precision work.
Antidepressants
Many antidepressants produce sedation, especially when treatment is first commenced. Tremor, blurring of near vision and interference of temperature are also side effects of these drugs. Fortunately tolerance does develop to the sedative effects.
Depending on the amount of sedation produced, and/or any side effect, the precaution and risk at work are the same as the previous group of drugs.
Antihistamines & Antisickness Pills
These drugs are well known for causing drowsiness, but the effects may vary from person to person, depending on the individual’s susceptibility and the strength of the drug. Anyone who is affected by drowsiness should be informed that their driving and ability to operate machinery is likely to be impaired, and warned of the risks.
Stimulants and Appetite Suppressants
Generally these increase risk-taking behaviour. Driving and work performance are likely to be adversely affected, especially if combined with alcohol.
Pain Relief and Anti-inflammatory drugs
The effects of the majority of the anti-inflammatory drugs are largely unknown. The more powerful pain relief tablets such as morphine produce marked sedation therefore driving and operating machinery should not be performed. Of the milder pain killer’s codeine is known to affect driving related skills. The effects of all painkillers are increased by alcohol.
Anticonvulsants
Studies into their effect have shown impairment of concentration, sustained attention, and other aspects of performance. The effects seem to be worst when two types of the drug are taken together. The importances of these effects in well-controlled persons who take single medication over a long term are unknown. Tremor can occur in some patients occasionally. Driving should be stopped if the treatments are changed.
Antihypertensive drugs
These drugs are used for lowering the blood pressure, and, generally speaking, those on long term therapy, who are well controlled should have little problems relating to work. However, side effects such as fatigue, loss of stamina, and tiredness have all been reported, if experienced this could have an adverse effect on work performance.
Most antihypertensive drugs affect blood flow to the skin and can impair the body’s response to cold conditions. Care should be exercised for the first few weeks after treatment commences.
In susceptible people beta-blockers have been known to produce bronchospasm (spasm in the airways) and this should be considered if employees are working in irritant atmospheres.
Antidiabetic drugs
All these drugs are used to reduce blood sugar, as even mild hypoglycaemia (low blood sugar) can affect performance of thought and movement. Only well controlled insulin diabetics should be allowed to drive and operate machinery.
Further advice on diabetics can be found on page 16.
Anticoagulants
The main effect of these drugs is to reduce the time it takes the blood to clot. In the majority of cases the underlying condition requiring treatment will need greater consideration with regards to the suitability of an employee for a particular task. Tasks, which carry with them a high risk of injury causing severe bleeding, should be avoided.
Eye and eardrops
Several eye drops produce blurring of vision, and would effectively reduce visual abilities required for driving or close detailed work.
In the long term the regular use of antibiotic eardrops may aggravate any effects noise may have on the ear.
Many other drugs can produce a sedation effect, and this would be enhanced by alcohol or by combining drugs together. Patients should have been warned of possible effects, and consideration given to them if they experience problems.
Ears and Hearing difficulties
A common problem to affect the ears is discharge, which mainly arises from bacterial or fungal infections of the middle or external ear. With regard to employment considerations of appearance, hygiene, the ability to wear hearing protection in high noise areas, and use of telephonic equipment need to be given. Occupations which involve work as food handlers at all stages, from processing the raw food product to retailing or catering may need to exclude anyone with active or recurring ear infections on the grounds of hygiene.
Other occupations such as diving or flying may also need to exclude individuals who are suffering from conditions, which affect the ears ability to equalise the barometric pressure within the ear. Tinnitus (ringing or buzzing in the ear), may affect an individuals performance as a result of the psychological upsets associated with the disease i.e. inability to concentrate or insomnia as a result of the intrusive sound.
Profound deafness or difficulty in hearing need not in itself be reason to exclude people from employment, especially when only slight modification of work practices need to be made in order for the individual to be able to perform the tasks required. However consideration needs to be given to the safety aspects of the job and the need to hear audible or verbal warnings. When deaf persons are employed it would be advisable to establish a system of visual warnings to accompany such devices as fire alarms etc. It may also be necessary to inform other employees of the person’s disability, but this should be done with the persons consent.
