An occupational health nurse is working with their employer to identify and address physical agents

Publisher Summary

Occupational health includes numerous specialty fields. Occupational health nurses and physicians perform medical surveillance activities along with the diagnosis and treatment of work-related injury and disease. Occupational epidemiologists and toxicologists often provide a supporting role for occupational medicine professionals and industrial hygienists. Occupational epidemiologists provide support for assessing the incidence and prevalence of work-related diseases. Occupational toxicologists evaluate the effects of chemical agents on workplace health based on toxicology findings. These health professionals become involved in developing hazard communication information, setting safe exposure levels such as occupational exposure limits, and aiding in the assessment of the potential for work-related health effects from chemical exposure situations. The roles of these various professionals can overlap and a multidisciplinary team can become involved to address complex occupational health issues. Professionals who work in these diverse aspects of the occupational health field share the need for accessing information related to the toxicology and adverse health effects of chemicals. Many of the resources used in occupational health practice are general resources shared by other specialties in toxicology. This chapter focuses on those resources of particular interest to occupational health.

Observation

An impartial rater, such as a therapist or occupational health nurse, may observe job performance and note the variety of demands required in the cognitive and behavioral spectrum. Use of a structured format or checklist helps observers attend to key factors and to consistently record demand levels. In order for analyses to be complete, it may be necessary to observe for extended time periods or to sample time segments from different times of the day or week. Observational analysis is generally done in conjunction with other information sources (e.g., review of job descriptions, interviews) in order to guide time sampling to ensure that the review is comprehensive.

Key Points to Consider

1.

The Team Approach: health care providers such as physicians, PAs, occupational health nurses, industrial hygienists, and safety managers work together to address the prevention and treatment mission.

PAs in the workplace: PAs care for various work-related injuries such as back injuries from incorrect lifting, tendonitis of the wrists leading to carpal tunnel syndrome, muscle injuries, fractures, lacerations, and hearing loss. The preventive aspect of injuries is an integral part of occupational health care delivery. In many cases, assessing the injury and its future prevention is part of patient education at the end of the visit that may involve the safety manager.

PAs in the workplace see work-related illnesses caused by poor indoor air quality. Inadequate fresh air intake or poor exhaust systems may allow toxins, pollutants, and infection-causing bacteria or viruses to circulate in closed spaces that can lead to death or disease. Carbon monoxide from improperly vented internal combustion engines can cause asphyxiation. Other indoor pollutants such as mold, bacteria, or volatile inorganic chemicals can cause serious breathing difficulties such as asthma, bronchitis, tuberculosis, or latent problems such as cancer.

Treatment of immediate injuries and illnesses is accomplished for many workers by providers in an occupational and environmental medicine clinic. Life-threatening injuries or illnesses may be referred to a tertiary medical center.

Prevention is practiced by using surveillance and screening. Surveillance is accomplished by following a group of people identified as exposed to hazards, such as hearing conservation's annual audiogram. Screening is done by examining work groups that may have been exposed to a toxic substance, such as providing blood tests to painters or demolition crews to detect lead intoxication.

QUALITY MANAGEMENT

Quality is an elusive and enigmatic concept. How do you define quality as it relates to physical therapy clinical patient care service delivery? This fundamental question is key to successful physical therapy clinical management.

Generically, quality may best be defined simply as a subjective impression by a customer or client of the relative value of a given good or service. For physical therapy, quality of care delivered is normally measured by the subjective opinions of relevant others (e.g., patients and clients, peers, competitors, accreditation entities, educators, community leaders, media personnel, vendors, and relevant others) about the level of care along an invisible visual analog scale (with indicators of high, average, and low).

Quality is directly affected by management activities carried out by clinical managers and care professionals in particular practice settings. No managerial role, except perhaps human resource management, is as critically important to practice success as quality management.26

In terms of external oversight of quality in health care service delivery, the modifiers and definitions of quality have undergone substantial evolution and fine-tuning over the past several decades. From labels of quality assurance to total quality management to continuous quality improvement to improvement of organizational performance, quality management is just that: quality management. No person, organization, or system can ensure quality, just as no one can ensure any other outcome. What individuals, organizations, systems, accreditation entities, governmental agencies and bodies, patients, clients, and relevant others can do, however, is purposefully intervene, monitor, and make appropriate adjustments to services and products to continuously strive toward optimal product or service delivery in commercial transactions (including health care). That is what quality management is all about.

