PHYSICAL FACTORS

Tri Hari Irfani, M.D., M.P.H.

 Objectives:
• To know the definition of physical agents
• To identify the physical agents as risk factors in the work
and work environment
• To explain the main effects of physical hazards on health
• To know, roughly, the threshold values of physical hazards
• To recognize the main occupational diseases because of
physical hazards exposure and to know when to refer the
patient to an occupational physician
• To explain the specific role, tasks and responsibilities of the
occupational health services and occupational physician at
the workplaces with physical hazards exposure (prevention,
treatment)
Which are the physical agents?
• Noise
• Vibrations
• Temperature
• Lighting
• Radiations
• The 5th European Working Conditions Survey
shows that the physical hazards have
remained a problem for the European workers
in the last few years.
 Which are the main
characteristics?
• We cannot see
• We cannot touch
• We can feel them by the neuro-sensorial
organs (except radiation)
• We can measure them in the occupational
workplace/environment
• We cannot measure them in the human body
(except ionizing radiation)
 Which are the effects?
Worker
- occupational diseases
- occupational related
diseases
- accident of work

Source • Time of exposure

• Level of exposure
Workplace
- days of incapacity of work
- a new worker
- risk insurance
 How can we protect ?

Source Worker

I. Reduces the PA at
the source
Eg:
- isolation
- change the device
 How we can protect ?

Source Worker

II. Reduce
exposure time

Increase the
distance
 How can we protect ?

Source Worker

III. At the Worker Level

E.g.:
- isolation (special
cabin)
- individual equipment
protection
 What is the Role of the OH
Physician?
Identifies the
physical hazards

Screening at
Prevention
pre-employment

Monitoring health
OH physician Periodical
examination

First aid
Treatment
specific/supportive
 Noise
• What is noise?
– a group of unwanted or/and wanted sounds which
produce an unpleasant hearing sensation,
sometimes disturbing, which impede
communication
– an annoying sound
• The perception depends on the listener and the
circumstances (e.g. rock music can be pleasant for a
person, but uncomfortable in a surgery room).
 What is occupational noise?
• a complex of sounds, of variable intensities
and pitches, having different characteristics,
rhythmic or rhythmless, produced
continuously or discontinuously by machines,
tools, devices, means of transportation, the
human voice, etc, during the performance of
the professional activity
 Characteristics of sounds
Frequency
the level of the sound
= the peach of sound
or the sound pressure
Hertz
High pitches>3000 Hz
Low pitches<500 Hz
E.g. the woman’s voice
and the man’s voice
500 and 2000 Hz are
the most important
for understanding
speech
3000 Hz and 4000 Hz are the
first to be affected by noise
Intensity = Loudness =
the subjective human
response to sound
dB dependent on sound
pressure and, then, on
frequency
“0” dB does not mean the lack
of any sound, but a sound level
where the sound pressure is
equal to that of the reference
level which corresponds to 0.02
mPa.
E.g. if the noise produced by a
machinery is 97 dB (A), when
doubling the source of noise (if we
have 2 identical machineries), the
noise will increase by 3 dB, it will
not be doubled!
 What is the Threshold Limit Value?
• The Threshold Limit Value (TLV) depends on the work
specificity (International Standard, ISO 1999-1990).
• The Law establishing this is the Directive 2003/10/EC
of the European Parliament and of the European
Council.
• This directive is to be transposed into the national
legislation of all Member States.
• In the European countries the maximum admitted
values (Leq - weekly equivalent acoustic level) at the
workplace with normal neural-sensorial solicitation
are between 85 and 90 dB (A).
 What are the Health Effects?

http://www.hse.gov.uk/noise/vid
eo/hearingvideo.htm
 What are the Health Effects?
Auditory Non-auditory
Acute : • sleep disturbances
• tinnitus • general effects
• acoustic trauma (cardiovascular, metabolic
changes)
Chronic: • behavioural effects
• hypoaccousia
• Noise Induced
Hearing Loss (NIHL)
The audiogram - records both ways of sound
transmission: air and bone conduction