Vestibular disorders (vertigo & giddiness)
Giddiness may impact on work in one of two ways. Firstly, those who suffer from acute disorientating episodes coming on without warning may be a potential risk to themselves and others, and secondly those who are not suddenly affected by giddiness but who are liable to recurrent and unpredictable absences from work because of giddiness. In some cases giddiness may be the result, or manifestation, of a more serious disorder, which would itself have a greater impact on work. Those who suffer bouts of acute disorientating giddiness or dizziness should be excluded from occupations where there is a risk to the safety of themselves or theirs. Examples of tasks to be avoided would be :-
There are several conditions or even trauma that can result in reduced or total loss of vision. The impact this will have on performance will depend on whether the vision can be improved with corrective lenses and/or the nature of the tasks involved.
With training or modification to the work place or equipment many tasks could be performed by people with low vision standards or even by the blind, i.e. providing additional training, software on computers that use a larger font size, or just increasing the light levels in an area. In such cases each person’s needs should be assessed individually.
Short sighted people who’s vision is corrected with spectacles may not be suitable in occupations that require the use of self contained breathing apparatus because of the difficulty in maintaining a seal on the face mask. Spectacles with flat side arms may improve compatibility, but should only be used with equipment that maintains positive pressure within the facemask.
Soft contact lenses may absorb fumes and cause irritation, or even cause discomfort in extreme cold, as in cold stores, but this is likely to occur only after prolonged exposure in a cold environment. Reverting to the use of spectacles would eliminate this risk.
Some visual defects result in loss of peripheral vision (Tunnel Vision) or an imbalance between the eyes resulting in poor depth perception. Such conditions would make people unsuitable for driving, operating cranes or forklift trucks. Those suffering from or with a history of retinal detachment should avoid heavy manual work, heavy lifting or digging.
Monocular vision (Loss of sight or removal of one eye) does not exclude a person from holding a normal driving licence, however they would not meet the visual standards for LGV or PCV licences. Monocularity reduces the peripheral vision and affects depth perception, but the majority of people adjust quite well after a period of time, it would not therefore be reason alone to prohibit someone who has been monocular for many years from driving a forklift truck. In these cases a risk assessment of the area and task should be performed before allowing or refusing a driving permit. In new cases driving should be stopped until full adjustment has been made. In all cases consideration must be given to the protection of the good eye and for safety reasons it would be in advisable for them to work in an eye hazard area.
Defective colour vision occurs in approximately 8% of men and 0.2% of women, and from a practical point of view will be relevant in only a small number of occupations. Most drivers are able to identify traffic light systems with little difficulty by the sequence and contrast of the lights. Problems may occur in individuals who have gross loss of sensitivity at the red end of the spectrum where single red lights are used to mark hazards.
Particular care needs to be taken in occupations that use colour as a means of coding, i.e. electrical, metal and alloy manufacture, chemical or print and dye industries. Many of the problems however can be overcome by supplementing colour with other forms of identification such as labelling.
Several conditions of the eye are caused by infections. Whilst these usually respond well to treatment they may cause visual disturbances in the acute stages and these effects should be considered in occupations that require good visual acuity. The spread of infection may also need to be considered especially in the food industry where contamination of a product may occur.
There are wide ranges of skin conditions (dermatitis) that affect the population, but in everyday practice only a small number of these conditions will have an affect, or be affected, by work.
The presence of conditions such as eczema, psoriasis and severe dandruff may preclude those individuals from occupations within the food industry, some healthcare, and electronics industries, where contamination of the product may occur due to excessive skin flaking or exudates. There is also a potential of the carriage of secondary infection of the skin, which increases the risk of food contamination from catering staff etc. Multiple viral warts, especially of the hands, may also be unacceptable. A particular group at risk, where viral warts may become endemic, are wholesale butchers and employment should only be offered after treatment has been given.