The originators of quality improvement, known worldwide in business as kaizen, are the Japanese. They have recently begun on a large scale to express self-doubt about their own continued adherence to W. Edwards Deming's quality principles43 that gave them the preeminent competitive edge in world commerce in the 1950s, '60s, and '70s. Companies such as Sony and Toyota have begun to reconsider and retool their operations to refocus on quality and the best ways to optimize it.9

For health care organizations and systems, the principal external accreditation bodies are the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission (TJC) (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]),47 and the National Committee for Quality Assurance (NCQA).48 Each has a different domain of jurisdiction that is briefly described below.

The Joint Commission (TJC) is the largest of the three aforementioned private accreditation bodies. It assesses and accredits nearly 15,000 health care organizations nationwide, principally hospitals and hospital systems, home health entities, long-term care facilities, clinical laboratories, health care staffing agencies, and assisted living centers. The Joint Commission was founded in 1951 and has as one of its stated missions continuous quality improvement in health care delivery and public safety through systematic (every 3 years) and ad hoc monitoring of health care organizational performance. Its outcomes measurement system is called ORNX. Joint Commission accreditation standards address the panoply of patient management issues, from patient care to patient rights and ethics to information management to human resources management. The global goal of Joint Commission compliance is performance improvement of member organizations through intensive focus on processes and outcomes of patient care service delivery.

Performance measures (formerly called indicators) are used to evaluate health care organizations during accreditation. Hospitals typically monitor one major measure per year, with the principal focus on patient care and safety. System-wide performance measures include such areas as medications, security, and wound care. Departments within health care organizations, such as physical therapy, also assess one or two performance measures on an ongoing basis (e.g., patient satisfaction with care delivery).

One evaluative model for performance assessment is failure mode and effect analysis (FMEA).24 This quality management tool is a systematic procedure used to rank possible causes of product failure by industry and to implement preventive measures. As a quality improvement process, it was originally utilized by the auto industry in the 1960s. FMEA involves intensive oversight of component processes of an action with the goal of preventing product failure. Data and documentation about processes are crucial for its successful implementation. Like Deming's total quality management (TQM), FMEA is an industrial concept that has been applied, rather awkwardly, to health care service delivery. TQM is a 14-point quality improvement philosophy developed by Deming and adopted by post-World War II Japan in the 1950s to revitalize its industries.

The Commission on Accreditation of Rehabilitation Facilities (CARF),45 or Rehabilitation Accreditation Commission, accredits adult day services, assisted living centers, and behavioral health and medical rehabilitative facilities. It was established in 1966 and is based in Tucson, Arizona. CARF accredits 38,000 rehabilitation facilities in the United States, Canada, and Europe. Its definition of quality rehabilitation includes the elements of individualized patient care, responsiveness, and teamwork.

The National Committee for Quality Assurance (NCQA)48 evaluates and accredits managed care organizations (MCOs) and other health care systems, providing care to 69 million Americans nationwide. Its Health Plan Employer Data and Information Set (HEDIS) incorporates 60 performance measures, the data from which form MCO report cards that are available to the public. Its 2004 State of Health Care Quality found significant quality gaps in health care delivery nationwide that accounted for as many as 79,000 patient deaths annually, $9 billion in lost productivity, and $2 billion in avertable hospital cost outlays41 NCQA was founded in 1991 and is headquartered in Washington, D.C.

Augmenting the accreditation activities of these and other private accreditation entities are local, state, and federal agency oversight bodies, which affect health care quality improvement largely by controlling public reimbursement purse strings. The largest of these of these is the federal Department of Health and Human Services' Center for Medicare and Medicaid Services (CMS). The agency's web site is www.cms.us.gov.46

Measures of quality that form the basis for health care organizational assessment and improvement include, but are certainly not limited to, competency assessments, occurrence screening, patient care assessments, patient satisfaction surveys, peer review activities, performance appraisals, time-and-motion studies, and utilization review.