Normal audiogram
NIHL
 Treatment
1. Ceasing the exposure to noise and other
toxic substances (Hg, SC2, toluene,
Gentamycin, Kanamycin etc)

2. Medication: antioxidants, vitamins

3. Hearing aids in severe cases

 How can we protect from noise?
Technical and organizational measures

Source Worker

I. Reduces the N at III. At the worker level

II. Reduce
the source E.g.:
exposure time
E.g.: - isolation (special cabin)
- isolation - individual equipment
Increase the
- change the device protection (ear plugs or
distance
ear muffs)
 How can you protect from noise?
Medical measurements
• Pre-employment examination
• Periodical examinations
– Audiometric testing
• Risk assessment
• Risk management
 Ultrasounds and infrasound
Ultrasounds > 20000 Hz Infrasound 1-20 Hz
= inaudible = inaudible
Where to be found? (workplaces) Where to be found? (workplaces)
• - industry (used in detecting defects, • natural sources:
cleaning of pieces etc)
– geological (earthquakes,
• medicine (ultrasounds, dental landslides, avalanches) or
scaling, therapy)
– meteorological events (storms,
• devices against thieves, pests etc tornadoes)
• artificial sources:
– industrial machines
– ventilation systems, air
conditioning
– aircraft
– rail traffic
 What are the health effects of ultrasounds and
infrasound?
Ultrasounds Infrasound
Acute effects: 18-30 kHz
• headache, fatigue at the end of Acute exposure:
the day, sleepiness during day • to intensities high enough
time, the feeling of pressure to be heard, it can
inside the ear, walking
disturbances, numbness, and
determine a decrease in
sensitivity disturbances. vigilance
Chronic effects: Chronic exposure:
• vascular disturbances, increase of • to normal levels present in
the central and skin the environment, there is
temperatures, hyperglycemia,
increased number of eosinophiles not enough evidence
 Vibration
• Vibrations are the mechanical oscillations of an object
reported to an equilibrium point.
• Vibrations enter the body through the organ in contact with
the vibrating equipment. There are two situations:
– the hand-arm vibration exposure, when a worker operates
hand-held equipment such as a chain saw or jackhammer,
the vibrations affect the hands and the arms;
– the whole body vibration exposure, when a worker sits on
a vibrating seat or stands on a vibrating floor, the
vibrations exposure affect almost the entire body.
 How do you measure vibrations?
• The measurement of vibrations is made with a
special device and the established parameter
according to legal standards is the
acceleration
Whole-body Vibration Meter
Indonesia – Law and Regulation
Permenaker nomor 5 Tahun 2018 tentang K3
Linkungan kerja
What are the workplaces with vibrations?

• Mining, constructions, forestry work, car

driving (tractor, excavator, and bulldozer),
helicopter, etc.

• Sources of vibrations: pneumatic tools, chain

saw and other vibrating tools.
 What are the health effects?

Hand-arm vibration Whole body vibration

exposure exposure

20-500 HZ < 20 Hz
Target organs: Target organs:
- blood vessels of the fingers - organs of the abdominal cavity
- sensitive nerves of the hand - circulatory system
- bone-muscle-articulation - vertebral column
- structures of the hand-arm system - nervous system
 What are the health effects?
Hand-arm vibration Whole body vibration
exposure exposure
Vascular changes: Motion sickness: (0,1-2 HZ)
- Vibration – Induced White Finger (VWF) Gastro-intestinal disorders: (4-8 Hz)
- Hand – Arm Vibration Syndrome (HAVS) Circulatory disorders: (4-8 Hz)
- Carpal Tunnel Syndrome Visual disorders: (5-20 Hz)
Neurological changes: Osteo-musculo-skeletal disorders:
- night numbness, tactile sensitivity - especially back pain with disc or
decrease, alteration of the superficial arthrosis modifications
thermal pain sensitivity
Osteo-musculo-skeletal disorders:
-cysts at the carpal bones
-Osteoarthritis of the metacarpal- trapeze
bone articulation
-Kienbock disease (aseptic necrosis of the
semilunar bone)
-Dupuytren disease (retraction of the
superficial palmar aponevrosis)
 Laboratory investigations