Eczema
There are a number of causes for eczema, in general care should be taken when considering a prospective employee with a history of, or a pre-existing eczematous condition. Those individuals who suffer from eczema may well be at increased risk to the effects of irritant substances such as chromates, epoxy resins, oils and solvents. Very hot occupational environments, over dry as well as humid, may also aggravate some forms of eczema.
Psoriasis
Psoriasis affects around 2% of the adult population, and can be aggravated by physical or chemical trauma. Where the psoriasis is or has been extensive, heavy physical or emotionally stressful jobs may also aggravate it.
Orthopaedic conditions, which include injury as well as disease, form one of the largest and commonest groups of disabilities likely to be seen in individuals. They occur in both young, middle aged and elderly, and may be the result of an accident or degenerative changes in bone, joints, ligaments and muscles.
It would not be possible to discuss each and every possible case in guidelines such as these, and probably the best approach is to assess each prospective employee on his/her ability to perform the functions required in the role that they are being considered for.
When making the assessment consideration should be given to the degree that function of a limb has been affected, to the level of pain that may be present, how a condition is likely to progress and what adjustments can be made to the working environment for that individual.
In the majority of minor injuries full recovery is likely, and whilst there may be some limitation of movement initially this would improve as the person begins to get back into a normal routine.
Following more serious injuries, rehabilitation is likely to take longer, and there is always the possibility of a more permanent loss of function to some degree or other. Often individuals adapt quite well to their new circumstances and learn ways of overcoming what loss of function they may have. Some of the implications of the serious injury may have on work placement are discussed in the following sections.
This group of disorders includes the disabilities of movement such as the painful rheumatic diseases, disorders of muscles and of the nervous system. The diseases occur at various stages in life. Some are present at infancy and persist throughout life or develop during early childhood. Others occur in late adolescence or in the middle or later years of life.
There is high degree of self-selection in the first group, with the individuals having learned what they can achieve and having adapted to the disabilities that they suffer. Many perform tasks equally as well as the more able bodied, and can with assistance from employers, who are prepared to adapt the working environment, become valued members of staff.
For those in the second group, who may have already made career choices before the onset of symptoms, modification of working practices may be required, and should be reassessed as the condition progresses. Many people are able to perform their duties for many before symptoms become too severe or restrictions in movement or strength prevent normal use.
There are many forms of back conditions whish can cause acute short bursts of pain and the sufferer recovers very quickly and the chronic pain which causes prolonged suffering and prevents the sufferer from carrying out many tasks. They can be the result of injury or degenerative disease such as arthritis of the spine. Back problems should be a cause for concern especially since chronic back sufferers will have many restrictions placed on them and they will not be in a position to carry out any of the following tasks;
Most sufferers who recover from back injuries such as strains, sprains and muscular tears tend to make a full recovery and treat their backs with more care.
These are a group of work-related painful conditions that may include disorders of muscle, tendon and nerve. Often no physical abnormality is identified and the condition may represent a primary pain disorder. Early intervention with restrictions or modification of work activity in relation to forceful movements, awkward posture and repetitive movements is important in preventing chronic changes. Psychological factors may also contribute to individual susceptibility.
This is a term used to describe diseases of the nervous system. This would include any disease that would have a profound affect on any part of the brain or the spinal column. These would include, amongst many, cerebral vascular accidents (CVA or Stroke), multiple sclerosis, recovery from brain haemorrhage or operation to remove brain tumour, or any neurological degenerative disease that affects the co-ordination and speech of the individual.
Since the brain and the spinal column are responsible for conducting the way that we move and think, many issues have to be taken into consideration when identifying suitable placement for the sufferer. The most important of which is that the potential new employee would not be placed in any danger within the workplace and vice versa.
CVA or Strokes can fall into two categories, minor stroke which temporarily takes away the use of one limb and some facial paralysis and the more serious attack where the person is unconscious for a time, the subsequent recovery being a long protracted affair and typically results in permanent paralysis down one side of the body. A patient can go on to make a satisfactory recovery from either, but there would always be some limitations in the movement. A job where the applicant would have to have some degree of physical fitness would be out of the question, as would any work that involves working alone. Operating power vehicles would not be advisable; neither would work in the cold environment.