EXERCISE 5-2

Consider the following facts. ABC Outpatient Rehabilitation Services, Inc., is an interdisciplinary outpatient physical rehabilitation center employing two physicians, three physical therapists, one occupational therapist, one occupational health nurse, and two aides. No one on staff has yet been appointed as quality management coordinator. The following incidents have occurred over the past 30 days: a patient fell from a wheelchair (the patient did not sustain injury); another patient developed a minor nosocomial infection during care; and one staff member failed to pass required basic cardiac life support training and testing. Focusing on these three specific problems (and not on particular people), develop a quality audit checklist consisting of 10 focused questions for investigation of each of these three adverse events. Additionally, propose in a brief simulated letter that the position of quality coordinator be staffed, and nominate someone from the center to fill that position (from existing or expanded staff).

Examples of a physical therapy patient satisfaction survey appear in Figures 5-2 (in English) and 5-3 (in Spanish). They may be adapted for clinical use by readers.

EXERCISE 5-3

With the aid of a Spanish dictionary and bilingual collegial input, develop a one-page crutch gait instruction sheet for Spanish-speaking patients.

Spear reported on quality initiatives in health care organizations and departments and offered several important recommendations to equate quality of care standards with already high technical and professional aspirational standards. Spear focuses on what he calls “work-arounds” and how to minimize them. We have all experienced work-arounds, often referred to as redundancies, or “reinventing the wheel.” Such redundancies often occur when new clinical professionals join the clinical staff and are unfamiliar with routines, customary practices, guidelines, and protocols. In many cases, protocols (such as perioperative protocols) should be in place but are not.

According to Spear, minimizing ambiguities of performance and work-arounds requires clinic-wide systematic analyses of individual and collective performance of key tasks.39 He recommended experimentation with simulations to practice and master quick iterative (repetitive) tasks as a means of continuous quality improvement, with collective feedback. Spear also specifically recommends increased managerial and professional focus on clinical quality improvement at four levels: (1) output (i.e., carrying out the correct procedure on the right patient); (2) responsibility (e.g., clarifying which professional does what tasks); (3) event(s) initiating intervention (i.e., what is done in cases such as potentially compensable events, such as when patient injuries occur in the clinic); and (4) enhanced targeting and rewarding of procedural competence and clinical excellence. A key initial question for staff is, what specifically impedes you from optimal quality health care delivery to patients?

EXERCISE 5-4

Individually or in small groups, list and describe remedial action for 10 redundancies or “work-arounds” in clinical physical therapy practice. Share results.

Harris described the first major change to drug labeling in 25 years by the Food and Drug Administration (FDA).13 The new regulation applies only to new or updated drugs and to drugs approved within the past 5 years. Each new drug label will contain a box highlighting the risks and benefits of the medication, as well as any official changes to preexisting information about the drug, and a toll-free FDA contact phone number for patient (or provider) questions or issues about the drug. The new drug regulation also preempts certain health care malpractice lawsuits brought by patients against drug makers.

EXERCISE 5-5

What are physical therapists' roles and duties as clinicians and managers regarding minimization of drug administration and interaction errors?

Landro described quality improvement measures related to nosocomial infections and their prevention.18 He reported that 2 million inpatients (one in 20 patients) contract nosocomial infections every year. These infections are responsible for one half of all major patient complications. Every year, 90,000 patients nationwide die from nosocomial infections.

What can hospitals and clinics (including physical therapy clinics) do? Landro recommended the use of disposable disinfectant cloths for cleansing patients' skin, disinfectant-releasing gloves worn by providers, and microbe-resistant bed sheets and plinth covers.

Landro also recommended that hospitals and clinics use electronic monitoring systems to track outbreaks or infections. What can patients do to minimize the likelihood of nosocomial infections? Landro suggested that they remind hospital and clinic staff members to sanitize their hands before touching them and to wipe stethoscopes and related equipment with alcohol before each use. One to three days before operative or wound care procedures, patients should also consider showering with 4% chlorhexidine soap.

Patients also share even broader responsibility for the quality of care delivery.30 Physical therapy clinic managers should consider developing and posting a clinic Patient Statement of Rights and Responsibilities. Adherence to its principles by patients (to the maximal extent feasible) can be made part of the physical therapist-patient care contract for services. Copies of the Patient Bill of Rights and Responsibilities from Brooke Army Medical Center, San Antonio, Texas, appear in English and Spanish as Appendices C and D of this chapter. We personally thank the superlative medical clinical, administrative, and support staffs at Brooke Army Medical Center for their excellent care of military service members injured in Afghanistan, Iraq, and in trouble spots elsewhere around the world. Kudos!

