2018-健康管理手册：解决水泥行业的职业暴露（英文版）-2mb

Cement Sustainability Initiative (CSI) Health Management Handbook Summary

Core Content

This document outlines the Cement Sustainability Initiative (CSI)'s recommended good practices for managing health risks from occupational exposure to dust, respirable crystalline silica (RCS) and noise in the cement industry. It serves as a comprehensive guide for CSI member companies to implement proactive health management strategies that go beyond legal requirements.

Main Objectives

• To protect employees by promoting appropriate health management practices.
• To foster a common approach to occupational exposure management across the industry.
• To ensure compliance with health, safety, privacy, and discrimination laws.
• To support the implementation of good practices in all activities, including those under acquired companies, within five years.

Scope

• Applies to all business sectors related to the building materials part of CSI member companies.
• Defines reporting responsibilities based on management control:
  • Controlling shareholders (more than 50% shareholding) are responsible for full reporting.
  • In joint ventures, only the company with health and safety management responsibility should report.
  • If a controlling shareholder is not a CSI member, minority CSI members are not required to report.

Understanding Hazards and Management Tools

• Dust and RCS: Can lead to COPD, pneumoconiosis, and silicosis, a progressive lung disease.
• Noise: Can cause progressive hearing loss, with high-peak impulse noise leading to acute and permanent damage.
• Four key pillars of health management:
  1. Identification of high-risk areas.
  2. Assessment of personal exposure.
  3. Selection of control techniques.
  4. Design of adequate medical surveillance.

Dust, Respirable Crystalline Silica and Noise

4.1. Identification of Critical Areas

• All potentially risky areas should be identified using reference levels for dust and noise.
• Critical areas should be marked with signage indicating the required personal protective equipment (PPE).
• Non-quantitative assessments are not sufficient for accurate exposure evaluation; quantitative measurements are essential.

4.2. Assessment of Personal Exposure

• Phase 1: Identify employees at risk based on job type and exposure levels.

• Phase 2: Cluster employees into homogeneous exposure groups (HEGs) for more efficient monitoring.

• Phase 3: Perform quantitative exposure measurements within each HEG, with the average exposure level (logarithmic for noise) used to determine the risk level.

• Dust monitoring: Involves personal sampling over a full shift.

• Noise monitoring: Involves sound pressure level integration and exposure duration analysis, with prior consultation with occupational physicians.

4.3. Good Prevention Practices

• Adopt the hierarchy of controls to reduce exposure:
  1. At source: Through material selection, low-emission equipment, and de-dusting systems.
  2. At workplace: Through technical measures like sound insulation, automated production, and dust control systems.
• If control measures are not feasible, PPE and organizational changes (e.g., reducing exposure time) should be implemented.
• Recommended PPE includes:
  • Respiratory masks (minimum FFP2 standard).
  • Hearing protection (minimum 25 dB SNR).
• Training is required for all employees and third parties on the correct use of PPE.
• Face fit tests and comfort checks are strongly recommended for respiratory and hearing protection respectively.
• PPE must be stored properly to ensure continued effectiveness.

4.4. Personal Protective Equipment (PPE)

• Respiratory masks:
  • Must meet national or international standards.
  • Surgical masks are not suitable.
  • Masks should not be used in environments with dust concentrations higher than 30 times the occupational threshold.
• Hearing protection:
  • Must meet national or international standards.
  • Provide minimum 25 dB SNR attenuation.
  • Regular face fit tests and comfort checks are required.
• PPE management:
  • Ensure clean, dry, and secure storage.
  • Conduct periodic checks to ensure proper use.

Health Surveillance Protocols

5.1. General Considerations

• Health surveillance is a key element of the health management system.
• Should be proactive, conducted before symptoms appear.
• Must be aligned with international standards and scientific knowledge.
• Based on ILO Convention 161, health surveillance should be regular, risk-based, and confidential.

5.2. Protocol for Workers Exposed to Dust and RCS

• Frequency of controls:
  • Employees with no symptoms should be checked every three years.
  • In high-exposure environments, more frequent check-ups are recommended.
• Medical history (anamnesis):
  • Include occupational history, pulmonary diseases, smoking habits, and family history.
• Medical examinations:
  • Spirometry with FVC, FEV1, and FEV1/FVC ratio.
  • Thorax percussion, lung auscultation, and X-ray (only in specific cases).
• Actions following results:
  • If respiratory function worsens, or COPD/silicosis is diagnosed, further action is required.
  • If silicosis is detected, investigation into joint or kidney damage should be considered.
  • Employees with pre-existing pulmonary conditions may be advised to seek alternative work.

5.3. Protocol for Workers Exposed to Noise

• Frequency of controls:
  • First inspection within six months of employment.
  • Follow-up every one year, then at intervals adapted to risk.
  • Intervals should not exceed three years.
• Medical history (anamnesis):
  • Include noise exposure, previous hearing issues, ototoxic chemicals, use of hearing protection, and noise exposure outside work.
• Medical examinations:
  • Audiometry following national guidelines.
  • Otoscopy to check for earwax, fluid, or other pathologies.
• Actions following results:
  • A check-list is provided for cases of hearing loss.
  • Ensure proper PPE use, accurate risk assessment, and effective labeling of noise zones.
  • If necessary, reassignment of employees should be considered.

Key Performance Indicators (KPIs)

• Percentage of employees working in sites where recommendations are implemented.
• Occupational Illness Frequency Rate (OIFR): Number of recognized occupational illnesses per million worked hours.

Glossary

• Lung Cancer: Exposure to cement dust does not represent a known risk for lung cancer, although silicosis may increase the risk.
• Medical Practitioner: Health professionals licensed to diagnose and treat illnesses.
• Occupational Health Service: Services established to protect workers, adapt work to their health, and maintain their well-being.
• Occupational Hygienist: Experts in identifying and controlling workplace exposure risks.
• Occupational Physician: Specialists in occupational medicine, focusing on prevention, diagnosis, and treatment of work-related health conditions.
• Personal Exposure to Inhalable Dust: Refers to the level of dust inhaled by workers during their tasks.