Epilepsy (convulsions) was originally separated into two different types of seizure, grand mal (full fits) to petit mal (minor fits). However the categories for each type of fit have now been renamed and are known as absences, depending on the length of time that the patient lost consciousness. A fit that was originally known as petit mal is definitely more difficult to identify, simply because the sufferer simply appears to be daydreaming and this type of lost consciousness causes little distress to the sufferer. A grand mal fit is infinitely more easy to diagnose and can be brought on by a number of things, sounds, smells, lights etc. The convulsion usually begins with the person letting out one "yell" and then proceeding into a longer period of absence, which is normally accompanied by vigorous body jerking, frothing at the mouth (occasional bleeding from the tongue) and sometimes incontinence of urine.
Following the convulsive stage the muscles relax and breathing becomes normal, the casualty usually recovers within a few minutes, but may be dazed or behave strangely in a state of "automatism" and unaware of their actions. The fit may also be followed by a deep sleep.
There is no reason why someone with epilepsy should not make a valuable contribution to the workforce. However, due to the nature of the disease, the possibility of loss of consciousness, convulsion or confusion and behavioural changes, due regard must be given to the safety of the patient and his/her fellow work-mates. Each case should be carefully assessed on its own merits.
It
would be sensible to impose restrictions on individuals with epilepsy,
Generally, driving following a seizure would not be permitted until at least one year has passed without attacks, a licence would then be granted subject to frequent review. Vocational licences would be withdrawn until the patient is free from attacks for 10 years without medication, and no longer has a continuing liability to seizure.
Other precautions for people with epilepsy at risk of sudden loss of consciousness would be to prevent working at heights or climbing, to avoid driving or operating motorised vehicles and work on dangerous unguarded machinery or near open chemical or fluid tanks. Hand held power tools should be avoided unless the power is cut when the switch is released. Avoiding areas of specific hazards such as fire, electricity or hot metals and working in isolation for long periods would also be wise.
Consideration should also be given to the medication being taken, as it is possible for shift working to interfere with continuity of therapy. Studies have also shown that sleep deprivation, as arising from regular night shift work, can precipitate seizures, as can certain flashing lights.
For practical purposes there are two types of diabetes:
Non-insulin dependant diabetes mellitus (NIDDM)
Diabetics treated with diet alone should be able to undertake virtually any occupation, although care should be exercised when extremes of temperature are a factor.
Diabetics treated with diet and tablets can undertake most occupations although they should be well controlled and not have suffered any significant complications e.g. affecting vision.
Insulin dependant diabetes mellitus (IDDM)
Some diabetics who require treatment with insulin injections are prone to sudden loss of consciousness as a result of a reduction in blood sugar levels (hypoglycaemia) although in most cases this does not cause to many problems. It would be advisable not to place such individuals in areas where they may be a danger to themselves or to others should they suffer an attack
Newly diagnosed diabetics may also find shift working difficult until their condition has been stabilised and they are able to adjust their medication to accommodate the changing work patterns.
All diabetics are required to inform the DVLA of the onset of the condition. Providing that they can demonstrate good control and recognise symptoms they would usually be allowed to hold a normal driving licence. Since 1991 new applicants for group II licences would be barred, but drivers licensed prior would then be dealt with individually and be subject to satisfactory specialists report and certification. Other vocational drivers such as taxi drivers are usually subject to the licensing authorities standards, but where there are no guidelines Group II medical standards are often applied.
The conditions of the gastro-intestinal tract that are likely to cause problems at work or increase the risk to individuals is:
The following types of work may produce symptoms in some individuals who suffer with a hiatus hernia, and possibly lead to extended periods of absence:
Frequent bending, lifting and carrying heavy or awkward loads, pulling and pushing of heavy loads, work involving stooping, crouching or working in confined spaces.