Physical Therapy Skills Needed for Worksite Therapy

PTs working in industry must be highly skilled and confident in identifying, diagnosing, and treating musculoskeletal disorders as well as screening workers for situations that require the expertise of other health care practitioners. Because the PT often works independently of other PTs and occasionally independently of other medical professionals (e.g., occupational health physicians and nurses), limited opportunity exists to discuss challenging cases or learn new techniques from others. This autonomy can be isolating and may be difficult for PTs new to industrial rehabilitation.

In addition, working for industry instead of the medical community requires a balance of sometimes conflicting interests. Although PTs certainly maintain a role as patient advocate, they must also consider company goals and concerns. This delicate balance of maintaining the confidence of the workers and management influences how recommendations to accommodate an injured worker are made. The PT must be aware of all consequences other employees may experience from any job modification. For example, if the PT recommends that an injured worker take 5-minute stretch breaks every hour, the effect the break has on the rate of productivity the company must maintain, the additional workload other workers have to pick up, and maintenance issues if the line must be stopped or slowed must be considered. The needs of the injured worker may exceed the scope of what the company is capable or willing to accommodate. Thus pressure may be placed on the PT to generate a solution acceptable to both parties. This process requires creativity and is time consuming, but the contribution to both the workers and employers is enormous.

Worksite therapy services require the PT to have good communication skills. These skills include active communication among everyone involved with the injured worker, an understanding of roles and priorities, and an understanding of what information can and should be given to whom. Most clinicians are familiar with and have experience working with physicians, nurses, and case managers. However, worksite PTs often develop very close working relationships with these individuals. For example, an on-site physician may recruit the assistance of a PT to assist in diagnosing orthopedic injuries and consult with the PT on a regular basis to determine treatment options. When a physician is not available on-site, an occupational health nurse can serve as a liaison between PTs working on-site and community-based physicians or specialty providers. Communication among all medical providers is imperative for proper injury management.

Managers/supervisors, safety personnel, noninjured workers, team leaders (e.g., safety, ergonomics), engineers, ergonomists, and maintenance personnel are just a few of the other members that play important roles in returning injured workers and keeping them on the job. The PT must understand the goals and concerns of these individuals to maintain that balance between the injured worker and the company. Managers and supervisors play an important role in keeping employees on the job or returning them to work. A proactive manager can contribute significantly to the treatment of the injured worker by implementing administrative controls (e.g., modified duty, transitional duty, task rotations, reduced work days, and reduced productivity standards). However, it is important for the PT to remember that the primary concern of the manager and supervisor is productivity. When making suggestions for modification, transitional duty, or other return-to-work strategies, PTs should always consider whether the recommendations could potentially reduce the overall productivity or hinder another employee's productivity.

Safety personnel and ergonomists, whose concerns are often similar to those of the PT, are often the largest supporters of on-site therapy. Safety personnel focus primarily on the overall reduction of injuries and illnesses, lost work days, and all related costs. Ergonomists primarily focus on reducing injury rates and prevention of musculoskeletal occurrences. Both of these team members can be valuable resources for identifying jobs, determining appropriate modifications, and integrating the worker back into the job. They often have more experience in working directly with management and workers and can facilitate communication between these groups and the PT. Maintenance personnel and engineers ensure proper machine functioning at the rates and productivity standards outlined by management. However, they can often be recruited to identify possible engineering controls such as physically modifying existing equipment or even creating new pieces to accommodate physical limitations.

Finally, the PT must interact with noninjured workers. Not only does this build the trust and confidence mentioned earlier, but it also allows the PT to become part of the organization. In fact, the more the PT can interact with noninjured workers, the better the relationships. PTs who have attempted the jobs the workers perform daily and who interact with employees on all levels develop a higher level of respect within the organization.

Despite the above, worksite therapy does contain some disadvantages. For example, an injured employee working for the company may view the PT as an agent for the company. A company that requires the PT to compromise quality of care may fuel this employee concern. When pursuing a position on-site, PTs must ask related questions about the type of care the company is willing and wanting to give. Speaking to several of the people mentioned earlier (worksite physicians, occupational health nurses, safety officers, and ergonomists) will assist in defining the work culture and expectations. This initial communication may also help determine the willingness of the company to implement prevention strategies. If a company is not supportive of prevention, the PT may have difficulty working with management in other areas. For this reason, the PT should always work with the company to outline goals, expectations, and measures of success to avoid future problems. For example, the PT may have difficulty justifying services if the company does not wish to support and finance prevention strategies yet bases therapy reviews on decreasing injury rates.