Hand-arm vibration Whole body vibration

exposure exposure
Cold provocation test Bone X ray (lumbar vertebral column)
Vascular Doppler test RMN
Infrared thermograph test Biological investigations
Vibration perception test Gastric examination
Renal examination
Other investigations:
- Bone X –ray
- Biological
Treatment
• Cessation to vibrations exposure
• Symptomatic treatment
Medical prevention
• Pre-employment examination
• Periodical medical examination
• Increased caution for people with
cardiovascular diseases and musculo-skeletal
disorders
 How can we protect from
vibrations?
Technical and organizational measures

Source Worker

I. Reduce the V at the II. Reduce exposure time III. At the worker level
source E.g.:
E.g.: Avoid exposure to cold - individual protection
- Design an equipment (special gloves)
ergonomic tool to Vibration damping
attenuate the V system
- Change the device
 Radiation
What do we know about radiation?
• Radiation is a complex process through which
the energy emitted by a source is transmitted
through different media and then absorbed by
a support.
• According to the ionizing capacity of the
matter, we have ionizing and non-ionizing
radiation.
Visible Light

Enough energy
to produce
ionization
 Classification according to the
ionizing capacity of the matter
Ionizing radiation Non-ionizing radiation
Electromagnetic: Electromagnetic fields
- X rays Infrared (IR)
- Gamma rays Ultraviolet (UV)
Visual radiation (V)
Corpuscular : Laser
- Alpha particles Microwave
- Beta particles
- Neutrons
 Characteristics of radiation

Source Energy
deposit

Transport
The first interaction
 Ionizing radiation
How can we measure radiation?
The radiation dose is the most important measure from the
medical point of view. The radiation dose can be expressed as:
• Absorbed dose (D) - the amount of energy absorbed per unit
weight of the organ or tissue;
- measured in Gray (Gy).
• Equivalent dose (H) - Absorbed dose in Gy multiplied by a
weighing radiation factor (WR) which expresses the biological
effectiveness of radiation;
- measured in Sievert (Sv).
The equivalent dose takes into consideration the radiation type, because
the equal doses of all types of ionizing radiation are not equally harmful.
Effective dose (E) E = T wT.HT where wT.= weighing tissue/organ factor
and HT = equivalent dose in tissue/organ
 What are the limits of exposure to
radiation?
• The Threshold Limit Values (TLVs) published by the ACGIH
(American Conference of Governmental Industrial Hygienists)
are:
– 20 mSv - average annual dose for radiation workers, over
an average of five years
– 1 mSv - annual dose limit recommended for general public
(ICRP - International Commission on Radiological
Protection)
• The risk of radiation-induced diseases depends on the total
radiation dose that a person receives over the time.
Where we can find ionizing radiation?
Sources of radiation:
• natural (85%): cosmic, the natural radioactivity of the earth,
the natural radioactivity of the air (Radon), the natural
radioactivity of the water, vegetation, and food;
• artificial (15%): medical, occupational, and from other
sources such as: industrial, nuclear research, nuclear accident
(Chernobyl, Fukushima).
Workplaces: the medical sector (X-ray examinations ~
1mSv/year, nuclear medicine ~ 1-2mSv/year), research
(operating accelerators ~ 4-5mSv/year), industry (industrial X-
ray examination, radioisotopes production, manufacturing of
luminescent products), nuclear industry, natural sources
(Radon in the uranium mining activity, the cosmic radiation
during plane flights).
 What are the Health Effects?
TYPES OF
EFFECTS