Generally people who suffer peptic ulceration can pursue any occupation, but work can be affected as a result of episodes of abdominal pain, loss of sleep and vomiting. The use of modern drugs can relieve the symptoms and improve the condition, but does not prevent further ulceration in the future.. In cases where surgical treatment has been used (where medication has failed ) up to three months absence from work may be required post operatively. There is also the possibility of post operative effects having an impact on work, and depending on the technique used these may include such symptoms as diarrhoea after eating.
Persons suffering from inflammatory conditions of the bowel, and those who have undergone surgery for bowel disease would be suitable for most work. Some individuals do experience problems during periods of increased stress, and shift working may be a problem for some. As general fatigue is a common complaint of patients with bowel disease less strenuous work may be more appropriate. The other consideration needs to be the proximity and access of facilities such as toilets etc.. Time off from work as a result of relapses is not uncommon and may vary between two and eight weeks, according to severity.
Once inflammatory bowel disease has been diagnosed and an infectious cause for diarrhoea excluded there is no reason why work in such areas as food handling should not be permitted, providing that normal standards of personal hygiene are applied.
The difficulties people with ileostomies and colostomies have at work are generally the same as those mentioned previously but, additionally, they have to contend with preventing leakage occurring from the appliance, and difficulties may be experienced with the wearing of restrictive protective clothing. Working in extremely hot environments may also be inadvisable because of the risk of dehydration.
Hepatitis A
Food handlers generally need to be clear of symptoms for several weeks after jaundice has resolved before returning to work. There is no associated chronic carrier state.
Hepatitis B
In health care workers chronic carriers with known high risk for infectivity should not be allowed to perform exposure prone procedures that would place patients at risk of transmitted infection.
The effects of chronic liver disease will vary according to severity and symptoms experienced, and each needs to be assessed individually as to any complications that may have arisen. All persons with liver disease should avoid working with toxic substances that affect liver function.
For most forms of heart disease the general rule is that activities causing no undue symptoms can be undertaken safely.
Cardiac patients will usually be self-selective about the types of occupations they apply for, and where the symptoms of pain such as angina is experienced they are unlikely to consider manual work. The majority of problems occur when heavy physical work, the need to climb up and down stairs, rapid and tight pacing of repetitive operations as encountered on assembly lines, and stress as part of the tasks performed.
Shift working may present its own problems and would be inadvisable when particular types of medication have been prescribed.
Those with high blood pressure that is under control with medication can be expected to manage most activities encountered in work.
The extremes of cold, and the use of vibratory tools will aggravate conditions that affect circulation to the limbs. Where the circulation to the lower limbs is affected this may further limit walking distance, climbing stairs etc..
Where respiratory disease is progressive, and as lung function determinates the ability to undertake work will depend on the physical demands of the job.
Consideration must also be given to the need for respiratory protective equipment, as breathing through a filter mask prove very difficult and increase breathlessness.
Heat, cold, extremes of humidity, dust or irritant gasses are also poorly tolerated by individuals with asthma, chronic bronchitis, emphysema and other chronic airways disease.
The patterns of symptoms in severe asthma may also restrict sufferers from working shift work, as symptoms can be worse by night or in the early morning.
People with impaired lung function should generally not be allowed to work with respiratory sensitisers, but it may be reasonable for those with mild or moderate asthma with normal lung function to do so with regular respiratory health surveillance.
Conditions such as urinary tract infections and renal stones are fairly common conditions in the UK, there can also be a fairly high recurrence rate. This can lead to further absence from work due to unpleasant symptoms and pain. Work in hot environments such as furnace area should be avoided because of the relative dehydration and possible risk of stone formation.
Renal failure, which requires treatment with dialysis, can have serious consequences on work. When treated by haemodialysis (kidney machine) patients must attend three times per week for four to eight hours on each occasion. For those working full time, home dialysis can be done in the evenings and at weekends. Many patients feel ‘washed out’ after treatment and this can last into the following day, which will affect work performance.
Another method of dialysis known as Continuous Ambulatory Peritoneal Dialysis (CAPD) has to be performed three to four times daily and takes about thirty to forty minutes to complete, this can be performed at the workplace providing a suitable area can be found.