Worksite therapy offers both the PT and the company numerous advantages and few significant disadvantages. Although often challenging, worksite therapy is a unique opportunity for PTs to significantly improve their skills, independence, and confidence.

DEFINITION OF MARKETING

According to the American Marketing Association, the term marketing is defined as “the process of planning and executing the conception, price, promotion and distribution of ideas, goods and services to create exchanges that satisfy individual and organizational objectives” (p. 21).1 Central to this definition is a focus on the consumer. In the business of ergonomic services and consulting, this can emerge as satisfaction for the employee, employee's manager, occupational health nurse, safety officer, physician, or the organization contracting for the ergonomic service.

Marketing is a misunderstood term. It is often used synonymously with public relations, selling, fundraising, strategic planning, or development. According to Kotler, “Marketing is the analysis, planning, implementation and control of carefully formulated programs designed to bring about voluntary exchanges of values with target markets for the purpose of achieving organizational objectives. It relies heavily on designing the organization's offering in terms of the target market's needs and desires, and on using effective pricing, communication, and distribution to inform, motivate and service the markets” (p. 5).13

Paramount in this definition are needs and desires. Something that is identified as lacking in the market (an individual or group of individuals) reflects a need; a desire is a want or personal preference. The market is researched and analyzed to determine whether it reflects an absence of a good or service (need) or whether it prefers something in a different shape, format, time, or location (desire). According to Kiernan and colleagues, “Once the need or want is established, the potential buyer must view the good or service being offered as satisfying a need or want better than any other available good or service. It is the packaging and support of a good or service that assure an ongoing relationship with the customer both for purposes of repurchase and for influencing initial purchases by other potential buyers” (p. 50).12

According to Kotler, exchange is the process of obtaining a desired product from someone by offering something in return.13 This exchange is the core concept of marketing, and five conditions must be satisfied for the exchange potential to exist (Box 20-1). This activity is designed to be a value-creating process that leaves both parties better off because the exchange took place.

Marketing should be considered a dynamic activity that includes the successful analysis of a need, the design of a good or service to meet the need, the uniting of that good or service with a potential user, and the use of a good or service by the customer. In an ideal situation, marketing begins before a product or service is even developed. This has not always been the case. In particular, many industrial rehabilitation programs (e.g., work hardening) that may have begun with selling perspectives are now faced with the risk of becoming obsolete because they were developed as services for which no need currently exists at their cost, present locations, or format.8

Professional societies

Association of Societies for Occupational Safety and Health (ASOSH)

Web: http://www.asosh.org/ASOSH/about.htm

This is the association of 11 societies – the Chemical and Allied Industries’ Association (CAIA), the Institute of Safety Management (IoSM), National Occupational Safety Association (NOSA), the Mine Ventilation Society of South Africa (MVS of SA), the Safety First Association, the South African Institute of Environmental Health (SAIEH), the South African Radiation Protection Society (SARPS), the Southern African Protective Equipment Marketing Association (SAPEMA), the South African Society of Occupational Health Nurses (SASOHN), the South African Society of Occupational Medicine (SASOM) and the Southern African Institute for Occupational Hygiene (SAIOH); four supporting company members (IRCA, 3 M SA, South Africa RAI, and Transnet) and one individual member and two ex-officio members. Its main mission is to further co-operation and understanding and promotion of occupational health, safety and environmental health matters in southern Africa.

Postal address: Association of Societies for Occupational Safety and Health (ASOSH)P.O. Box 14402, Clubview 0014, South Africa

Phone/Fax: +27(0)12-654-8349

Email: [email protected]

Association of Veterinary and Crop Associations of South Africa (AFCASA)

Web: http://www.avcasa.co.za/about.html

This was established in 1958 to represent companies involved in the crop protection and animal health products industry in South Africa. From the beginning of 2003, AVCASA represents its three affiliate associations, namely SAAHA (South African Animal Health Association; www.saaha.co.za), CropLife SA (www.croplife.co.za) and Agricultural Chemical Distribution Association of South Africa (ACDASA; www.acdasa.co.za). It provides its members as well as farmers, guidelines for the classification, labeling, responsible handling and storage of products, occupational hazards and personal protection, as well as the disposal of waste and empty containers.