CELL DEATH CELL

BOTH
TRANSFORMATION

DETERMINISTIC STHOCASTIC
Somatic Somatic and hereditary ANTENATAL
Clinically attributable in individual Epidemiological attributable in large Somatic and hereditary
exposure population Expressed in the foetus,
E.g. acute radiation disease, burns E.g. cancer, mutations newborn or descendants

Existence of a threshold
(under this, no observable No threshold
effects) Probability of the effect
Severity increased by dosage increases by dosage
 Radiosensitivity (RS)
High RS Medium RS Low RS
Bone marrow Skin Muscles
Spleen Mezodermic Bones
Thymus tissue of organs Nervous system
Lymphatic (e.g. liver, heart,
nodules lung etc)
Gonads
Crystalline
Lymphocytes
 Clinical Aspects
ACUTE CHRONIC

GENERAL GENERAL
• Radiation Acute Syndrome • Chronic radiation disease
(RAS)

LOCAL LOCAL
• Acute radio dermatitis • Chronic radio dermatitis
• Eye impact • Skin cancer
• Infertility
 Treatment
In case of over-exposure:
• Identify the affected people, select, isolate and
monitor them
• Proper protection of the personnel involved in the
rescue and in the research !!!
• Reconstruct the accident through physical and
biological measurements and clinical data
• Symptomatic treatment (antivomitives, sedative
drugs, etc)
 How can we protect from ionizing
radiation ?
Technical and organizational measures
• Increase the distance from the source
• Reduce exposure time
• Protect exposed people
Fundamental concepts of radioprotection:
• Justification
• Optimization
• Dosage limitation
How can we protect from ionizing
radiation ?
Medical measures
- blood count !!!
- nucleoli test
- ophthalmological examination
- psychological test
 Non-ionizing radiation
• Non-ionizing radiation: electro-magnetic
fields, infrared, ultraviolet (UV), visual
radiation, laser, microwave

• How do we measure non-ionizing radiation?

Measure unit: frequency – Hz (cycle/second),
wavelength – λ (m)
 Non-ionizing radiation
Ultraviolet Visible Infrared
Source Natural: sunlight Natural: sunlight Natural: sunlight

Artificial: welding Artificial: electric Artificial: any

activities, cutting with lamp, lamps with object with
plasma, laser with UV, high intensity, temperature
incandescent metals, flashes, laser, higher than 0
lamp with Hg vapours, video terminals, degrees absolute
etc etc

Microwave radiation and radiofrequency wave

Source: in radio communications, industry (heating), drying, hardening of
metal, food sterilization, display screen, in medicine (diathermy)
Very low frequency radiation (<200Hz, especially 50-60 Hz) include
the frequencies used for the high voltage electric lines and the domestic
electric lines
Laser (Light Amplification by Stimulated Emission of
Radiation)
Source: cutting of metals, plastics, in communications, in medicine
 Non-ionizing radiation
What are the Health Effects?
• Two types:
- thermal effect
- non-thermal effect (genetic, phototoxic, and photo-allergic)
• Main affected organs: - eyes (Laser exposure)
- skin
• Clinical effects of exposure to very low frequency are very
controversial. Research has focused on possible carcinogenic,
reproductive, and neurological effects. Other suggested health
effects include cardiovascular, brain, behaviour, hormonal and
immune system changes.
 Non-ionizing radiation

Treatment:
• Restriction or cessation to the exposure
• Specific treatment of the eye and skin lesions
 Non-ionizing radiation
How can we protect from non-ionizing
radiation?
• Medical measures
People having mechanical or cardiac implants
are not allowed on/ around electromagnetic
fields !!!
• We can not employ people with:
– eye conditions
– central nervous system condition
– cardio-vascular condition
– skin diseases
 How can we protect from non-
ionizing radiation?
Technical and organizational measures

Source Worker

II. Reduce exposure time III. At the worker level

E.g.:
Increase source - individual protection
distance equipment (proper
clothing, special eye
Use protective shields protection)
- protection cream
 Lighting
• What do you know about lighting?
• Light is a key element for our capacity to see
and it is necessary to appreciate the form, the
colour and the perspective of the objects that
surround us.
• Light or visible light is electromagnetic
radiation that is visible to the human eye, and
is responsible for the sense of sight.
• Good lighting implies:

– uniform illumination
– optimal luminance
– no glare
– adequate contrast conditions and use of correct
colours as detail and background
– absence of stroboscopic effect or intermittent
light
 How do we measure lighting?
• The device for measuring lighting is the lux meter.
• The measuring unit for lighting is “lux”
(luminance) i.e. the luminous flux per unit area at
any point, on a surface exposed to incident light.