The main problems encountered are fatigue and the tendency to tire quickly, this makes demanding and heavy manual work unsuitable. Shift working and long hours may also present problems as they require greater adaptation and would best be avoided.
For the majority of patients who receive kidney transplants normal return to work would be expected, but they should avoid the possibility of blows or trauma to the lower abdomen, as there is a requirement to protect the area of the transplant. Health care workers may also have an increased susceptibility to acquired infection from contact with cases of TB., chicken pox etc..
In recent years the advances in chemotherapy as treatment for malignant blood diseases such as leukaemia, has led to an increase in the number of patients going into remission, which can last for a considerable time. Generally speaking a complete remission is said to have occurred if no abnormal cells can be detected, and the blood count is within normal limits. During this complete remission there is no reason why any patient cannot return to any form of employment. In some cases absence from work can occur as the result of infections developing as a result of immunosuppression.
Haemophiliacs should be considered individually as many are capable of undertaking the majority of tasks. Several affected patients are best suited to sedentary jobs such as office or clerical work, and should avoid heavy manual labour because of the risk of injury or bleeding occurring into the joints and deep tissues.
The factors influencing a return to work following abdominal surgery and hernia repair include wound strength, size of scar, presence of infection and continued pain or numbness of the area.
Many surgeons and doctors have their own views on how long patients require for recuperation, but for the majority of simple cases four to six weeks appears to be the average. More complex or serious operations may require three to four months before full recovery and a return to manual is considered. However this is often influenced by the patient’s own attitude and motivation, or the occurrence of complications.
Provided the patient has been prescribed fit by his general practitioner the individual’s suitability for employment should be accepted, but specific consideration may need to be given to particular aspects of the work that may not have been anticipated in pronouncing fitness.
When considering anyone with a history of a psychiatric disorder of any description consideration should be given to the past frequency, severity and length of attacks. Also past behaviour at work should be explored, references and statements from previous employers can be invaluable for this purpose.
An applicant should not be refused employment simply because of a psychiatric illness. If depression or anxiety has been caused by worries over employment or finances a more secure job may well improve future health.
Placement should involve consideration of potential risks of sudden changes of mod and concentration, or the effect medication may have on behaviour.
It can often be very difficult at interview or during baseline screening individuals who have a dependency on alcohol or drugs. Unless there are associated diseases present as a result of abuse, such as tremor, conjunctivitis or the smell of alcohol, problems often become evident only after a period of time and observation, usually after placement has been made.
It is therefore important that employers have good alcohol and drugs policies in place, and that all employees and prospective candidates are aware of the consequences of substance abuse and how it will affect their continued employment.
The issue of Occupational Health in relation to the effects of work on health or the effects of health on work is a very complex subject and not one that can be referred to inexperienced individuals. As previously mentioned there can be many factors and variables to be considered in both the condition and the tasks involved, there are also the legal issues that need to be considered when looking at suitable placement of employees or prospective employees.
Employers will frequently require advice from experienced medical and health care practitioners, who in turn may need to contact specialist practitioners, before making a final judgement. It may well be in the employers best interest to remain unaware of the presence or absence of medical conditions in selecting applicants for employment as they cannot then be knowingly discriminating on medical grounds and infringe the Disability Discrimination Act where this applies.
The use of an occupational health service in advising on any restrictions on medical fitness to work after selection of suitable applicants is recommended. An employer with some limited medical information apparently not selecting an applicant for medical reasons would do so a at considerable risk of subsequent litigation, and such action may not be deemed reasonable where access to an occupational service is already available. An employer would also be expected to make reasonable adjustments or restriction to work activity if subsequently advised to do so.
Reference:
Copyright South West Occupational Health Services 2002 Prepared by: South West Occupational Health Services Stanhope Gig The Old Coach House, Upottery, Devon EX14 9PN Issued: December 2000 Re issued: March 2002 Revision: #9; 02 | ||||||||||||||||||||||||||||||||||||||||||||||
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Revised: December
01, 2004. |
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