Postal address: P.O. Box 1995, Halfway House 1685, South Africa

Physical address: Lanzerac, Constantia Park, 526, 16th Road, Midrand, South Africa

Phone: +27(0)11-805-2000

Fax: +27(0)11-805-2222

Email: [email protected]

Chemical and Allied Industries’ Association (CAIA)

This was established in 1993 and since 1994 the CAIA launched Responsible Care in South Africa to respond to public concerns about the manufacture, storage, transport, use, and disposal of chemicals.

Web: http://www.caia.co.za/index.htm

Postal address: P.O. Box 91415, Auckland Park 2006, South Africa

Phone: +27-(0)11-482-1671

Paraffin Safety Association of Southern Africa

This was borne out of concern of high paraffin poisoning in the country. It provides educational material to paraffin users though a network of partnerships. These include NGOs community groups, emergency and healthcare workers, herbalists and any other group or individual who can effectively disseminate safety information. It has trained a corps of master trainers who train and provide educational material in the 11 official languages to these community partners. Following the government gazetting legislation on stove standards, the Paraffin Safety Association is focusing on packaging standards to ensure paraffin is sold in clearly marked, childproof containers.

Web: http://www.pasasa.org/pasasa/

Postal address: P O Box 2321, Clareinch 7740, South Africa

Address: 125 Belvedere Road, Claremont 7740, Cape Town

Phone: +27(0)21-671-5767

Fax: +27(0)21-671-0233

Email: [email protected]

Responsible Container Management Association of Southern Africa

This is the southern African organization for industrial packaging with links to various international organizations. It has the backing of industry's commitment to the public to continuously improve its health, safety, and environmental practice and performance as one of its main purposes.

Web: http://www.rcmasa.org.za/

Phone: +27(0)32-942-8256

Fax: +27(0)32-942-8328

Email: [email protected]

South African Chemical Institute (SACI)

This was established in 1912 with the aim of advancing the science and practice of chemistry in South Africa and promoting and upholding the status of the profession of chemistry.

Web: http://www.saci.co.za/

Postal address: South African Chemical Institute, The Secretary, P.O. Box 407, WITS 2050, South Africa

Address: Humphrey Raikes Building room 500 Wits Campus, Johannesburg, South Africa

Phone: +27(0)11-717-6741 (from 8 a.m.–1.30 p.m.)

Fax: +27(0)11-717-6779

Email: [email protected]

South African Council for Natural Scientific Professions (SACNASP)

Its objectives are to promote the practice of natural science professions in South Africa, exercise control over the standard of professional conduct of professional natural scientists, monitor the standard of education and training of natural scientists and to recognize education and training which is a prerequisite for registration in terms of the Act.

Web: http://www.sarnap.org.za/

Postal address: Private Bag x540, Silverton 0127, Gauteng Province, South Africa

Address: Council for Geoscience, Suite B313, 280 Pretoria Road, Silverton0127, Gauteng Province, South Africa

Phone: +27(0)12-841-1075/50

Fax: +27(0)12-841-1057

Email: [email protected]

South African Institute of Environmental Health

Web: http://www.saieh.co.za/

This organization was established to advance and promote the science and practice of Environmental Health as well as to promote the basic training as well as comprehensive specialized advanced education of environmental health professionals as well as environmental research.

Postal address: Private Bag X37, Greyville 4023, South Africa

Address: 34 Wallace Rd, Morningside 4000, Durban, South Africa

Phone: +27(0)31-303-2480

Fax: +27(0)31-312-9441

Email: [email protected]

Southern African Institute for Occupational Hygiene (SAIOH)

Web: http://www.saioh.org/

It advances the discipline of Occupational Hygiene.

Postal address: SAIOH, P.O. Box 14402, Clubview 0014, South Africa

Phone: +27(0)12-654-8349

Fax: +27(0)12-654-8358

Email: [email protected]

South African Association of Physicists in Medicine and Biology (SAAPMB)

The Association encompasses a number of different fields such as Medical Physics, Nuclear Medicine, Radiation Oncology, Radiobiology, Medical Physics, and Health Informatics. Its emphasis is on the interaction of Physics with the human body. While the Association has a number of independent members it also acts as an umbrella organization for three related societies, namely: The South African Medical Physics Society (SAMPS), The South African Radiation Protection Society (SARPS) and the SARS.