• Legal framework: according to the European

legislation
• A good lighting level is necessary to be sufficient
(at least equal with the specific values)
 What are the sources and workplaces?
• Sources: natural: the sunlight,
artificial: lighting by incandescence,
fluorescence, high-pressure sodium or mercury lamp,
low-pressure sodium or tungsten lamp, mixed
lighting (i.e. natural and artificial).
• The sunlight is composed of: 40% visible radiation, 59%
infrared visible radiation, 1% ultraviolet visible radiation.
• Workplaces: agriculture, constructions, sailing
activities, foundries, office work.
• Professions: workers in outdoor activities in summer
and winter, inside activities with visual solicitation
(jeweler, watchmaker, etc).
 What are the Health Effects?
Poor lighting may affect the workers'
Health Performance
• Visual trouble (visual • Errors
fatigue, tearing, and other • Accidents
visual problems)
• Fatigue
• Headache
• Musculoskeletal disorders
 Treatment
Workplace Worker

Solving the technical problems Against visual disorders:

of inadequate lighting: - ophthalmologic eyewash,
- type of light vitamins, protection or
- position correction glasses
- distances Against fatigue:
- organization of work - vitamins
- 10 minutes breaks every 1 hour - antioxidants
(e.g. fine, very fine, computer Against MSD:
work) - physiotherapy
- swimming
- NSAID

It is recommended to use natural lighting!

 How can we prevent the effects of poor
lighting?
Technical measures
• For good lighting it is necessary to have an
ergonomic organization of the workplace and
to take into consideration:
– the precision required for the performed tasks
– the amount of work
– the mobility of the worker
– the characteristics of the workplace (windows,
type of lighting and the season)
How can we prevent the effects of
poor lighting?
Medical measures

• Monitoring the visual capacity of employees

before employment and after that, through
periodical examination (usually, a screening
examination per year).
 Microclimate (cold and warm climate)

• The microclimate is characterized by:

- temperature (dry)
- relative humidity
- air current speed
- surface temperature
- caloric radiation
• Very cold and very hot temperatures could be
dangerous to health.
 Temperature action and worker
reaction
Cold/warm • Temperature
• Air movement Worker
environment • Humidity

• Proper insulation (protective

clothing)
• Physical activity
• Controlled exposure to cold or
warm
 How do we measure temperature?

• Measuring device: globe thermometer

• Measuring unit: temperature in degrees
Celsius or Fahrenheit
• Legal framework: according to the European
legislation
 Heat environment
• What are the workplaces with warm/hot
exposure?
Outdoor occupations, such as: constructions, road
repairing, open-pit mining and agriculture - summer
sunshine being the main source of heat.
Inside occupations, such as: foundries, steel mills,
bakeries, smelters, glass factories, and furnaces -
extremely hot or molten material being the main source
of heat; in laundries, restaurant kitchens, and canneries,
high humidity adds to the heat burden.
 Heat environment
• What is acclimatization?
• The temporary adaptation of the body to work in heat
conditions and to which a person is exposed over time.
• Complete heat acclimatization generally takes 6 to 7
days, but some individuals may need longer.
• When a person gets acclimatized, the central
temperature decreases with up to 1 degree Celsius and
the cardiac frequency decreases with 10-14
beats/minute, compared to a non-acclimatized person in
the same conditions.
• This is a consequence of the increased sweating process
and a good vaso-motor control.