Medical Surveillance

MEDICAL
SURVEILLANCE
dr. I.B Adiatmaja
Occupational Health – HSSE Corporate

Occupational Health Program




Health Prevention/Protection:
 Health Risk Assessment;
 Health Surveillance;
 Instruction and Training;
 First Aid and Medical Emergency Treatment;
 Sickness Monitoring; Canteen Hygiene;
 Record Keeping
Health Promotion:
 Assessment of Risk: Life style and Environment;
 Drug and Alcohol Policy;
 Aids and the work place;
 Information and assistance.

Pengertian
 Surveilans = mengawasi

Surveilans Kes. Kerja
 Pengumpulan data secara sistematik
 Analisis : frekuensi, distribusi, tren
 Interpretasi dan dikomunikasikan
 Tindakan pencegahan
HAZARD BASED
Page 3

Komponen Surveilans Kes. Kerja
 Surveilans hazard kesehatan
Pengukuran hazard - dibandingkan dengan NAB/TLV

 Surveilans efek kesehatan
Pemeriksaan kesehatan

 Biological monitoring
Pemeriksaan biomarker - dibandingkan dengan BEI

Page 4

TUJUAN
 Identifikasi pola penyakit
 Deteksi dini paparan hazard

 Memantau pekerja yang terpapar di

luar pekerjaan
 Melindungi pekerja yang rentan
 Mematuhi peraturan
 Identifikasi kebutuhan pelayanan
kesehatan

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MANFAAT
 Metode untuk deteksi dini
 Penentuan PAK/Non PAK
 Dasar untuk upaya preventif dan

promosi kesehatan

Page 6

Health Risk Assessment






Hazard Identification:
 Departmental level;
 MSDS;
Hazard Measurement and Exposure
Evaluation:
 Noise & Vibration; Gas, vapor, dust;
Thermal stress; Radiation; Biological;
Ergonomic; Psycho-social;
 Environmental and Biologic Monitoring.
 TLVs and BEIs
Risk Control:
 Engineering; Administrative; PPE. (ALARP)

RECOMMENDED MEDICAL TEST
FOR HIGH RISK GROUPS
Group/Exposure:

Noise

Dusts

Heat Stress

Solvent Vapor







Welders
Drivers
Canteen Personnel
Medical personnel

Recommended Tests:

Audiometry

Spirometry, Chest X-ray

Harvard Step Test; ECG

Neurological, e.g. Swedish
Q16; Renal function, LFTs,
Spirometry, Bio-monitoring

Urinalysis, Bio-monitoring

Eye/ear testing, ECG (> 40)

Feces culture, Chest X-ray

Serology for Hep-B, LFTs,

Chest X ray.

RECORD KEEPING
 Data bases: Medical and






Environmental (exposures);
Medical check up data, Daily medical;
Confidentiality, legibility, security;
Paper and Electronic;
Retention time:
best practice: 30 years;
 Indonesian law: 3 years.


MEDICAL SURVEILLANCE




Pre-employment medical:
 Baseline data;
 Prevalent diseases in the community;
Pre-placement;




Periodic:






Job related;

Job Related;
Health Promotion;

Post Sickness;
Termination.

KAPAN
 OSHA : 28 pajanan
 Dianjurkan :

-

Pajanan berisiko
Belum diketahui efek kes.nya
Banyak keluhan pekerja
Ada individu dengan risiko tinggi
“Acton level” bahan belum diketahui

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HIGH RISK GROUPS
 Exposure to Chemicals, eg.







solvents, heavy metals, free silica,
pesticides, etc.
Exp. to Noise & Vibration;
Exposure to Radiation;
Exposure to extreme temperature;
Special Groups: Food-handlers,
Drivers, Welders, Health personnel,
Fire brigade, etc.

Sickness Monitoring
 Occupational Diseases:
baseline; exposure;
 Reportable


 Morbidity statistics (onsite clinic):
 National Disease Registry;
 Monthly, Annually;
 Data analysis an inference:
 Medical check up data and clinic data;
 in/out patient data; Medical absenteeism.

Information, Instruction and Training








Health Policy and OH program;
Safe work procedures;
 Chemical Safety;
 Food Safety;
 Confined space;
Protective equipment:
 Ear, eye, skin, respiratory.
Training plan for OH officers;
Clear job description?
Access to internet/e-mail.

OH INFORMATION




Worldwide:
 US-OSHA/NIOSH;
 ACGIH, ACOEM, AIHA;
 HSE Executive;COSHH;
 WHO/ILO
Indonesia:
 PNKK Depnaker;
 Balai Hiperkes Depnaker;
 AHKKI, IDKI.
 Depkes: SIKER.

PAK
PENYAKIT AKIBAT KERJA ADALAH
SETIAP
PENYAKIT
YANG
DISEBABKAN OLEH PEKERJAAN
ATAU LINGKUNGAN KERJA
PERMENAKERTRAN 1/1981

Page 16

PENGERTIAN
• PAK : Penyakit yang diderita pekerja dalam

hubungannya dengan kerja, baik karena faktor risiko
kondisi tempat kerja, peralatan kerja, material yang
dipakai, proses produksi, cara kerja, limbah perusahaan
dan hasil produksi (Harjono)

•Kepres 22/1993 : Penyakit yang timbul karena
hubungan kerja
• Pasal 1 : penyakit yg disebabkan oleh perkerjaan atau
lingkungan kerja
• Pasal 4 : 31 jenis penyakit
•Kepmenaker 79/2003 : Pedoman Diagnosis dan
Penilaian Cacat karana Kecelakaan dan Penyakit Akibat
kerja
Page 17

No

Penyakit Akibat kerja

Penyakit
Berhubungan
Dengan Kerja

Penyakit Umum di
kalangan pekerja

1

Termasuk kecelakaan
kerja

Bukan (?) termasuk
kecelakaan kerja

Bukan termasuk
kecelakaan kerja

2

Ada jaminan asuransi
kecelakaan kerja
(kompensasi)

Tidak ada (?)
jaminan asuransi
kecelakaan kerja

Tidak ada jaminan
kecelakaan kerja

3

Biasanya disebabkan
oleh 1 faktor di
pekerjaan

disebabkan oleh
multifaktor, tetapi
faktor pekerjaan
cukup dominan

Disebabkan oleh 1
atau multi faktor,
tidak/sedikit
sekali
berhubungan
dengan pekerjaan

4

Contoh : Tuli Akibat
Bising di tempat kerja,
asbestosis, silikosis,
dermatitis di tempat
kerja, asma di tempat
kerja

Contoh : penyakit
jantung koroner,
psikosomatis.

Contoh : Infeksi
telinga, gondok,
demam berdarah,
tifus

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NIHL = TULI AKIBAT BISING

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ASBESTOSIS & MESOTELIOMA

Page 20

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CTS = CARPAL TUNNEL SYNDROME

Page 22