Web: http://www.saapmb.org.za/overview.htm

Email: [email protected]

South African Pharmacology Society

It was founded in 1966 with its first congress held in 1967. While the Society always played a central role in promoting the science of basic and clinical pharmacology in general, it enjoys support from academic, industrial, and professional practice spheres. Its objectives are to foster, promote, encourage, develop, and support interest, teaching and research in basic and clinical pharmacology.

Web: http://www.sapharmacol.co.za/home.htm

Postal address: P.O. Box 16, Pharmacology, North-West University, Potchefstroom 2520, South Africa

Phone: +27(0)18-299-4015

Email: [email protected]

Southern African Society of Aquatic Scientists

SASAqS is a learned society established in 1964 as the Limnological Society of South Africa. It is concerned with the research, management, and conservation of inland waters throughout southern Africa.

Web: http://www.dwaf.gov.za/iwqs/sasaqs/

Email: [email protected]

Society of Environmental Toxicology and Chemistry (SETAC) Africa

Dr Victor Wepener

Phone: +27(0)11-489-3373

Fax: +27(0)11-489-2286

Email: [email protected]

Toxicology Society of South Africa (TOXSA)

Web: http://www.toxsa.up.ac.za/

It was established in 2001 by a group of interested scientists. The aims of the Society are to promote and advance the study and application of toxicology in all its aspects in South Africa.

Postal address: NIOH, P O Box 4788, Johannesburg 2000, South Africa

Phonel: +27(0)11-712-6428

Fax: +27(0)11-712-6532

A DISABILITY MANAGEMENT LEXICON

There is no universal definition of DM, because it crosses many literature sources, including vocational, medical, human resources, ergonomic, safety and health, and legal. However, the quotation at the opening of this chapter captures the multidimensional nature of DM.

The clinical literature represents a lexicon of DM concepts, practices, and principles (Akabas et al, 1992; Huffman & Johnson, 1994; Lukes & Wachs, 1996; Schwartz et al, 1989; Shrey & LaCerte, 1995; Smith, 1997; Tate, 1992; Walker, 1998). The term disability management is used to describe a plethora of interventions, each of which is geared toward some aspect of disability prevention, treatment, and management.

Today's disability managers, including physical therapists (PTs), occupational therapists (OTs), and case managers, must have a command of a complex array of issues. These issues fall within diverse domains of knowledge shown in Table 3-1. It is incumbent that clinicians who wish to expand their role into DM possess working knowledge that typically resides in non-medical domains. These domains include legal, human resources, technology, risk management, ethics, utilization review/management, insurance, reimbursement, labor relations, business, and accreditation.

Chapter 1 provides an overview of disablement models and definitions of disability. By extension, this chapter addresses DM principles and practices that can be applied within most disablement models and rehabilitation programs.

B Occupational Health Team: Roles and Responsibilities

A unique challenge of occupational health in the animal care setting is that it involves the health of the workers, the animals, and the shared work environment. These interrelationships require a systems-based, comprehensive approach that seeks to simultaneously maximize human, animal, and environmental health. This concept is increasingly recognized as a ‘One Health’ approach requiring interdisciplinary cooperation between multiple types of professionals. Professionals that could contribute to such a One Health ‘team’ for occupational health in animal care settings include human health care providers, veterinarians, industrial hygienists, and engineers.

Improving animal workers’ occupational health and safety is a challenge that requires collaboration among the occupational health team. One Health occupational health services include enhancing surveillance to detect exposure events; assessing infection risk in specific tasks; reducing risk through animal disease control; and interrupting transmission pathways by appropriate use of engineering controls, work practices, and personal protective equipment. To ensure that steps are taken in such a way as to maximize both human and animal health, input from all team members – human, animal, and environmental health/industrial hygiene – is crucial in these efforts.

Basics of Infection Control

The fundamental concept of infectious disease control is that all patients admitted to the hospital are potentially infectious. An adequate body of knowledge about the basics of infection control exists which can be translated into action. However, the gap between knowledge and practice needs to be bridged with interventions feasible for developing-country settings.

Basic infection control measures deal with every aspect of the healthcare delivery system, since infection can spread at any point during the course of the patient's interaction with the system (Box 21.1).